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Abstract: Background: Photodynamic therapy is a therapeutic modality that has consolidated its activity in the photooxidation of organic matter, which arises from the activity of reactive oxygen species. Objective: To evaluate the effect of red laser 660nm with the photosensitizer methylene blue on Propionibacterium acnes in vitro. Method: The experimental design was distributed into four groups (1 - control group without the application of light and without photosensitizer, 2 - application of light, 3 - methylene blue without light, and 4 - methylene blue with light). Tests were subjected to red laser irradiation 660nm by four cycles of 5 minutes at 3-minute intervals. Results: It was evidenced the prominence of the fourth cycle (20 minutes) groups 2, 3 and 4. Study limitations: Despite the favorable results, the laser irradiation time photosensitizer associated with methylene blue were not sufficient to to completely inhibit the proliferation of bacteria. Conclusion: Further studies in vitro are recommended to enable the clinical application of this photosensitizer in photodynamic therapy.

Introduction : Erysipelas is an acute skin infection of a streptococcal-related aetiology. Penicillin is the first-line antibiotic in the treatment of erysipelas; however, a number of other antibiotics are used. Aim of the research : To evaluate the clinical response of erysipelas to clindamycin in hospitalised patients. Material and methods : A retrospective cohort study was performed of all patients hospitalised with erysipelas and treated with the antibiotic clindamycin in Hospital de Base, São José do Rio Preto between 2000 and 2008. Results : The efficacy of this medication was evaluated. Failure of clinical treatment was detected in 4% of the 50 patients treated with clindamycin, but no failure was seen in 51 patients who were treated with clindamycin combined with other antibiotics. Conclusions : Clindamycin is clinically efficacious (96%) to treat patients hospitalised for erysipelas. Clindamycin is a good therapeutic option.

ABSTRACT The aim of this work was to study on a new low-elastic textile that fulfilled the criteria of fabrics for the manufacture of compression garments to treat lymphedema. The evolution of Godoy & Godoy compression sleeves was performed by following the patients treated for arm lymphedema. Sixty-six patients with ages ranging from 35 to 83 years and a mean of 58.8 years were included in this study. Diagnosis, by the clinical evaluation confirmed by the volumetry, was defined as a volume difference of more than 200 mL between the arms. All the participants were submitted to treatment sessions once, or two times weekly in an outpatient setting. The material used for the compression sleeve in this study was commercialized in Brazil under the name of Gorgurão(r). When high alterations in the pattern of sleeves were made, the patients were monitored by weekly volumetric assessments. The criterion to maintain the modifications in the design was that the hand did not present with edema. By the end of the study, the design of the sleeve was changed so as not to use compression therapy of the hands in 81.8% of the cases; 12.2% continued with compression of the hand, 3.0% stopped using compression completely and 3.0% used only a glove. Thus, Godoy & Godoy compression sleeves could be an efficient option for compression in the treatment of arm lymphedema as they provided better independence in day-to-day activities.

RESUMO Objetivo: Analisar a bibliografia relacionada aos tipos de terapias para lesões venosas, enfatizando o uso da bota de Unna, e investigar e discutir os principais aspectos relacionados ao seu uso, comparados aos de outras técnicas. Método: Revisão integrativa da literatura dos últimos 5 anos, por meio de buscas na BVS, LILACS, BDENF, SciELO, MEDLINE/PubMed. Resultados: Foram identificadas 22 publicações, com 15.931 casos entre adultos ou idosos, cuja média de idade foi igual ou superior a 60 (35-78) anos, sem discrepância na porcentagem de gênero. A bota de Unna apresentou um tempo inferior de cicatrização que a bandagem elástica simples e de duas camadas. Conclusão: Embora outras técnicas compressivas possam mostrar-se mais eficientes do que a bota de Unna, por agregar mais tecnologia, a bota se destaca por ser um curativo tradicional de baixo custo. A bandagem multicamada é uma técnica padrão-ouro. Esta revisão mostrou que a bota de Unna pode não ser a melhor opção, por demandar um tempo superior de cicatrização em comparação à bandagem multicamada, mas atende à expectativa com um alto índice de eficiência no tratamento, ainda se comparada ao curativo simples, bandagem simples ou de duas camadas.

Background. Elastic compression stockings (ECS) are effective in preventing and reducing occupational edema (OE), but the optimal pressure according to the prevalent working position during the day is still controversial. Objective. To compare the effectiveness of ECS with different pressures (15–20 mmHg or 20–30 mmHg) for reducing OE in individuals working in different prolonged postures. Methods. This cross-sectional study comprised 116 lower limbs of 58 individuals divided into three groups according to their prevalent postures over the day (sitting, standing, or combination). Volumetric measurements were taken at the beginning and at the end of three consecutive days. On the first day, individuals did not use compression stockings; on the second and third days, they used, respectively, 15–20 mmHg and 20–30 mmHg knee-length stockings. Differences between morning and evening volumes (measured edema) were calculated, compared, and correlated. Results. Volumetric variations were significantly lower on the second compared to the first day when individuals in all three groups used 15–20 mmHg compression stockings (p-value < 0.001). Measurements were even lower when they used 20–30 mmHg stockings: this decrease was more significant for the sitting (p-value < 0.001) than the standing (p-value < 0.05) and combined groups (p-value < 0.05). Reduction of measured edema was more significant in individuals working in a prolonged seated position. No significant difference was found only on comparing sitting and standing groups after the use of the 15–20 mmHg compression stockings. Conclusions. The use of ECS over a working day reduces OE in prolonged sitting, standing, and combined positions, with the reductions being greater with the higher pressure.

