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Puech-Leão P, Bregalda Neves C, Simão da Silva E. Angioplasty and Stent Placement in Symptomatic Internal Carotid Occlusion. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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2
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Pagani E, Glina S, Puech-Leão P, Strunz CM, Chao S, Timo-Iaria C. Anxiety and high plasma catecholamines do not impair pharmaco-induced erection of psychogenic erectile dysfunctional patients. Int J Impot Res 2003; 15:282-6. [PMID: 12934057 DOI: 10.1038/sj.ijir.3901002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to assess the influence of anxiety and plasma catecholamines on the pharmaco-induced erection of psychogenic erectile dysfunction (ED) patients. A total of 23 patients with psychogenic ED aged from 19 to 43 y were submitted to: (1) anxiety evaluation by the Spielberger's State and Trait Anxiety Inventory-STAI; (2) intracavernous injection of PGE1 10 microg+phentolamine 1 mg with the response monitored by Rigiscan; (3) blood sampling from cavernous bodies and cubital vein for adrenaline and noradrenaline levels determination by high performance liquid chromatography. The whole procedure was done in a single clinical setting at the same day. We found no significant correlation between the erection rigidity and the cavernous or peripheral catecholamines or between erection rigidity and anxiety scores. Some patients showed rigid erections despite high anxiety scores or penile catecholamine levels while others, with incomplete erections, had much smaller levels. These results are suggestive of a more complex mechanism controlling the penile sympathetic responsiveness in psychogenic ED patients.
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Affiliation(s)
- E Pagani
- São Paulo University Heart Institute and H.Ellis Institute, São Paulo, Brazil.
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Rojas Martinez R, Puech-Leão P, Guimarães PM, Netto BM. Persistence of the embryonic lateral marginal vein: report of two cases. Rev Hosp Clin Fac Med Sao Paulo 2001; 56:159-62. [PMID: 11781597 DOI: 10.1590/s0041-87812001000500006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.
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Affiliation(s)
- R Rojas Martinez
- Department of Vascular Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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4
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Abstract
PURPOSE To describe endovascular repair of a large aneurysm of the innominate artery in a patient with episodes of transient cerebral ischemia. CASE REPORT A 44-year-old man with a history of transient hemiparesis and aphasia demonstrated a large mass in the upper right hemithorax on chest radiography. Systolic brachial pressure in the right arm was 100 mm Hg versus 130 mm Hg in the left. Imaging disclosed a large 12-mm-diameter aneurysm involving the brachiocephalic trunk 1 cm above its origin and the first portion of the right subclavian artery, which was occluded after the dilated segment. The aneurysm was treated with a tapered endograft made from polyester graft attached to a Palmaz stent inserted via a carotid artery arteriotomy. The distal end of the graft was anastomosed to the common carotid artery. Completion angiography showed exclusion of the aneurysm, which has been confirmed by imaging at 21 months. After 2 years, the patient is free from neurological symptoms and has a strong carotid pulse; no arm claudication developed. CONCLUSIONS Endovascular correction of innominate artery aneurysms is feasible whenever there is an adequate proximal neck for attachment. In these cases, thoracotomy may be avoided.
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Affiliation(s)
- P Puech-Leão
- Vascular Surgery Division, Faculty of Medicine, University of São Paulo, Brazil.
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Wolosker N, Nishinari K, Nakano L, Anacleto AM, Puech-Leão P. The use of stents in the treatment of traumatic intimal flaps: case report. Rev Hosp Clin Fac Med Sao Paulo 2001; 56:119-22. [PMID: 11717719 DOI: 10.1590/s0041-87812001000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment of arterial traumatic intimal lesions is controversial due to its unknown natural history. Current therapeutical options include arterial reconstruction and clinical observation. The idea of using stents to correct intimal flaps is based on their use to correct dissections, flaps, and arterial irregularities after angioplasty. We report the successful treatment of a traumatic intimal flap of the superficial femoral artery, caused by gunshot trauma, with a Palmaz stent in the acute period. One year after the operation, a duplex scan revealed normal flow in the artery and complete exclusion of the intimal flap; distal pulses were palpable, and the patient was completely asymptomatic.
