Navegando por Palavras-chave "Síndrome Pós-Flebítica"
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- ItemSomente MetadadadosAvaliação do autotransplante venoso valvulado no tratamento da insuficiência venosa profunda crônica do membro inferior(Universidade Federal de São Paulo (UNIFESP), 1993) Abrao, Elias [UNIFESP]; Miranda Júnior, Fausto [UNIFESP]
- ItemAcesso aberto (Open Access)Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores(Universidade Federal de São Paulo (UNIFESP), 2001) De Souza, Edvaldo [UNIFESP]; Figueiredo, Luiz Francisco Poli de [UNIFESP]Introduction: The deep vein thrombosis (DVT) has as serious complications lung embolism, important cause of mortality, and post-thrombosis syndrome ,the most frequent cause of chronic vein stasis of the lower limbs. The signs and clinical symptoms of DVT present a high rate of false-positive and false-negative, when compared to objective methods of diagnosis. The correct diagnosis of DVT, confirmed by phlebography or other non-invasive methods , permits the appropriate treatment with anticoagulants, reducing the incidence of lung embolism and minimizing chronic vein stasis. It also avoids the unnecessary exposure to the risks of anticoagulant therapy in the negative cases. With the indiscriminate use of subsidiary exams, the incidence of negative exams has increased, reducing the cost-benefit of these diagnostic methods. Philip S. Wells, of the University of Ottawa, Canada, in 1995 and 1997, proposed a method of clinical prediction for the diagnosis of DVT, and he concluded that it is possible to stratify groups accurately into high, moderate and low probability, rationalizing the use of supplementary diagnostic methods, method that needs validation in other centers, as suggested by the author himself. Objective: To test the hypothesis that the model of clinical prediction proposed by Wells is capable of stratifying the patients into groups of high, moderate and low probability of DVT of the lower limbs. Method: Prospective study, including 111 consecutive patients, 114 members, with signs and symptoms of DVT in the lower limbs. Of these, 99 carried out phlebography, resulting in 102 extremities studied. The patients were examined according to the order of their arrival in the hospital or by the request of intra-hospital evaluation of patients admitted for other reasons. A postgraduate student of vascular surgery, a second year resident of General Surgery, and a second year medical student, who had never had contact with patients with DVT, filled out forms based on the proposal by Wells, and would not have further contact with the examined patient. The phlebography were carried out by doctors that didn`t know about the forms and were just interpreted at the end of the study, by three other assisting doctors that didn`t know the identity of the patients and had not participated in the treatment or previous evaluation. Results: In 65 (63,7%) of the 102 lower limbs the presence of DVT was proven by phlebography. The clinical model of Wells demonstrated a prevalence of DVT of 85,5% in the category of high probability, 50% in the group of moderate probability and 25% in the category of low probability. The location of DVT was proximal, starting from the popliteal vein, by 80,6%, 25% and 12,5%, while it was located exclusively in the veins of the calf by 4,8%, 25,0% and 12,5%, in the high, moderate and low probability groups, respectively. The coefficient of reproducibility of Cronbach among the postgraduate, the resident and the student was 86,3%. Conclusion: The model of clinical prediction of DVT proposed by Wells allows adequate identification of patients with high probability and with DVT proximal. However, the method is unsatisfactory for the identification of DVT in the patients allocated in the moderate and low probability groups.
- ItemSomente MetadadadosValidação externa do escore Villalta traduzido para português brasileiro em pacientes com trombose venosa profunda prévia e sintomas compatíveis com síndrome pós-trombótica(Universidade Federal de São Paulo (UNIFESP), 2021) Avila, Rafael Bernardes De [UNIFESP]; Flumignan, Ronald Luiz Gomes [UNIFESP]; Universidade Federal de São PauloObjective: We sought to systematically translate the Villalta Score from the English language into Brazilian Portuguese, and to assess the external validation when applied to a population with at least 6 months of previous diagnosis of deep vein thrombosis and with compatible symptoms of post-thrombotic syndrome; to compare the ultrasound findings with the severity of post-thrombotic syndrome; and to develop a digital informative application about the post-thrombotic syndrome. Methods: We systematically translated the original Villalta score into Brazilian Portuguese. Fifty participants who underwent two outpatient visits were evaluated using the translated Villalta Score. We assessed its intra-rater and inter-rater agreement, comparing the original Villalta Score versus Brazilian Portuguese Villalta Score; Brazilian Portuguese Villalta Score versus a widely used scale for chronic venous insufficiency, the CEAP clinical component, and the clinical post-thrombotic syndrome severity versus the duplex ultrasonography findings. Results: The intraobserver evaluation of Villalta Score grades had a simple Kappa coefficient of 0.73, and the simple Kappa coefficient interobserver for Villalta Score grades was 0.67. When Villalta Score was compared to CEAP clinical component, it established an excelent Pearson correlation of aproximately 0.9. There was difference among Villalta Score values compared to duplex ultrasonography initial deep vein thrombosis territory, with femoropopliteal showing higher values than distal veins. Higher Villalta Score values were correlated to duplex ultrasonography venous recanalization and reflux. Conclusions: There was a good interobserver and intraobserver agreement when the Brazilian Portuguese Villalta Score was applied; and when compared to CEAP clinical component, Villalta Score showed an excelent correlation. When Villalta Score grading was compared to duplex ultrasonography characteristics, there were statistical and clinical correlation, with presence of reflux and recanalization showing higher Villalta Score values. The application was developed and widely available via the internet.