Objective. The present study was aimed at evaluating the use of mechanical and manual lymphatic therapy as a treatment for lymphedema resulting from orthopedic surgery that became painful after an episode of erysipelas. Case Report. A 70-year-old male patient suffered direct trauma resulting in a compound fracture of the tibia and fibula of the left leg. He was treated with an external fixator for four months followed by plaster cast immobilization for three weeks. He presented with fever and paresthesia in the lower left limb that resulted in an episode of erysipelas, and the patient evolved with painful lymphedema. Treatment using the Godoy and Godoy technique was proposed, including manual and mechanical lymphatic therapy. Water displacement volumetry was used to quantify the leg size reduction. Results. After 10 sessions of therapy, the patient presented a significant reduction in the limb volume and remission of symptoms. Conclusions. The method used may be a promising option for the treatment of posttraumatic edemas with pain.

The case of a 54-year-old cardiac patient is reported, who was admitted to hospital with a complaint of sudden pain in the legs associated with edema, paresthesia, and coldness. Arterial embolism of the lower limbs was diagnosed and the patient was submitted to bilateral embolectomy. The patient evolved with a burning sensation, hypersensitivity in the right leg, swelling, and difficulty bending and stretching the sole of the foot and the knee. A physical examination detected edema and increased tension in the anterior, lateral, and posterior compartments. Treatment using intermittent massage of the leg during the evaluation of the patient was chosen in an attempt to stimulate lymphatic and venous drainage. After a few minutes of stimulation, there was significant improvement in the pain and edema. In 40 minutes, there was total reduction of the pain in the posterior and lateral compartments and improvement of over 50% in the anterior compartment. After this, the patient started to bend the knee without pain and bend the sole of the foot with slight pain. On the following day, the patient was walking around the hospital ward without difficulty. It seems that intermittent massage is a therapeutic option in selected cases of compartment syndrome.

The aim of this study was to evaluate perimetric reductions in the clinical treatment of cellulite (aesthetics) using the Godoy method in a randomized retrospective clinical trial. The medical records of 150 patients treated for cellulite in the period from 2006 to 2011 in the Clinica Godoy were revisited. Treatment comprised manual and mechanical lymph drainage and cervical stimulation for one hour per day over 10 days. The paired t-test was used for statistical analysis, with an alpha error of 5% (P-value

Introduction: Pain associated with lymphedema is common, but it is rarely a limiting factor. The aim of the present study is to report the effect of five days of intensive treatment of a patient with sequelae of poliomyelitis associated to an infection that progressed to lymphedema and six months of intense pain. Case summary: A 65-year-old patient with sequelae of poliomyelitis from the first year of life evolved with infectious processes and lymphedema after several surgeries for fractures. The patient suffered constant limiting pain for six months. The lymphedema was confirmed by bioimpedance after she sought treatment. The patient was submitted to intensive treatment eight hours/day for five consecutive days using Mechanical Lymphatic Therapy (RA Godoy©). Outcome Measures: After the first day of treatment the pain was reduced to moderate intensity, after the second day, ankle movement improved facilitating ambulation and after the third day, she felt no more pain. The patient is continuing with maintenance therapy using the RA Godoy© device for one hour/day at home. Conclusion: Limiting pain is uncommon in lymphedema but in this case, it was associated with repetitive infectious events. The pain disappeared with Mechanical Lymphatic Therapy.

Manual lymph drainage has become the mainstay in the treatment of lymphedema for decades now. Five evolving variants have been described by Godoy & Godoy over the years: i) manual lymph drainage using rollers; ii) self-applied manual lymph drainage using rollers; iii) manual lymph drainage using the hands (manual lymphatic therapy); iv) mechanical lymphatic therapy using the RAGodoy® device; and v) lymphatic therapy using cervical stimulation in general lymphatic treatment. After breast cancer treatment using adapted technique with intermittent compression therapy. Lymphoscintigraphy, volumetry and bioimpedance were employed to analyze such treatment techniques applied to the upper and lower extremities. These treatment and evaluation topics are described in this brief report.

Background and Purpose. Mental disability is often characterized by significant limitations in adaptive skills. When this condition is associated with lymphedema, treatment requires greater commitment of the care team. The objective of this study is to report the treatment of lymphedema using only one therapeutic technique, a low-stretch grosgrain stocking. Case Report. We report the case of a 14-year-old mentally challenged female patient with lymphedema of the left leg, motor difficulties, and impaired speech and sight. According to the caregiver, lymphedema was present at birth; however, the patient had not been submitted to specific treatment. Thus, only one technique, an adapted low-stretch grosgrain compression stocking, was proposed as it could be used during daily life activities. The adaptation involved the grosgrain stocking, fastened using eyelets and cord up to the thigh, being sewn onto a pair of cotton shorts. The result was a clinical improvement with reductions in the perimeter and volume due to the compliance of the patient and the family to treatment. Conclusion. The use of a single treatment strategy in the form of a low-stretch stocking in such cases together with the involvement of a multidisciplinary team can lead to good treatment outcomes for chronic lymphedema.

Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers’ ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema.

