Academic literature on the topic 'Varicus'
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Journal articles on the topic "Varicus"
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Bouguerche, Chahinez, Daniel C. Huston, Thomas H. Cribb, Egil Karlsbakk, Mohammed Ahmed, and Oleksandr Holovachov. "Hidden in the fog: morphological and molecular characterisation of Derogenes varicus sensu stricto (Trematoda, Derogenidae) from Sweden and Norway, and redescription of two poorly known Derogenes species." Parasite 30 (2023): 35. http://dx.doi.org/10.1051/parasite/2023030.
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Derogenes varicus (Müller, 1784) is widely reported as a trematode with exceptionally low host specificity and a wide, bipolar distribution. However, several recent studies have suggested that D. varicus represents a species complex and based on molecular evidence, four genetic lineages (labeled as “DV1–4”) have been designated within the D. varicus species complex. This possibility requires improved (ideally molecular) characterisation of specimens from the type-host (Salmo salar) and type-locality (off Denmark). During examination of trematode parasites of fish from Scandinavian and Arctic waters (Sweden and Norway), we found specimens of D. varicus in the stomach of Merlangius merlangus off the coast of Sweden, and in Gadus morhua off the coast of Sweden and Norway; we compared them to D. varicus from the type-host, the Atlantic salmon Salmo salar from Norway, to verify their conspecificity. Newly generated sequences (28S rDNA, ITS2 and cox1) of Scandinavian and Arctic specimens consistent with D. varicus all formed a single clade, DV1. 28S sequences of D. varicus from S. salar from Norway, i.e., close to the Danish type locality, clustered within the DV1 clade along with sequences of D. varicus from various hosts including Limanda limanda, G. morhua and Myoxocephalus scorpius from the White Sea and the Barents Sea (Russia), without any host-related structuring. We thus consider that the lineage DV1 represents D. varicus sensu stricto. Additionally, specimens from M. merlangus had a similar morphology and anatomy to those of D. varicus from L. limanda, G. morhua and M. scorpius from T. Odhner’s collection, supporting the presence of a single species in the DV1 lineage designated herein as D. varicus sensu stricto. We redescribe D. varicus sensu stricto, add new morphological characters and provide morphometric data. We infer that D. varicus types DV2–4 all relate to separate species. We also revise type-specimens of Derogenes minor Looss, 1901 from the A. Looss collection in the Swedish Museum of Natural History and provide redescriptions of it and of the type-species of the genus, Derogenes ruber Lühe, 1900. In light of their morphological distinctiveness relative to D. varicus sensu stricto, we reinstate D. parvus Szidat, 1950 and D. fuhrmanni Mola, 1912.
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Tornabene, Luke, D. Ross Robertson, and Carole C. Baldwin. "Varicus lacerta, a new species of goby (Teleostei, Gobiidae, Gobiosomatini, Nes subgroup) from a mesophotic reef in the southern Caribbean." ZooKeys 596 (June 8, 2016): 143–56. https://doi.org/10.3897/zookeys.596.8217.
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We describe a new species of goby, Varicus lacerta sp. n., which was collected from a mesophotic reef at Curacao, southern Caribbean. The new species is the tenth species of Varicus, all of which occur below traditional SCUBA depths in the wider Caribbean area. Its placement in the genus Varicus is supported by a molecular phylogenetic analysis of three nuclear genes and the mitochondrial gene cytochrome b. In addition, the new species has one anal-fin pterygiophore inserted anterior to the first haemal spine, which distinguishes Varicus species from most species in the closely related and morphologically similar genus Psilotris. Varicus lacerta sp. n. is distinguished from all other named species of Varicus by the absence of scales, having highly branched, feather-like pelvic-fin rays, and in its live coloration. We provide the cytochrome c oxidase I DNA barcode of the holotype and compare color patterns of all species of Varicus and Psilotris for which color photographs or illustrations are available. This study is one of several recent studies demonstrating the utility of manned submersibles in exploring the diversity of poorly studied but species-rich deep-reef habitats.
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Bouguerche, Chahinez, Daniel C. Huston, Egil Karlsbakk, Mohammed Ahmed, and Oleksandr Holovachov. "Untangling the Derogenes varicus species complex in Scandinavian waters and the Arctic: description of Derogenes abba n. sp. (Trematoda, Derogenidae) from Hippoglossoides platessoides and new host records for D. varicus (Müller, 1784) sensu stricto." Parasite 31, no. 26 (2024): 1–25. https://doi.org/10.1051/parasite/2024024.
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Bouguerche, Chahinez, Huston, Daniel C., Karlsbakk, Egil, Ahmed, Mohammed, Holovachov, Oleksandr (2024): Untangling the Derogenes varicus species complex in Scandinavian waters and the Arctic: description of Derogenes abba n. sp. (Trematoda, Derogenidae) from Hippoglossoides platessoides and new host records for D. varicus (Müller, 1784) sensu stricto. Parasite (Paris, France) 31 (26): 1-25, DOI: 10.1051/parasite/2024024, URL: http://dx.doi.org/10.1051/parasite/2024024
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Bouguerche, Chahinez, Daniel C. Huston, Egil Karlsbakk, Mohammed Ahmed, and Oleksandr Holovachov. "Untangling the Derogenes varicus species complex in Scandinavian waters and the Arctic: description of Derogenes abba n. sp. (Trematoda, Derogenidae) from Hippoglossoides platessoides and new host records for D. varicus (Müller, 1784) sensu stricto." Parasite 31 (2024): 26. http://dx.doi.org/10.1051/parasite/2024024.
Full textAbstract:
Several studies have shown that the euryxenic trematode Derogenes varicus (Müller, 1784) represents a species complex. Four lineages have been designated (DV1–4) with the DV1 clade corresponding to D. varicus sensu stricto. Herein, we investigate newly collected specimens of D. varicus sensu lato from Scandinavian and Arctic waters using integrative taxonomy. The trematodes were collected from Melanogrammus aeglefinus, Eutrigla gurnardus, Trachinus draco, and Merluccius merluccius off the Atlantic coast of Sweden and from Hippoglossoides platessoides from Arctic Svalbard. 28S sequences of derogenids from Sweden were identical to D. varicus sensu stricto, confirming its euryxeny. The 28S sequences of Derogenes sp. from H. platessoides were identical to Derogenes DV2 and differed from D. varicus sensu stricto by 3% and from Derogenes DV3 by 2%. The 28S sequence divergences of Derogenes sp. from H. platessoides with D. ruber and D. lacustris were 3 and 10%, respectively. ITS2 and cox1 divergences between Derogenes sp. from H. platessoides and other Derogenes species/lineages were at levels of interspecific differences. The species from H. platessoides is described here as D. abba n. sp. We also examined the type material of Progonus muelleri (Levinsen, 1881), the type and only species of the genus Progonus, with redescription and designations of paralectotypes. Based on specimens from Theodor Odhner’s collections at the Swedish Museum of Natural History, SMNH, Stockholm, we provide novel morphological and anatomical data for D. varicus sensu lato species complex. Lastly, we investigated Arthur Looss’s “lost collection” of Trematodes at the SMNH and characterised a putative species Derogenes sp. “limula”.
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Akele, David, André Boya Aboh, Gildas Idoleke, Damien Goudohessi, and Elie Montchowui. "Exploitation de l’escargot aquatique Lanistes varicus (Müller, 1774) dans la Basse Vallée de l’Ouémé au Bénin, Afrique de l’Ouest." International Journal of Biological and Chemical Sciences 16, no. 4 (2022): 1608–20. http://dx.doi.org/10.4314/ijbcs.v16i4.20.
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L’escargot aquatique Lanistes varicus est activement exploité dans la Basse Vallée de l’Ouémé au Bénin à cause de sa chair qui est très appréciée par les consommateurs. Cependant, les données relatives à l’importance socio-économique de son exploitation sont quasi inexistantes. Pour évaluer l’abondance et étudier l’importance socio-économique de cet escargot, une enquête a été réalisée de juin à aout 2017 auprès des populations de la Basse Vallée de l’Ouémé au Bénin. Des observations directes et des mesures sur le terrain ont porté sur les techniques de collecte, les quantités exploitées (comptage et pesé des escargots) et la commercialisation de l’escargot. La technique de collecte utilisée dans la vallée de Ouémé est le ramassage à la main de l’escargot dans les plaines inondables. Elle est une activité réalisée essentiellement par les femmes et les enfants. Lanistes varicus est plus abondant en période de crue (densité : 7235 sujets/hectare) qu’avant crue (densité : 5360 sujets/hectare).Le poids moyen individuel de cet escargot a varié de 26,9 à 31,2 g. L’escargot ramassé sert à la consommation domestique et la commercialisation sur le marché sous régional d’Azowilissè. Le prix moyen de cession est de 80 FCFA/kg pendant la crue contre 90 FCFA/kg avant crue. L’exploitation de L. varicus constitue une activité génératrice de revenus pour les femmes et les enfants pendant la crue où les activités de champs sont réduites à cause de l’inondation. La biologie et l’écologie de L. varicus doivent être étudiées en vue de sa domestication.