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Affiliation(s)
- N Wolosker
- Division of Vascular Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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6
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Wolosker N, Nishinari K, Ferrari FB, Nakano L, Halpern H, Puech-Leão P. Infrarenal aortic aneurysm repair by retroperitoneal approach combined with laparoscopic cholecystectomy: two case reports. J Laparoendosc Adv Surg Tech A 2001; 11:115-7. [PMID: 11327125 DOI: 10.1089/109264201750162455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Simultaneous repair of abdominal aortic aneurysm and treatment of cholelithiasis by the transperitoneal approach is controversial because of the risk of prosthesis infection. We report two patients who underwent a successful combined procedure using a retroperitoneal approach for the aortic aneurysm repair and a laparoscopic approach to the cholecystectomy. This combined approach reduces the risk of infection of the aortic prosthesis and is associated with a rapid return of normal peristalsis.
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Affiliation(s)
- N Wolosker
- Division of Vascular Surgery, University of São Paulo Medical School, Brazil.
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7
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Abstract
Dilatation of the common iliac arteries is one of the most frequent causes for exclusion of patients in a series of endovascular correction of abdominal aortic aneurysms (AAAs). In this article we describe the banding technique we use to constrict the large iliac arteries. Four patients underwent endovascular treatment for AAAs with bifurcated grafts. Five of the eight common iliac arteries were 16 to 20 mm in diameter and were constricted around the endoprosthesis by banding with two cotton tapes through a retroperitoneal access. An angioplasty balloon was used as a counterresistance inside the graft. Completion angiogram and postoperative computed tomographic scans showed no endoleak in all cases. No complications occurred in the follow-up (3-10 months). Banding of the common iliac artery is an efficient procedure for endoluminal correction of AAAs when the diameter of the common iliac arteries is greater than 16 mm and less than 20 mm.
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Affiliation(s)
- P Puech-Leão
- Division of Vascular Surgery, Department of Vascular Surgery, University of São Paulo Faculty of Medicine, São Paulo, Brazil.
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8
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Abstract
OBJECTIVES to investigate the presence of a ground reaction force pattern specific to the patient with unilateral intermittent claudication (IC), and the relationship of this pattern with onset of claudication. DESIGN identification of impulse pattern during gait of lower limbs with and without ischaemia, in patients with unilateral IC and controls. METHODS thirty patients with unilateral IC and six peripheral arterial disease non-claudicant patients had their gait recorded using the F-Scan system during a treadmill test. Their plantar impulse pattern was calcuated. Examined lower limbs were subdivided into groups: ischaemic limbs (30), contralateral limbs (30) and lower limbs of patients without IC (12). Two impulse patterns were found: the descending one, where impulse values decrease during gait, and the non-descending one, where these values do not decrease during gait. The numerical distribution of patterns among limb groups was determined and their ratios compared. Correlation between claudication onset and impulse pattern was also investigated. RESULTS most ischaemic limbs exhibited a descending pattern, in contrast with control and contralateral non-ischaemic limbs (p<0.02). There was no relationship between impulse pattern and claudication onset. CONCLUSIONS ischaemic lower limbs present the descending pattern of plantar impulse. No relationship exists between this pattern and claudication pain.
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Affiliation(s)
- R M Ayzin Rosoky
- Division of Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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9
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Puech-Leão P. We are clickable. Rev Hosp Clin Fac Med Sao Paulo 2000; 55:43. [PMID: 10959122 DOI: 10.1590/s0041-87812000000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wolosker N, Rosoky RA, Nakano L, Basyches M, Puech-Leão P. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication. Rev Hosp Clin Fac Med Sao Paulo 2000; 55:61-4. [PMID: 10959125 DOI: 10.1590/s0041-87812000000200005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to determine whether the ankle-brachial index (ABI) could be used to predict the prognosis for a patient with intermittent claudication (IC). We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.
