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[PMID]:29318581
[Au] Autor:Vietto V; Franco JV; Saenz V; Cytryn D; Chas J; Ciapponi A
[Ad] Endereço:Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
[Ti] Título:Prostanoids for critical limb ischaemia.
[So] Source:Cochrane Database Syst Rev;1:CD006544, 2018 01 10.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity and mortality due to cardiovascular disease in the general population. Although numerous treatments have been adopted for patients at different disease stages, no option other than amputation is available for patients presenting with critical limb ischaemia (CLI) unsuitable for rescue or reconstructive intervention. In this regard, prostanoids have been proposed as a therapeutic alternative, with the aim of increasing blood supply to the limb with occluded arteries through their vasodilatory, antithrombotic, and anti-inflammatory effects. This is an update of a review first published in 2010. OBJECTIVES: To determine the effectiveness and safety of prostanoids in patients with CLI unsuitable for rescue or reconstructive intervention. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (January 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). In addition, we searched trials registries (January 2017) and contacted pharmaceutical manufacturers, in our efforts to identify unpublished data and ongoing trials. SELECTION CRITERIA: Randomised controlled trials describing the efficacy and safety of prostanoids compared with placebo or other pharmacological control treatments for patients presenting with CLI without chance of rescue or reconstructive intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. We resolved disagreements by consensus or by consultation with a third review author. MAIN RESULTS: For this update, 15 additional studies fulfilled selection criteria. We included in this review 33 randomised controlled trials with 4477 participants; 21 compared different prostanoids versus placebo, seven compared prostanoids versus other agents, and five conducted head-to-head comparisons using two different prostanoids.We found low-quality evidence that suggests no clear difference in the incidence of cardiovascular mortality between patients receiving prostanoids and those given placebo (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.41 to 1.58). We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared with placebo (RR 0.97, 95% CI 0.86 to 1.09). Adverse events were more frequent with prostanoids than with placebo (RR 2.11, 95% CI 1.79 to 2.50; moderate-quality evidence). The most commonly reported adverse events were headache, nausea, vomiting, diarrhoea, flushing, and hypotension. We found moderate-quality evidence showing that prostanoids reduced rest-pain (RR 1.30, 95% CI 1.06 to 1.59) and promoted ulcer healing (RR 1.24, 95% CI 1.04 to 1.48) when compared with placebo, although these small beneficial effects were diluted when we performed a sensitivity analysis that excluded studies at high risk of bias. Additionally, we found evidence of low to very low quality suggesting the effects of prostanoids versus other active agents or versus other prostanoids because studies conducting these comparisons were few and we judged them to be at high risk of bias. None of the included studies assessed quality of life. AUTHORS' CONCLUSIONS: We found high-quality evidence showing that prostanoids have no effect on the incidence of total amputations when compared against placebo. Moderate-quality evidence showed small beneficial effects of prostanoids for rest-pain relief and ulcer healing when compared with placebo. Additionally, moderate-quality evidence showed a greater incidence of adverse effects with the use of prostanoids, and low-quality evidence suggests that prostanoids have no effect on cardiovascular mortality when compared with placebo. None of the included studies reported quality of life measurements. The balance between benefits and harms associated with use of prostanoids in patients with critical limb ischaemia with no chance of reconstructive intervention is uncertain; therefore careful assessment of therapeutic alternatives should be considered. Main reasons for downgrading the quality of evidence were high risk of attrition bias and imprecision of effect estimates.
[Mh] Termos MeSH primário: Isquemia/tratamento farmacológico
Perna (Membro)/irrigação sanguínea
Doenças Vasculares Periféricas/tratamento farmacológico
Prostaglandinas/uso terapêutico
[Mh] Termos MeSH secundário: Alprostadil/uso terapêutico
Amputação/estatística & dados numéricos
Epoprostenol/uso terapêutico
Seres Humanos
Iloprosta/uso terapêutico
Isquemia/mortalidade
Perna (Membro)/cirurgia
Úlcera da Perna/tratamento farmacológico
Nafronil/uso terapêutico
Ácidos Nicotínicos/uso terapêutico
Pentoxifilina/uso terapêutico
Prostaglandinas/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Vasodilatadores/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Nicotinic Acids); 0 (Prostaglandins); 0 (Vasodilator Agents); 42H8PQ0NMJ (Nafronyl); A99MK953KZ (Inositol Niacinate); DCR9Z582X0 (Epoprostenol); F5TD010360 (Alprostadil); JED5K35YGL (Iloprost); SD6QCT3TSU (Pentoxifylline)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006544.pub3


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[PMID]:29187071
[Au] Autor:Chen YC; Huang CL; Huang JW
[Ad] Endereço:1 Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
[Ti] Título:Endovascular Stent Can Be the Treatment of Choice for Spontaneous Iliac Vein Rupture: A Case Report.