 The aquatic snail Lanistes varicus is actively exploited in the Lower Ouémé Valley of Benin because of its meat, which is highly valued by consumers. However, data on the socio-economic importance of the exploitation of this species are lacking. To assess the abundance and study the socio-economic importance of this snail, a survey was carried out from June to August 2017 among the populations of the Lower Ouémé Valley in Benin. Direct observations and field measurements focused on collection techniques, quantities exploited (counting and weighing of snails) and marketing of the snail. The collection technique used in the Ouémé Valley is snail collection in the flood plains by hand. It is an activity carried out mainly by women and children. Lanistes varicus is more abundant during the flood period (density: 7235 subjects/hectare) than before the flood (density: 5360 subjects/hectare). The average individual weight of this snail varied from 26.9 to 31.2 g. The snail collected is used for domestic consumption and marketing on the Azowilissè sub-regional market. The average selling price was 80 FCFA/kg during the flood, compared to 90 FCFA/kg before the flood. The exploitation of L. varicus constitutes an income-generating activity for women and children during the flood when field activities are reduced due to the flood. The biology and ecology of L. varicus need to be studied for domestication.
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Fuentes, Katlyn M., Carole C. Baldwin, D. Ross Robertson, Claudia C. Lardizábal, and Luke Tornabene. "Two new species of Varicus from Caribbean deep reefs, with comments on the related genus Pinnichthys (Teleostei, Gobiidae, Gobiosomatini, Nes subgroup)." ZooKeys 1180 (September 20, 2023): 159–80. https://doi.org/10.3897/zookeys.1180.107551.
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Tropical deep reefs (~40–300 m) are diverse ecosystems that serve as habitats for diverse communities of reef-associated fishes. Deep-reef fish communities are taxonomically and ecologically distinct from those on shallow reefs, but like those on shallow reefs, they are home to a species-rich assemblage of small, cryptobenthic reef fishes, including many species from the family Gobiidae (gobies). Here we describe two new species of deep-reef gobies, Varicus prometheus sp. nov. and V. roatanensis sp. nov., that were collected using the submersible Idabel from rariphotic reefs off the island of Roatan (Honduras) in the Caribbean. The new species are the 11<sup>th</sup> and 12<sup>th</sup> species of the genus Varicus, and their placement in the genus is supported by morphological data and molecular phylogenetic analyses. Additionally, we also collected new specimens of the closely-related genus and species Pinnichthys aimoriensis during submersible collections off the islands of Bonaire and St. Eustatius (Netherland Antilles) and included them in this study to expand the current description of that species and document its range extension from Brazil into the Caribbean. Collectively, the two new species of Varicus and new records of P. aimoriensis add to our growing knowledge of cryptobenthic fish diversity on deep reefs of the Caribbean.
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Fuentes, Katlyn M., Carole C. Baldwin, D. Ross Robertson, Claudia C. Lardizábal, and Luke Tornabene. "Two new species of Varicus from Caribbean deep reefs, with comments on the related genus Pinnichthys (Teleostei, Gobiidae, Gobiosomatini, Nes subgroup)." ZooKeys 1180 (September 20, 2023): 159–80. http://dx.doi.org/10.3897/zookeys.1180.107551.
Full textAbstract:
Tropical deep reefs (~40–300 m) are diverse ecosystems that serve as habitats for diverse communities of reef-associated fishes. Deep-reef fish communities are taxonomically and ecologically distinct from those on shallow reefs, but like those on shallow reefs, they are home to a species-rich assemblage of small, cryptobenthic reef fishes, including many species from the family Gobiidae (gobies). Here we describe two new species of deep-reef gobies, Varicus prometheussp. nov. and V. roatanensissp. nov., that were collected using the submersible Idabel from rariphotic reefs off the island of Roatan (Honduras) in the Caribbean. The new species are the 11th and 12th species of the genus Varicus, and their placement in the genus is supported by morphological data and molecular phylogenetic analyses. Additionally, we also collected new specimens of the closely-related genus and species Pinnichthys aimoriensis during submersible collections off the islands of Bonaire and St. Eustatius (Netherland Antilles) and included them in this study to expand the current description of that species and document its range extension from Brazil into the Caribbean. Collectively, the two new species of Varicus and new records of P. aimoriensis add to our growing knowledge of cryptobenthic fish diversity on deep reefs of the Caribbean.
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Scott, J. S. "Digenean (Trematoda) populations in winter flounder (Pseudopleuronectes americanus) from Passamaquoddy Bay, New Brunswick, Canada." Canadian Journal of Zoology 63, no. 7 (1985): 1699–705. http://dx.doi.org/10.1139/z85-253.
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Examination of monthly samples of winter flounder (Pseudopleuronectes americanus) from Passamaquoddy Bay revealed seven digenean parasites (Genolinea laticauda, Podocotyle atomon, Stenakron vetustum, Fellodistomum furcigerum, Derogenes varicus, Lecithaster gibbosus, and Steganoderma formosum) in the alimentary tract and two metacercariae (Stephanostomum baccatum and Cryptocotyle lingua) in the body surface tissues and gills. Prevalence of alimentary tract parasites ranged from 0.2 in S. formosum to 39.8 in P. atomon and intensity ranged from 1.5 for D. varicus to 7.0 for S. formosum (one fish). Monthly and seasonal levels of prevalence varied: high in spring and autumn and low in summer and winter for most species. Prevalence and length-frequency distributions of the parasites did not support differential migration by size group or diminishing feeding activity from spring to winter in winter flounder, as proposed in other studies.
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TORNABENE, LUKE, and CAROLE C. BALDWIN. "Psilotris vantasselli, a new species of goby from the tropical western Atlantic (Teleostei: Gobiidae: Gobiosomatini: Nes subgroup)." Zootaxa 4624, no. 2 (2019): 191–204. http://dx.doi.org/10.11646/zootaxa.4624.2.3.
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A new species of goby is described from submersible and scuba collections off Bonaire and New Providence Island, Bahamas. A molecular phylogenetic analysis of mitochondrial and nuclear genes confirms the placement of the new species within the genus Psilotris of the Nes subgroup of the Gobiosomatini. The new species is easily distinguished from congeners and morphologically similar species of Varicus by its unique coloration, which includes eight narrow, bright yellow bars on the trunk, each with a small orange spot centered on the lateral midline. In addition, the combination of the absence of scales on the head and body and the presence of modified ctenoid scales on the base of the caudal fin, branched pelvic-fin rays, and 15–16 pectoral-fin rays further differentiates the new species from other species of Psilotris and Varicus.
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Scott, James S., and Shelley A. Bray. "Helminth parasites of the alimentary tract of Atlantic halibut (Hippoglossus hippoglossus L.) and Greenland halibut (Reinhardtius hippoglossoides (Walbaum)) on the Scotian Shelf." Canadian Journal of Zoology 67, no. 6 (1989): 1476–81. http://dx.doi.org/10.1139/z89-209.
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Examination of the alimentary tracts of 272 Atlantic halibut (Hippoglossus hippoglossus (L.)) and 71 Greenland halibut (Reinhardtius hippoglossoides (Walbaum)) from the Scotian Shelf yielded a total of 25 helminth parasite species, 23 from H. hippoglossus (16 Digenea, 3 Cestoda, 2 Acanthocephala, 2 Nematoda) and 16 from R. hippoglossoides (11 Digenea, 3 Cestoda, 1 Acanthocephala, 1 Nematoda). Parasite prevalence and intensity were low (< 50% and < 10%, respectively) in both hosts, except for Derogenes varicus and Steganoderma formosum in H. hippoglossus and anisakid nematodes in R. hippoglossoides. Consideration of change in parasite prevalence and mean intensity in relation to fish length and diet suggests fish prey as transport hosts for D. varicus in larger halibuts, and crustaceans as the intermediate hosts for S. formosum before transmission to its principal host, H. hippoglossus. Geographical change in parasite prevalence and intensity was in the form of southwest to northeast clines along the Shelf, probably related to environmental factors. There was no evidence for stock differentiation in either of the hosts based on parasite fauna.
Dissertations / Theses on the topic "Varicus"
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Viarengo, Luiz Marcelo Aiello. "Tratamento de varizes dos membros inferiores com laser endovenoso em pacientes com ulcera em atividade e medida das temperaturas intra e perivenosas durante o procedimento." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309251.