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Affiliation(s)
- N Wolosker
- Department of Surgery, Vascular Surgery Section, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Brazil
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11
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Presti C, Puech-Leão P, Albers M. Superficial femoral eversion endarterectomy combined with a vein segment as a composite artery-vein bypass graft for infrainguinal arterial reconstruction. J Vasc Surg 1999; 29:413-21. [PMID: 10069905 DOI: 10.1016/s0741-5214(99)70269-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the results of composite artery-vein bypass grafting for infrainguinal arterial reconstruction. METHODS This study was designed as a retrospective case series in two tertiary referral centers. Forty-eight of 51 patients underwent the procedure of interest for the treatment of ischemic skin lesions (n = 42), rest pain (n = 3), disabling claudication (n = 1), and infected prosthesis (n = 2). The intervention used was infrainguinal composite artery-vein bypass grafting to popliteal (n = 18) and infrapopliteal (n = 30) arteries, with an occluded segment of the superficial femoral artery prepared with eversion endarterectomy and an autogenous vein conduit harvested from greater saphenous veins (n = 43), arm veins (n = 3), and lesser saphenous veins (n = 2). The main outcome measures, primary graft patency rates, foot salvage rates, and patient survival rates, were described by means of the life-table method for a mean follow-up time of 15.5 months. RESULTS The cumulative loss during the follow-up period was 6% and 24% at 6 and 12 months, respectively. The primary graft patency rates, the foot salvage rates, and the patient survival rates for patients with popliteal grafts were 60.0% +/- 9.07%, 75.7% +/- 9.18%, and 93.5% +/- 6.03%, respectively, at 1 month; 53.7% +/- 11.85%, 68.9% +/- 12.47%, and 85. 0% +/- 9.92% at 1 year; and 46.7% +/- 18.19%, 68.9% +/- 20.54%, and 53.1% +/- 17.15% at 5 years. For infrapopliteal grafts, the corresponding estimates were 72.4% +/- 7.06%, 72.9% +/- 6.99%, and 92.7% +/- 4.79% at 1 month; 55.6% +/- 10.70%, 55.4% +/- 10.07%, and 77.9% +/- 9.02% at 1 year; and 33.6% +/- 22.36%, 55.4% +/- 30.20%, and 20.8% +/- 9.89% at 5 years. CONCLUSION The composite artery-vein bypass graft is a useful autogenous alternative for infrainguinal arterial reconstruction when a vein of the required quality is not available or when the procedure needs to be confined to the affected limb.
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Affiliation(s)
- C Presti
- Vascular Surgery Section, Department of Surgery, University of São Paulo Medical School, Brazil
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Costa VP, Kuzniec S, Molnar LJ, Cerri GG, Puech-Leão P, Carvalho CA. The effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease. An investigation by color Doppler imaging. Ophthalmology 1999; 106:306-10. [PMID: 9951482 DOI: 10.1016/s0161-6420(99)90086-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN Prospective. PARTICIPANTS A total of 17 consecutive patients with severe OCAD and neurologic symptoms (with a history of transitory ischemic attack or cerebral vascular accident) participated. INTERVENTION All 17 patients underwent carotid endarterectomy. The CDI of both orbits was performed by one masked investigator before surgery and at 1 week and 1 month after surgery. MAIN OUTCOME MEASURES Peak systolic velocity, end diastolic velocity, and resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters at all intervals. RESULTS Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries increased significantly 1 week and 1 month after carotid endarterectomy (P < 0.05). After surgery, the resistive indices in the central retinal and temporal short posterior ciliary arteries decreased significantly at both intervals (P < 0.05). The six patients who had reversed ophthalmic artery flow before surgery showed forward ophthalmic artery flow after carotid endarterectomy. The contralateral orbits showed no significant hemodynamic change after endarterectomy (P < 0.05). CONCLUSIONS Hemodynamic changes in patients with severe OCAD undergoing carotid endarterectomy suggest improvement in the ipsilateral retrobulbar blood flow.
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Affiliation(s)
- V P Costa
- Department of Ophthalmology, University of São Paulo, Brazil
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Abstract
OBJECTIVE To evaluate duplex ultrasonography for diagnosis of arterial trauma in limbs and neck. METHOD Fifty-one wounds in 47 patients, with indication for arteriography, were prospectively studied and grouped according to the presence (PCS group: 21 wounds, 41.2%) or absence (ACS group: 30 wounds, 58.8%) of clinical signs of arterial injury. All underwent duplex ultrasonography and arteriography. RESULTS Arteriography disclosed arterial injury in 21 wounds, of which 19 were visualized by duplex ultrasonography. In the other 30 wounds neither methods disclosed any arterial injury. The sensitivity of duplex ultrasonography was 90.5%, the specificity was 100% and the accuracy was 96.1%. In PCS group duplex ultrasonography showed 14 injuries (93.3%) and one false-negative result, and in ACS group, five injuries (83.3%) and one false-negative result in the ACS group. CONCLUSIONS Duplex ultrasonography reproduces the results of arteriography as a non-invasive diagnostic method in trauma of the limbs and neck.
