VENOUS LEG ULCERS AND EMOTIONAL CONSEQUENCES
Venous leg ulcers are a chronic disease that affects populations around the world. For sufferers, it leads to physical, social, economic, and emotional consequences. The aim of this study was to assess the presence of anxiety and depression, as well as to investigate possible associations with sociodemographic variables. A total of 30 patients, both men and women, with venous ulcers receiving care under outpatient treatment in a teaching hospital of a provincial city of São Paulo State, were included in this study. The evaluation tools used were the following: the Hospital Anxiety and Depression Scale (HADS) and a sociodemographic questionnaire that included job status, religion, marital status, gender, duration of disease, and age. A descriptive analysis of the data was performed. Statistical analysis used means, the Student t test, and the c2 test. Anxiety was identified in 30% of the patients and depression in 40%. No statistically significant correlation was found between anxiety or depression and the sociodemographic variables. Patients with chronic venous ulcers may present with anxiety and depression independent of socioeconomic variables such as religion, occupation, marital status, and duration of lesion.
USE OF ULTRASONOGRAPHY TO SCREEN FOR OCCULT CANCER IN PATIENTS WITH IDIOPATHIC VENOUS THROMBOSIS
Background: Patients with idiopathic deep vein thrombosis have a high enough incidence of cancer to justify an investigation of underlying malignant disorders. Aim: This study aimed to retrospectively analyze pelvic and abdominal ultrasound as a screening method for occult cancer in patients with idiopathic deep vein thrombosis. Method: The medical records of 120 individuals diagnosed with idiopathic deep vein thrombosis, who had been submitted to pelvic and abdominal ultrasound at admission or within 30 days after discharge, were evaluated. Results: Malignancies were confirmed by histopathological analysis in 4 patients after abnormalities suggestive of neoplasms had been identified in the examination. Four other patients without any changes at ultrasound had malignancies diagnosed by other methods. Conclusion: Ultrasonography to screen for abdominal occult cancer in patients with idiopathic venous thrombosis is recommended.
TUMOR MARKERS IN SCREENING FOR NEOPLASMS IN PATIENTS WITH DIOPATHIC DEEP VEIN THROMBOSIS
The aim of this study was to evaluate the CEA, CA 125, CA 15-3, CA 19-9 and AFP tumor markers as screening tests for neoplasms in idiopathic deep venous thrombosis (DVT). The hospital records of 500 patients with confirmed diagnosis of DVT by lower limb Doppler ultrasonography were assessed in retrospective longitudinal and quantitative study in Hospital de Base Medicine School, São José do Rio Preto in the period from January 2005 to March 2010. An investigation of tumor markers had been randomly requested for 167 of these patients. There was significant difference for the CEA marker in patients with neoplasms detected after idiopathic DVT (124.42 ± 474.82) compared to other patients in this group (1.64 ± 1.41; p = 0.0017, 95% confidence interval (CI): -198.76 to -46.788) and for the CA 15-3 marker (57.5 ± 0.707 in patients with cancer and DVT and 18 ± 11.015 in patients with only idiopathic DVT; p = 0.0019; 95% CI: -58.844 to -20.156). Only the CA 15-3 marker proved to be noticeably sensitive for screening in the statistical tests. Cancer was diagnosed in 32% of 28 the patients who had elevated levels of at least one of the markers. All patients without diagnosis of malignancy had serum levels of tumor markers within the reference values. An investigation of tumor markers proved useful both in the exclusion of malignancies and to indicate screening utilizing other more specific examinations for patients with a high probability of neoplastic syndrome.
THE USE OF COMPRESSION STOCKINGS FOR VENOUS DISORDERS IN BRAZIL
Objective: The aim of this study was to analyse the medical indication and the use of elastic compression stockings, and to assess patient adherence to treatment in different regions of Brazil. Method: The prescription and clinical indication of elastic stockings were evaluated in a prospective, descriptive, cross-sectional, multicentre study for a population of private patients. In 2009, 3414 patients from 123 treatment centres in southern, south-eastern and north-eastern Brazil were evaluated using a questionnaire. The following variables were analysed: sociodemographic (gender, age, occupation and education), lifestyle (physical activity and time spent standing); classification of venous disease (CEAP [clinical, aetiological, anatomical and pathophysiological] classification – clinical criteria), indications for prescription, consumer behaviour (strength, acquisition and use of stockings) and criteria of satisfaction (improvement, duration of use, adherence). The effects of compression therapy were assessed at a follow-up visit approximately 30 days after starting treatment with the following items being assessed: complaints about pain, discomfort, burning sensation and oedema of the leg while using elastic stockings. Multivariate analysis was used to compare data with an alpha error of 5% (P value , 0.05) being considered acceptable. Results: The average age increased with the severity of chronic venous insufficiency; the main indications used byphysicianswere leg pain and discomfort; 89.3% of patients bought stockings and thus started treatment with more than 90% of these reporting improvements in symptoms. Conclusion: Elastic stockings are available to the Brazilian population, look acceptable at the
time of purchase and provide good results; however, some limitations regarding their use need to be addressed.
THE DIFFERENCES IN THE ANKLE RANGE OF MOTION IN DISTINCT ETHNICAL GROUPS MEASURED BY GONIOMETRY
The aim of this study was to evaluate if there are any differences in the range of motion of the ankle joint for distinct ethnicities measured by goniometry. A total of 288 ankles of 152 individuals were evaluated and divided into four ethnic groups: 18 male and 20 female Caucasians (75 ankles), 11 male and 26 female Oriental individuals (72 ankles), 25 male and 16 female Black people (70 ankles) and 19 male and 17 female Mulattos (71 ankles). All of the participants were of similar ages and were examined in a single
evaluation in the morning by the same examiner using the same goniometric device. Statistical analysis was achieved using means and standard deviation and a comparison of the scores, z-statistics of the normal distribution were calculated with an alpha error of 5% considered acceptable. The total mean obtained from all ethnical groups, considering
both left and right legs and both genders, was 60.45º. The averages of the distinct ethnicities were: 63.84º for Caucasians, 66.91º for Orientals, 55.21º for Black people and 55.87º for Mulattos. All groups were significantly different in relation to ankle motion range compared to the other groups, except between Black people and Mulattos. There were statistically significant differences when separately analyzing the means of goniometric measures of the right and left ankles in men and women of the Caucasian and Oriental ethnic groups.