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Orientadores: Fabio Husemann Menezes, João Poterio Filho<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-09T07:32:33Z (GMT). No. of bitstreams: 1
Viarengo_LuizMarceloAiello_D.pdf: 5372848 bytes, checksum: 053f8a2b3ec69d775d15f4e631b7f2c9 (MD5)
Previous issue date: 2007<br>Resumo: Este estudo foi desenvolvido para avaliar, prospectivamente, os resultados do tratamento de varizes com úlcera em atividade com laser endovenoso (EVL), comparando com um grupo sob tratamento clínico, durante um ano. Foram estudados 52 pacientes consecutivos portadores de varizes com úlcera em atividade há mais de um ano, divididos em dois grupos aleatórios. O Grupo I, tratamento clínico, formado por 25 indivíduos; o Grupo II, tratamento com EVL, constituído por 27 indivíduos. Todos os pacientes foram estudados com ultra-som no início e término do estudo. Os pacientes do Grupo II foram seguidos com ultra-som com 7 dias, 30 dias e a cada 3 meses. As áreas das feridas foram avaliadas a cada 3 meses. O laser utilizado para o tratamento endovenoso das varizes tronculares foi um laser de diodo, com comprimento de onda de 980 nanômetros, com potência nominal de 15W com fibra óptica condutora de laser de 600 microns, introduzida endovenosamente por punção percutânea dirigida por ultra-som e com emprego de anestesia local por infiltração intumescente associado a sedação leve por via oral com 15mg de Midazolam®. As medidas de temperaturas intra e perivenosa foram realizadas com um termômetro digital acoplado ao computador. Em 12 meses, 81,5% das feridas dos pacientes do Grupo II estavam cicatrizadas enquanto no Grupo I apenas 24% estavam cicatrizadas. A recorrência de úlcera foi de 44,4% no Grupo I, sem nenhuma recorrência no Grupo II. A área média das feridas no Grupo I reduziu de 18,04cm² para 13,16cm² ao final de um ano, enquanto no Grupo II reduziu de 22,7cm² para 3,64cm² (p<0,05). A temperatura média registrada foi de 79,3ºC no intravenoso e de 43,0ºC nos tecidos perivenosos. Não houve efeito adverso importante. O tratamento de varizes com laser endovenoso em pacientes com úlcera venosa em atividade mostrou-se seguro, com taxa de cicatrização das feridas superior à dos pacientes com tratamento clínico no prazo de um ano, e não houve recorrência<br>Abstract: Conventional saphenous vein stripping is difficult to be indicated for the treatment of varicose veins in patients classified as CEAP C4, C5 or C6. This study was developed to consecutively evaluate treatment results for varicose veins with active ulcers using endovenous laser (EVL), compared to a groupundergoing clinical treatment, during a year. Fifty-two consecutive patients presenting with varicose veins with active ulcers for more than a year were divided for treatment into two randomized groups: Group I, clinical treatment, composed of 25 subjects, were submitted to elastic or inelastic compression therapy according to individual medical recommendation; Group II, EVL treatment, composed of 27 subjects, were submitted to great and or small saphenous vein ablation with a 980 nm diode endovenous laser, plus the clinical treatment. Intravenous and perivenous temperatures were measured continuously with a digital thermometer connected to a computer during the EVL treatment. All patients were followed for 12 months and studied with ultrasound at the beginning and end of the study. The ulcers¿areas were evaluated initially and at every 3 months. In 12 months, 81.5% of the wounds in patients in Group II and only 24% in patients in Group I had healed. Ulcer recurrence rate was 44.4% in Group I. The average wound area in Group I decreased from 18.04cm² to 13.16cm² at the end of the year. In Group II, the wound area decreased from 22.7cm² to 3,64cm² (p<0,05). Mean intravenous and perivenous temperatures of 79.3ºC and 43.0ºC were recorded. In conclusion, the treatment for varicose veins with endovenous laser (EVL) as described is safe in patients with active ulcers. Wounds healed faster than in patients undergoing clinical treatment alone during a one-year period. There was no ulcer recurrence in patients treated with EVL<br>Doutorado<br>Cirurgia<br>Doutor em Cirurgia
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Conejo, Sosa Irene. "Optimización de factores pronósticos y tratamiento de la hemorragia digestiva por varices esofágicas en pacientes con cirrosis hepática." Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/673678.
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L'hemorràgia aguda per varius esofàgiques és una complicació freqüent de la hipertensió portal associada amb estadis avançats de la cirrosi hepàtica. Actualment, el tractament hemostàtic d'aquesta hemorràgia consisteix en l'ús de fàrmacs vasoconstrictors esplàcnics i la lligadura endoscòpica de les varius, associant profilaxi antibiòtica ja que aquesta ha demostrat millorar la supervivència d'aquests pacients.
Amb la present tesi, el nostre objectiu és optimitzar la teràpia estàndard de l'hemorràgia aguda per varius esofàgiques, mitjançant el refinament d'eines d'estratificació pronòstica, amb l'objectiu d'identificar poblacions de baix risc que puguin beneficiar-se d'abordatges menys agressius.
Entre les complicacions després d'una hemorràgia aguda per varius esofàgiques, una molt freqüent és la infecció bacteriana, la qual afavoreix la recidiva hemorràgica i pot conduir a una fallada multiorgànica. La profilaxi antibiòtica en aquests pacients millorarà la seva supervivència. No obstant això, l'ús d'antibiòtics d'ampli espectre s'ha associat a un augment de la incidència d'infeccions per gèrmens multirresistents i no està clar quin hauria de ser l'antibiòtic d'elecció, existint controvèrsia sobre la necessitat d'utilitzar antibiòtics de major espectre en pacients amb bon pronòstic.
L'objectiu del primer treball d'aquesta tesi és avaluar el risc d'infecció i complicacions associades a aquestes en una cohort de pacients afectes de cirrosi hepàtica que presenten una hemorràgia aguda per varius esofàgiques, tractats amb la teràpia estàndard, emfatitzant en la identificació de grups de baix risc en què es podria plantejar una desescalada en la profilaxi antibiòtica. El nostre estudi mostra que el risc de patir una infecció bacteriana després d'una hemorràgia aguda per varius esofàgiques en els pacients amb bona funció hepàtica no és sempre baixa. Els pacients amb un consum actiu d'alcohol tenen un risc significativament major d'infectar-se que els pacients amb cirrosi d'altres etiologies. A més, la ceftriaxona és un antibiòtic amb major efectivitat a l'hora de reduir el nombre d'infeccions, però això no es tradueix en una menor mortalitat ni en una menor recidiva hemorràgica, de manera que en els pacients amb menor risc infecciós podria plantejar restringir-ne el seu ús pel risc d'augmentar el nombre d'infeccions per gèrmens multirresistents.
D'altra banda, després d'una hemorràgia aguda, molts pacients presenten recidiva del sagnat. Això determinarà un pitjor pronòstic. Estudis previs han plantejat practicar, en les primeres 72 hores, una derivació intrahepàtica via transjugular (TIPS) en pacients Child-Pugh B i amb hemorràgia activa en l'endoscòpia inicial, i en pacients Child-Pugh C amb menys de 14 punts. Però múltiples publicacions posteriors mostren que la mortalitat dels pacients Child-Pugh B tractats amb la teràpia estàndard actual és significativament menor que la del braç control de l'estudi de TIPS precoç.
El segon treball d'aquesta tesi és una reevaluació multicèntrica internacional del pronòstic sota tractament estàndard dels pacients d'alt risc, segons la definició original per a la indicació de TIPS precoç, així com l'exploració de criteris de risc alternatius (MELD19, ChildC-C1). Amb els nostres resultats observem que els pacients Child-Pugh C, independentment de la seva creatinina basal, o aquells que presenten un MELD superior o igual a 19, han de ser considerats com d'alt risc i ser valorats per al tractament amb un TIPS precoç. En canvi, els pacients Child-Pugh B, sota el tractament estàndard actual, tenen una mortalitat tres vegades menor que els pacients Child-Pugh C (independentment de la presència d'hemorràgia activa en l'endoscòpia inicial) i similar a la descrita amb l'ús de TIPS precoç. Per això, els criteris per a la indicació de TIPS precoç haurien de ser reconsiderats.<br>La hemorragia aguda por varices esofágicas es una complicación frecuente de la hipertensión portal asociada con estadios avanzados de la cirrosis hepática. Actualmente, el tratamiento hemostático de esta hemorragia consiste en el uso de fármacos vasoconstrictores esplácnicos y la ligadura endoscópica de las varices, asociando profilaxis antibiótica ya que esta ha demostrado mejorar la supervivencia de estos pacientes.
Con la presente tesis, nuestro objetivo es optimizar la terapia estándar de la hemorragia aguda por varices esofágicas, mediante el refinamiento de herramientas de estratificación pronóstica, con el objetivo de identificar poblaciones de bajo riesgo que pudieran beneficiarse de abordajes menos agresivos.
Entre las complicaciones tras una hemorragia aguda por varices esofágicas, una muy frecuente es la infección bacteriana, la cual favorece la recidiva hemorrágica y puede conducir a un fallo multiorgánico. La profilaxis antibiótica en estos pacientes mejorará su supervivencia. Sin embargo, el uso de antibióticos de amplio espectro se ha asociado a un aumento de la incidencia de infecciones por gérmenes multirresistentes y no está claro cuál debería ser el antibiótico de elección, existiendo controversia sobre la necesidad de utilizar antibióticos de mayor espectro en pacientes con buen pronóstico.