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Affiliation(s)
- S Kuzniec
- Vascular Surgery Discipline of the Surgery Department, University of São Paulo School of Medicine, Brazil
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Waksman H, Aun R, Kauffman P, Puech-Leão P. [Evaluation of middle cerebral artery blood flow velocity with transcranial Doppler in carotid endarterectomy]. Rev Hosp Clin Fac Med Sao Paulo 1998; 53:139-45. [PMID: 10436647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Thirty patients, submitted to 34 carotid endarterectomies, from September, 1992 to April, 1996, on Hospital Albert Einstein, São Paulo, have been studied. In these surgeries, Middle Cerebral Artery (MCA) was miniaturized with Transcranial Doppler (TCD). The purpose of this study were to verify the relationship between MCA blood flow velocity with postoperative neurologic complications: studying the velocity variations with risk of cerebral low perfusion and carotid stump back pressure, during carotid clamping; confirming that the TCD information, could show when it is necessary to use shunting, and its efficiency; and to know whether the method could detect intraoperative embolization. The equipment used was a Transpect TCD-EME 2000. During surgery, when carotid stump back pressure was bellow of 54.4 mmHg, Pruitt-Inahara shunt was applied. The flow velocity value observed with TCD was divided in 3 parts: phase 1, basal, since anesthesy induction until carotid clamping; phase 2, clamping, during the period when the carotid artery was occluded; phase 3, post-declamping, from the time the carotid artery was declamping until the end of surgery. The MCA flow velocity was available on three phases, in cm/s and percentually on phases 2 and 3, in relation to basal phase. The embolizations, detected by TCD, were classified in: a) a few embolizations in less than 10 second period, b) many embolizations in more than 10 second period. Based on the results obtained, its possible to conclude that the MCA flow velocity is related to the risk of cerebral low perfusion during carotid clamping; it was not possible to stablish any relation of MCA flow velocity to carotid stump back pressure; the TCD informs when the use of shunt is necessary and its efficiency; the postoperative neurologic complications were caused by embolizations. The conclusion is that the TCD is useful and easily applicated on carotid endarterectomy.
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Affiliation(s)
- H Waksman
- Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo
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Guimarães PC, Puech-Leão P, Netto BM, Wolosker N, Aun R, Yamamoto LU. Variations in white blood count, thromboxane B2 levels and hematocrit in chronic venous hypertension. SAO PAULO MED J 1998; 116:1721-6. [PMID: 9876450 DOI: 10.1590/s1516-31801998000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze variations in leukocyte count and thromboxane B2 production in the femoral vein of patients with chronic venous hypertension (CVH). DESIGN Prospective clinical study, controlled, non randomized and open. LOCATION Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, referral center, university hospital. PARTICIPANTS 15 patients with recurring stasis ulcer were analyzed, selected randomly from the venous diseases outpatient center, and 4 without lower limb venous alterations were also analyzed. INTERVENTION Blood samples from the femoral and brachial veins were drawn following supine and 45 degrees reverse Trendelenburg. MAIN OUTCOMES MEASURES Direct leukocyte count and analysis of the thromboxane B2 with enzyme linked immunosorbent assay test. RESULTS After 30 minutes in reverse Trendelenburg, patients with CVH showed a leukocyte count reduced by +/- 27% (p = 0.02) and thromboxane B2 levels increased by +/- 158% (p = 0.02). CONCLUSIONS We suggest that future studies of medications for stasis ulcers include their effects on leukocyte entrapment and thromboxane B2 production in the lower limb venous system.
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Affiliation(s)
- P C Guimarães
- Vascular Surgery Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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Costa VP, Kuzniec S, Molnar LJ, Cerri GG, Puech-Leão P, Carvalho CA. Collateral blood supply through the ophthalmic artery: a steal phenomenon analyzed by color Doppler imaging. Ophthalmology 1998; 105:689-93. [PMID: 9580236 DOI: 10.1016/s0161-6420(98)94025-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging. DESIGN The design was a case-controlled study. PARTICIPANTS Among 56 consecutive patients with severe (>70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow. INTERVENTION Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed. MAIN OUTCOME MEASURES Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. RESULTS Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P < 0.05). CONCLUSION This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.
