PubMed Health⌕ Search

Biomedical subjects

N Wolosker

Publications and source records attributed to N Wolosker.

18 recordsLinked to original sources
PubMed2006

Relationship between soluble thrombomodulin in patients with intermittent claudication and critical ischemia.

INTRODUCTION: Thrombomodulin (TM) has been described as a marker of endothelial injury in atherosclerosis. The role of TM as a predictor of PAD severity is to be proven. The goal of the present study is to compare the level of plasmatic (TMp) in patients with intermittent claudication with patients with critical ischemia in the lower limbs. MATERIALS AND METHODS: TMp was measured using ELISA in the plasma of 41 patients with intermittent claudication degree 1 and in 40 patients presenting critical ischemia in the lower limbs degrees 2 and 3, according to TASC. The hypotheses of normality and homogeneity of the variance had been proven via Shapiro-Wilk and Levene tests, respectively. The comparison of the TMp between the groups was done using the t-Student test. RESULTS: No statistically significant difference was observed. The average levels of TMp for intermittent claudication were 5.2 ng/ml (0.78-13.61 ng/ml) and TMp for critical ischemia in the lower limbs were 6.34 (0.82-18.22 ng/ml) where p=0.265. CONCLUSION: TMp does not seem to be an appropriate marker for PAD severity.

Aged↗
PubMed2004

Totally implantable femoral vein catheters in cancer patients.

INTRODUCTION: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients. When it is impossible to implant the reservoir on the anterior wall of the thorax, or when there is an obstruction of the superior vena cava system, alternative access routes must be sought. Of these, the femoral vein is the most utilized. Few studies have been performed to analyse the results obtained from the implantation and utilization of such catheters in the femoral vein. The goal of this work was to prospectively study the results obtained from the implantation of 20 TIC in femoral veins in a large-sized cancer hospital with its own dedicated vascular clinical team. MATERIAL AND METHODS: Twenty femoral TIC were inserted in 20 patients out of a group of 560 cancer patients submitted to TIC implantation for chemotherapy. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed a mean duration of 215 days for the catheters. There were 16 patients with no complications. There were no early complications. Among the late complications, three were infections, representing 0.69/1000 days of catheter use, and one was a deep vein thrombosis (0.23/1000 days of catheter use). One catheter was removed due to primary bacteremia and one due to subcutaneous pocket infection. Fourteen patients died while the catheter was functioning and four patients are still making use of the catheter. CONCLUSION: The low rate of complications implying catheter loss in this study confirms the safety and convenience of the use of femoral TIC in patients who cannot be submitted to implantation in the superior vena cava system.

Adult↗
PubMed2001

Infrarenal aortic aneurysm repair by retroperitoneal approach combined with laparoscopic cholecystectomy: two case reports.

Simultaneous repair of abdominal aortic aneurysm and treatment of cholelithiasis by the transperitoneal approach is controversial because of the risk of prosthesis infection. We report two patients who underwent a successful combined procedure using a retroperitoneal approach for the aortic aneurysm repair and a laparoscopic approach to the cholecystectomy. This combined approach reduces the risk of infection of the aortic prosthesis and is associated with a rapid return of normal peristalsis.

Aged↗
PubMed2001

Use of arteriography for the initial evaluation of patients with intermittent lower limb claudication.

CONTEXT: Many patients with intermittent claudication continue to be forwarded to the vascular surgeon for initial evaluation after arteriography has already been accomplished. OBJECTIVE: The main objective of this work was to analyze the usefulness and the need for this procedure. TYPE OF STUDY: Retrospective study. SETTING: The patients were divided into two groups: Group 1, with the arteriography already performed and Group 2 without the initial arteriography. PARTICIPANTS: One hundred patients with intermittent claudication were retrospectively studied. Other specialists had forwarded them for the first evaluation of intermittent claudication, without any previous treatment. MAIN MEASUREMENTS: All patients were treated clinically for at least a 6-month period. The total number of arteriographies performed in the two groups was compared and the need and usefulness of the initial arteriography (of Group 1) was also analyzed. RESULTS: The evolution was similar for both groups. The total number of arteriographies was significantly higher in Group 1 (Group 1 with 53 arteriographies vs. Group 2 with 7 arteriographies). For this group, it was found that arteriography was only useful in five cases (10%), because the surgeries were based on their findings. However, even in those cases, no need for arteriography was observed, as the procedure could have been performed at the time of surgical indication. CONCLUSION: There are no indications for arteriography in the early evaluation of patients with intermittent claudication, because it does not modify the initial therapy, independent of its result. In cases where surgical treatment is indicated, this procedure should only be performed prior to surgery.

Angiography↗
PubMed2000

Ground reaction force pattern in limbs with intermittent claudication.

