Navegando por Palavras-chave "microcirculação"
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- ItemAcesso aberto (Open Access)Ausência de correlação entre as alterações morfológicas e bioquímicas na microcirculação de pacientes com esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2004-02-01) Kayser, Cristiane [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The cold stimulus-fingertip lacticemy test (CS-FTL) evaluates a microcirculation biochemical component and presents abnormal results in systemic sclerosis (SSc). Nailfold capillaroscopy is a well established method for the assessment of morphological aspects of Raynaud's phenomenon associated with SSc. The present study sought to compare the nailfold capillaroscopy findings with the CS-FTL parameters in individual fingers of patients with systemic sclerosis. METHODS: 14 SSc patients with 3 fingers having discrepant degree of microangiopathic SD pattern by nailfold capillaroscopy were studied. Fingertip lacticemy was determined in the three fingers selected before (pre-CS-FTL) and 10 minutes after cold stimulus (post-CS-FTL). The percentage difference between post- and pre-CS-FTL was designated ΔCS-FTL. RESULTS: There was great intraindividual variability (between the different digits) in values of the CS-FTL test. There was no statistically significant difference in pre-CS-FTL, post-CS-FTL and ΔCS-FTL values when comparing the fingers with similar capillaroscopic pattern and the discrepant finger in the 14 SSc patients. There was no correlation between the morphological findings registered by nailfold capillaroscopy and the functional alterations measured by the CS-FTL test. CONCLUSIONS: The absence of correlation between morphological microangiopathic alterations detected by nailfold capillaroscopy and the functional perfusion alterations, verified by the CS-FTL test, suggests a relationship between the latter and proximal vascular lesions, such as arterioles, digital and palmar arch arteries.
- ItemAcesso aberto (Open Access)Capilaroscopia periungueal seriada (CPU) como parâmetro de monitoramento da evolução de pacientes com diagnóstico inicial de fenômeno de Raynaud (FRy) isolado ou de doença indiferenciada do tecido conjuntivo (DITC)(Sociedade Brasileira de Reumatologia, 2005-12-01) Higashi, Viviane Shinsato [UNIFESP]; Kayser, Cristiane [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Retrospective serial analysis of nailfold capillaroscopy (NFC) alterations and its correlation with diagnostic evolution in patients initially presenting isolated Raynaud's phenomenon (RP) or undifferentiated connective tissue disease (UCTD). METHODS: We evaluated 19 patients with previous diagnosis of isolated Raynaud's Phenomenon or UCTD who had two or more NFC exams within at least one-year interval. RESULTS: Eleven patients have had initial diagnosis of isolated RP; seven maintained the RP diagnosis, three developed Systemic Sclerosis (SSc), and one evolved to Sjögren´s Syndrome (SSj). Eight patients were diagnosed with UCTD in the first evaluation and all of them kept the initial diagnosis. Nine patients presented changes in NFC pattern. Seven patients presented intensification of SD pattern (group A). In three of these patients, the diagnosis has evolved from isolated FRy to SSc. The remaining four cases (one RP and three UCTD) maintained the initial diagnosis. Group B included two cases in which the SD pattern has been attenuated or disappeared. One of these patients has evolved from isolated RP to SSj. Ten patients had the NFC pattern unaltered (Group C) and all of them have kept the initial diagnosis (four with UCTD and six with RP). All patients who had evolved to SSc have shown intensification or appearance of SD pattern (sensitivity=100%). On the other hand, among the 16 patients who have not evolved to SSc, 12 had not shown appearance or intensification of SD pattern (specificity=75%). CONCLUSIONS: The appearance or intensification of SD pattern in serial NFC analysis during the study period has shown high sensitivity and moderate specificity in regard to the development of SSc.
