RESUMO
Sequential Intermittent Pneumatic Compression (SIPC) is an accepted method for treatment of peripheral lymphedema. This prospective study evaluated the effect in 11 patients of a single session of SIPC on both lymphedema volume of the leg and isotope lymphography (99Tc dextran) before SIPC (control) and 48 hours later after a 3 hour session of SIPC. Qualitative analysis of the 2 lymphoscintigrams (LS) was done by image interpretation by 3 physicians on a blind study protocol. The LS protocol attributed an index score based on the following variables: appearance, density and number of lymphatics, dermal backflow and collateral lymphatics in leg and thigh, visualization and intensity of popliteal and inguinal lymph nodes. Volume of the leg edema was evaluated by measuring limb circumference before and after SIPC at 6 designated sites. Whereas there was a significant reduction of circumference in the leg after SIPC (p<0.05), there was no significant difference in the index scores of the LS before and after treatment. This acute or single session SIPC suggests that compression increased transport of lymph fluid (i.e., water) without comparable transport of macromolecules (i.e., protein). Alternatively, SIPC reduced lymphedema by decreasing blood capillary filtration (lymph formation) rather than by accelerating lymph return thereby restoring the balance in lymph kinetics responsible for edema in the first place.
Assuntos
Perna (Membro)/irrigação sanguínea , Linfedema/diagnóstico por imagem , Linfedema/fisiopatologia , Adulto , Idoso , Circulação Colateral/fisiologia , Feminino , Humanos , Cinética , Linfedema/terapia , Linfografia , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Tecnécio , Fatores de TempoRESUMO
No período de novembro de 1998 a dezembro de 1999 foram acompanhados 100 pacientes em atendimento domiciliar. Todos os pacientes foram incluídos no programa por apresentarem patologias crônicas que necessitam de cuidados hospitalares em seu domicílio. Foram avaliados aspectos como sexo, diagnóstico, tempo de acompanhamento, mortalidade e reinternaçöes. Após avaliaçäo dos dados concluímos que o atendimento domiciliar é uma modalidade de tratamento que auxilia no controle dos doentes com patologias crônicas, diminuindo o número e tempo de internaçöes hospitalares.
Assuntos
Humanos , Masculino , Feminino , Doença Crônica/reabilitação , Serviços de Assistência Domiciliar , Tratamento DomiciliarRESUMO
The time-course changes of the responsiveness of glycogen breakdown to alpha- and ss-adrenergic agonists during insulin-induced hypoglycemia (IIH) were investigated. Blood glucose levels were decreased prior to the alteration in the hepatic responsiveness to adrenergic agonists. The activation of hepatic glucose production and glycogenolysis by phenylephrine (2 microM) and isoproterenol (20 microM) was decreased in IIH. The changes in the responsiveness of glycogen catabolism were first observed for isoproterenol and later for phenylephrine. Hepatic ss-adrenergic receptors showed a higher degree of adrenergic desensitization than did alpha-receptors. Liver glycogen synthase activity, glycogen content and the catabolic effect of dibutyryl cyclic AMP (the ss-receptor second messenger) were not affected by IIH.
Assuntos
Agonistas alfa-Adrenérgicos/farmacologia , Agonistas Adrenérgicos beta/farmacologia , Bucladesina/farmacologia , Hipoglicemia/metabolismo , Glicogênio Hepático/metabolismo , Fígado/efeitos dos fármacos , Animais , Glucose/biossíntese , Glicólise/efeitos dos fármacos , Hipoglicemia/induzido quimicamente , Injeções Intraperitoneais , Insulina/administração & dosagem , Isoproterenol/farmacologia , Masculino , Fenilefrina/farmacologia , Ácido Pirúvico/metabolismo , Ratos , Ratos Wistar , Fatores de TempoRESUMO
The time-course changes of the responsiveness of glycogen breakdown to a- and Beta-adrenergic agonists during insulin-induced hypoglycemia (IIH) were investigated. Blood glucose levels were decreased prior to the alteration in the hepatic responsiveness to adrenergic agonists. The activation of hepatic glucose production and glycogenolysis by phenylephrine (2 µM) and isoproterenol (20 µM) was decreased in IIH. The changes in the responsiveness of glycogen catabolism were first observed for isoproterenol and later for phenylephrine. Hepatic ß-adrenergic receptors showed a higher degree of adrenergic desensitization than did a-receptors. Liver glycogen synthase activity, glycogen content and the catabolic effect of dibutyryl cyclic AMP (the Beta-receptor second messenger) were not affected by IIH.