OBJECTIVES: to investigate the presence of a ground reaction force pattern specific to the patient with unilateral intermittent claudication (IC), and the relationship of this pattern with onset of claudication. DESIGN: identification of impulse pattern during gait of lower limbs with and without ischaemia, in patients with unilateral IC and controls. METHODS: thirty patients with unilateral IC and six peripheral arterial disease non-claudicant patients had their gait recorded using the F-Scan system during a treadmill test. Their plantar impulse pattern was calcuated. Examined lower limbs were subdivided into groups: ischaemic limbs (30), contralateral limbs (30) and lower limbs of patients without IC (12). Two impulse patterns were found: the descending one, where impulse values decrease during gait, and the non-descending one, where these values do not decrease during gait. The numerical distribution of patterns among limb groups was determined and their ratios compared. Correlation between claudication onset and impulse pattern was also investigated. RESULTS: most ischaemic limbs exhibited a descending pattern, in contrast with control and contralateral non-ischaemic limbs (p<0.02). There was no relationship between impulse pattern and claudication onset. CONCLUSIONS: ischaemic lower limbs present the descending pattern of plantar impulse. No relationship exists between this pattern and claudication pain.

Adult↗
PubMed1998

Endovascular grafting of a popliteal aneurysm using the saphenous vein.

PURPOSE: To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. METHODS AND RESULTS: A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. CONCLUSIONS: Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.

Aged↗
PubMed1994

[Non-iatrogenic trauma of the brachial artery].

Brachial artery trauma are treated quite frequently in the emergency units. Between January 1987 and December 1990 we studied prospectively 50 patients with brachial artery trauma at the Hospital das Clinicas, of University of Sao Paulo. The patients mean age ranged from 2 to 64 years. Males were predominant with 46 patients. Most of them were white (66%). Penetrating injuries were the most frequent. Most of these injuries were caused by gunshot wounds or stabing. Absence of distal palpable pulses was the predominant finding among the clinical features (94%). 74% of the patients do not present important ischemia. The right side was more affected (34 patients). 14 patients had concomitant nerve injury. 35 patients (70%) were submitted to arterial reconstruction with saphenous vein. 12 patients (24%) had end-to-end vascular anastomoses. 3 patients (6%) were submitted to brachial artery ligation. 2 patients underwent simultaneous median nerve repair. In 3 patients we used fasciotomy. 6 patients developed arterial occlusion following vascular reconstruction and in one of them it was necessary to perform amputation. 2 patients had wound infection with saphenous vein repair disruption. Both were treated with brachial artery ligation and one underwent amputation. One patient died on the post operative period owing to associated lesions. Limb preservation was achieved in 47 patients (94%). 33 (70.2%) had no neurological deficit and 14 (29.7%) had some degree of neurological deficit. None of the patients had venous hypertension at the time of discharge.

Adolescent↗
PubMedDate not supplied

Predictive value of the ankle-brachial index in the evaluation of intermittent claudication.

The purpose of this study was to determine whether the ankle-brachial index (ABI) could be used to predict the prognosis for a patient with intermittent claudication (IC). We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.

Ankle↗
PubMedDate not supplied

The use of stents in the treatment of traumatic intimal flaps: case report.

Treatment of arterial traumatic intimal lesions is controversial due to its unknown natural history. Current therapeutical options include arterial reconstruction and clinical observation. The idea of using stents to correct intimal flaps is based on their use to correct dissections, flaps, and arterial irregularities after angioplasty. We report the successful treatment of a traumatic intimal flap of the superficial femoral artery, caused by gunshot trauma, with a Palmaz stent in the acute period. One year after the operation, a duplex scan revealed normal flow in the artery and complete exclusion of the intimal flap; distal pulses were palpable, and the patient was completely asymptomatic.

Adult↗
PubMedDate not supplied

Trauma to arteries of the forearm.

Trauma to arteries of the forearm corresponds to 20% of total arterial trauma. The authors analyzed 24 patients with non iatrogenic trauma of the forearm arteries, cared for from January 1987 to December 1990. All patients were male, trauma by penetrating instrument was the most frequent, with 21 cases (87.5%), absence of pulses was the most frequent clinical manifestation (62.5%), fifteen patients did not present ischemic manifestations (54.2%) and half of the patients did not exhibit neurological symptoms. Injury to only one artery was found in 11 cases, five of them in the radial artery (20.8%), five in the ulnar artery (20.8%) and one in the interosseous artery (4.2%). Concurrent injury to the radial and ulnar arteries was found in 13 cases (54.1%). Regarding nervous impairment, injury to the radial nerve was found in four cases (16.6%) and of the median and ulnar nerves, one case in each (4.1%). All patients with concurrent injury to the ulnar and radial arteries (13) were submitted to arterial restoration. The 11 patients with injury to a sole artery of the forearm were managed as follows: ligature of the interosseous artery in one case, ligature of the radial artery in four cases, raphe of the radial artery in one case, ligature of the ulnar artery in three cases, restoration of the ulnar artery using a segment of the v. saphena in the two cases in which the Allen test had been positive. One patient died in the immediate postoperative period as a result of multiple organ failure due to polytraumatism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Maintenance treatment of diabetic patients, associating arterial obstructive tibio-peroneal disease.

