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In the CT scan of a patient with knee tumor and deep vein thrombosis confirmed by phlebography, the casual observation of a thrombus image in the vein was made, characterized by wall contrastation in opposition to a lack of luminar contrastation. Then, CT scans of the lower limbs and the pelvic region were performed in 14 patients with suspected DVT, who were followed consecutively. Diagnosis of ruptured Baker cyst was made in one patient and DVT in 13 patients. DVT was demonstrated in both lower limbs of three patients. Diagnosis of DVT was confirmed in six of seven exams involving the legs. CT scan could detect thrombi in muscular veins and in deep femoral and internal iliac veins. In six patients with suspected pulmonary embolism, CT scan was also made of the thoracic region and showed pleuropulmonary involvement concomitant with lower limb DVT. The characteristic image of DVT in CT is that of a contrasted ring. Its brightness may be due to contrastation of the venous wall through its vasa vasorum, whereas the thrombus obstructs the luminar flow of the contrast medium. Reproducibility of the characteristic image of thrombus presence in the vein at different levels of the lower limbs and pelvic region gives CT the status of alternative diagnosis means for DVT. False negatives and false positives should be evaluated.

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For non-invasive detection of obstructive disease in the internal iliac artery, the femoral compression test was devised. This test consists in the compression of the inguinal arcade of the patient with the examiner's thumb, until the disappearance of the arterial beats in this region and peripherically in the correspondent lower limb, while one auscultates the sound in the dorsal penial artery with ultrasonic stethoscope and measures the penial pressure. The test was considered positive when there was abolition of sound in the penial artery, or reduction superior to 15% in the penial pressure. The test was negative when there was no abolition or reduction of sound and pressure, as referred respectively. In 15 normal individuals the 30 tests, one for each inguinal region, were negative. In 23 patients with ischemia of lower limbs registered by the analysis of angiographies to which they were submitted, there were 39 tests, one in each inguinal region, in which there was femoral pulsation. There was abolition of sound in the penial dorsal artery in 20 of 22 tests in which the arteriography showed obstruction of the homolateral internal iliac artery. In 15 tests, in which there was reduction of penial pressure, the arteriography showed presence of unique or multiple stenosis in the internal homolateral iliac artery. In two cases of patency of the internal homolateral iliac artery, the test was negative. The positivity of the test was significantly higher in patients with obstructive lesions of internal iliac artery when compared to normal individuals (p < 0.001, chi-square test).(ABSTRACT TRUNCATED AT 250 WORDS)

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

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O tempo de tromboplastina parcial ativada (TTPA) vem sendo utilizado com metodo alternativo ao tempo de protrombina (TP) para controle do uso clinico das antivitaminas K. No caso do TP considera-se como sendo a faixa da seguranca as atividades protrombinicas entre 15 e 30% do normal.Com relacao ao TTPA considera-se qualquer valor acima do limite superior a normalidade como indicativo de hipocoagulacao nao existindo referencias sobre uma faixa de seguranca para controle do uso das antivitaminas K. Neste trabalho adotou-se para o TTPA o mesmo procedimento de avaliacao da atividade protrombinica, ou seja, obtencao de TTPA de diluicoes de plasma normal com solucao fisiologica e com plasma adsorvido Para tanto, foram estudadas 16 curvas de diluicao em cada solvente, a partir de misturas com quatro plasmas de individuos normais. Obteve-se os valores de TTPA correspondentes as diluicoes que determinam a faixa de seruganca do TP. Embora devam ser considesiderados anticoagulantes todos os doentes com TTPA acima do limite superior da normalidade e possivel que a faixa de seguranca quando se utiliza este metodo, esteja entre 1,35 e 1,90 utilizando-se a relacao: TTPA das diluicoes entre 10 a 30% do normal/TTPA normal (100%)

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Foram analisados tres grupos de pacientes com problemas nutricionais relacionados ou nao a cirurgia, os quais se submeteram a alimentacao por sonda naso-enterica. O periodo de tratamento usual foi de tres a quatro semanas, com oferta calorica media situando-se entre 45,6 e 70,1 kcal/kg/d.As dietas em estudo foram representadas por uma preparacao de soja confeccionada no Hospital das Clinicas, por uma dieta de soja, industrializada (Sobee), e por uma solucao completa de nutricao parenteral diluida, administrada pela sonda enteral (NPP oral). Em todos os grupos houve tendencia a melhora do peso da albumina serica, sendo que o maior ganho ponderal foi observado nos casos que receberam Sobee

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Neste trabalho, realizado em 20 pacientes portadores de hemotorax traumatico, os autores estudaram as caracteristicas do sangue contido na cavidade pleural, em vistas ao seu aproveitamento para reinfusao. Concluem que este sangue tem caracteristicas muito semelhantes as do sangue circulante, exceto pela reducao dos fatores de coagulacao. Em decorrencia nao e necessario anticoagula-lo para reinfundi-lo

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E apresentado um dispositivo para realizacao de autotransfusao intra-operatoria, constituido por um recipiente de acrilico, descartavel e capaz de coletar, anticoagular e filtrar o sangue. A autotransfusao foi praticada em 12 casos, sendo 8 em cirurgia de emergencia e 4 em cirurgia seletiva. O dispositivo mostrou-se simples e de facil utilizacao, mas elevada frequencia de contaminacao em amostra de sangue aspirado indica a necessidade de aprimoramento na manipulacao do mesmo

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