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Telangiectasias is most prevalent on the lower limbs and has been estimated to manifest in 40%-90% of the population. Treatments for telangiectasias include sclerotherapy, laser therapy, intense pulsed light treatment, microphlebectomy, and thermocoagulation. Cryo-Laser & Cryo-Sclerotherapy (CLaCS) effectively combines thermal and injection sclerotherapy. In this treatment, unwanted veins are targeted by a transdermal laser and immediately receive injection sclerotherapy. During the whole procedure, an air-cooling device (Cryo) blows onto the surrounding skin and tissue to prevent skin burn. Here, we present a case report of a challenging telangiectasias treated with ClaCS.

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Introducción: El síndrome de Peutz-Jeghers se caracteriza por hiperpigmentación mucocutánea y hamartomas gastrointestinales que pueden aparecer desde el estómago hasta el ano. Tiene un patrón de herencia autosómico dominante y expresividad variable. El diagnóstico se basa en los hallazgos clínicos y la apariencia histológica de los pólipos. No ha sido reportado hasta ahora asociación de esta entidad a telangiectasias y prolapso de la válvula mitral. Objetivo: Describir los hallazgos que permitieron establecer el diagnóstico de Síndrome de Peutz-Jeghers en un paciente y brindar asesoramiento genético. Presentación del caso: Paciente masculino de 36 años de edad con antecedentes de prolapso de la válvula mitral que acude a consulta de genética clínica con su esposa para solicitar asesoramiento genético, debido a que tienen una hija con diagnóstico de Síndrome de Peutz-Jeghers y desean conocer el riesgo de tener otro hijo afectado. Al examen físico se observa mácula hiperpigmentada en labio inferior y varias de estas en encías. Con tales hallazgos y el antecedente de tener la hija Síndrome de Peutz-Jeghers se emite el mismo diagnóstico en el padre. Como dato de interés se constatan en este individuo múltiples telangiectasias en tórax, cuello y espalda. Los estudios realizados en busca de la causa de estas fueron negativos. Conclusiones: Los antecedentes y los hallazgos encontrados en el paciente permitieron realizar el diagnóstico de Peutz-Jeghers y brindar asesoramiento genético. Se presenta el primer reporte de esta enfermedad asociada a telangiectasias y prolapso de la válvula mitral en la literatura científica(AU)

Introduction: Peutz-Jeghers syndrome is characterized by mucocutaneous hyperpigmentation and gastrointestinal hamartomas that can appear from the stomach to the anus. It has an autosomal dominant inheritance pattern and variable expressiveness. The diagnosis is based on clinical findings and histological appearance of the polyps. No association between this entity and telangiectasias and mitral valve prolapse has been reported so far. Objective: To describe the findings that made it possible to establish the diagnosis of Peutz-Jeghers syndrome in a patient and to provide genetic counseling. Case presentation: Thirty-six-year-old male patient with a history of mitral valve prolapse who attends a clinical genetics consultation with his wife to request genetic counseling due to the fact that their daughter was diagnosed with Peutz-Jeghers Syndrome and they want to know about the risk of having another affected child. On physical examination, a hyperpigmented macule on the lower lip and several of these on the gums were observed. With such findings and the antecedent of having a daughter with Peutz-Jeghers syndrome, the same diagnosis is made in the father. As data of interest, multiple telangiectasias on the thorax, neck and back were found in this individual. The studies carried out to identify the same cause were negative. Conclusions: The history and findings in this patient allowed us to make the diagnosis of Peutz-Jeghers syndrome as well as to provide genetic counselling. The first report of this disease associated with telangiectasias and mitral valve prolapse is presented in the scientific literature(AU)

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ABSTRACT Cutis marmorata telangiectasia congenita is a rare cutaneous vascular disorder that may be associated with different systemic manifestations like body asymmetry, cutaneous, ophthalmologic, vascular, and neurological manifestations. We describe ophthalmologic alterations found in three patients with cutis marmorata telangiectatica congenita highlighting the rare retinal manifestations.

RESUMO A Cutis marmorata telangiectasica congênita é uma desordem vascular cutânea rara que pode estar associada a diferentes manifestações sistêmicas, como assimetria corporal, alterações cutâneas, oftalmológicas, vasculares e neurológicas. Descrevemos alterações oftalmológicas encontradas em três pacientes com cutis marmorata telangiectasia congênita, destacando as raras manifestações retinianas.