When a melito-diabetic patient presents trophic infected injury on the limb, it is essential an evaluation of the circulatory conditions for therapeutic procedures orientation. In some circumstances, although arterial pulsation is absent, there is no ischemia of tissues. In these cases, the maintenance treatment, with eventual resection of the necrosed and infected tissues may be adopted. Evolution of 70 diabetic patients with trophic injuries on extremities were submitted to a maintenance treatment. Age of patients varied from 28 to 88 years, with an average of 56.8. The most occurrence was verified in women, with 42 cases. Diabetes non-dependent on insulin (type II) was observed in 64 patients (91.5%), being the remaining 6 patients of type I. Diabetic retinopathy was observed in 14 (20%) of the patients, neuropathy in 22 (31%) and nephropathy in 8 patients (11.4%). All the patients presented arterial pulsation until the popliteal region. They were divided in 2 groups, considering trunk arteries of legs: Group I, pervial legs arteries, composed by 48 patients; Group II, occluded legs arteries, with 22 patients. In what refers to the anatomic local of the injuries, patients were classified in three groups: Group A, formed by 32 patients (45.7%), presenting injuries in one or two toes only, without affecting the metatarsic region; Group B, formed by 16 patients (22.9%), trophic injuries affecting the metatarsic region and Group C, formed by 22 patients (31.4%), injuries affecting the calcaneous region. Injuries in both of the groups were caused by mechanical traumatism. Duration of the injury in the inferior member varied from 7 to 48 days, resulting in a 12 days average.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Surgical treatment of noniatrogenic trauma of the femoral arteries.

Trauma to the femoral arteries corresponds to 30 percent of all arterial traumas. The authors reviewed 74 patients with noniatrogenic trauma of the femoral arteries treated from January 1991 to December 1993. Ages ranged from 11 to 50 years, with a mean of 24. Seventy-one patients were male and three female. Fifty-two patients (70.2 percent) were white, 20 (27 percent) were black and two (2.8 percent) were Asian. Trauma due to firearms had the highest incidence, with 61 cases (82.4 percent). Absence of pulse was the most frequent clinical symptom (62.5 percent). Severe ischemia, with risk of loss of limb, was found in 66.2 percent of the cases. The superficial femoral artery was impaired in 77 percent of the cases. A preoperative arteriography was performed on only five patients, victims of multiple penetrating trauma or an asymptomatic penetrating wound along a vessel passage. In six cases, arterial and venous ligature was the chosen procedure. In three cases, a primary arterial anantomosis was performed. Simple arterriorraphy was feasible in one patient. In 64 of the patients, a venous graft was undertaken using a segment of the inverted great saphenous vein withdrawn from the other lower limb. Fasciotomoy was used in 32 patients (43.2 percent), all of whom exhibited pasting of the lower limb muscles at admission. One patient died during the immediate postoperative period as the result of multiple organ failure caused by polytraumatism. Preservation of the limb was attained in 72 patients (97.3 percent) Severe, previously-incurred ischemia was responsible for the only two amputations, aggravated by an exceedingly long delay between the time of injury and surgery. One of these patients, in addition to severe ischemia, had extensive injuries to the soft tissues. We conclude that trauma of the femoral arteries, attended while the limb still maintains its vitality, has a positive clinical outcome with a high rate of limb preservation. Mortality usually results from injury to other organs.

Adolescent↗
PubMedDate not supplied

Arterial embolectomy in lower limbs.