El objetivo del primer trabajo de esta tesis es evaluar el riesgo de infección y complicaciones asociadas a éstas en una cohorte de pacientes afectos de cirrosis hepática que presentan una hemorragia aguda por varices esofágicas, tratados con la terapia estándar, enfatizando en la identificación de grupos de bajo riesgo en los que se podría plantear una desescalada en la profilaxis antibiótica. Nuestro estudio muestra que el riesgo de padecer una infección bacteriana tras una hemorragia aguda por varices esofágicas en los pacientes con buena función hepática no es siempre bajo. Los pacientes con un consumo activo de alcohol tienen un riesgo significativamente mayor de infectarse que los pacientes con cirrosis de otras etiologías. Además, la ceftriaxona es un antibiótico con mayor efectividad a la hora de reducir el número de infecciones, pero esto no se traduce en una menor mortalidad ni en una menor recidiva hemorrágica, por lo que en los pacientes con menor riesgo infeccioso podría plantearse restringir su uso por el riesgo de aumentar el número de infecciones por gérmenes multirresistentes.
Por otro lado, después de una hemorragia aguda, muchos pacientes presentan recidiva del sangrado. Esto determinará un peor pronóstico. Estudios previos han planteado practicar, en las primeras 72 horas, una derivación intrahepática vía transyugular (TIPS) en pacientes Child-Pugh B y con hemorragia activa en la endoscopia inicial, y en pacientes Child-Pugh C con menos de 14 puntos. Pero múltiples publicaciones posteriores muestran que la mortalidad de los pacientes Child-Pugh B tratados con la terapia estándar actual es significativamente menor que la del brazo control del estudio de TIPS precoz.
El segundo trabajo de esta tesis es una reevaluación multicéntrica internacional del pronóstico bajo tratamiento estándar de los pacientes de alto riesgo, según la definición original para la indicación de TIPS precoz, así como la exploración de criterios de riesgo alternativos (MELD19, ChildC-C1). Con nuestros resultados observamos que los pacientes Child-Pugh C, independientemente de su creatinina basal, o aquellos que presentan un MELD superior o igual a 19, han de ser considerados como de alto riesgo y ser valorados para el tratamiento con un TIPS precoz. En cambio, los pacientes Child-Pugh B, bajo el tratamiento estándar actual, tienen una mortalidad tres veces menor que los pacientes Child-Pugh C (independientemente de la presencia de hemorragia activa en la endoscopia inicial) y similar a la descrita con el uso de TIPS precoz. Por ello, los criterios para la indicación de TIPS precoz tendrían que ser reconsiderados.<br>Esophageal variceal bleeding is a frequent complication of portal hypertension associated with advanced stages of liver cirrhosis. Currently, the hemostatic treatment of this hemorrhage consists of the combined use of splanchnic vasoconstrictor drugs and endoscopic ligation of varicose veins, associating prophylactic antibiotic treatment which has been shown to improve the survival of these patients.
With this thesis, we aim to address the optimization of the standard therapy for acute variceal bleeding by refining prognostic stratification tools, with the main objective of identifying low-risk populations treated with standard therapy who could benefit of less aggressive approaches.
Among the complications after an acute bleeding, one of the most frequent is bacterial infection, which increases rebleeding index and may lead to multiple organ failure. However, the increased use of broad-spectrum antibiotics has been associated with an augmented incidence of multi-resistant infections and it is not clear which should be the antibiotic of choice, since there is controversy regarding the need to use broader antibiotics in patients with a good prognosis.
The objective of the first work of the thesis will be to assess the risk of infection associated with acute variceal bleeding in a cohort of patients with liver cirrhosis, all treated with standard therapy,
with special emphasis on the identification of low-risk groups in which a de-escalation in antibiotic prophylaxis could be considered. Our study shows that the risk of developing a bacterial infection after acute variceal bleeding in patients with a good liver function is not always low. Patients with active alcohol intake have a significantly higher risk of infection than patients with cirrhosis of other etiologies, despite being under prophylactic treatment. Likewise, ceftriaxone is an antibiotic with greater effectiveness in reducing infections, but it does not translate into lower mortality or lover rate of hemorrhagic recurrence. Therefore, in patients with lover risk of infections, ceftriaxone could be considered restricting its use due to the risk of increasing the risk of infections by multidrug-resistant bacteria.
On the other hand, numerous studies have shown that after an acute variceal bleeding, a high percentage of patients have a recurrent bleeding. This determines a worse prognosis and a higher mortality rate. Previous studies have proposed placing a transjugular intrahepatic portosystemic shunt (TIPS) in the first 72 hours after admission in patients with Child-Pugh B and active bleeding in the initial endoscopy and in Child-Pugh C patients with less than 14 points. However, multiple subsequent publications show that the mortality of Child-Pugh B patients treated with current standard therapy is significantly lower than that of the control arm of the Early or Pre-emptive TIPS study.
Within this background, the second work of this thesis was based on an international multicentric re-evaluation of the prognosis under standard treatment of high-risk patients, according to the original definition for the indication of early TIPS, as well as the exploration of alternative risk criteria (MELD19, ChildC-C1). We observed that Child-Pugh C patients, regardless of their baseline creatinine, or those with a MELD score greater than or equal to 19, must be considered high-risk patients due to their high mortality and should be evaluated for treatment with an early TIPS. In contrast, Child-Pugh B patients, under the current standard treatment, have three times lower mortality than Child-Pugh C patients, regardless of the presence of active bleeding at first endoscopy, and similar to mortality described with use of early TIPS. Therefore, the criteria for the indication of early TIPS would have to be reconsidered.<br>Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina
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Carle, Jean-Paul. "Prophylaxie des ruptures de varices oesophagiennes par sclérothérapie per-endoscopique : étude multicentrique randomisée." Montpellier 1, 1988. http://www.theses.fr/1988MON11270.
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Meneses, Daniela Gois. "Evolução clinica e endoscopica da hipertensão portal em crianças e adolescentes : experiencia de um serviço terciario." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313696.
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Orientadores: Adriana Maria Alves De Tommaso, Elizete Aparecida Lomazi da-Costa-Pinto<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-13T01:18:31Z (GMT). No. of bitstreams: 1
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Previous issue date: 2009<br>Resumo: A história natural da hipertensão portal (HP) é pouco conhecida em crianças e dados relacionados à evolução em longo prazo são escassos. O objetivo desse estudo foi descrever a evolução endoscópica da HP em 98 pacientes (0 a18 anos) admitidos no Hospital de Clínicas da UNICAMP, no período de março de 1986 a dezembro de 2006 e seguidos, em média, por 6,4 anos. Estudo descritivo e longitudinal. Dados coletados por meio de revisão de prontuários. Analisadas informações referentes a gênero; idade; etiologia; avaliações clínicas, laboratoriais e endoscópicas; tratamentos clínico, endoscópico e cirúrgico da hipertensão portal; complicações do tratamento endoscópico; episódios de hemorragia digestiva alta; evolução das varizes esofagogástricas e da gastropatia da hipertensão portal; causas de óbito. Realizada análise estatística descritiva, comparação de proporções Qui-Quadrado ( c2) com Correção de Yates ou o método Exato de Fisher, comparação entre grupos Teste T (de Student) com Correção de Welch. O nível de significância estabelecido foi p0,05. A maioria dos pacientes era do gênero feminino (58,2%). A causa mais comum de HP foi obstrução da veia porta extra-hepática (OVPEH) (44,9%), seguida pelas doenças que evoluem para cirrose (40,8% dos pacientes). A idade mediana à admissão foi de 4,3 anos. Os sinais endoscópicos de risco de sangramento à admissão, o antecedente de HDA e sua ocorrência durante o seguimento foram mais frequentes nos pacientes não cirróticos (p= 0,0001, p= 0,0001 e p= 0,0015, respectivamente). Cerca de 40% (3998) dos pacientes, em sua maioria cirróticos, não apresentaram HDA durante o