[So] Source:Vasc Endovascular Surg;52(2):131-134, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy. CASE PRESENTATION: A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged. CONCLUSION: Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.
[Mh] Termos MeSH primário: Procedimentos Endovasculares/instrumentação
Veia Ilíaca
Doenças Vasculares Periféricas/terapia
Stents
[Mh] Termos MeSH secundário: Idoso
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Veia Ilíaca/diagnóstico por imagem
Doenças Vasculares Periféricas/diagnóstico por imagem
Flebografia/métodos
Desenho de Prótese
Fatores de Risco
Ruptura Espontânea
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417739090


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[PMID]:29202645
[Au] Autor:Ewertz M; Land LH; Dalton SO; Cronin-Fenton D; Jensen MB
[Ad] Endereço:a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Denmark.
[Ti] Título:Influence of specific comorbidities on survival after early-stage breast cancer.
[So] Source:Acta Oncol;57(1):129-134, 2018 Jan.
[Is] ISSN:1651-226X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While comorbidity indices are useful for describing trends in survival, information on specific comorbidities is needed for the clinician advising the individual breast cancer patient on her treatment. Here we present an analysis of overall survival, breast cancer-specific mortality, and effect of medical adjuvant treatment among breast cancer patients suffering from 12 major comorbidities compared with breast cancer patients without comorbidities. MATERIAL AND METHODS: The study population was identified from the Danish Breast Cancer Cooperative Group and included 59,673 women without prior cancer diagnosed with early-stage breast cancer in Denmark from 1990 to 2008 with an estimated median potential follow-up of 14 years and 10 months. Information on comorbidity and causes of death was derived from population-based registries. Multivariable proportional hazards regression models were used to assess the effect of comorbidities on mortality, all-cause and breast cancer specific, using patients without comorbidity as reference. RESULTS: At breast cancer diagnosis, 16% of patients had comorbidities and 84% did not. Compared with the latter, the risk of dying from all causes was significantly increased for all types of comorbidity, but the risk of dying from breast cancer was significantly increased only for peripheral vascular disease, dementia, chronic pulmonary disease, liver, and renal diseases. Comorbidities diagnosed within 5 years of breast cancer diagnosis correlated with a greater risk of dying than comorbidities diagnosed more than 5 years before breast cancer diagnosis. With a few exceptions, the effect of adjuvant treatment on breast cancer mortality was similar among patients with and without comorbidity. CONCLUSION: Breast cancer mortality was not significantly elevated for patients with prior myocardial infarction, congestive heart failure, cerebrovascular disease, connective tissue disease, ulcer disease, and diabetes. The similar effect of adjuvant treatment in patients with and without comorbidity underlines the importance of adhering to guideline therapy.
[Mh] Termos MeSH primário: Neoplasias da Mama/mortalidade
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/patologia
Carcinoma Ductal de Mama/mortalidade
Carcinoma Ductal de Mama/patologia
Carcinoma Lobular/mortalidade
Carcinoma Lobular/patologia
Estudos de Coortes
Comorbidade
Demência/mortalidade
Dinamarca/epidemiologia
Feminino
Seguimentos
Seres Humanos
Nefropatias/mortalidade
Hepatopatias/mortalidade
Pneumopatias/mortalidade
Meia-Idade
Doenças Vasculares Periféricas/mortalidade
Sistema de Registros
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1080/0284186X.2017.1407496


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[PMID]:28451812
[Au] Autor:Katsanos K; Spiliopoulos S; Reppas L; Karnabatidis D
[Ad] Endereço:Department of Interventional Radiology, School of Medicine, Patras University Hospital, Panepistimiou St., 26504, Rion, Greece. katsanos@med.upatras.gr.