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Affiliation(s)
- V P Costa
- Department of Ophthalmology, University of São Paulo, Brazil
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Abstract
PURPOSE To identify the predictive risk factors for rupture of thoracoabdominal aortic aneurysms (TAA). METHODS Thirty-one patients with TAA who did not have the indications for surgical repair of the aneurysm were selected. Inclusion criteria were maximum diameter less than 60 mm, refusal of surgical treatment, and high surgical risk. The selected patients participated in a prospective follow-up study for a median period of 47 months and underwent at least two thoracoabdominal computed tomographic scans a year to measure transverse and anteroposterior diameters. Identification of the predictive factors associated with rupture was undertaken with multivariate analysis by means of Cox regression model. RESULTS During the study period five patients underwent elective repair, six died of unrelated causes, nine had aneurysms that ruptured (all with diameters greater than 50 mm), and 11 reached the end of the study without rupture or surgical management. Initial anteroposterior diameter and annual growth rate of the anteroposterior diameter were the variables associated with rupture of the TAA according to the multivariate statistical analysis by means of Cox regression model. CONCLUSION We recommend elective repair for a fit patient with asymptomatic TAA with an initial anteroposterior diameter of 50 mm only when there is an annual growth rate of at least 10 mm. Patients with similar diameters but with smaller annual growth rates should be treated conservatively and undergo thoracoabdominal computed tomography every 6 months. Patients with an initial anteroposterior diameter of 60 mm and an annual growth rate of 6 mm should undergo surgical treatment. These guidelines for elective repair of TAA are based on the results of a relatively small series and have to be carefully individualized for each patient.
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Affiliation(s)
- A C Lobato
- Department of Surgery, University of São Paulo School of Medicine, São Paulo SP, Brazil
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Abstract
PURPOSE To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. METHODS AND RESULTS A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. CONCLUSIONS Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.
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Affiliation(s)
- P Puech-Leão
- Department of Surgery, University of São Paulo Faculty of Medicine, Brazil.
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19
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de Andrade MF, Nishinari K, Puech-Leão P. [Intertrigo in patients with lower limb lymphedema. Clinical and laboratory correlation]. Rev Hosp Clin Fac Med Sao Paulo 1998; 53:3-5. [PMID: 9659735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cutaneous lesions in the interdigital spaces are commonly seen in lymphedema patients and their prevention and suitable care is one of the cornerstones of any successful treatment, by preventing acute inflammations and additional worsening in limb volume and fibrosis. We obtained swab specimens from the interdigital area from 21 patients followed in the Lymphedema Unit of the Department of Vascular Surgery of the University of São Paulo; thirteen of them had lesions suggestive of tinea pedis. The pathological agent could be identified in 11 out of these 13 patients: fungal infection alone was responsible for seven lesions, Corynebacterium minutissimum for another two and both agents were isolated from two patients. Although two patients had evident clinical lesion of the skin, no fungal or bacterial species could be isolated. From the eight patients without interdigital lesions, Candida and Corynebacterium was found in one. We concluded that clinical examination has a high sensibility (84%) and specificity (91%) but the high prevalence of Corynebacterium minutissimum suggests that adequate treatment should follow careful laboratory examination.
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Affiliation(s)
- M F de Andrade
- Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo
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Costa VP, Kuzniec S, Molnar LJ, Cerri GG, Puech-Leão P, Carvalho CA. Clinical findings and hemodynamic changes associated with severe occlusive carotid artery disease. Ophthalmology 1997; 104:1994-2002. [PMID: 9400757 DOI: 10.1016/s0161-6420(97)30066-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN A case-controlled study. PARTICIPANTS Fifty-six consecutive patients with severe OCAD and an age- and sex-matched control group consisting of 56 healthy patients without OCAD were studied. INTERVENTION All 112 patients underwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator. MAIN OUTCOME MEASURES Peak systolic velocity, end diastolic velocity, and the resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters measured in patients with severe OCAD with those obtained in the control group. The hemodynamic parameters of patients with asymmetric OCAD (stenosis > 70% in one internal carotid artery and stenosis < 50% in the contralateral artery) were also compared. In an attempt to determine risk factors associated with the ocular ischemic syndrome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS. RESULTS Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the central retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Younger age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carotid stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.038) were significant risk factors for OIS. CONCLUSIONS Patients with severe OCAD show hemodynamic changes that suggest reduced retrobulbar blood flow. Patients with severe bilateral OCAD, high-grade carotid stenosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.