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RESUMEN Introducción: La enfermedad de Coats es una vasculopatía retiniana idiopática, poco frecuente, que puede progresar a desprendimiento de retina exudativo y glaucoma neovascular. Típicamente se presenta en la infancia, es la tercera causa más frecuente de leucocoria infantil. Presentación de caso: Paciente masculino de dos años de edad, procedente de zona rural. Asiste a consulta, porque la mama notó que el niño desvía el ojo derecho hacia fuera desde que nació. Conclusiones: La enfermedad de Coats simula otras vasculopatías retinianas y el retinoblastoma. La conducta a seguir dependerá de la, forma clínica de presentación y complicaciones asociadas.

ABSTRACT Introduction: Coats disease is a rare, idiopathic retinal vasculopathy that can progress to exudative retinal detachment and neovascular glaucoma. Typically occurring in childhood, it is the third most common cause of childhood leukocoria. Case report: Patient masculine of two years of age, coming from rural area. You attended consultation, because he/she suckles her he/she noticed that the boy deviates the right eye toward it was since he was born. Conclusions: Coats disease simulates other retinal vasculopathies and retinoblastoma. The behavior to be followed will depend on the clinical form of presentation and associated complications.

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Resumen Objetivo: Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa). Metodología: Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple. Resultados: La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica. Conclusiones: El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.

Abstract Objective: To analyze the prevalence of chronic venous disorders (CVD) in the embera-chamí from Cristianía (Karmata Rua), in the southwest of Antioquia, and to study possible associated factors (AF). Methodology: A cross sectional study of a random sample of 488 subjects. The diagnosis was performed through Doppler ultrasonography. Information about sociodemographic, behavioral and anthropometric AFs was collected. The most relevant AFs were selected through multiple binary logistic regression. Results: The prevalence of varicose veins was 27.5% and that of chronic venous insufficiency (cvi) was 0.8%. Superficial anatomical segments were compromised in 34.8% of individuals. Age was the most important AF, with an Odds Ratio (OR) between 3.33 and 6.30 according to the type of cvd. Being a female, parity, fat in the thigh/leg and large size were associated with telangiectasias. Age, abdominal fat and leg shape were AF of varicose veins. Superficial veins in both sexes were associated with age and abdominal fat and in women, also with a family background of varicose veins. Deep and perforator veins were associated with age and peripheral fat depletion. Conclusions: The low prevalence pattern of CVDs in embera-chamí may be a consequence of lifestyles involving daily physical activity and genetic differences shared with Amerindians. Deep and perforating disorders should be considered in differential health care programs in relation to mestizos.

Resumo Objetivo: Analisar a prevalência de doenças venosas crônicas (dvc) na Embera-Chami Christiania (KarmataRua), no sudoeste do estado de Antioquia, e conhecer seus fatores associados (AF). Metodologia: Um estudo de coorte de uma amostra aleatória de 488 indivíduos. O diagnóstico foi feito por ecoduplex venoso. Informações sobre FA sócio demográficas, comportamentais e antropométricas foram coletadas. Os FAs mais relevantes foram selecionados para múltipla regressão logística binária. Resultados: A prevalência de varizes foi de 27,5% e a de insuficiência venosa crônica (ivc) foi de 0,8%. Houve comprometimento dos segmentos anatômicos superficiais em 34,8% dos indivíduos. A idade foi a FA mais importante, com Odds Ratio (OR) entre 3,33 e 6,30 de acordo com o tipo de dvc. Sexo feminino, paridade, gordura na coxa e perna e altura foram associados a telangiectasias. Idade, gordura abdominal e formato de perna foram FA de varizes. Nas veias superficiais, em ambos os sexos, idade e gordura abdominal estavam associadas e, nas mulheres, também a história familiar de varizes. Às profundas e perfurantes foram associadas a idade e depleção de gordura periférica. Conclusões: O padrão de baixa prevalência de DVC em embera-chamí pode ser uma consequência de estilos de vida relacionados à atividade física diária e diferenças genéticas compartilhadas com ameríndios. Em programas diferenciais de atenção à saúde, distúrbios profundos e perfurantes devem ser considerados em relação aos mestiços.

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Introduction To date, there are limited descriptive data on the ultrasonographic characteristics of reticular and perforator veins associated with telangiectasias of the thigh. Objectives Evaluate the prevalence, anatomic correlations of reticular and perforator veins associated with lateral thigh telangiectasias. Methods This was a cohort study performed between June and December of 2014. Twenty-four female patients (43 limbs) with telangiectasias of the lateral thigh were evaluated by duplex ultrasound. Reticular and perforator veins were characterized according to valvular competency, vein diameter and connection with perforator veins at the thigh. Body mass index, current use of oral contraceptive, and history of pregnancy correlation data were also collected. A non-parametric Kruskal-Wallis test and a Student's t-test test were used for analysis. Results All 43 limbs had incompetent reticular veins underlying telangiectasias sites. A total of 20 incompetent perforator veins were found to be connected to the reticular veins. Obese and overweight patients had a higher prevalence of incompetent perforator veins and larger reticular veins when compared to those with normal weight (P < 0.05). Lower extremities with telangiectasias had a higher frequency of total perforator veins (n = 33) and incompetent perforator veins (n = 16) than extremities without telangiectasias (p = 0.001). Conclusion Lateral thigh telangiectasias were associated with both incompetent reticular and perforator veins. Obese and overweight patients were especially affected.