[Ti] Título:Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?
[So] Source:Cardiovasc Intervent Radiol;40(7):964-977, 2017 Jul.
[Is] ISSN:1432-086X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.
[Mh] Termos MeSH primário: Aterectomia/instrumentação
Procedimentos Cirúrgicos de Citorredução/instrumentação
Procedimentos Endovasculares/instrumentação
Doenças Vasculares Periféricas/cirurgia
[Mh] Termos MeSH secundário: Algoritmos
Desenho de Equipamento
Artéria Femoral/cirurgia
Seres Humanos
Salvamento de Membro/instrumentação
Ensaios Clínicos Controlados Aleatórios como Assunto
Stents
Grau de Desobstrução Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s00270-017-1649-6


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[PMID]:29310388
[Au] Autor:Kim YM; Moon C; Goo DE; Park SB; Park JW
[Ad] Endereço:Department of Physical Medicine and Rehabilitation.
[Ti] Título:Lymphedema secondary to idiopathic occlusion of the subclavian and innominate veins after renal transplantation: A case report.
[So] Source:Medicine (Baltimore);96(48):e8942, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Among the causes of swelling in the extremities of renal transplantation patients, secondary lymphedema caused by complete idiopathic obstruction of large veins is rare and may be difficult to diagnose and treat. PATIENT CONCERNS: A 64-year-old man presented with severe edema and pain that occurred suddenly in the right arm. DIAGNOSES: The patient was diagnosed as stage-2 secondary lymphedema caused by idiopathic occlusion of the subclavian and innominate veins. INTERVENTIONS: Lymphoscintigraphy and ascending venography of the right arm confirmed the diagnosis. Intensive complete decongestive therapy for lymphedema was performed. OUTCOMES: Following 2 weeks of active rehabilitation, the pain level and edema status were significantly improved. LESSONS: When idiopathic swelling of the extremities occurs in renal transplant patients, secondary lymphedema caused by venous occlusion may be the cause. When direct intervention for the venous occlusion proves to be difficult, a conservative approach may be helpful.
[Mh] Termos MeSH primário: Veias Braquiocefálicas
Transplante de Rim
Linfedema/etiologia
Doenças Vasculares Periféricas/complicações
Veia Subclávia
[Mh] Termos MeSH secundário: Derivação Arteriovenosa Cirúrgica
Veias Braquiocefálicas/diagnóstico por imagem
Diagnóstico Diferencial
Seres Humanos
Falência Renal Crônica/terapia
Linfedema/diagnóstico por imagem
Linfedema/reabilitação
Linfedema/terapia
Masculino
Meia-Idade
Doenças Vasculares Periféricas/diagnóstico por imagem
Doenças Vasculares Periféricas/terapia
Veia Subclávia/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008942


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[PMID]:28926380
[Au] Autor:Atallah R; Li JJ; Lu W; Leijendekkers R; Frölke JP; Al Muderis M
[Ad] Endereço:1Department of Surgery (R.A.), Physical Therapy, Department of Orthopaedics (R.L.), and Osseointegration, Department of Surgery (P.F.), Radboud University Medical Center, Nijmegen, the Netherlands 2Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney, New South Wales, Australia 3Australian School of Advanced Medicine, Macquarie University, North Ryde, New South Wales, Australia 4School of Medicine, The University of Notre Dame Australia, Auburn, New South Wales, Australia 5Norwest Private Hospital, Bella Vista, New South Wales, Australia.
[Ti] Título:Osseointegrated Transtibial Implants in Patients with Peripheral Vascular Disease: A Multicenter Case Series of 5 Patients with 1-Year Follow-up.