The objective of this study is to describe the evolution of the skin during rehabilitation for elephantiasis using intensive treatment. We report on the case of a 55-year-old patient with a seven-year history of leg edema. The patient reported that it began with repeated outbreaks of erysipelas over several years. One leg evolved with significant edema leading to an inability to ambulate and for about one month the patient said that he could not get out of bed. Moreover the patient was obese weighing 130 kilos and with a BMI of 39. Intensive treatment was performed over three weeks resulting in a significant reduction in limb volume. The treatment consisted of Mechanical Lymphatic Therapy (RAGodoy), Cervical Lymphatic Stimulation (Godoy & Godoy technique), and a custom-made inelastic stocking of a grosgrain textile. What caught the attention during therapy were the open wounds resulting from fragmentation of the plaque as the edema reduced; the plaque was about 0.5 cm thick. As the treatment evolved the plaque disappeared and the wounds healed. The limb size decreased by more than 80% in three weeks after which the patient began to be treated in an outpatient setting with ambulation using a grosgrain stocking.

The aim of the present study was to evaluate the resting and working pressures associated to a restrain mechanism, in patients suffering from lymphedema of the upper limbs, postbreast cancer treatment, whilst performing occupational and day-to-day self-care activities. Six female patients under treatment of lymphedema due to surgical, radiotherapeutic and chemotherapeutic treatment of breast cancer, in the age group between 32 and 76 years (mean 54 years old, ± 31.11) were selected. A compression sleeve of “gorgurão” (cotton-polyester material) was applied as a restrain mechanism. The occupational and daily personal care activities evaluated were those common to all participants. These activities included washingup, cooking in a small pan, sweeping the floor using the affected arm, brushing the teeth, brushing the hair, washing small items of clothes, ironing clothes and making the bed. For statistical analysis, mean and standard deviation between resting pressures and minimum and maximum working pressures were determined. The two-tailed student t-test and variance analysis were used for repeated measurements. The Bonferroni limit was used in the analysis of the variables to calculate the alpha error, with a value of 5%, considered statistically significant. All of the analyzed activities associated to the “gorgurão” compression sleeve generated both resting and working pressures (p

BACKGROUND: Endovascular stent-graft repair of aortic dissections is a relatively new procedure, and although apparently less invasive, the efficacy and safety of this technique have not been fully established. OBJECTIVE: To evaluate mortality in patients with complicated Stanford type B aortic dissections submitted to endovascular treatment. METHODS: Clinical, anatomical, imaging and autopsy data of 23 patients with complicated type B aortic dissections were reviewed from November 2004 to October 2007. The main indications for transluminal thoracic stent-grafting included: persistent pain in spite of medical therapy, signs of distal limb ischemia, signs of aortic rupture, progression of aneurismal dilation of the descending aorta during follow-up (defined as a diameter > 50 mm) and the diameter of descending thoracic aorta of 40mm or larger at the onset of aortic dissection. Data were analyzed statistically; all p-values were two-tailed and differences < 0.05 were considered to indicate statistical significance. Continuous variables were expressed as mean (± SD), and medians were compared by the Student's t test. Differences in categorical variables between the groups were analyzed by the Chi-square or Fisher's exact test. RESULTS: The procedure presented primary technical success in 82.6% of patients. Four patients (17.4%) had an incomplete proximal entry seal. Three patients (13%) died within 30 days of the procedure and eight patients (34.8%) died after 30 days. CONCLUSION: Endovascular correction of complicated Stanford type B aortic dissections is a feasible and effective treatment option.INTRODUÇÃO: O tratamento endovascular na dissecção de aorta é um procedimento relativamente novo e, embora aparentemente menos invasivo, a eficácia e a segurança dessa técnica não estão totalmente estabelecidas. OBJETIVO: Avaliar a mortalidade e complicações nos pacientes submetidos a tratamento endovascular na dissecção de aorta tipo B de Stanford. MÉTODOS: Foram revisados, a partir de novembro de 2004 a outubro de 2007, em estudo clínico, anatômico, de imagens e dados da autopsia de 23 pacientes com dissecção aórtica tipo B. As principais indicações para o procedimento foram: dor persistente apesar da terapia médica, sinais de isquemia distal do membro, sinais de ruptura da aorta, progressão da dilatação do aneurisma da aorta descendente, durante o seguimento (definida como um diâmetro > 5 cm) e descendente da aorta torácica de 40 mm ou mais de diâmetro no início da dissecção aórtica. Os dados foram analisados estatisticamente considerados erro alfa de 5%. As variáveis contínuas foram expressas como média (± dp) e medianas e comparadas pelo teste t Student. As diferenças entre os grupos em variáveis categóricas e analisadas pelo chi-quadrado ou teste exato de Fisher. RESULTADOS: O procedimento apresentou sucesso técnico primário em 82,6% dos pacientes. Quatro (17,4%) pacientes tinham um selo de entrada incompleto proximal. Três (13%) pacientes morreram antes de 30 dias e oito (34,8%), após 30 dias do procedimento. CONCLUSÃO: Os procedimentos endovasculares são factíveis na dissecção da aorta torácica tipo B, na qual as complicações das causas de mortalidades alertam sobre a gravidade da doença e de intercorrências das próteses como no caso das fistulas.