seguimento. A profilaxia endoscópica primária associou-se a período livre de sangramento digestivo significativamente mais longo (p= 0,036) no grupo de cirróticos. A erradicação das varizes de esôfago, em cirróticos e não cirróticos, associou-se a diminuição do risco de sangramento dessas varizes (p= 0,0001) e não ocasionou aumento quantitativo de varizes gástricas (p=0,12) e(ou) gastropatia da hipertensão portal (p= 0,87). No entanto, ocorreu aumento do número de episódios de sangramento de origem gástrica. Após tratamento para erradicação ou redução do risco de sangramento, 3342 (78,5%) pacientes foram seguidos por um período superior a 1 ano. Os sinais de risco de sangramento reapareceram em 72,7% dos pacientes, em média 16,2 meses após interrupção do tratamento endoscópico. O óbito foi mais frequente entre os cirróticos (p= 0,001). Em conclusão, os sinais endoscópicos de risco de sangramento e a frequencia de HDA predominaram entre os não cirróticos. A profilaxia endoscópica primária foi mais efetiva entre os cirróticos. O tratamento endoscópico é eficaz para diminuição dos sinais de risco de sangramento de varizes de esôfago, porém há um alto índice de recidiva desses sinais e aumento dos episódios de HDA por variz gástrica e gastropatia da HP após erradicação das varizes de esôfago. A mortalidade foi superior entre os cirróticos<br>Abstract: The natural evolution of portal hypertension (PH) is little known in children and data related to long term evolution are scarce. The aim of this study was to evaluate the endoscopic evolution of PH in 98 patients. This is a descriptive and transversal study, in which were included both male and female patients with PH, aged from 0 to 18 years, enrolled at the Clinical Hospital of the FCM/UNICAMP. The mean follow-up was 6.4 years. Data from March 1986 to December 2006 were collected through review of medical records, and information analyzed were related to gender; age; etiology; clinical, laboratory and endoscopic evaluation; clinical, endoscopic and surgical treatments of PH; complications of endoscopic treatment; upper gastrointestinal
bleeding episodes; evolution of esophagogastric varices and PH gastropathy; causes of death. Descriptive statistical analysis and comparison of proportions were accomplished, through Chi-Square (c2) with Yates correction or the Fisher's exact method; comparison among groups: Student's t Test with Welch's Correction. The significance level was p<0,05. Most patients were female (58.2%). The main cause of PH was obstruction of extra-hepatic portal vein (OEHPV) (44.9%), followed by diseases that progress to cirrhosis (40.8%). The median age at admission was 4.3 years. Endoscopic signs of bleeding risk at admission, the history of upper gastrointestinal bleeding (UGB) and its occurrence during follow-up were more frequent among noncirrhotic patients. Among patients who were included in this study, 39.8% (39/98) has not showed UGB during follow-up, most of them cirrhotic. Primary endoscopic prophylaxis in cirrhotic group was associated to a longer period without showing digestive bleeding. Total eradication of esophageal varices in both cirrhotic and noncirrhotic patients was associated to a reduction of bleeding risk in those varices. It was not detected a quantitative increase of gastric varices (p=0.12) and/or PH gastropathy (p=0.87). However, it was observed an increase in the number of bleeding episodes from gastric varices. After treatment for eradication or reduction of bleeding risk, 33/42 patients were followed for a period over 1 year. Signs of bleeding risk reappear in 72.7% of patients, on average 16.2 months after interruption of endoscopic treatment. Death was more frequent among cirrhotics (p=0.001). In conclusion, endoscopic signs of bleeding risk and frequency of UGB episodes was predominant among non-cirrhotic. Primary endoscopic prophylaxis was more effective among cirrhotic. Although endoscopic treatment is effective in reducing the risk of bleeding from esophageal varices, there is a high index of recurrence of that signs and an increase in episodes of UGB from gastric varices and gastropathy from PH after eradication of espophageal varices. The mortality was higher among cirrhotic<br>Mestrado<br>Pediatria<br>Mestre em Saude da Criança e do Adolescente
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Tafarel, Jean Rodrigo [UNIFESP]. "Avaliação dos escores MELD, Child-Turcotte-Pugh, APRI, contagem de plaquetas e testes hepáticos como indicadores da presença de varizes de esôfago com ou sem necessidade de profilaxia para sangramento." Universidade Federal de São Paulo (UNIFESP), 2010. http://repositorio.unifesp.br/handle/11600/9106.
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Previous issue date: 2010-10-29<br>Objetivo: Determinar se o escore MELD (Model for end-stage liver disease), classificação de Child-Turcotte-Pugh (CTP), APRI (AST to platelet ratio index), testes hepáticos e contagem de plaquetas são preditores da presença de varizes esofágicas (VE) ou de VE com necessidade de profilaxia para sangramento varicoso (VNP). Métodos: Trezentos pacientes cirróticos (193 homens; média etária de 53,10 anos; hepatite C crônica como etiologia predominante da cirrose) foram analisados prospectivamente. Considerou-se como VE de fino calibre aquelas que desapareciam com a insuflação do órgão; médio calibre aquelas que ocupavam até 1/3 da luz esofágica e de grosso calibre aquelas que ocupavam mais do que 1/3 da luz. Varizes de médio e grosso calibre foram consideradas VNP. Realizaram-se análises uni e multivariada para estabelecer a relação entre a presença de varizes (qualquer calibre e VNP) e as características destes pacientes (MELD, classificação CTP, APRI, exames de bioquímica hepática e contagem de plaquetas). Resultados: Cento e setenta e um pacientes (57%) possuíam VE, dos quais 35% (n = 105) possuíam VNP. A distribuição das VE de acordo com a classificação de CTP foi: A, 49%; B, 75,30% e C, 80% (p < 0,01). Em análise univariada os preditores independentes da presença de VE foram: MELD > 8 (p = 0,02); APRI > 1,64 (p = 0,01); contagem plaquetária inferior a 93.000/mm3 (p < 0,01); AST > 1,34xLSN (p = 0,01) e bilirrubina total > 1mg/dl (p = 0,04). Escore MELD acima de 8 teve o maior valor discriminante para a presença de VE, com sensibilidade de 80,10% e especificidade de 51,20%. Fatores independentemente associados à VNP foram: trombocitopenia (< 92.000/mm3; p < 0,01) e AST > 1,47xLSN (p = 0,03). Contagem plaquetária < 92.000/mm3 possui sensibilidade de 65,70% e especificidade de 57,90% para a presença de VNP. Conclusões: Escore MELD elevado foi o melhor preditor isolado da presença de VE de qualquer calibre e plaquetopenia < 92.000/mm3, foi o melhor preditor para varizes com necessidade de profilaxia. No entanto, nenhum destes concilia altos valores de sensibilidade e especificidade.<br>Purpose: The aim of this study was to determine whether MELD, Child-Turcotte-Pugh (CTP) class, APRI and laboratory tests could predict the presence of EV or varices which need prophylactic therapy (EV with medium or large size). Methods: Three hundred cirrhotic patients (193 men; mean age 53,1 years; majority with cirrhosis from chronic C hepatitis) were prospective analyzed. Uni and multivariate analysis were used to evaluate associations between the presence of EV (any size and medium or large EV) and patients’ characteristics (MELD, CTP class, APRI, platelets count and liver tests). Small varices were regarded as those which flatten with insufflation; medium varices those which protruded less than 1/3 of the lumen and large ones those which protruded more than 1/3. Results: One hundred seventy one patients (57%) had EV, of whom 35% (105) had varices which need prophylactic therapy. The distribution of EV according to the CTP class was as follows: A, 49%; B, 75,3% and C, 80%. Independent predictors of the presence of EV were: MELD > 8 (p = 0,02); APRI > 1,64 (p = 0,01); a platelet count < 93.000/mm3 (p < 0,01); AST > 1,34xUNL (p = 0,01) and total bilirubin > 1 mg/dl (p = 0,04). MELD > 8 had the highest discriminative value for presence of EV with sensitivity of 80,1% and specificity of 51,2%. Factors independently associated with EV which need prophylactic therapy were: thrombocytopenia (< 92.000/mm3; p < 0,01) and AST > 1,47xUNL (p = 0,03). A platelet count < 92.000/mm3 had sensitivity of 65,7% and specificity of 57,9% for the presence of varices which need prophylactic therapy. Conclusions: High values on MELD are associated with EV and thrombocytopenia (< 92.000/mm3), with varices which need prophylactic therapy. Considering their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all cirrhotic patients.<br>TEDE<br>BV UNIFESP: Teses e dissertações
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Kisilevzky, Nestor Hugo. "Tips para o controle das complicações clinicas da hipertensão portal." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310609.