[So] Source:J Bone Joint Surg Am;99(18):1516-1523, 2017 Sep 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Osseointegration is an alternative treatment for amputees who are unable to wear or have difficulty wearing a socket prosthesis. Although the majority of limb amputations are due to vascular disease, such amputations have been perceived as a contraindication to osseointegration surgery. We report the outcomes of osseointegrated reconstruction in a series of 5 patients with limb amputation due to peripheral vascular disease. METHODS: Five patients with transtibial amputation and a history of peripheral vascular disease who received an osseointegration implant from 2014 to 2015 were followed for 12 months. Clinical and functional outcomes were assessed, including pain, the amount of time the patient wore the prosthesis, mobility, walking ability, and quality of life. Adverse events, including infection, fracture, implant failure, revision surgery, additional amputation, and death, were monitored and recorded. RESULTS: Five transtibial amputees (56 to 84 years of age) followed for 1 year after osseointegration surgery were included in this case series. The mobility of all patients was improved at the time of follow-up. Three patients were wheelchair-bound prior to the surgery but all 5 were able to walk and perform daily activities at the time of follow-up. Four of the 5 patients were pain-free at 12 months postoperatively, and all 5 were using the osseointegrated prosthesis. Two patients had a single episode of superficial soft-tissue infection. CONCLUSIONS: An osseointegrated implant may be considered a feasible alternative to the conventional socket prosthesis for patients with peripheral vascular disease. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Amputados/reabilitação
Osseointegração
Doenças Vasculares Periféricas/complicações
Implante de Prótese/métodos
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Avaliação da Deficiência
Estudos de Viabilidade
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Implante de Prótese/efeitos adversos
Implante de Prótese/normas
Qualidade de Vida
Caminhada
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01295


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[PMID]:28877108
[Au] Autor:Meyers T
[Ad] Endereço:Tina Meyers, MBA, BSN, CWOCN, Harris Health Systems, Landscape Court, Conroe, Texas.
[Ti] Título:Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.
[So] Source:J Wound Ostomy Continence Nurs;44(5):429-433, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. METHODS: Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. RESULTS: None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P < .001). Patients in the intervention group had a significantly greater decrease in goniometric scores (mean decrease = 1.4 ± 2.25) compared to the control group by day 3 (mean decrease = 0.1 ± 0.52 P = .004) and the last study day (mean decrease = 2.0 ± 3.02 for the intervention group vs 0.07 ± 0.96 for the control group; P < .001). CONCLUSIONS: Study findings indicate that a heel protector that ensures off-loading and maintains the foot in a neutral position is more effective for prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.
[Mh] Termos MeSH primário: Contratura/prevenção & controle
Lesão por Pressão/prevenção & controle
Higiene da Pele/instrumentação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Enfermagem de Cuidados Críticos/métodos
Complicações do Diabetes
Feminino
Calcanhar/lesões
Seres Humanos
Escala de Gravidade do Ferimento
Unidades de Terapia Intensiva/organização & administração
Unidades de Terapia Intensiva/estatística & dados numéricos
Masculino
Meia-Idade
Doenças Vasculares Periféricas/complicações
Placa Plantar/lesões
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170907
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000355


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[PMID]:28838587
[Au] Autor:Harwood AE; Broadbent E; Totty JP; Smith GE; Chetter IC
[Ad] Endereço:Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom. Electronic address: amy.harwood@hey.nhs.uk.
[Ti] Título:"Intermittent claudication a real pain in the calf"-Patient experience of diagnosis and treatment with a supervised exercise program.
[So] Source:J Vasc Nurs;35(3):131-135, 2017 Sep.
[Is] ISSN:1532-6578
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intermittent claudication (IC) is a common condition which has severe impacts on quality of life, physical function, and mental health. Supervised exercise is the recommended first-line treatment for patients with this condition; however, these are not always feasible or accessible to patients. As the proportion of patients who have this treatment remains suboptimal, it is important to better understand the perception of exercise in this population. A gap in the literature exists about the barriers and facilitators to exercise in patients completing, dropping out of, or declining an exercise program. A qualitative analysis was undertaken to understand this further. Twenty-five patients were interviewed face to face, 10 who had completed exercise, 10 who had declined, and 5 who had dropped out of an exercise program. Three major themes emerged from the data, IC, and perception to exercise and experience or beliefs of the exercise program.Addressing the barriers and facilitators to exercise in patients with IC is crucial in optimizing the delivery and uptake of exercise programs. More education or time investment is needed with these patients during initial diagnostic to help overcome perceived barriers and emphasis healthy behavioral changes.