José Maria Pereira de Godoy1, Lina MO Azoubel2, Maria de Fátima Guerreiro Godoy2,31Department of Cardiology and Cardiovascular Surgery, Medicine School of São Jose do Rio Preto-FAMERP, Brazil; 2Godoy Clinic, Lymphovenous Rehabilitation, Medicine School, São José do Rio Preto-FAMERP, Brazil; 3CAPES (Coordination of improvement of Personal of Superior Level), Rio de Janeiro, BrazilAbstract: The aim of the current study is to report on the minimal surgical treatment of elephantiasis of the feet to facilitate the use of compression mechanisms. The cases of two patients with congenital lymphedema that evolved to elephantiasis involving the feet are reported. Intensive treatment of the lymphedema was performed with a significant reduction in size thus allowing a better identification of the limits of tissue masses for the surgical approach. This reduction enabled primary suturing of the lesions to be carried out and fast healing of the wounds. The surgery greatly improved large deformities of the toes and feet and facilitated further treatment of the lymphedema using bandaging. Thus, the skin was preserved, there was a reduction in the size of the feet, and the patients were able to start wearing shoes.Keywords: elephantiasis, surgical treatment, feet, lymphedema

The aim of this paper is to report new options in the treatment of lymphedema for under-privileged populations. Several articles and books have been published reporting recent advances and contributions. A new technique of manual lymph drainage, mechanisms of compression, development of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have been developed for the treatment of lymphedema. This novel approach can be adapted for the treatment of lymphedema in mass.

CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05). RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p < 0.05) entre os membros operados e os não-operados, sendo 56,8% com volume maior que 50 mL e 31,9% com perímetro maleolar maior que 2 cm. Não se encontrou associação entre a presença do edema e características da amostra ou da cirurgia e de intercorrências clínicas perioperatórias ou tardias. CONCLUSÕES: Pacientes submetidos a ressecções de veia safena magna para sua utilização como ponte coronariana poderão apresentar edema no membro associado.BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than 50 mL or higher than 2 cm between the operated and the contralateral leg were considered as presence of significant edema. Chi-square, Fisher’s, McNemar’s and Student’s t tests were used for statistical analysis. Significance level was set at 5% (a = 0.05). RESULTS: Statistically significant differences (p < 0.05) were found between operated and contralateral legs, with 56.8% of the individuals having a difference in volume greater than 50 mL and 31.9% having a difference in malleolar region perimeter greater than 2 cm. There was no association between presence of edema and sample characteristics, surgery, perioperative or late clinical complications. CONCLUSIONS: Patients submitted to resection of the great saphenous vein for coronary artery bypass grafting may evolve with edema of the operated leg.

CONTEXTO: A presença de edema vespertino nos membros inferiores de indivíduos normais, após jornada habitual de trabalho, foi demonstrada na literatura nacional e internacional. O ritmo de formação e o acúmulo desse edema variam de acordo com os distintos turnos laborais. OBJETIVO: O edema de membros inferiores tem sido descrito após jornadas habituais de trabalho e representa uma queixa freqüente na prática vascular. O objetivo deste estudo foi avaliar a evolução do edema em indivíduos normais durante os distintos turnos laborais. MÉTODO: Foram feitas avaliações volumétricas de ambos os membros inferiores em 20 profissionais da área da saúde do Hospital e Maternidade São Marcos de Maringá, no Paraná. A escolha dos participantes foi por ordem de chegada, e as volumetrias foram feitas por técnica de deslocamento de água às 7, 13 e 19 h. Para análise estatística foi utilizado o teste t de Student, considerando erro alfa de 5%. RESULTADO: Dos 20 participantes, 19 eram do sexo feminino e 1 do masculino, sem evidência de doença venosa nos membros inferiores e pertencentes a C0 e C1 da classificação CEAP (C = clínica, E = etiologia, A = segmento anatômico, P = fisiopatologia). As idades dos participantes variaram entre 20 e 53 anos. Detectou-se aumento significativo de volume nos membros inferiores entre os distintos períodos avaliados, com p = 0,0001 e 0,0001, respectivamente. A maior variação ocorreu no período da manhã, com média ± desvio padrão de 107,2±63,5 mL, enquanto que à tarde, a variação foi de 44,5±35,4 mL. CONCLUSÃO: O edema é uma constante durante atividades laborais, mesmo em pessoas sem doença venosa manifesta e sofre influência do turno laboral ao qual o trabalhador se encontra exposto.BACKGROUND: Presence of evening edema of lower limbs in normal individuals after a regular working shift has been shown in the national and international literature. Formation rhythm and accumulation of this type of edema vary according to different work shifts. OBJECTIVE: Edema of the legs has been described after regular work shifts and is a common complaint in vascular practice. The objective of this study was to evaluate the evolution of edema in apparently normal individuals during distinct work shifts. METHOD: Volumetric assessments of both legs were performed in 20 healthcare professionals at São Marcos Hospital and Maternidade in Maringá, Brazil. Individuals were selected on a consecutive basis with water displacement volumetry being performed at 7:00 a.m., 1:00 p.m. and 7:00 p.m. Student's t test was used for statistical analysis with an alpha error of 5% being considered acceptable. RESULTS: The study group consisted of 19 women and one man with ages ranging from 20 to 53 years old. The participants had no evidence of venous diseases of the lower limbs and were C0 or C1 according to the CEAP classification (C = clinical, E = etiology, A = anatomy, P = pathophysiology). Significant increases in the volume of both legs were seen after both shifts (p = 0.0001 in both cases). The greatest variation occurred during the morning with a mean ± standard deviation of 107.2±63.5 mL, while in the afternoon mean increase was 44.5±35.4 mL. CONCLUSION: Edema is constant in work activities, even in individuals without obvious venous diseases, and is influenced by work shift.