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Orientador: Luiz Sergio Leonardi<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-06T13:32:27Z (GMT). No. of bitstreams: 1
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Previous issue date: 2006<br>Resumo: Objetivo: O propósito deste estudo foi avaliar a eficácia do procedimento denominado TIPS (Transjugular Intrahepatic Portosystemic Shunt) em pacientes com hepatopatia crônica e hipertensão portal, verificar a incidência de complicações e a existência de fatores prognósticos da evolução clínica. Casuística e Método: Foram revistos todos os procedimentos realizados numa única Instituição, por um único operador, entre 1996 e 2004. Quarenta e quatro pacientes, sendo 30 do sexo masculino e 14 do feminino e com idade média de 52 anos, todos de raça branca, foram submetidos a TIPS. O sintoma principal foi hemorragia digestiva alta em 28, ascite refratária em 11 e síndrome hepatorrenal em 5. Foram verificados os níveis séricos de bilirrubina, albumina, atividade de protrombina e creatinina. Observou-se que 9 eram Child-Pugh A, 24 eram Child-Pugh B e 11 eram Child-Pugh C. Resultados: O TIPS foi completado com sucesso em todos os pacientes (100%), verificando-se uma queda do gradiente pressórico P/S médio de 49,69% que foi estatisticamente significativa. Comprovou-se a melhora clínica em 35 pacientes (79,55%), sendo 24/28 pacientes com HDA, 8/11 pacientes com ascite refratária e 3/5 com SHR. A mortalidade geral PO foi de 13,64%, sendo mais incidente nos pacientes caracterizados como Child-Pugh C (45,45%). Os fatores mais relevantes de mau prognóstico foram o aumento da bilirrubina e do nível de creatinina e a diminuição na atividade de protrombina. Verificou-se que 75% dos pacientes sobreviveram durante o período de observação de um ano. A sobrevida média de pacientes Child-Pugh A foi de 11,5 meses, nos Child-Pugh B foi 10,97 meses e nos Child-Pudh C foi apenas 5,90 meses, evidenciando uma diferença estatisticamente significativa na sobrevida dos pacientes de acordo com a classificação de Child-Pugh. Foram observadas complicações relacionadas com o procedimento em 14 casos (31,80%). Comprovou-se a oclusão do TIPS em 5 pacientes. Conclusão: O TIPS foi eficiente para diminuir a pressão portal e resolver as complicações clínicas em pacientes com hepatopatia crônica e hipertensão portal. As complicações e a morbi-mortalidade relacionadas com o procedimento podem ser consideradas aceitáveis. A mortalidade foi diretamente influenciada por alguns fatores clínicos, tais como classe Child-Pugh C e elevação dos níveis séricos de bilirrubina e creatinina<br>Abstract: Purpose: the purpose of this study was to evaluate the efficacy of TIPS (Transjugular Intra-hepatic Portosystemic Shunt) in patients with chronic liver disease and portal hypertension, to verify the safety of the procedure and the complication rates directly related to it. The existence of prognostic factors of postoperative outcome was also verified. Casuistry and Method: all the cases of patients submitted to TIPS in a single Institution by a single operator during an 8-year period of time were reviewed. 44 patients, being 30 males and 14 females, with an average age of 52, all of them white, were submitted to TIPS. All the patients had chronic liver disease and portal hypertension having as main symptom recurrence of gastro-esophagic bleeding or congestive gastropathy in 28, refractory ascite in 11 and hepatorenal syndrome in 5. The serum levels of bilirubin, albumin, prothrombin time and creatinine were verified. Patients were stratified according to the Child-Pugh classification resulting that 9 were Child-Pugh A, 24 were Child-Pugh B and 11 were Child-Pugh C. Results: TIPS was successfully performed in all the patients (100%), verifying a fall in the mean porto systemic gradient pressure of about 49,69% (from 18,98 mmHg to 9,55 mmHg) that was statistically significant. Additionally, it was observed clinical improvement in 35 patients (79,55%), being 24 out of 28 patients with bleeding, 8 out of 11 patients with refractory ascite and 3 out of 5 with hepatorenal syndrome. The postoperative general mortality was 13,64% being the highest incidence in patients classified as Child-Pugh C (45,45%). The analysis of the clinical variables that characterized the patients showed that the most relevant factors associated to a poor outcome were high serum levels of bilirubin and creatinin and prolonged prothrombin time. Seventy five percent of patients survived during the first year of observation. The mean survival time was 11,5 months for patients Child-Pugh A, 10,97 months for patients Child-Pugh B and only 5,90 months for patients Child-Pugh C, evidencing a significant statistical difference in patients survival related to the Child-Pugh status. Complications directly related to the procedure were observed in 14 cases (31,80%). Additionally it was seen the occlusion of TIPS in 5 patients. Conclusion: TIPS is efficient to reduce portal pressure and to solve clinical complications in patients with chronic liver disease and portal hypertension. Complications and morbidity and mortality related to the procedure can be considered acceptable. Mortality was directly influenced by some clinical factors such as Child-Pugh class C, high bilirubin and creatinine levels which means, that a good selection should be done when TIPS is indicated. TIPS is a valuable tool to preserve patients who are in the waiting list for a liver transplantation<br>Mestrado<br>Cirurgia<br>Mestre em Cirurgia
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Pellissier, Pierre-Edouard. "Les complications locales de la sclérose endoscopique des varices oesophagiennes dans la prévention secondaire des hémorragies digestives par hypertension portale : à propos de 63 cas." Saint-Etienne, 1990. http://www.theses.fr/1990STET6404.
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Lima, Talles Bazeia. "Segurança do risedronato na cirrose hepática análise endoscópica de pacientes com varizes esofágicas em tratamento de osteoporose /." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/153765.
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Previous issue date: 2018-02-28<br>Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)<br>A osteoporose é uma complicação frequente da cirrose hepática (CH) que pode levar a fraturas, comprometendo a qualidade e a expectativa de vida. Bisfosfonatos são frequentemente utilizados para reduzir o risco de fraturas por osteoporose, mas podem provocar danos à mucosa gastrointestinal. O objetivo deste estudo foi avaliar a segurança do risedronato em pacientes com CH e varizes de esôfago (VE). De 354 pacientes com CH, 164 foram considerados elegíveis e alocados de acordo com a densidade mineral óssea após densitometria. No grupo intervenção, 52 indivíduos com osteoporose receberam tratamento com risedronato oral (35 mg / semana), suplementação de cálcio e vitamina D. No grupo controle, 51 indivíduos com osteopenia receberam apenas suplementação de cálcio e vitamina D. Todos foram submetidos a endoscopias de vigilância durante 1 ano e à densitometria ao final do estudo. A média etária e a proporção de mulheres foi maior no grupo intervenção. O MELD (Model of End-Stage Liver Disease) no grupo intervenção e controle foi 9,6 (5,9-15,5) e 10,3 (6,5-19), respectivamente (p= 0,047). O grupo controle teve mais casos de doença hepática alcoólica (p< 0,001). Em ambos os grupo a maioria dos indivíduos tinha classificação Child-Pugh A e VE de baixo risco de sangramento. Não houve diferença entre os grupos quanto aos achados endoscópicos observados durante a intervenção. Não houve hemorragia digestiva alta no grupo intervenção, mas em 2 casos do grupo controle. O grupo intervenção foi o único em que houve ganho de massa óssea (coluna lombar): média do T score -3,2 e -2,7 pré e pós-tratamento, respectivamente (p= 0,001). Porém houve mais casos de artralgia e mialgia nesse grupo (p= 0,031 e 0,006), respectivamente. Esses resultados, de efeito prático imediato, sugerem que o risedronato é seguro na CH compensada com VE de baixo risco de sangramento sob vigilância endoscópica.<br>Osteoporosis is a common complication of liver cirrhosis that can lead to fractures, compromising quality of life and survival rate. Bisphosphonates are often used to reduce the risk of fractures caused by osteoporosis, but can lead to digestive mucosal damage. The aim of this study was to evaluate the safety of risedronate for patients with cirrhosis and esophageal varices. Of the 354 cirrhotic patients invited to participate, 164 were considered eligible and allocated according to the bone mineral density after densitometry. In the intervention group, 52 individuals with osteoporosis received oral risedronate 35 mg weekly plus calcium and vitamin D supplementation. In the control group, 51 individuals with osteopenia received only calcium and vitamin D supplementation. All the subjects underwent surveillance endoscopies within 1 year and another bone densitometry at the end of the trial. The mean age and the proportion of women were higher in the intervention group. The Model of End-Stage Liver Disease (MELD) scores in the intervention and control group were 9.6 (5.9-15.5) and 10.3 (6.5-19), respectively (p= 0.047). The control group had more subjects with alcoholic liver disease (p< 0.001). In both groups the majority of the individuals had Child-Pugh A classification and low-risk bleeding esophageal varices. There was no difference between the groups regarding esdoscopic findings during the intervention. There was no upper gastrointestinal bleeding in the intervention group but 2 in the control group. The intervention group was the only one that achieved increase in bone density (lumbar spine): Mean T score -3,2 and -2,7 pre and post treatment, respectively (p= 0,001). However, arthralgia and myalgia were more frequent in this group (p= 0.031 and 0.006 respectively). The results, which are of immediate practical effect, suggest that risedronate is safe in compensated liver cirrhosis with low-risk bleeding esophageal varices under endoscopic surveillance and allowed a gain of bone mass.<br>FAPESP: 2016/07117-9
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Monici, Leonardo Trevizan. "Coagulação por microondas versus escleroterapia apos ligadura elastica endoscopica para tratamento de varizes esofagicas em cirroticos." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309110.