- ItemAcesso aberto (Open Access)Capilaroscopia periungueal: importância para a investigação do fenômeno de Raynaud e doenças do espectro da esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2004-02-01) Kayser, Cristiane [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Nailfold capillaroscopy is a noninvasive method useful for the evaluation of microcirculation morphologic component. It allows an early differential diagnosis between subjects with primary Raynaud's phenomenon and patients with secondary Raynaud's phenomenon. In systemic sclerosis and sclerodermaspectrum syndromes there are capillaroscopic findings easily distinguished from the pattern of healthy controls, and characterized by the presence of enlarged loops, avascular areas and diffuse loss of capillaries. Because of their diagnostic relevance, the acquaintance of internists and rheumatologists with nailfold capillaroscopy is of utmost importance.
- ItemSomente MetadadadosInfluência da pressão expiratória final positiva na microcirculação de pacientes com choque distributivo(Universidade Federal de São Paulo (UNIFESP), 2013-11-27) Nunes, Nathaly Fonseca [UNIFESP]; Machado, Flavia Ribeiro Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This study aims to evaluate the impact of increased positive end expiratory pressure (PEEP) on the sublingual microcirculation in patients with distributive shock and acute respiratory distress syndrome. This is a prospective observational study conducted including patients with distributive shock and ARDS, with invasive arterial pressure and pulmonary artery catheter monitoring and in whom an increase in PEEP levels was requested by the attending physician. PEEP was increased to reach a plateau pressure of 30cmH20. The microcirculation was assessed using sidestream darkfield technology. All variables were recorded before and after the increase in PEEP. We included 12 patients. The median increase in PEEP was 7.5 (6.0 - 10.0) cmH2O. The microcirculation variables did not change significantly after increasing PEEP. However, the subgroup of patients with a decrease of mean arterial pressure ≥ 10% (n = 5) trended to have a decrease in perfused vascular density (p = .08). There was a weak positive correlation between the change in mean arterial pressure and the change in perfused vascular density (R2 = 0.387, p = 0.031). When the microcirculatory variables variation was compared between the subgroups, a significant reduction of perfused vascular density (p = 0.01) was found only in the subgroup of patients with a decrease of mean arterial pressure ≥ 10%. There was no difference in the microcirculation variables when patients were stratified according to the decrease in cardiac index and the amount of PEEP increment. We concluded that the increase in PEEP levels did not significantly change the microcirculation. However, in those patients who had a decrease in mean arterial pressure ≥ 10% after the increment in PEEP, also had a decreased in perfused vascular density.
- ItemAcesso aberto (Open Access)Laser Doppler Imaging para quantificação do fluxo sanguíneo de polpa digital em condições basais e após estímulo frio em pacientes com esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2010-04-01) Correa, Marcelo Jose Uchoa [UNIFESP]; Perazzio, Sandro Felix [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Kayser, Cristiane [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: The objective of this study was to investigate the dynamic behavior of the blood flow of the microvascular circulation of the fingertips before and after two cold stimuli (CS), using Laser Doppler Imaging with different intensities in patients with systemic sclerosis (SSc) and in healthy individuals. PATIENTS AND METHODS: Fourteen SSc patients (51.2 ± 5.5 years) with Raynaud's phenomenon and 12 healthy controls (44.8 ± 9.0 years) were included in this study. Two CS protocols (submersion of the hands in water at 10 ºC or 15 ºC for 1 minute) were performed on the same day. Mean fingertip blood flow (FBF) of four digits of the left hand was measured using LDI (Moor LDI-VR, Moor Instruments) at baseline and at 1, 4, 10, 25, and 40 minutes after CS. RESULTS: Baseline blood flow was significantly lower in both CS protocols in SSc patients when compared to controls (312.9 ± 102.7 vs 465.4 ± 135.4 PU, P = 0.006 at 15 ºC; 305.2 ± 121.0 vs 437.9 ± 119.8 PU; P = 0.01 at 10 ºC). In the control group, a significant decrease in FBF after CS, when compared to baseline, was observed 1 minute (P = 0.001) after CS at 15 ºC and at 1 (P = 0.005) and 25 minutes (P = 0.001) after CS at 10 ºC. In SSc patients, a significant decrease in FBF was observed in both CS protocols at 1, 4, and 10 minutes (P < 0.000; P = 0.002; P = 0.014, after CS at 15 ºC; P < 0.000; P = 0.004; P = 0.001, after CS at 10 ºC). CONCLUSIONS: Laser Doppler Imaging showed lower baseline fingertip perfusion and further reduction after CS in SSc patients compared to controls. Quantification of fingertip blood flow by LDI may be useful in the longitudinal monitoring of the disease status and therapeutic interventions in SSc.