CONTEXTO: O presente estudo avalia a mobilidade da articulação talocrural nos seis estágios clínicos da classificação CEAP (clínica, etiológica, anatômica e patofisiológica do International Consensus Committee Reporting Standards on Venous Disease) para doença venosa utilizando a goniometria, e detecta redução da mobilidade articular nos estágios mais avançados da doença, C5 e C6 (úlcera cicatrizada ou ativa). OBJETIVO: Investigar a existência de uma relação entre a severidade clínica da doença venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural. MÉTODO: Selecionaram-se aleatoriamente 120 membros pertencentes a 88 pacientes brancas, que foram separados com base em sua apresentação clínica de acordo com a categoria C da classificação CEAP, sendo distribuídos em 6 grupos pertencentes às categorias de C0-C1 (grupo controle) até C6, com 20 membros cada um e médias de idade próximas para cada grupo. O grau de mobilidade do tornozelo foi acessado por goniometria de apoio plantar em posição de decúbito supino. RESULTADOS: Os grupos C de CEAP apresentam diferença significativa em relação ao grau de mobilidade da articulação talocrural medida por goniometria (p < 0,001). C6 difere significativamente dos demais grupos (p < 0,05); C5 difere significativamente de C6, C3, C2 e C0-C1 (p < 0,05), mas não apresenta diferença significativa do grupo C4; C4 difere significativamente do grupo C6 (p < 0,05) e não difere dos demais grupos; C0-C1, C2 e C3 não apresentam diferença significativa entre si e em relação a C4, e diferem dos grupos C5 e C6 (p < 0,05). O nível de significância utilizado para os testes foi de 5%. CONCLUSÃO: Existe relação entre a severidade clínica da insuficiência venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural, e ela se faz mais evidente na presença de úlcera venosa ativa ou cicatrizada.BACKGROUND: This study assesses talocrural joint mobility considering the six stages of CEAP classification (clinical, etiologic, anatomic and pathophysiologic by the International Consensus Committee reporting standards on venous disease) for venous disease using goniometry, and detects reduction in joint mobility in more advanced stages of the disease, C5 and C6 (healed or active ulcer). OBJECTIVE: Investigate the existence of a relationship between clinical severity of chronic venous disease of the lower limbs and reduction in talocrural joint mobility. METHODS: A total of 120 limbs from 88 Caucasian patients were randomly selected. They were divided based on clinical presentation according to the C clinical category of CEAP, being distributed into six groups belonging to categories from C0-C1 (control group) to C6, with 20 limbs each and similar mean age for each group. Range of ankle mobility was assessed by goniometry in the supine position. RESULTS: C groups on the CEAP classification showed significant difference in relation to talocrural joint mobility measured by goniometry (p < 0.001). C6 was significantly different from the other groups (p < 0.05); C5 was significantly different from C6, C3, C2 and C0-C1 (p < 0.05), but with no significant difference from C4; C4 was significantly different from C6 (p < 0.05) and not different from the other groups; C0-C1, C2 and C3 were not significantly different between themselves and in relation to C4, but were different from C5 and C6 (p < 0.05). Significance level used for tests was 5%. CONCLUSION: There is a relationship between clinical severity of chronic venous insufficiency of the lower limbs and reduction in talocrural joint mobility, which is more evident in the presence of active or healed venous ulcer.

OBJETIVO: O objetivo do estudo foi avaliar a eficácia de um novo filtro de veia cava, de baixo perfil, na retenção de coágulos em modelo in vitro. MÉTODO: O filtro consiste em dois cones opostos pelo ápice. O cone distal é formado por oito hastes de aço inoxidável, que têm a função de retenção dos êmbolos. O cone proximal é constituído de quatro hastes, cuja função é ancorar e centralizar. Os filtros foram introduzidos e fixados no interior de um tubo de PVC transparente de 25, 30 e 35 mm de diâmetro interno, em posição vertical, e conectados com um sistema pulsátil de fluxo (bomba peristáltica). Foi utilizado, para veículo, um reservatório com solução salina (0,9%) com 40% de glicerina, mantido em temperatura ambiente. Confeccionaram-se trombos com sangue bovino em tubos plásticos de 3, 4,5 e 6 mm de diâmetro e, posteriormente, foram segmentados nas medidas de 10, 15, 20 e 30 mm de comprimento, totalizando 12 diferentes tamanhos. Realizaram-se 100 liberações para cada tipo de êmbolo e tamanho das cânulas, totalizando 3.600 eventos. Foram feitos lançamentos seqüenciais com cinco êmbolos, sendo 10 para cada tamanho de êmbolo e cânulas, totalizando 360 eventos. Fez-se avaliação da capacidade de retenção dinâmica utilizando os três diferentes tamanhos de cânulas com 100 eventos cada, totalizando 300 eventos. RESULTADOS: Detectou-se que o diâmetro e comprimento dos êmbolos, assim como diâmetros da cânula, podem comprometer a eficácia do filtro. A média de captura de êmbolos pelos filtros foi de 80,5% nas cânulas de 35 mm, 88,7% para cânulas de 30 mm e 86,6% para cânulas de 25 mm. CONCLUSÃO: Conclui-se que a eficácia desse filtro sofre interferência relacionada ao tamanho dos êmbolos e diâmetro da cânula.OBJECTIVE: The objective of the current study was to evaluate the efficacy of a new low-profile vena cava filter in the retention of emboli in an in vitro model. METHOD: The filter consists of two cones connected at the apexes. The distal cone is comprised of eight stainless steel arms with a purpose of retaining emboli and the proximal cone, made of four arms, acts as an anchor to centralize the filter. Filters were installed and fixed inside three systems using transparent PVC tubes of different sizes (internal diameters of 25, 30 and 35 mm) that were held in a vertical position and connected to a pulsating flow system (peristaltic pump). A reservoir of 0.9% saline solution with 40% glycerin at room temperature was used as the vehicle. Thrombi were made from bovine blood in 3-mm, 4-mm, 5-mm and 6-mm plastic tubes and later the thrombi were sectioned into 10-mm, 15-mm, 20-mm and 30-mm lengths. Each of the 12 sizes of thrombi was assessed 100 times in each of the three systems, with a total of 3,600 events. Five emboli were sequentially released, 10 for each size of embolus and tube, with a total of 360 events. An evaluation of the capacity of the three systems - 100 events each, total of 300 events - to dynamically retain the emboli was made. MRESULTS: The diameter and length of the emboli, as well as tubes greater than 35 mm in diameter can negatively affect the efficacy of the filter. The average of emboli capture for the filters was 80.5% in 35-mm tubes, 88.7% for 30-mm tubes and 86.6% for 25-mm tubes. CONCLUSION: We conclude that the efficacy of this filter is influenced by the size of the emboli and the diameter of the PVC tubes.