Arterial embolisms in the lower limbs occur frequently, and are of great interest to the vascular surgeon. The authors studied 159 cases of arterial embolisms in lower limbs from January 1991 to July 1993. Ages varied from 12 to 98, with a mean of 58. Eighty patients were male and 78 were female. In most cases, etiology of the embolus was well-established, and mainly caused (78 percent) by atrial fibrillation. Occlusion was most frequent in the femoral artery (53.4 percent). All patients presented severe lower limb ischemia, but not gangrene, on admission. The duration of ischemia, between the onset of symptoms and the liberation of arterial flow, was in most patients (67.9 percent) less than 24 hours. All patients were submitted to lower limb embolectomy with the Fogarty catheter, of which 70.9 percent were done through the femoral artery. Fasciotomy was performed on 48 patients due to a compartimental syndrome. Nineteen patients died immediately after operation; 68.4 percent due to heart failure. Twenty-three (16.4 percent) of the 140 surviving patients (150 operated limbs) were submitted to amputations after the occlusion of artery branches, which had undergone embolectomies. One hundred and twenty-seven limbs (84.6 percent) were preserved in 117 patients (83.5 percent). Eleven cases (7.3 percent) required repeated surgery with the Fogarty catheter. The patients with muscle tenderness, paralysis, or ischemia lasting longer than 24 hours had worse results in relation to the preservation of the limb (p < 0.05). We conclude that patients who present lower limb embolisms, are in good clinical condition, and who do not have any necrosis in the limbs, have good outcomes as to limb preservation, along with low complication rates, after embolectomy with the Fogarty catheter. Limb preservation was significantly higher in patients who did not present muscle tenderness, and who had normal motor activity and a ischemia duration of less than 24 hours.

Adolescent↗
PubMedDate not supplied

Variations in white blood count, thromboxane B2 levels and hematocrit in chronic venous hypertension.

OBJECTIVE: To analyze variations in leukocyte count and thromboxane B2 production in the femoral vein of patients with chronic venous hypertension (CVH). DESIGN: Prospective clinical study, controlled, non randomized and open. LOCATION: Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, referral center, university hospital. PARTICIPANTS: 15 patients with recurring stasis ulcer were analyzed, selected randomly from the venous diseases outpatient center, and 4 without lower limb venous alterations were also analyzed. INTERVENTION: Blood samples from the femoral and brachial veins were drawn following supine and 45 degrees reverse Trendelenburg. MAIN OUTCOMES MEASURES: Direct leukocyte count and analysis of the thromboxane B2 with enzyme linked immunosorbent assay test. RESULTS: After 30 minutes in reverse Trendelenburg, patients with CVH showed a leukocyte count reduced by +/- 27% (p = 0.02) and thromboxane B2 levels increased by +/- 158% (p = 0.02). CONCLUSIONS: We suggest that future studies of medications for stasis ulcers include their effects on leukocyte entrapment and thromboxane B2 production in the lower limb venous system.

Adolescent↗
PubMedDate not supplied

[Arteritis dependent on infective process: the convenience of heparin use].

Twenty patients with peripheral arteritis due to an infectious disease were studied with the purpose to detect the etiological agent in the vessels belonging to ischemic areas; to establish the relationship between the onset and evolution of the ischemic lesions and the infectious disease; and to verify the appropriateness of the treatment with anticoagulants. Ten patients had meningococal disease with positive blood culture for Neisseria meningitidis. The meningococci were found in vessel walls of ischemic areas. The cutaneous lesions had sudden onset and a rapid evolution. Five patients had pneumonia or gastroenteritis. No microorganisms were detected in the vessel walls of the ischemic areas. The cutaneous necrotic lesions appeared from two to six days after the infectious disease was diagnosed. Therefore, heparinization was considered appropriate to block the extension of the disseminated intravascular coagulation secondary to the vasculitis. Three patients had, probably, post-streptococcal sensibilization arteritis and two post-measles arteritis. No etiological agent was identified in the vessel walls. The necrotic lesions of the extremities appeared from five to 21 days after the clinical course of the infection. The lesions had the complete evolution in a period from one to four days. It was considered appropriate to start the heparinization in the evolutive period of the peripheral lesions in an attempt to reduce the ischemia by the interruption of the intravascular coagulation related to the vasculitis. In heparinized patients in whom the necrotic lesions did not extend completely in the extremities, the evolution to irreversible gangrene and limb loss did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Ischemic rest pain of the lower extremities. Treatment with peripheral nerve crush.

The authors report the results obtained from peripheral nerve crushing in the treatment of ischemic rest pain and/or trophic lesions of toes and feet. They studied retrospectively 102 patients who were submitted to peripheral nerve crushing at the "Hospital das Clínicas da Universidade de São Paulo" during a sixteen-year period, from March 1971 to April 1987. These patients had no other choice, either clinical or surgical. The results were evaluated under three aspects: elimination of pain, evolution of trophic lesions and postoperative complications. The follow-up period varied from 1 month to 6 years (mean of 18 months). The results showed immediate elimination of pain in 94% of the patients. The remaining 6% were reoperated on within 24 to 48 hours, due to technical failure in identifying some of the nerves during the first operation. Regarding the trophic lesions, in 71% of the patients the results were good and the remaining underwent amputation at leg or thigh. The worst results were obtained in patients with necrotic lesions (p < 0.05). Three patients presented surgical wound dehiscence. The authors conclude that peripheral nerve crushing constitutes a valid alternative for a select group of patients with uncontrollable ischemic rest pain in the feet.

Adult↗