Endoluminal Vacuum Therapy (EVAC) in Managing Esophagogastric Anastomosis Fistula / Terapia de vacío endoluminal (Endo-Vac) en el manejo de la fístula de anastomosis esofagogástrica

Abstract Endoluminal vacuum therapy (EVAC) is a promising alternative for the endoscopic management of gastrointestinal fistulas or perforations that do not respond to endoscopic procedures using clips and stents or are even refractory to surgical procedures. In this case report, we describe the successful endoscopic closure of an esophagogastric anastomotic fistula using EVAC, connected to a vacuum system through a probe in the cavity, which did not close with clip management given the friability and edema of the peri-wound tissue. In conclusion, it is a successful alternative to treat these complications, which are sometimes difficult to resolve.

Resumen La terapia de vacío endoluminal (Endo-Vac) es una alternativa promisoria en el manejo endoscópico de las fístulas o perforaciones gastrointestinales, que no responden a procedimientos endoscópicos cuando se utilizan técnicas como clips, stents o incluso refractarias a procedimientos quirúrgicos. En este reporte de caso describimos el cierre endoscópico exitoso de una fístula anastomótica esofagogástrica, utilizando la terapia Endo-Vac, conectada a un sistema de vacío mediante una sonda en la cavidad, que no presentó cierre inicial a manejo con clips, dada la friabilidad y el edema del tejido perilesional. Se concluye que esta es una alternativa exitosa en el cierre de estas complicaciones, que en ocasiones son de difícil resolución.

Use of Vacuum-suction in Depressed Skull Fractures ­ Case Report and Technical Nuances of Nonoperative Treatment

Up to 20% of victims from skull fractures are represented by the pediatric population, and 50% of these lesions are depressed skull fractures. The treatment is multimodal in nature, ranging from conservative treatment to open surgical repair. The last one is associated, although in a small proportion, to complications, such as infections, hematomas and even death, besides the risks of the anesthetic procedure itself. The authors of the present article present a case report of the successful treatment of a depressed skull fracture in a newborn patient, using the vacuum-suction technique. The use of vacuum-suction may be beneficial for the pediatric patients, as it is a quick, non-invasive procedure, without the need for general anesthesia.

Vacuum physiotherapy after first stage buccal mucosa graft (BMG) urethroplasty in children with proximal hypospadias

ABSTRACT Introduction To assess the feasibility of vacuum physiotherapy meant to decrease graft contraction and recurrent penile curvature (PC), hence successful tubularization and a straight penis in patients underwent two-stage buccal mucosa graft (BMG) urethroplasty, in proximal hypospadias repair. Material and methods Between January 2014 and July 2018, 59 two-stage BMG urethroplasties performed at our referral center, were included in the study. The parents were counseled to use the vacuum device between the two stages. An internal, self-administered, semiquantitative, non-validated questionnaire was designed to record parent and patient adherence to the vacuum physiotherapy and parent satisfaction. Success rate of graft tubularization, curvature correction rates, and status of early (4 months) postoperative urinary stream were evaluated. Results Of 45/59 (76.3%) who returned the questionnaire, 77.8% followed the recommended physiotherapy protocol using the vacuum device. 93.3% of parents replied that the use of the vacuum was easy or moderately easy. None of the parents interrupted the physiotherapy because of perceived difficulty or intolerability. 100% of parents would have repeated the physiotherapy, if they had to. Overall, success rate of tubularization was 98.3% (58/59), complete curvature correction was achieved in 88.2% (52/59) of patients, and 79.7% (47/59) of patients showed a straight and powerful early post-operative urinary stream. Conclusions Physiotherapy with the vacuum device is safe, easy and practically feasible. Our vacuum physiotherapy protocol had high compliance rate. Vacuum physiotherapy should be considered for further assessment in patients undergoing two stage hypospadias repair using buccal mucosa.

Factores de predisposición genéticos y epigenéticos de los trastornos de ansiedad / Genetic and epigenetic predisposing factors of anxiety disorders

Los trastornos de ansiedad constituyen un grupo de alteraciones psicológicas y neurológicas que representan varias formas de miedo y ansiedad anormales o patológicas (Orozco & Baldares, 2012). Aun cuando alrededor del 14% de la población del planeta ha sufrido algún trastorno de ansiedad, las causas que desencadenan el mismo no son del todo claras (Posada, 2013). La aproximación clásica de los estudios para la identificación de los factores de predisposición de estos trastornos neuropsiquiátricos se ha orientado a las teorías de la personalidad como la Teoría de Eysenck (Mitchell & Kumari, 2016) y la Teoría Bio-Psicológica de la personalidad (Knyazev, Pylkova, Slobodskoj-Plusnin, Bocharov, & Ushakov, 2015). Sin embargo, a partir de estos estudios, han surgido nuevas propuestas involucrando los aspectos neuroanatómicos y neurofuncionales. La transmisión eléctrica y química de la información y como esta se asocia a distintas conductas demuestran la relevación de la regulación de la producción y recaptación de neurotransmisores en sistema nervioso central (SNC). Aunque esta regulación se encuentra directamente relacionada con la expresión genética, em tanto se han identificado ciertos genes candidatos que aportan un porcentaje a esta predisposición, estos no son totalmente determinantes. Actualmente, dado a este vacío, se ha comenzado a investigar la influencia de factores epigenéticos que en conjunto con los factores genéticos permitirían ampliar la explicación de los factores de predisposición de ciertos trastornos neuropsiquiátricos que anteriormente eran considerados de etiología ambiental