- ItemSomente MetadadadosVideocapilaroscopia periungueal em crianças e adolescentes saudáveis: descrição dos padrões de normalidadevideocapilaroscopia periungueal em crianças e adolescentes saudáveis: descrição dos padrões de normalidade(Universidade Federal de São Paulo (UNIFESP), 2014-08-20) Piotto, Daniela Gerent Petry [UNIFESP]; Terreri, Maria Teresa de Sande e Lemos Ramos Ascensao Terreri [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdução: A videocapilaroscopia (VCP) é um método amplamente utilizado para a avaliação das alterações morfológicas da microcirculação nas doenças reumáticas autoimunes. Entretanto, os estudos em indivíduos saudáveis são limitados, especialmente em crianças e adolescentes. Objetivo: Descrever os padrões de normalidade da VCP em crianças e adolescentes saudáveis e avaliar a concordância intra e interobservador das dimensões do capilar. Metodologia: Foi realizado um estudo observacional transversal com 900 capilares analisados em 100 participantes saudáveis entre 5 e 18 anos. A VCP foi realizada utilizando-se o aparelho estereomicroscópio Olympus com aumento de 100x. Os seguintes parâmetros foram avaliados: dimensões do capilar (comprimento, espessura e distância intercapilar) e o número de capilares/mm. Foram fotografadas três imagens consecutivas com nove capilares por participante, totalizando 900 capilares analisados. Quatro grupos de faixas etárias foram estudados: 5 a 7 anos (17 crianças); 8 a 10 anos (24 crianças); 11 a 14 anos (30 crianças) e 15 a 18 anos (29 crianças). A variabilidade intra e interobservador foi testada em 25% dos indivíduos por dois examinadores com experiência neste método. Resultados: As dimensões do capilar (média±DP) foram: comprimento 278,6 ±60,3 ?m; distância intercapilar 124,1±28,1 ?m, espessura 15,0±2,6 ?m e número de capilares/mm 7,8±1,5. Em relação ao gênero, somente a distância intercapilar foi maior nas meninas (p=0,011). Ao comparar as quatro faixas etárias, somente a distância intercapilar manteve-se constante ao longo do tempo (p=0,088). Os adolescentes entre 15 e 18 anos apresentaram capilares mais compridos (318,7±64,4 ?m) e com maior espessura (16,2 ±3,3 ?m) em relação às outras faixas etárias (p<0,001 e p=0,012 respectivamente). Em relação ao número de capilares/mm houve um aumento significativo com a idade: 6,1 capilares/mm (5 a 7 anos); 7,0 (8 a 10 anos); 8,0 (11 a 14 anos) e 9,3 (15 a 18 anos) (p<0,001). Houve uma correlação negativa entre a distância intercapilar e o número de capilares/mm. Houve uma boa concordância intra e interobservador na análise das dimensões do capilar e do número de capilares/mm através da VCP. Em relação a presença de alterações morfológicas, 11% dos participantes apresentavam capilares ectasiados (espessura percentil>97,5) e 10% áreas avasculares (distância intercapilar percentil>97,5). Conclusão: Este estudo avaliou os padrões de normalidade da VCP em crianças e adolescentes saudáveis e estratificados por faixas etárias. O número de capilares/mm, o comprimento e a espessura do capilar aumentaram com a idade, enquanto a distância intercapilar se manteve nas diferentes faixas etárias.