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La enfermedad de Coats, es una vasculopatía retiniana idiopática que sin tratamiento puede progresar a desprendimiento de retina exudativo y glaucoma neovascular. Se considera una patología de difícil diagnóstico, por su presentación clínica que simula otras vasculopatías retinianas ó retinoblastoma. Resulta indispensable contar con herramientas clínicas y paraclínicas para llegar a un diagnóstico acertado y poder realizar un manejo adecuado y oportuno. Presentamos el caso de un niño de 17 años, con enfermedad de Coats valorado y tratado en el Hospital Militar Central de Bogotá desde los 5 años de edad; Se realiza seguimiento clínico de 12 años de evolución y se discuten posibles diagnósticos diferenciales.

Coats disease is an idiopathic retinal vasculopathy that can progress to exudative retinal detachment and neovascular glaucoma if is not treated. It is considered a condition of difficult diagnosis due to clinical presentation, simulating retinoblastoma or other retinal vascular disease. It is essential to have clinical and paraclinical tools to have a correct diagnosis and to make adequate and timely handling. We report the case of a child of 17 years old with Coats disease assessed and treated at the Central Military Hospital in Bogota from 5 years of age during 12 years. Th e clinical evolution is described and a brief depiction of the disease is presented with its diff erential diagnoses.

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Abstract It is an autosomal dominant vascular disorder, which has a variety of clinical manifestations, with epistaxis being one of the most common. Many treatment options exist for epistaxis, but with no consensus on which is the method of choice. We describe the case of a patient with hereditary hemorrhagic telangiectasia (HHT) secondary epistaxis with septoplasty managed with synthetic hard graft, which improved intensity and frequency of bleeding episodes. This technique is a variant of the septodermoplasty described by several authors, but the use of synthetic dura can help in obtaining better results and avoid taking skin grafts from other sites different from the surgical site.

Resumen Esta condición es un trastorno vascular autosómico dominante, que tiene una variedad de manifestaciones clínicas; entre las más comunes, se encuentra epistaxis. Existen múltiples opciones terapéuticas para la epistaxis, pero no hay un consenso sobre cuál es el método de elección. Se describe el caso de un paciente con epistaxis secundaria a telangiectasias hemorrágicas hereditarias (THH) manejado con septoplastia con injerto de dura sintética, la cual obtuvo mejoría en la intensidad y frecuencia de los episodios de sangrados. Esta técnica es un variante de la septodermoplastia descrita por diversos autores, pero el uso de dura sintética puede ayudar a obtener mejores resultados y evita toma de injertos dérmicos de otros sitios diferentes al sitio quirúrgico.

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Se presenta reporte preliminar de una investigación prospectiva con la aplicación de la endoscopia terapéutica en pacientes con Proctitis radiógena procedentes de la consulta externa del Instituto Nacional de Oncología y Radiobiología, en los que se aplica Argón Plasma Coagulación (APC) para ablación de las lesiones vasculares, como consecuencia del efecto de las radiaciones en el recto. Se detalla la aplicación del método terapéutico en 20 pacientes, todos del sexo femenino, el síntoma cardinal en todos los casos fue el sangrado rectal, el promedio de sesiones de tratamiento fue de 3 y todos los casos refirieron mejoría evidente por disminución del sangrado desde la primera sesión, con disminución importante o eliminación de las telangiectasias durante el seguimiento y no se presentaron complicaciones mayores con el procedimiento. Se considera que el tratamiento endoscópico constituye un método valioso y una opción factible, segura y eficaz para el tratamiento de la proctitis actínica.

We performed a prospective research applying therapeutic endoscopy in patients suffering of Actinic Proctitis, after radiation for pelvic cancer. We used Argon Plasma Coagulation to remove vascular lesions in these patients. We described the application of this therapeutic in 20 patients, all of them female, with rectal bleeding. Patients received as average, 3 sessions of treatment, and all of the them get better since the first session, with importantreduction of the bleeding and the number of telangiectasias. There were no complications with this technique. We consider that therapeutic endoscopic treatment with APC is a valuable and safe treatment for patients, suffering with Actinic Proctitis.