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O complexo tratamento de dissecção da aorta ainda apresenta controvérsias devido à gravidade do caso e à necessidade de individualização da terapêutica. A gravidade relaciona-se ao difícil diagnóstico pelas queixas inespecíficas e pelas graves complicações inerentes à evolução da doença (ruptura aórtica, síndrome de má perfusão, dissecção retrógrada, dor ou hipertensão refratária). Este relato apresenta um homem de 61 anos, tabagista e hipertenso mal controlado, que evoluiu para dissecção aórtica de tipo B de Stanford. Foi abordado através de técnica endovascular com uso de endoprótese com stent para tratamento do caso após falha do tratamento medicamentoso. O tratamento endovascular mostrou-se uma ferramenta eficaz para o tratamento definitivo, com boa taxa de sobrevida ao final do primeiro ano após o procedimento

Complex treatment of aortic dissection is still a controversial subject because of the severity of these cases and the need to treat on a case-by-case basis. Severity is related to the difficulty of diagnosis caused by nonspecific complaints and by the serious complications inherent to disease progression (aortic rupture, hypoperfusion syndrome, retrograde dissection, refractory hypertension or pain). This article reports the case of a 61-year-old male smoker with poorly controlled hypertension who suffered a Stanford type B aortic dissection. After drug-based treatment failed, the patient was treated using endovascular techniques to place an endoprosthesis with stenting. Endovascular treatment is proving to be an effective tool for definitive treatment, with a good survival rate at the end of the first year after the procedure

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OBJECTIVES: To evaluate the presence of ET-1 in patients with scleroderma and its correlation with the level of disease activity; to verify if the levels of endothelin are associated with the clinical profile and autoantibodies of scleroderma, and even if there is an association with microvascular injury detected by nailfold capillaroscopy. METHODS: A total of 74 patients, 37 patients with scleroderma, the remaining being controls, were subjected to measurement of ET-1 by ELISA. Patients with scleroderma were evaluated through a questionnaire about characteristics of the disease and determination of autoantibodies. Disease severity was defined by the criteria of Medsger and microvascular disease was accessed through nailfold capillaroscopy. RESULTS: Of the 37 patients with scleroderma, three (8.1%) were men and 34 (91.89%) women, with a mean age of 48.97 ± 13.36 years and mean disease duration of 42.54 ± 13, 35. The amounts of ET-1 in the controls was 0.41 to 5.65 pg / ml (median of 2.26 pg / ml) and, in the scleroderma group, from 0.41 to 8.82 pg / ml (median, 0.41 pg / ml), with p = 0.0007. There was no correlation with disease duration, patient age and the degree of skin involvement. No correlation was found between serum levels of ET-1 and disease severity (p = 0.13). Higher levels of ET-1 were observed in the form of overlap (1.49 to 6.82 pg / ml). CONCLUSION: The levels of ET-1 in scleroderma were inferior to controls. There was no association of ET-1 levels with the variables studied.

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OBJECTIVE: To evaluate the intima-media thickness of the common carotid artery in patients with and without scleroderma; to verify a possible association with disease severity; to assess the relationship of intima-media thickness with known cardiovascular risk factors. METHODS: In a case-control study, were selected 30 patients with scleroderma and 30 without the disease and matched according to age, sex and cardiovascular risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. The age ranged from 17 to 79 years (mean 49). All patients underwent carotid artery evaluation by high-resolution vascular Doppler in order to measure the intima-medial thickness of the carotid 2 cm from the bifurcation. In all the analysis was considered the greatest value of intima-media thickness in right and left carotid arteries. RESULTS: The sample consisted of 30 patients, being 29 (96.67%) women and one man (3.3%). In this sample, 11/30 (36.67%) had high blood pressure, 5/30 (16.67%) had diabetes mellitus, 6/30 (20%) had dyslipidemia and 2/30 (6.67%) were smokers. Comparing the measure of the increased risk (maximum intima-media thickness between the left and right side), was obtained an average of 0.77 mm for group scleroderma and a value of 0.70 mm for the control group (p = 0.21). In assessing the association between disease severity and carotid intima-media thickness, was found no significant association (p= 0.925). CONCLUSION: Was found a slight increase in intima-medial thickness of common carotid artery in patients with scleroderma but without statistical significance. Regarding the severity of the disease and intima-medial thickness of common carotid artery, there was no significant difference.