RATE OF OCCUPATIONAL LEG SWELLING IS GREATER IN THE MORNING THAN IN THE AFTERNOON
The aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day. Volumetric variations of the legs of 70 hospital
employees, enrolled in three groups, were evaluated. Group I: 35 morning shift workers; Group II: 35 afternoon shift workers; and Group III: 15 individuals randomly selected
from Groups I and II, who were evaluated on the day they worked 12 hours consecutively. Volumetry was performed before and after each shift for both legs of the participants in Groups I and II. For Group III volumetry was performed early in the morning, at noon and in the evening. For statistical analysis, the Student’s t-test and Mann-Whitney test
were used with an alpha error of 5% being considered acceptable (P value , 0.05). Significant increases in volume were recorded for the limbs in all three groups (P value ,
0.001). On comparing Groups I and II, the accumulation of fluids was significantly higher in the morning than in the afternoon (P value , 0.003). Asymptomatic workers may
present with oedema of the legs during their work with the rate of oedema being different for morning and afternoon shifts. The possibility of wearing compression stockings should be considered for this type of work.
PREVALENCE OF DEATH DUE TO ULMONARY EMBOLISM AFTER TRAUMA
Background: Pulmonary thromboembolism is an important cause of death affecting thousands of people worldwide. The current study aims to evaluate the prevalence of death due to pulmonary embolism after trauma. Materials and Methods: The diagnoses of the causa mortis of all patients treated in the Accident and Emergency Department of Hospital
de Base in São José do Rio Preto, in the period from July 2004 to June 2005, were identified from autopsy reports to check whether pulmonary thromboembolism was involved. Result: A total of 109 deaths due to trauma were detected in this period with pulmonary embolism occurring in 3 (2.75%) patients. Conclusion: Pulmonary thromboembolism is
an important cause of mortality in trauma patients and so prophylactic measures should be taken during the treatment of these patients.
PREVALENCE OF ANTICARDIOLIPIN ANTIBODIES IN PREGNANCIES WITH HISTORY OF REPEATED MISCARRIAGES
Abstract: Aim: This study aimed at evaluating the prevalence of high anticardiolipin antibody and lupus anticoagulant levels in women with histories of at least two miscarriages.
Methods: The presence of high anticardiolipin antibody and lupus anticoagulant levels were evaluated in 52 patients with ages between 17 and 41 (mean 26.7 years old) who had histories of repeated miscarriages. Results: High anticardiolipin antibody levels were identified in 55.77% and lupus anticoagulant levels in 2% of the individuals. Conclusion: In conclusion, women who suffer from repeated miscarriages present with a high prevalence of anticardiolipin antibodies. Further studies on this issue are crucial as these antibodies are associated with hypercoagulability and thus increased the risk of thromboembolic events.
IS THE WEARING OF ELASTIC STOCKINGS FOR HALF A DAY AS EFFECTIVE AS EARING THEM FOR THE ENTIRE DAY?
Background There is good evidence for the use of compression for some clinical indications but little is known about dosimetry in compression. Objective The aim of this work was to evaluate whether or not the use of compression stockings during part of the day would help in the reduction of evening oedema in patients with clinical, epidemiological, anatomical and physiopathological (CEAP) classifications C0 and C1. Methods The effects of elastic compression stockings on volumetric variations during the working day were evaluated for the legs of two men and 18 women (40 legs). The inclusion criterion was classification as C0 (10 legs) or C1 (30 legs) according to the CEAP criteria. Participants used three-quarter-length elastic compression stockings (20–30 mmHg) on three consecutive days for the entire day or only for the morning or they did not use the stockings at all. Volumetry using the water displacement technique was performed in the morning and in the evening. When the patients wore the stockings only during the morning, volumetry was also performed at 13:00 h. Results Significant increases in volume were observed for both legs when stockings were not used compared with the use of stockings in the morning only. After removing the stockings, both legs had significant increases in volume in the afternoon. However, use for half the day was better than not using the stockings at all. Conclusions The use of elastic compression stockings can reduce volumetric variations during working hours, with the use of stockings for the entire day being better than for just half the day.
INTERFERENCE OF DAY‐TO‐DAY CTIVITIES ON THE WORKING PRESSURES IN PATIENTS USING ELASTIC STOCKINGS
The objective of current study was to evaluate if day‐to‐day activities can exert an influence on the treatment of patients that use elastic stockings. Working pressures during day‐to‐day activities were evaluated. Five male and five female individuals, with ages varying from 36 to 47 years old, participated in the study. They were requested to continue with routine day‐to‐day activities during the evaluation period. Sigvaris® 30/40 mmHg elastic stockings were utilized. An apparatus that assesses the pressure at half‐second
intervals, either dynamically or under static conditions was employed. The individuals were monitored for variable lengths of time of from one to three hours and at the end of data collection, the measurements were expressed as pressures at half‐second intervals in the form of a graph. Pressure variations were identified in accordance to the muscle activity, mainly when the calf muscle was involved. Day‐to‐day activities have a great influence on the variations of working pressure in individuals using elastic stockings and so, the stockings are useful as an adjuvant form of therapy in patients with venolymphatic diseases.