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Affiliation(s)
- V P Costa
- Department of Ophthalmology, University of São Paulo, Brazil
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21
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Salles LR, Puech-Leão P, Netto BM, Kuzniec S, Aun R, Mariño JC, de Aguiar ET. [Risk factors of stroke in carotid endarterectomy]. Rev Hosp Clin Fac Med Sao Paulo 1997; 52:291-4. [PMID: 9629737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to find risk factors of carotid endarterectomy related stroke (CERS), 102 consecutive carotid endarterectomies, performed within two years on 95 patients were analyzed. Age, sex, diabetes, smoking, hypertension, degree of the operated and non operated carotid stenosis, previous neurological symptoms, anesthesia, protamine, cerebral monitoring, shunt, patch, post op. hypertensive crisis and clamping time were compared with the incidence of CERS. Four patients had major neurological deficits, two of which were fatal (3.92%). Six patients had minor transitory neurological deficit (5.8%). The use of patch and a long clamping time were the only identifiable statistically significant factors (p = 0.016 and p = 0.0053 respectively) that increase the odds of a CERS.
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Affiliation(s)
- L R Salles
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo
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22
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Abstract
In order to test the capability of a reinjection to improve an incomplete pharmaco-induced erection, we submitted 30 impotent patients, with incomplete erectile responses to 10 micrograms PGE1 + 1 mg phentolamine, to a second injection of 15 micrograms PGE1 + 1.5 mg phentolamine + 30 mg papaverine, fifteen minutes after the first injection. Twenty-one patients improved their erection including nine who achieved complete rigidity. We conclude that incomplete pharmaco-induced erections can frequently be improved by reinjection.
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Affiliation(s)
- E Pagani
- Instituto H. Ellis, Sao Paulo, Brazil
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23
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Pagani E, Puech-Leão P, Glina S, Reis J. 5-16-07 Penile autonomic and somatic tests in impotent diabetics. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Pagani E, Puech-Leão P, Glina S, Reis J. 5-16-06 Penile sympathetic skin response and neurogenic impotence. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Arterial embolisms in the lower limbs occur frequently, and are of great interest to the vascular surgeon. The authors studied 159 cases of arterial embolisms in lower limbs from January 1991 to July 1993. Ages varied from 12 to 98, with a mean of 58. Eighty patients were male and 78 were female. In most cases, etiology of the embolus was well-established, and mainly caused (78 percent) by atrial fibrillation. Occlusion was most frequent in the femoral artery (53.4 percent). All patients presented severe lower limb ischemia, but not gangrene, on admission. The duration of ischemia, between the onset of symptoms and the liberation of arterial flow, was in most patients (67.9 percent) less than 24 hours. All patients were submitted to lower limb embolectomy with the Fogarty catheter, of which 70.9 percent were done through the femoral artery. Fasciotomy was performed on 48 patients due to a compartimental syndrome. Nineteen patients died immediately after operation; 68.4 percent due to heart failure. Twenty-three (16.4 percent) of the 140 surviving patients (150 operated limbs) were submitted to amputations after the occlusion of artery branches, which had undergone embolectomies. One hundred and twenty-seven limbs (84.6 percent) were preserved in 117 patients (83.5 percent). Eleven cases (7.3 percent) required repeated surgery with the Fogarty catheter. The patients with muscle tenderness, paralysis, or ischemia lasting longer than 24 hours had worse results in relation to the preservation of the limb (p < 0.05). We conclude that patients who present lower limb embolisms, are in good clinical condition, and who do not have any necrosis in the limbs, have good outcomes as to limb preservation, along with low complication rates, after embolectomy with the Fogarty catheter. Limb preservation was significantly higher in patients who did not present muscle tenderness, and who had normal motor activity and a ischemia duration of less than 24 hours.