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OBJETIVO: Avaliar a presença da ET-1 em pacientes portadores de esclerodermia e a sua correlação com o nível de atividade da doença; verificar se os níveis de endotelina estão associados com o perfil clínico e de autoanticorpos da esclerodermia e, ainda, se há associação com lesão microvascular detectada pela capilaroscopia periungueal. MÉTODOS: Um total de 74 pacientes, sendo 37 portadores de esclerodermia e o restante controle, foram submetidos à dosagem de ET-1 por meio de teste de ELISA. Pacientes com esclerodermia foram analisados através de um questionário sobre características da doença e pesquisa de autoanticorpos. A gravidade da doença foi definida pelos critérios de Medsger e a doença microvascular foi acessada através de capilaroscopia periungueal. RESULTADOS: Dos 37 pacientes com esclerodermia três (8,1%) eram homens e 34 (91,89%) mulheres, com idade média de 48,97 ? 13,36 anos e tempo médio de doença de 42,54 ? 13,35 anos. Os valores da ET-1 nos controles foram de 0,41 a 5,65 pg/ml (mediana de 2,26 pg/ml) e nos com esclerodermia de 0,41 a 8.82 pg/ml (mediana de 0,41 pg/ml) com p de 0,0007. Não houve correlação com o tempo de doença, idade do paciente e com o nível de acometimento cutâneo. Não encontrou-se correlação entre nível de ET-1 sérica e gravidade da doença (p=0,13). Níveis maiores de ET-1 foram observados na forma de superposição (1,49 a 6,82 pg/ml). CONCLUSÃO: Os níveis de ET-1 em esclerodérmicos mostraram-se inferiores aos controles. Não houve associação dos níveis de ET-1 com as variáveis estudadas.

Objectives: To evaluate the presence of ET-1 in patients with scleroderma and its correlation with the level of disease activity; to verify if the levels of endothelin are associated with the clinical profile and autoantibodies of scleroderma, and even if there is an association with microvascular injury detected by nailfold capillaroscopy. METHODS: A total of 74 patients, 37 patients with scleroderma, the remaining being controls, were subjected to measurement of ET-1 by ELISA. Patients with scleroderma were evaluated through a questionnaire about characteristics of the disease and determination of autoantibodies. Disease severity was defined by the criteria of Medsger and microvascular disease was accessed through nailfold capillaroscopy. RESULTS: Of the 37 patients with scleroderma, three (8.1%) were men and 34 (91.89%) women, with a mean age of 48.97 ± 13.36 years and mean disease duration of 42.54 ± 13, 35. The amounts of ET-1 in the controls was 0.41 to 5.65 pg / ml (median of 2.26 pg / ml) and, in the scleroderma group, from 0.41 to 8.82 pg / ml (median, 0.41 pg / ml), with p = 0.0007. There was no correlation with disease duration, patient age and the degree of skin involvement. No correlation was found between serum levels of ET-1 and disease severity (p = 0.13). Higher levels of ET-1 were observed in the form of overlap (1.49 to 6.82 pg / ml). CONCLUSION: The levels of ET-1 in scleroderma were inferior to controls. There was no association of ET-1 levels with the variables studied.

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Spondyloarthritis (SpA) are diseases with increased gut inflammation. To search for (anti-Saccharomyces cerevisiae) ASCA IgA, ASCA IgG, and anti-endomysial antibodies (EmA-IgA) in a cohort of 70 patients with SpA, we found 18.6% (13/70) positive for IgA-ASCA in the SpA group and 3/57 (5.2%) in the control group (P = 0.031). ASCA IgG and EmA-IgA were found at the same frequency in SpA and controls. No relationship of ASCA IgA positivity could be established with disease activity (measured by ESR, C-reactive protein, and BASDAI), presence of uveitis, or peripheral arthritis neither with functional status measured by BASFI. SpA patients present an increase in the IgA-ASCA positivity without any relationship to disease activity, functional index, clinical profile or the presence of HLA-B27. There is no evidence of higher prevalence of EmA-IgA in SpA patients in the studied sample.

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OBJETIVO: Avaliar a espessura da camada médio-intimal da artéria carótida comum em pacientes com e sem esclerodermia e verificar possível associação com sua gravidade. MÉTODOS: Em estudo caso-controle, foram selecionados 30 pacientes com esclerodermia e 30 sem a doença e pareados de acordo com a idade, sexo, hipertensão arterial sistêmica, diabete melito e hipercolesterolemia. Todos os pacientes foram submetidos à avaliação das artérias carótidas pela ultrassonografia vascular de alta resolução e realizada a medida do espessamento da camada médio-intimal das carótidas comuns a 2cm da bifurcação carotídea. Em toda a análise foi considerado o maior valor da camada médio-intimal nas artérias carótidas direita e esquerda. RESULTADOS: A amostra foi composta de 30 pacientes estudados, sendo 29 (96,67%) mulheres e um homem (3,3%) com idade de 17 a 79 anos (média de 48 anos). Nesta amostra existiam 11/30 (36,67%) com hipertensão arterial, 5/30 (16,67%) com diabete melito, 6/30 (20%) com dislipidemia e 2/30 (6,67%) fumantes. Ao comparar a medida do maior risco (espessura máxima entre o lado esquerdo e o lado direito), obteve-se média de 0,77mm para o grupo esclerodermia e valor de 0,70mm para o grupo controle (p=0,212). Ao avaliar a associação entre gravidade da doença e a camada médio-intimal da carótida, não se encontrou associação significativa (p=0,925). CONCLUSÃO: Encontra-se discreto aumento do espessamento da camada médio-intimal da artéria carótida comum em pacientes com esclerodermia, mas sem significância estatística. Com relação à gravidade da doença e o espessamento da camada médio-intimal da carótida comum, não foi verificada diferença.