O objetivo do presente estudo foi avaliar a prevalência da deficiência da proteína S em pacientes com trombose venosa profunda e a interferência do anticoagulante oral durante a investigação. Foram avaliados aleatoriamente 87 pacientes, sendo 47 do sexo feminino e 40 do sexo masculino, com idades entre 17 e 56 anos e média de 36,3 anos, que apresentaram trombose venosa profunda (TVP) de membros inferiores. O diagnóstico da TVP foi feito com dúplex e confirmado pela flebografia nos casos de dúvidas. A mensuração da proteína S foi realizada pelo método coagulométrico, avaliando atividade biológica. Os exames foram colhidos um mês após a remoção da anticoagulação oral em todos os pacientes. Em trinta deles foram colhidos também durante a anticoagulação. Em 6,9% dos pacientes foi confirmada, em duas mesurações, a deficiência da proteína S. Na avaliação durante a anticoagulação, os trinta pacientes apresentaram redução dos níveis dessa proteína. Concluímos que a deficiência da proteína S em nosso estudo foi semelhante ao observado na literatura, sendo que a sua investigação mais confiável deve ser realizada após a suspensão do anticoagulante oral.

The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema.Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema.Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

The case of a rare complication is reported of a 53-year-old patient with giant polycystic kidney (4250 g) that evolved with acute small bowel occlusion. The patient was submitted to surgery which identified that the intestinal occlusion was due to external compression of the intestinal loops. Excision of the mass solved the case.

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value

The objective of the current study was to assess whether Venosan elastic stockings have a synergistic effect on the maintenance of results after Mechanical Lymphatic Therapy. Eleven patients with grade II lymphedema of the legs, regardless of cause, were evaluated in the Clinica Godoy between September and November 2012. The participants’ ages ranged from 53 to 83 years old with a mean of 65.1 years. Two groups were formed with Group I using Venosan elastic stockings and Group II not using any type of compression therapy. Evaluations of the lymphedematous legs were performed before and after each drainage session using bioimpedance. Patients who wore elastic stockings had a greater volume reduction than those who did not wear stockings (unpaired t-test: P value < 0.001).

The objective of this study was to evaluate pain in women with breast cancer-related lymphedema and the characteristics of aggravating factors and coping mechanisms. The study was conducted in the Clinica Godoy, São Jose do Rio Preto, with a group of 46 women who had undergone surgery for the treatment of breast cancer. The following variables were evaluated: type and length of surgery; number of radiotherapy and chemotherapy sessions; continued feeling of the removed breast (phantom limb), infection, intensity of pain, and factors that improve and worsen the pain. The percentage of events was used for statistical analysis. About half the participants (52.1%) performed modified radical surgery, with 91.3% removing only one breast; 82.6% of the participants did not perform breast reconstruction surgery. Insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain; it was mild in 28.8% of the cases (scale 1–5), moderate in 34.8% (scale 6–9), and severe in 4.3%. The main mechanisms used to cope with pain were painkillers in 41.30% of participants, rest in 21.73%, religious ceremonies in 17.39%, and chatting with friends in 8.69%. In conclusion, many mastectomized patients with lymphedema complain of pain, but pain is often underrecognized and undertreated.

Introduction: The aims of the current study are to report on preliminary epidemiological data of pregnant women with human immunodeficiency virus (HIV).Material and methods: HIV tests of 4653 pregnant women from Săo José do Rio Preto, Brazil between May 1995 and May 1997 were assessed, and the following epidemiological aspects were noted: age ethnic background, number of gestations, marital status, type of delivery, and the patients’ knowledge about the disease including: forms of transmission, diseases associated with positive cases, and the difficulties in and evolution of the approach to the disease in Brazil. Statistical analysis used percentages with means and standard deviation.Results: HIV tests were positive in 48 (1.03%) of the pregnant women. The mean age was 24.3±0.6 years. 35 (72.9%) of the individuals were married and 13 (27.1%) had been pregnant one to four times previously. 52.0% knew they were HIV positive and in 23 (48.0%), diagnoses was made during the consultations for this pregnancy. In 25 (52.0%) the form of transmission was unknown; events and gravid diseases occurred in 4 (31.2%) cases. In 38 (79.2%) cases delivery occurred before the 36th week of gestation, with delivery being vaginal in 38 (79.2%) cases, and there were puerperal complications in 8 (16.7%).Conclusions: The routine examination to test for HIV during pregnancy allows the identification of women who are unaware of infection by the virus and performance of medicinal prevention for these pregnant.