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Affiliation(s)
- N Wolosker
- General Hospital of the College of Medicine of the University of São Paulo, Brazil
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Kuzniec S, Estenssoro AE, Lima MDP, Mendes CM, Puech-Leão P. [Abdominal aortic aneurysm infected with Campylobacter fetus spp fetus. Report of a case and review of the literature]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:284-8. [PMID: 8578095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aortic aneurysm infected with Campylobacter fetus spp fetus is rare, the first case having been reported in 1971. We present a case of abdominal aortic aneurysm, with a history of abdominal pain, fever and chills, with identification of this gram negative bacillus in the culture of the aortic wall and visualization of the microorganism in histological examination. Surgical correction was performed by interposition of a dracon prosthetic graft. The patient had a good postoperative course, receiving prolonged antibiotic therapy (intravenous cephalothin for 7 days and oral erythromycin for 6 months), remaining without symptoms for 12 months, when the follow-up was ended. In the 11 cases reported in the literature, 9 presented fever, suggesting the infectious etiology. Four were operated on with the aneurysm already ruptured and all of them died. The other patients, with non-ruptured aneurysms at the time of the operation, were all symptomatic, and they survived. Anatomic reconstruction was performed in 4 cases, with dacron graft interposition and antibioticotherapy, without reported signs of infection on the follow-up (6 to 45 months). Aortic infection with Campylobacter fetus spp fetus is potentially fatal, needing immediate surgical treatment. It is possible to have good long term results with an anatomically placed prosthetic graft and antibiotic therapy.
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Affiliation(s)
- S Kuzniec
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo
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Guimarães PC, Puech-Leão P, Netto B, Chao S, Molnar L, Benabou J. [Action of elastic compression on valvular closing time]. Rev Hosp Clin Fac Med Sao Paulo 1995; 50:264-6. [PMID: 8578090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The study was carried out in ten patients with venous insufficiency of limbs verified by clinical standards, photopletismography and descending venogram witch, previous venous stasis ulcer and branquial/ankle doppler index greater than 0.9. The valvular closing time (VCT) was measured with Duplex scanning, at the level of popliteal vein bellow de lesser safenous vein entrance. The ten patients showed an initial VCT greater than 0.5 sec, with the utilization of the elastic compression and new measurement of VCT, seven showed a normalization of VCT (valves lower than 0.5 sec). The elastic compression of limbs is efficient in reducing the venous reflux and it could be evaluated individually with a non invasive test--The Duplex scanning.
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Affiliation(s)
- P C Guimarães
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo
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Glina S, Silva MF, Puech-Leão P, Reis JM, Lucon AM. Veno-occlusive dysfunction of corpora cavernosa: comparison of diagnostic methods. Int J Impot Res 1995; 7:1-10; discussion 11. [PMID: 7670587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and the intracavernous pressure drop test are the most used tests for the diagnosis of venoocclusive dysfunction. To verify whether patients show equivalent results in each of these four tests, and to ascertain whether there is any influence of the sequence of the exams over the results, 123 male patients with erectile dysfunction, aged 21 to 82 years (mean 48), were evaluated. All were submitted to the four tests in randomized sequence. Two criteria were used to define the normal results of pump cavernosometry and pharmaco-cavernosometry, both based on patients with normal veno-occlusive function. The incidence of normal results varied from 6.5% in pump cavernosometry according to criterion I to 64.2% in pharmaco-cavernosometry according to criterion II. Results of the four tests agreed completely (all normal or all abnormal) in 43.9% of the patients when criteria I was used and 58.3% with criteria II. Incidence of normal results in each test did not vary according to the sequence in which the exams were done. Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and intracavernous pressure drop test did not show equivalent results for individual patients. Results were not influenced by the sequence of the tests.
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Affiliation(s)
- S Glina
- Instituto H. Ellis, São Paulo, Brasil
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Abstract
According to the physiopathological process beyond it, veno-occlusive dysfunction (VOD) may be classified in organic or functional VOD. The former is caused by lack of control of smooth muscle relaxation, while the later is related with morphological alterations of the corporeal tissue. The differential diagnosis of those two types is fundamental when venous surgery is to be discussed. Functional VOD may be treated with sex therapy, while in organic VOD, surgical treatment may be considered. The experience with venous surgery for impotence at the H. Ellis Institute was not encouraging. Although a few patients were cured, the long-term follow-up showed that only 9 out of 57 patients were able to have a normal sexual life. New diagnostic tools, as well as a better understanding of the erectile mechanism, may lead to a better selection of cases with an improvement of the results in the future. Today, venous surgery remains as an option to patients with organic VOD, who are willing to accept a 45% probability of improvement for a few months, having been informed about all the other options in the treatment of erectile disorders.