[Mh] Termos MeSH primário: Terapia por Exercício
Claudicação Intermitente/diagnóstico
Claudicação Intermitente/terapia
Extremidade Inferior
Dor
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Entrevistas como Assunto
Masculino
Cooperação do Paciente/psicologia
Doenças Vasculares Periféricas/complicações
Doenças Vasculares Periféricas/terapia
Pesquisa Qualitativa
Recuperação de Função Fisiológica
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE


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[PMID]:28823865
[Au] Autor:Fariñas MC; Campo A; Duran R; Sarralde JA; Nistal JF; Gutiérrez-Díez JF; Fariñas-Álvarez C
[Ad] Endereço:Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain. Electronic address: mcfarinas@humv.es.
[Ti] Título:Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts.
[So] Source:J Vasc Surg;66(5):1417-1426, 2017 Nov.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). METHODS: This was a prospective cohort study of all consecutive patients who underwent PVG of the abdominal aorta with or without iliac-femoral involvement and peripheral PVG from April 2008 to August 2009 at a university hospital. Patients younger than 15 years and those with severe immunodeficiency were excluded. The follow-up period was until 3 years after surgery or until death. RESULTS: There were 261 patients included; 230 (88.12%) were male, and the mean age was 67.57 (standard deviation, 10.82) years. The reason for operation was aortic aneurysm in 49 (18.77%) patients or lower limb arteriopathy in 212 (81.23%) patients. NIs occurred in 71 (27.20%) patients. Of these, 42 were surgical site infections (SSIs), of which 61.9% occurred in the lower extremities (14 superficial, 10 deep, and 2 PVG infections) and 38.1% in the abdomen (7 superficial, 7 deep, and 2 PVG infections); 15 were respiratory tract infections; and 15 were urinary tract infections. Active lower extremity skin and soft tissue infection (SSTI) at the time of surgery was a significant predictor of NI for both types of PVG (abdominal aortic PVG: adjusted odds ratio [OR], 12.6; 95% confidence interval [CI], 1.15-138.19; peripheral PVG: adjusted OR, 2.43; 95% CI, 1.08-5.47). Other independent predictors of NI were mechanical ventilation (adjusted OR, 55.96; 95% CI, 3.9-802.39) for abdominal aortic PVG and low hemoglobin levels on admission (adjusted OR, 0.84; 95% CI, 0.71-0.99) and emergent surgery (adjusted OR, 4.39; 95% CI, 1.51-12.74) for peripheral PVG. The in-hospital mortality rate was 1.92%. The probability of surviving the first month was 0.96, and significant predictors of mortality were active lower extremity SSTI (adjusted risk ratio [RR], 12.07; 95% CI, 1.04-154.75), high postsurgical glucose levels (adjusted RR, 1.02; 95% CI, 1.00-1.04), and noninfectious surgical complications (adjusted RR, 19.38; 95% CI, 2.25-167.29). The long-term mortality rate was 11.88%. The probability of surviving at 12, 24, and 36 months was 0.94, 0.92, and 0.87, respectively. Variables significantly associated with long-term death were older age (adjusted RR, 1.08; 95% CI, 1.01-1.15), high values of creatinine on discharge (adjusted RR, 1.91; 95% CI, 1.08-3.38), and an SSI with the highest adjusted RR (6.35; 95% CI, 1.87-21.53). CONCLUSIONS: SSI was the primary NI. The risk of NI depended primarily on the presence of a lower extremity SSTI at the time of surgery, whereas mortality was determined by age, surgical complications during the operation, and SSI. These findings suggest that in those cases in which surgery is reasonably delayed, surgery should be deferred until the lower extremity SSTIs are resolved.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/cirurgia
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/instrumentação
Prótese Vascular/efeitos adversos
Infecção Hospitalar/microbiologia
Doenças Vasculares Periféricas/cirurgia
Infecções Relacionadas à Prótese/microbiologia
Infecções Respiratórias/microbiologia
Infecção da Ferida Cirúrgica/microbiologia
Infecções Urinárias/microbiologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Biomarcadores/sangue
Implante de Prótese Vascular/mortalidade
Distribuição de Qui-Quadrado
Creatinina/sangue
Infecção Hospitalar/diagnóstico