OBJECTIVE: To evaluate the intima-media thickness of the common carotid artery in patients with and without scleroderma; to verify a possible association with disease severity; to assess the relationship of intima-media thickness with known cardiovascular risk factors. METHODS: In a case-control study, were selected 30 patients with scleroderma and 30 without the disease and matched according to age, sex and cardiovascular risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. The age ranged from 17 to 79 years (mean 49). All patients underwent carotid artery evaluation by high-resolution vascular Doppler in order to measure the intima-medial thickness of the carotid 2 cm from the bifurcation. In all the analysis was considered the greatest value of intima-media thickness in right and left carotid arteries. RESULTS:The sample consisted of 30 patients, being 29 (96.67%) women and one man (3.3%). In this sample, 11/30 (36.67%) had high blood pressure, 5/30 (16.67%) had diabetes mellitus, 6/30 (20%) had dyslipidemia and 2/30 (6.67%) were smokers. Comparing the measure of the increased risk (maximum intima-media thickness between the left and right side), was obtained an average of 0.77 mm for group scleroderma and a value of 0.70 mm for the control group (p = 0.21). In assessing the association between disease severity and carotid intima-media thickness, was found no significant association (p= 0.925). CONCLUSION: Was found a slight increase in intima-medial thickness of common carotid artery in patients with scleroderma but without statistical significance. Regarding the severity of the disease and intima-medial thickness of common carotid artery, there was no significant difference.

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Introdução: As queimaduras são importantes causas de limitações e sequelas, constituindo um grande problema de saúde pública no Brasil. Mesmo com o advento de novas técnicas de reparo, a abordagem que produz melhores resultados e que possui a melhor relação custo-benefício ainda é a prevenção. Objetivo: O presente estudo visa avaliar os conhecimentos relativos à prevenção de queimaduras da população que aguarda consulta nos Centros Municipais de Urgências Médicas de Curitiba. Método: Estudo prospectivo realizado por meio de entrevista, com questionário sobre prevenção de queimaduras. As informações foram coletadas entre pacientes durante o período de março a junho de 2010. Resultados: Foram entrevistadas 776 pessoas que aguardavam atendimento médico por outro motivo que não a queimadura. A maioria era do sexo feminino, sendo que 84,57% tinham entre 20 e 59 anos. Cerca de 39,30% já haviam tido episódio de queimadura e 45,87% ficaram com algum tipo de sequela. As crianças frequentavam a cozinha no horário de preparo dos alimentos em 34,66% das casas, sendo que apenas 16,36% dos entrevistados afirmaram possuir algum tipo de material de prevenção domiciliar contra queimaduras. Somente 26,67% dos entrevistados demonstraram saber o que fazer no caso de uma queimadura, 31,44% dos pacientes receberam alguma informação decorrente de campanhas públicas e apenas 2,44% obtiveram algum dado sobre queimadura enquanto aguardava atendimento na Unidade de Saúde. Conclusão: Apesar da eficácia das ações preventivas ser conhecida, os pacientes não recebem informações sobre queimaduras nem mesmo nas unidades de saúde, como os Centros Municipais de Urgências Médicas de Curitiba.

Introduction: Burn injuries are an important cause of limitations, sequels and a public health problem in Brazil. Although there is an increase in both burn repairing techniques, prevention still deliver the best results and holds the best cost-benefit. Objective: This study aims to assess the knowledge regarding burn injuries prevention of the patients waiting treatment at the County Medical Emergency Centersin Curitiba. Methods: as conducted a prospective study by interviewing questionnaire on prevention of burns. Information was collected from patients during the period from March to June 2010. Results: It was interviewed 776 people waiting for medical reason other than the burn. Most were female and age range was between 20 and 59 in84.57%. About 39.30% had an episode of burning and 45.87% got some kind of sequel. The children attend the kitchen during the food preparation in 34.66% of the houses and only 16.36% reported having some type of material to prevent burns. Around 26.67% got informationabout what to do in case of a burn, 31.44% of patients received some information from the public campaigns and only 2.44% had any information about burn while waiting for medical care. Conclusion: Despite health effectiveness of preventive actions to be known, patients received no information about burns even in health facilities as the Emergency medical center in Curitiba.

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