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Previous issue date: 2007<br>Resumo: Antecedentes: A ligadura elástica endoscópica (LE) é um dos métodos mais utilizados para profilaxia secundária de sangramento por varizes esofágicas, mas a recorrência varicosa é freqüente após este tratamento. A associação de LE com escleroterapia endoscópica por injeção (EI) reduz este risco. A coagulação por microondas (MC) é um método térmico de terapia endoscópica e sua associação com LE poderia reduzir o risco de recidiva de varizes. Objetivo: Avaliar a segurança e a eficácia da associação de LE com MC para o tratamento e prevenção da recidiva de varizes esofágicas em pacientes cirróticos com antecedente de hemorragia por varizes, em comparação com a associação de LE com EI. Desenho: Estudo prospectivo randomizado e controlado. Pacientes: Setenta pacientes cirróticos com episódio prévio de sangramento por varizes esofágicas tratados com LE até que restassem apenas vasos de fino calibre. Métodos: Trinta e seis pacientes foram randomizados para receber EI com etanol absoluto (Grupo A) e trinta e quatro para receber MC (Grupo B) até a completa erradicação das varizes. Foi realizado seguimento endoscópico para detecção de recidiva. Principais parâmetros avaliados: Ressangramento, complicações das intervenções, mortalidade dos pacientes, recorrência de varizes e fatores que afetam a recidiva. Resultados: Não houve diferença significativa entre os grupos A e B em termos de recidiva de varizes (27,7% versus 17,6%), ressangramento (8,3% versus 0%) e mortalidade em um tempo médio de seguimento de 34,9 ± 11,4 meses. As complicações foram raras e nenhuma diferença significativa foi verificada entre os grupos. A presença de varizes gástricas afetou a recorrência de varizes com um risco relativo de 3,9 vezes (IC de 1,14 a 13,1). Conclusões: A aplicação de MC no esôfago após a LE é segura e eficaz no tratamento de varizes esofágicas. Não houve diferença nas taxas de recorrência comparando-se a associação de LE com MC em relação à LE com EI. A presença de varizes gástricas aumenta o risco de recidiva<br>Abstract: Background: Endoscopic band ligation (LE) is an usual choice for secondary prophylaxis of esophageal variceal bleeding but recurrence of varices is frequent after this treatment. Association of EBL with endoscopic injection sclerotherapy (EI) reduces this risk. Microwave coagulation (MC) is a thermal endoscopic therapy method and its association with EBL may reduce the risk of variceal recurrence. Objective: Evaluate the safety and efficacy of the association of LE with MC for treatment and prevention of recurrence of esophageal varices compared to the association of LE with EI. Design: Randomized controlled trial. Patients: Seventy cirrhotic patients with previous bleeding from esophageal varices treated with EBL until only thin vessels remained. Interventions: Thirty-six patients were randomized to receive EI with ethanol (Group A) and thirty-four to receive MC (Group B) until complete eradication. Endoscopic follow-up was performed to detect recurrence. Main outcome measurements: Rebleeding, intervention complications, mortality, variceal recurrence and factors that affect recurrence. Results: No significant difference was found between Groups A and B in variceal recurrence (27.7% vs. 17.6%), rebleeding (8.3% vs. 0%) and mortality in a mean follow-up of 34.9 ± 11.4 months. Complications were rare and no difference was observed between both groups. The presence of gastric varices affects recurrence with an odds ratio of 3.9 (1.14 to 13.1). Conclusions: Application of MC in the esophagus after band ligation is safe and effective. There is no difference in recurrence rates comparing the association of LE with MC to LE plus EI. The presence of gastric varices increases the risk of esophageal varices recurrence<br>Mestrado<br>Clinica Medica<br>Mestre em Clinica Medica
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Joaquim, Fabiana Lopes. "Úlcera metafísica: um constructo teórico a partir da percepção existencial de pessoas com úlceras venosas crônicas." Universidade Federal Fluminense, 2017. https://app.uff.br/riuff/handle/1/5965.
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Previous issue date: 2017<br>Doutorado Acadêmico em Ciências do Cuidado em Saúde<br>As úlceras venosas crônicas acometem os membros inferiores e provocam nas pessoas dificuldades relacionadas à necessidade de adaptação à condição clínica, levando estes a repensar valores, entender a enfermidade, seguir procedimentos e enfrentar o olhar da sociedade repleta de mitos e estigmas. Frente ao exposto, esta pesquisa teve como objeto a percepção existencial das pessoas que vivem com úlceras venosas crônicas e a tese defendida e comprovada resultante do construto teórico é que através da compreensão da percepção existencial das pessoas que vivem com úlceras venosas crônicas, pautada em uma perspectiva merleaupontiana, que prioriza as experiências vividas, é possível identificar a presença das “úlceras metafísicas”, o que auxilia a produzir em coexistência o cuidado a partir do contexto sociocultural, contribuindo para o fortalecimento das Ciências do Cuidado em Saúde. O objetivo geral foi compreender como as pessoas adultas e idosas percebem sua existência frente às úlceras venosas; e os objetivos específicos foram descrever como as pessoas com úlceras venosas crônicas percebem a própria existência e analisar esta percepção à luz da fenomenologia de Merleau-Ponty. É um estudo fenomenológico, descritivo, com abordagem qualitativa. O campo de pesquisa foi o Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro (HUAP), localizado em Niterói/RJ. Participaram 36 pacientes que vivem com úlceras venosas crônicas e que aceitaram participar da pesquisa. A coleta de dados ocorreu por meio do instrumento de protocolo de pesquisa; da entrevista fenomenológica, operacionalizada pela pergunta: Como é para o (a) senhor (a) viver com a(s) lesão/lesões da úlcera venosa? ; do instrumento de registro das expressões relacionadas à narratividade do corpo; e pela observação não estruturada. O parecer de aprovação ocorreu junto ao Comitê de Ética e Pesquisa do HUAP sob o número 1.581.358 e CAAE: 51981915.6.0000.5243. Os dados inerentes às entrevistas e aos instrumentos de registro das expressões relacionadas à narratividade do corpo se complementaram e se reafirmaram entre si, resultando em três categorias: 1) Vivendo com a doença: sinais e sintomas como marcas de uma vida - os resultados apontam que o desvelar existencial dos participantes têm repercussões inerentes ao estado patológico, levando à invisibilidade social e à indissociação das feridas; 2) O ser além da lesão e a afetividade - como consequência desta percepção, as pessoas com as referidas lesões passam a sentir necessidade da afetividade perdida por consequência do corpo lesionado. Frente a esta realidade, família e amigos são amparo no “mundo da vida”, auxiliando nas potencialidades; 3) A volta ao passado e o atual isolamento social - recordar a existência antes da lesão traz à tona a questão do isolamento social. Ante a este isolamento e às percepções do “mundo da vida”, evidencia-se a importância da espiritualidade como sustentáculo. Conclui-se que a existência das pessoas que apresentam as úlceras venosas vai além da lesão física, fazendo com que estas necessitem se reencontrar corporalmente, dando um novo sentido ao “mundo percebido”, minimizando, e por que não dizer cicatrizando? as “úlceras metafísicas” originadas da incompreensão do mundo ao ser que se encontra com a lesão.<br>Chronic venous ulcers affect the lower limbs and cause difficulties related to the need to adapt to the clinical condition in people, leading them to rethink values, understand the disease, follow procedures and face the eyes of society full of myths and stigmas. In view of the above, this research had as its object the existential perception of people living with chronic venous ulcers and the thesis defended and proven, resulting from the theoretical construct, that it is possible to identify the presence of “metaphysical ulcers” by understanding the existential perception of people living with chronic venous ulcers, based on a Merleau-Pontian perspective that prioritizes lived experiences. This helps to produce, in coexistence, care from the sociocultural context, contributing to the strengthening of Health Care Sciences. The general objective was to understand how adults and elderly people perceive their existence in the face of venous ulcers; and the specific objectives were to describe how people with chronic venous ulcers perceive their own existence and analyze this perception in the light of Merleau-Ponty‟s phenomenology. It is a phenomenological, descriptive study, using a qualitative approach. The research area was the Wound Repair Ambulatory of the Antônio Pedro University Hospital (HUAP), located in Niterói/RJ. Participants were 36 patients living with chronic venous ulcers who accepted to participate in the study. Data collection took place through: a research protocol instrument; the phenomenological interview, operationalized by the question: How do you live with the venous ulcer lesion(s)? ; the instrument of registration of expressions related to the narrativity of the body; and unstructured observation. The approval opinion was presented to the Ethics and Research Committee of HUAP under number 1.581.358 and CAAE: 51981915.6.0000.5243. The data inherent to the interviews and the recording instruments of the expressions related to the narrativity of the body were complemented and reaffirmed among themselves, resulting in three categories: 1) living with disease: signs and symptoms as marks of a life - the results indicate that the existential disclosure of the participants have inherent repercussions to the pathological state, leading to social invisibility and the indissociation of the wounds; 2) the individual beyond injury and affectivity - as a consequence of this perception, people with those injuries begin to feel the need for the affection lost as a consequence of the injured body. Faced with this reality, family and friends are supported in the “life world”, helping in the potentialities; 3) the return to the past and the current social isolation - remembering the existence before the injury brings up the question of social isolation. Faced with this isolation and perceptions of the “life world”, the importance of spirituality as a support is evident. It is concluded that the existence of people with venous ulcers goes beyond physical injury, causing them to find themselves again in their bodies, giving a new meaning to the “perceived world”, minimizing, and why not saying, healing “metaphysical ulcers” originated from the incomprehension of the world by the individual who is injured.