Introduction: Gestation constitutes a state of acquired hypercoagulability and the success of a pregnancy depends on an adequate placental blood circulation. The objective of this study was to evaluate the evolution of pregnant women suffering from antiphospholipid antibody syndrome and repetitive miscarriages treated with low doses of heparin and aspirin. Material and methods: The patient report cards of 27 patients with histories of multiple miscarriages (2 or more events) and who suffered from antiphospholipid antibody syndrome were reviewed over 32 gestations. The ages of the gravidas were between 17 and 41 years old with a mean age of 26.6 years. Inclusion criteria included positive tests for lupus anticoagulant and anticardiolipin antibodies. The use of subcutaneous heparin at 5000 IU was recommended twice daily in these cases, as was the oral administration of 100 mg of aspirin. Results: Of the 32 gestations studied 84.4% were successful and 15.6% miscarried. Gestational ages at delivery varied from 34 to 41 weeks, with a mean of 37 weeks. Gestational ages for the foetal losses varied from 7 to 26 weeks with an average of 15.2 weeks. Conclusions: The association of heparin at the recommended dosage with aspirin was efficient in preventing miscarriages in patients with histories of repetitive foetal loss.

The aim is to stress the importance of prophylaxis against deep venous thrombosis in gravidas with high levels of anticardiolipin antibodies with or without a history of repetitive miscarriages. The evolutions of two gravidas who were treated in pre-natal and vascular surgery outpatients’ clinics and who suffered from deep venous thrombosis, miscarriages and high anticardiolipin antibody levels are reported. The gestations terminated at full term after prophylaxis for miscarriages was applied. The report suggests that patients with deep venous thrombosis and high anticardiolipin antibody levels may present with miscarriages and, therefore, prophylactic treatment is recommended.

Um das principais dificuldades encontradas no tratamento do linfedema em crianças são os mecanismos de contenção. O objetivo do presente estudo é relatar uma experiência inicial com meias de gorgurão em criança. Descrevem-se as dificuldades encontradas no tratamento do linfedema em uma criança e mostra-se uma alternativa de contenção, que é a meia de gorgurão.One of the main difficulties found in the treatment of lymphedema in children is the mechanism of compression that should be used. The objective of present study was to report an initial experience with infant gorgurão (cotton-polyester textile) stockings. The difficulties found in the treatment of infant lymphedema are described and an alternative method of compression using a gorgurão stocking is provided.

OBJETIVO: O objetivo do presente estudo é relatar as complicações no tratamento de varizes em membros inferiores com laser endovascular. MÉTODOS: Foram levantadas, no período de junho de 1999 a dezembro de 2002, algumas complicações, como queimadura de pele, neurite do nervo safeno, hiperpigmentação e fibrose no local da safena em 250 pacientes submetidos a tratamento endovascular com laser em varizes de membros inferiores. O diagnóstico das complicações foi clínico e baseado nos sinais e sintomas. Avaliou-se 196 pacientes do sexo feminino e 54 do sexo masculino, com idades variando entre 25 e 79 anos, no Hospital Militar de Buenos Aires. Foram tratados com laser de diodo de alta potência de 810 nm de longitude de onda mediante um sistema de fibras óticas semi-rígidas de quartzo de 400 e 600 µm e ponta de contato plana em modo cirúrgico contínuo. Para análise estatística, foram calculadas as percentagens. RESULTADOS: Lesões tipo queimadura foram observadas em 3,2%, hiperpigmentação em 9,6%, fibrose no local da safena por mais de 6 meses em 5,6% e neurite do nervo safeno em 4,8%. CONCLUSÃO: Conclui-se que o tratamento com laser endovascular de varizes de membros inferiores não é desprovido de intercorrências e que os fatores que levaram a essas complicações devem ser identificados e reavaliados.OBJECTIVE: The aim of the present study is to report the complications seen in the endovascular laser treatment of varicose veins of the lower limbs. METHODS: From June 1999 to December 2002, 250 patients submitted to the endovascular treatment of varicose veins of the lower limbs using lasers and suffering from complications, such as skin burns, saphenous neuritis, hyperpigmentation and fibrosis along the course of the saphenous vein, were assessed. The diagnosis of the complications was made clinically based on the signs and symptoms evidenced. Of the 250 patients, aged 25-79 years, treated in the Hospital Militar de Buenos Aires, 196 were female and 54 were male. High power 810 nm wavelength laser diodes were applied using semi-rigid 400 and 600-micron fiber-optic quartz systems in continuous contact with the skin. Percentages were used for statistical analysis. MRESULTS: Burn-type injuries were observed in 3.2% of cases, hyperpigmentation in 9.6%, fibrosis along the course of the saphenous vein over at least 6 months in 5.6% and saphenous neuritis in 4.8%. CONCLUSION: We concluded that the endovascular laser treatment for varicose veins of the lower limbs is not free from complications; therefore, all factors involved should be identified and assessed.