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Affiliation(s)
- P Puech-Leão
- Department of Vascular Surgery, University of Saõ Paulo School of Medicine, Brazil
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Glina S, Puech-Leão P, dos Reis JM, Reichelt AC, Chao S. Surgical exclusion of the crural ending of the corpora cavernosa: late results. Eur Urol 1990; 18:42-4. [PMID: 2401305 DOI: 10.1159/000463864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty-three patients with corpora cavernosa incompetence responsive to perineal compression were submitted to surgical exclusion of the crural ending of the corpora cavernosa. There were two mild complications: perineal hematoma and incisional pain for 10 days. At the end of the first month, 65% of the patients claimed better erections, and the late good results were 47.7%, with an average follow-up period of 18.9 months. Three of the failed cases were later submitted to a penile prosthesis implantation.
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Affiliation(s)
- S Glina
- Instituto H. Ellis, São Paulo, Brazil
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31
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Puech-Leão P. [Male sexual impotence]. AMB Rev Assoc Med Bras 1990; 36:35-7. [PMID: 1962880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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32
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Puech-Leão P. The noninvasive diagnosis of vasculogenic impotence. J Vasc Surg 1988; 7:820. [PMID: 3373624 DOI: 10.1016/0741-5214(88)90052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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33
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Abstract
Blood drainage of the corpora cavernosa is made by the deep dorsal vein and by the deep crural veins. The root of the corpora can be compressed against the ischium during papaverine test or cavernometry. In a series of patients with cavernosal leakage, this maneuver demonstrated that the crural edge of the corpora is the point of leakage in many of them. Exclusion of the crural edge by ligation of the corpora proximal to the entrance of the arterial supply caused improvement of erections in 7 of 8 patients.
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34
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Arap S, de Campos-Freire G, Glina S, Pompeo AC, Campagnari JC, Puech-Leão P, Borrelli M. [Comparative study of penile arterial pressure and sexual potency in patients subjected to single or multiple renal transplantation]. Rev Hosp Clin Fac Med Sao Paulo 1986; 41:36-8. [PMID: 3547592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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35
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Grinberg M, Kajita LJ, Esteves Filho A, Mansur AJ, Puech-Leão P, Bellotti G, Pileggi F. [Digital subtraction angiography in the demonstration of arterial lesions associated with infective endocarditis]. Arq Bras Cardiol 1985; 44:125-30. [PMID: 3910000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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36
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Albers MT, Langer B, Aun R, Mariño JC, de Luccia N, Puech-Leão P, Presti C. [Endarterectomized arteries as vascular substitutes in reconstructive aorto-iliac and femoro-popliteal surgery]. Rev Hosp Clin Fac Med Sao Paulo 1984; 39:6-11. [PMID: 6484441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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37
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Puech-Leão P, Puech-Leão LE, Albers MT. [Penile revascularization in the treatment of vasculogenic sexual impotence]. Rev Hosp Clin Fac Med Sao Paulo 1984; 39:23-5. [PMID: 6484436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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38
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Puech-Leão LE, Puech-Leão P, Albers MT. [Repairing vascular surgery in the treatment of sexual impotence]. AMB Rev Assoc Med Bras 1983; 29:123-124. [PMID: 6606194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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39
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Albers MT, Puech-Leão P, Manasterski J, Wolosker M, Puech-Leão LE. [Changes in male sexual function after aortofemoral bypass]. Rev Hosp Clin Fac Med Sao Paulo 1981; 36:167-71. [PMID: 7330558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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40
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Abrantes Erhart E, Castro Ferreira M, Marchese AT, Puech-Leão P. Microsurgical nerve sutures improve rehabilitation and may prevent Wallerian degeneration. Arq Neuropsiquiatr 1975; 33:193-9. [PMID: 1101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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41
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Castro Ferreira M, Puech-Leão P, Tedesco Marchese AJ. [Microsurgery of the vas deferens. Experimental study]. AMB Rev Assoc Med Bras 1975; 21:243-4. [PMID: 1081706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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42
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Erhart EA, Ferreira MC, Marchese AT, Azze RJ, Puech-Leão P. [Nerve sutures with a microsurgical technic that may avoid complete Wallerian degeneration]. AMB Rev Assoc Med Bras 1975; 21:213-7. [PMID: 802730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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