Infecção Hospitalar/mortalidade
Infecção Hospitalar/terapia
Feminino
Mortalidade Hospitalar
Hospitais Universitários
Seres Humanos
Estimativa de Kaplan-Meier
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Modelos de Riscos Proporcionais
Estudos Prospectivos
Infecções Relacionadas à Prótese/diagnóstico
Infecções Relacionadas à Prótese/mortalidade
Infecções Relacionadas à Prótese/terapia
Infecções Respiratórias/diagnóstico
Infecções Respiratórias/mortalidade
Infecções Respiratórias/terapia
Fatores de Risco
Espanha
Infecção da Ferida Cirúrgica/diagnóstico
Infecção da Ferida Cirúrgica/mortalidade
Infecção da Ferida Cirúrgica/terapia
Fatores de Tempo
Resultado do Tratamento
Infecções Urinárias/diagnóstico
Infecções Urinárias/mortalidade
Infecções Urinárias/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170822
[St] Status:MEDLINE


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[PMID]:28807201
[Au] Autor:Shaikh IA; Rishi MT; Youssef M; Selvaraju V; Thirunavukkarasu M; Ukani G; Lakshmanan R; Palesty JA; Maulik N
[Ad] Endereço:Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut; Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut.
[Ti] Título:Overexpression of Thioredoxin1 enhances functional recovery in a mouse model of hind limb ischemia.
[So] Source:J Surg Res;216:158-168, 2017 Aug.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is keen interest in finding nonsurgical treatments for peripheral vascular disease (PVD). Previously, we demonstrated that selective activation of Thioredoxin1 (Trx1), a 12-kDa cytosolic protein, initiates redox-dependent signaling and promotes neovascularization after ischemic heart disease. Therefore, Trx1 might possess immense potential to not only treat murine hind limb ischemia (HLI) through effective angiogenesis but also provide PVD patients with nonsurgical therapy to enhance neovascularization and improve blood perfusion. METHODS: To determine whether activation of Trx1 increases blood perfusion in HLI, two different strategies were used-gene therapy and transgenic model system. In adenoviral-mediated gene therapy, 8- to 12-wk-old mice were divided into two groups: (1) control Adeno-LacZ (Ad-LacZ) and (2) Adeno-Thiroedoxin1 (Ad-Trx1). The mice underwent surgical intervention to induce right HLI followed by injection with Ad-LacZ or Ad-Trx1, respectively. In the second strategy, we used wild-type and transgenic mice overexpressing Trx1 (Trx1 ). All the animals underwent Doppler imaging for the assessment of limb perfusion followed by immunohistochemistry and Western blot analysis. RESULTS: Significant increases in perfusion ratio were observed in all the Trx1 overexpressed groups compared with their corresponding controls. Expressions of heme oxygenase-1, vascular endothelial growth factor, and the vascular endothelial growth factor receptors Flk-1 and Flt-1 were increased in Trx1 overexpressed mice compared with their respective controls. Blood perfusion in the ischemic limb gradually improved and significantly recovered in Trx1 and Ad-Trx1 groups compared with their corresponding controls. The capillary and arteriolar density in the ischemic zone were found to be higher in Trx1 group compared with wild type. CONCLUSIONS: The overall outcomes of our study demonstrate that Trx1 enhances blood perfusion and increases angiogenic protein expression in a rodent HLI model. These results suggest that Trx1 is a potential target for clinical trials and drug therapy for the treatment of PVD.
[Mh] Termos MeSH primário: Terapia Genética/métodos
Membro Posterior/irrigação sanguínea
Isquemia/terapia
Doenças Vasculares Periféricas/terapia
Tiorredoxinas/metabolismo
[Mh] Termos MeSH secundário: Animais
Biomarcadores/metabolismo
Western Blotting
Membro Posterior/metabolismo
Imuno-Histoquímica
Isquemia/genética
Isquemia/metabolismo
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Camundongos Transgênicos
Doenças Vasculares Periféricas/genética
Doenças Vasculares Periféricas/metabolismo
Tiorredoxinas/genética
Regulação para Cima
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Txn1 protein, mouse); 52500-60-4 (Thioredoxins)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE



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