Aim. The aim of this study was to evaluate the efficacy of lymph drainage to reduce edema of pregnant women. Method. Pregnant women (30 limbs) from the Obstetrics Outpatient Clinic of the Medical School of Santa Casa in São Paulo in the period December 2009 to May 2010 were enrolled in this quantitative, prospective study. The patients, in the 5th to 8th months of gestation, were submitted to one hour of manual lymph drainage of the legs. The volume of the legs was measured by water displacement volumetry before and after one hour of drainage using the Godoy & Godoy manual lymph drainage technique. The paired t-test was used for statistical analysis with an alpha error of 5% being considered significant. Results. Manual lymph drainage significantly reduced swelling of the legs of pregnant women during the day (P=0.04). Conclusion. Manual lymph drainage helps to reduce limb size during the day of pregnant women.

Aim. The aim of this paper is to report a novel intensive therapy of gynoid lipodystrophy (cellulite) based on a new hypothesis. Methods. Were evaluated in 10 patients with ages ranging between 25 and 59 years (mean 35.6 years) grade IV cellulite identified by clinical evaluation. Before initiating treatment, perimetry was performed at 5 cm intervals along both thighs, at the gluteal fold, 5, 10, and 15 cm above the gluteal fold, at the navel, and 5 cm above the navel. The patients were submitted to a 4-hour daily treatment session that consisted of manual and mechanical lymph drainage and cervical stimulation by the Godoy & Godoy technique adapted for the treatment of cellulite. After 10 sessions over two weeks, the patients were again evaluated. The paired t-test was utilized for statistical analysis with an alpha error of 5% (P value < 0.05). A reduction was identified at all of the measurement points (paired t-test; P value < 0.0001). Results. The mean reductions varied between 4.0 and 5.7 cm at the measurement points but reductions of more than 10 cm in perimeter were achieved in some patients. Conclusion. This technique involving lymphatic system stimulation is efficacious in the treatment of cellulite.

The aim of this study is to report the control of lymphorrhea in the intensive treatment of elephantiasis, using an Unna boot. The case of a 29-year-old female patient is reported. This young patient evolved with the more serious form of lymphedema, elephantiasis, after surgical treatment of an abdominal neoplasm and radiotherapy. Warty excrescences were present on both legs and genitalia where lymphorrhea was constant. The patient arrived at the Godoy's Clinic for treatment. She was weighed and perimetric evaluations were made at the start of treatment and thereafter every day during an intensive outpatient treatment of eight hours daily for three weeks. Treatment included manual lymph drainage, mechanical lymph drainage using the RA Godoy device, and the continuous use of compression stockings with adjustments made every three hours. An Unna boot was employed as compression at sites of dermal lesions (warty excrescences) with overlapping use of individualized compression stockings that were individually adapted. The Unna boot was renewed every two days during the first week and every 3 days during the second and third weeks. By the end of this course of treatment, most of the warty excrescences had reduced in size or even disappeared and the lymphorrhea was controlled.

Introdução: Os ácidos gordos essenciais têm sido usados como substâncias aplicadas em pensos; entretanto, poucos estudos têm sido relatados. Objectivo: O objectivo do presente estudo foi enfatizar a utilização destas substâncias em feridas crónicas. Caso: Relatam-se dois casos de feridas crónicas, sendo um relativo a um paciente com pé diabético e outro a um doente com úlcera venosa. As feridas receberam desbridamentos mecânicos ou químicos e em seguida foram realizados os pensos nos quais os ácidos gordos essenciais enriquecidos foram utilizados como substância tópica, seguida de oclusão com gazes. Foram avaliados a tolerância dos pensos, a dor referida pelos pacientes e os aspectos clínicos das feridas. Discussão: As substâncias permitiram a manutenção da humidade das feridas, boa tolerância em relação aos pensos e à dor com manutenção da integridade das feridas durante as trocas dos pensos. Os ácidos gordos representam uma boa opção para feridas desbridadas ou limpas com boa tolerância e facilidade na manutenção.

Bridged incisions do not eliminate lesions to the lymphatic vessels and so the identification of risk factors associated to lymphatic lesions is important.Incisões-ponte não eliminam a lesão de vasos linfáticos e assim a identificação de fatores de risco associados às lesões linfática é importante.

Os autores relatam o caso de uma paciente com 19 anos de idade, portadora de lúpus eritematoso sistêmico, que apresentou edema súbito e progressivo em membro superior esquerdo e dor e circulação colateral visível em região supraclavicular esquerda. Foi realizado diagnóstico de trombose venosa em veia jugular externa esquerda por meio do dúplex scan. Nos exames laboratoriais, evidenciou-se a presença de anticorpo anticardiolipina.

Background: The present study aimed to evaluate the use of multi-frequency, multi-segment bioimpedance for the diagnosis and therapeutic follow-up of clinical stages II and III lymphedema of the lower limbs. Methods and Results: A diagnostic clinical trial was conducted to evaluate the sensitivity and specificity of multi-frequency, multi-segment bioimpedance compared to volumetry for diagnosing and therapeutically following up clinical stages II and III lymphedema of the lower limbs. Treatment comprised the intensive Godoy Method® (eight hours per day for five days). One hundred limbs from 50 patients were evaluated, with 64 true-positive diagnoses, two false positives, three false negatives, and 31 true negatives, resulting in a sensitivity of 95.52% and specificity of 93.94%. Conclusion: Multi-frequency and multi-segment bioimpedance analysis is effective in the diagnosis and therapeutic follow-up of clinical stages II and III lymphedema of the lower limbs, achieving similar results to those obtained using water displacement volumetry.