Books on the topic "Varicus"
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Ramelet, Albert-Adrien. Les varices et télangiectasies. Le Quotidien du médecin, 2003.
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Reynolds, Julia. The Light Inside the Shadow: An Anthology of Works by BlueBoard Members. ANU Press, 2013.
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Nicolás, Kanellos, ed. Hispanic American literature: A brief introductionand anthology. HarperCollins College Publishers, 1995.
Find full textBook chapters on the topic "Varicus"
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Davenport, Andrew, Todd W. Costantini, Raul Coimbra, et al. "Varices." In Encyclopedia of Intensive Care Medicine. Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-00418-6_3364.
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Bonder, Alan, Ignacio Alfaro, and Andres Cardenas. "Varices." In Endoscopy in Liver Disease. John Wiley & Sons, Ltd, 2017. http://dx.doi.org/10.1002/9781118660799.ch4.
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van Gunst, S. G., V. G. Pigmans, and C. J. in ’t Veld. "Varices." In NHG Standaarden voor praktijkassistente en -ondersteuner 2009. Bohn Stafleu van Loghum, 2009. http://dx.doi.org/10.1007/978-90-313-6916-4_78.
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Rosa, Isadora, and António Dias Pereira. "Varices." In Encyclopedia of Pathology. Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-40560-5_1690.
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Boons, Lidwien. "Varices." In Kleine Kwalen en alledaagse klachten bij zwangeren. Bohn Stafleu van Loghum, 2019. http://dx.doi.org/10.1007/978-90-368-2407-1_39.
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van Gunst, S. G., and V. G. Pigmans. "Varices." In NHG-standaarden voor de praktijkassistente 2014. Bohn Stafleu van Loghum, 2013. http://dx.doi.org/10.1007/978-90-368-0485-1_87.
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van Gunst, S. G., and V. G. Pigmans. "Varices." In NHG-Standaarden voor praktijkassistente 2010. Bohn Stafleu van Loghum, 2010. http://dx.doi.org/10.1007/978-90-313-7755-8_80.
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van Gunst, S. G., and V. G. Pigmans. "Varices." In NHG-Standaarden voor de praktijkassistente 2013. Bohn Stafleu van Loghum, 2013. http://dx.doi.org/10.1007/978-90-313-9987-1_88.
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Boons, Lidwien. "Varices." In Kleine Kwalen en alledaagse klachten bij zwangeren. BSL Media & Learning, 2025. https://doi.org/10.1007/978-90-368-3107-9_35.
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Luo, Xuefeng, and Li Yang. "Gastric Varices and Ectopic Varices." In Portal Hypertension VII. Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-08552-9_44.
Full textConference papers on the topic "Varicus"
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Garg, Nitin, Mayank Choudhary, Kriti Mehendiratta, Kabeer Rajput, and Deepak Raj Gupta. "Gate controllability enhancement in various GAA MOSFETS and their dependence on various parameters." In 2024 15th International Conference on Computing Communication and Networking Technologies (ICCCNT). IEEE, 2024. http://dx.doi.org/10.1109/icccnt61001.2024.10726059.
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Klyuchevskii, Anatoly. "Baikal rift system: signs of nonlinear self-organizing system." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-14.
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Serebrennikov, SP, and C. Batsayhan. "The study of ancient and modern deformations in fault zones in Mongolia." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-22.
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Trofimenko, SV, and VG Bykov. "The ripple effect in the space-time seismicity north-east of the Amur plate." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-41.
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Ovsyuchenko, A. N., and E. A. Rogozhin. "Operational results of the geological survey of the strongest earthquakes in Russia in the beginning of the XXI century." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-01.
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Bataleva, Elena A., and Vladislav Batalev. "Magnetotelluric monitoring of the stress-strain state of the medium (for the Central Tien Shan)." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-02.
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Ryapolova, Julia, E. V. Deev, E. V. Sokol, S. N. Koch, and G. G. Rusanov. "Quaternary travertine Kurai fault zone (Gorny Altai): lithotypes, petrographic and geochemical characteristics." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-03.
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Rasskazov, Sergey, E. P. Chebykin, A. M. Ilyasova, I. S. Chuvashova, E. N. Vodneva, and A. K. Seminsky. "Identification of strain effects in the activities of 234U / 238U in groundwater on the profile Irkutsk Baikal." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-04.
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Nazarevich, Andrew, and L. E. Nazarevich. "Seismicity seismotectonics, the perturbations of source zones and earthquake prediction (for example, studies in the Carpathian region of Ukraine)." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-05.
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Seminsky, Constantine, C. Demberel, A. A. Bobrov, and D. Mungunsuren. "Faulting in the crust Uulaanbaatarskogo geodynamic polygon (Mongolia): results of the study of radon and seismic activity." In Geological and geophysical environment and the various manifestations of seismicity. LJournal, 2015. http://dx.doi.org/10.18411/svfu1230915-06.
Full textReports on the topic "Varicus"
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Ahrens L., R. Thern, and W. van Asselt. Orbits at Various Tunes. Office of Scientific and Technical Information (OSTI), 1987. http://dx.doi.org/10.2172/1131565.
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Allen, Jonathan, Daniel Kleppner, Henry I. Smith, et al. Submicron Structures and Various Technology. Defense Technical Information Center, 1990. http://dx.doi.org/10.21236/ada226438.
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Oberst, R. D., Jill Marie Bieker, and Caroline Ann Souza. Inactivation of various influenza strains to model avian influenza (Bird Flu) with various disinfectant chemistries. Office of Scientific and Technical Information (OSTI), 2005. http://dx.doi.org/10.2172/877140.
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Yang, Dali, Michelle H. Yang, and Alexander Steven Edgar. Characterization of Various Materials Using Refractometry. Office of Scientific and Technical Information (OSTI), 2018. http://dx.doi.org/10.2172/1469513.
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Dongarra, J. J., and T. H. Dunigan. Message-passing performance of various computers. Office of Scientific and Technical Information (OSTI), 1996. http://dx.doi.org/10.2172/219525.
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Azmy, Y. Y. (Method for solving various transport equations). Office of Scientific and Technical Information (OSTI), 1990. http://dx.doi.org/10.2172/7272684.
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Malensek, A. J., and A. J. Elwyn. CASIM input parameters for various materials. Office of Scientific and Technical Information (OSTI), 1994. http://dx.doi.org/10.2172/10176127.
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Bhattarai, Rabin, Yufan Zhang, and Jacob Wood. Evaluation of Various Perimeter Barrier Products. Illinois Center for Transportation, 2021. http://dx.doi.org/10.36501/0197-9191/21-009.
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Construction activities entail substantial disturbance of topsoil and vegetative cover. As a result, stormwater runoff and erosion rates are increased significantly. If the soil erosion and subsequently generated sediment are not contained within the site, they would have a negative off-site impact as well as a detrimental influence on the receiving water body. In this study, replicable large-scale tests were used to analyze the ability of products to prevent sediment from exiting the perimeter of a site via sheet flow. The goal of these tests was to compare products to examine how well they retain sediment and how much ponding occurs upstream, as well as other criteria of interest to the Illinois Department of Transportation. The products analyzed were silt fence, woven monofilament geotextile, Filtrexx Siltsoxx, ERTEC ProWattle, triangular silt dike, sediment log, coconut coir log, Siltworm, GeoRidge, straw wattles, and Terra-Tube. Joint tests and vegetated buffer strip tests were also conducted. The duration of each test was 30 minutes, and 116 pounds of clay-loam soil were mixed with water in a 300 gallon tank. The solution was continuously mixed throughout the test. The sediment-water slurry was uniformly discharged over an 8 ft by 20 ft impervious 3:1 slope. The bottom of the slope had a permeable zone (8 ft by 8 ft) constructed from the same soil used in the mixing. The product was installed near the center of this zone. Water samples were collected at 5 minute intervals upstream and downstream of the product. These samples were analyzed for total sediment concentration to determine the effectiveness of each product. The performance of each product was evaluated in terms of sediment removal, ponding, ease of installation, and sustainability.
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Delyea, Cole. Latin Jazz Sound Characteristics (Various Artists). ResearchHub Technologies, Inc., 2024. http://dx.doi.org/10.55277/researchhub.jo9s63ck.
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Delyea, Cole. Gospel Music Sound Characteristics (Various artists). ResearchHub Technologies, Inc., 2024. http://dx.doi.org/10.55277/researchhub.naofz1z4.
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