Anxiety disorders are a group of psychological and neurological disorders that represent various forms of abnormal or pathological fear and anxiety (Orozco & Baldares, 2012). Even though around 14% of the planet's population has suffered from an anxiety disorder, the causes that trigger it are not entirely clear (Posada, 2013). The classical approach of studies for the identification of the predisposing factors of these neuropsychiatric disorders has been oriented to personality theories such as the Eysenck Theory (Mitchell & Kumari, 2016) and the Bio-Psychological Theory of Personality (Knyazev, Pylkova, Slobodskoj-Plusnin, Bocharov, & Ushakov, 2015). However, from these studies, new proposals involving neuroanatomical and neurofunctional aspects have emerged. The electrical and chemical transmission of the information and how it is associated with different behaviors demonstrate the relief of the regulation of the production and reuptake of neurotransmitters in the central nervous system (CNS). This regulation is directly related to genetic expression, however, although certain candidate genes that contribute a percentage to this predisposition have been identified, these are not totally determinant (Montag, Reuter, Newport, Elger & Weber, 2008). Currently, given this gap, we have begun to investigate the influence of epigenetic factors that, together with genetic factors, would allow us to expand the explanation of the predisposing factors of certain neuropsychiatric disorders that were previously considered to be of environmental etiology

Continuous peritoneal lavage with vacuum peritoneostomy: an experimental study

OBJECTIVE: Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy. METHOD: Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT. RESULTS: Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces. CONCLUSION: Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.

Survival of Salmonella spp. in minced meat packaged under vacuum and modified atmosphere

Abstract The effect of different modified atmosphere packaging regimes on the behavior of Salmonella spp. on minced meat was studied. Minced meat was experimentally contaminated with a Salmonella spp. cocktail (S. Enteritidis, S. Typhimurium, S. Infantis and S. Arizonae), packaged under vacuum or modified atmosphere with initial headspaces containing 20%O2/50%CO2/30%N2 and 20%O2/30%CO2/50%N2) and stored at 3 ± 1 °C for 12 days. Samples were analyzed for Salmonella spp., viable and lactic acid bacteria count every third day. Salmonella spp. counts decreased during storage in all packaging types, with reductions of about 1.5 log CFU/g. A significant difference (p < 0.01) was noted between Salmonella spp. counts in meat packaged in vacuum and modified atmospheres, although there was no significant difference in Salmonella spp. count between meat packaged in 50%CO2, and meat packaged in 30%CO2. At the end of the study, there were significant differences (p < 0.01; p < 0.05) in total viable and lactic acid bacterial counts between meat packaged in vacuum and modified atmosphere, and the lowest counts were noted in meat packaged in modified atmosphere with 50%CO2.

Removing the by-products acetic acid and NH4 + from the L-tryptophan broth by vacuum thin film evaporation during L-tryptophan production

Background: During L-tryptophan production by Escherichia coli, the by-products, acetic acid and NH4 +, accumulate in the fermentation broth, resulting in inhibited cell growth and activity and decreased L-tryptophan production. To improve the L-tryptophan yield and glucose conversion rate, acetic acid and NH4 + were removed under low-temperature vacuum conditions by vacuum scraper concentrator evaporation; the fermentation broth after evaporation was pressed into another fermenter to continue fermentation. To increase the volatilisation rate of acetic acid and NH4 + and reduce damage to bacteria during evaporation, different vacuum evaporation conditions were studied. Results: The optimum operating conditions were as follows: vacuum degree, 720 mm Hg; concentration ratio, 10%; temperature, 60°C; and feeding rate, 300 mL/min. The biomass yield of the control fermentation (CF) and fermentation by vacuum evaporation (VEF) broths was 55.1 g/L and 58.3 g/L at 38 h, respectively, (an increase of 5.8%); the living biomass yield increased from 8.9 (CF) to 10.2 pF (VEF; an increase of 14.6%). L-tryptophan production increased from 50.2 g/L (CF) to 60.2 g/L (VEF) (an increase of 19.9%), and glucose conversion increased from 18.2% (CF) to 19.5% (VEF; an increase of 7.1%). The acetic acid concentrations were 2.74 g/L and 6.70 g/L, and the NH4 + concentrations were 85.3 mmol/L and 130.9 mmol/L in VEF and CF broths, respectively. Conclusions: The acetic acid and NH4 + in the fermentation broth were quickly removed using the vacuum scraper concentrator, which reduced bacterial inhibition, enhanced bacterial activity, and improved the production of L-tryptophan and glucose conversion rate.

Cupping therapy and chronic back pain: systematic review and meta-analysis / Ventosaterapia e dor crônica nas costas: revisão sistemática e metanálise / Ventosaterapia y dolor crónico en la espalda: revision sistemática y metanálisis

ABSTRACT Objectives: to evaluate the evidence from the literature regarding the effects of cupping therapy on chronic back pain in adults, the most used outcomes to evaluate this condition, the protocol used to apply the intervention and to investigate the effectiveness of cupping therapy on the intensity of chronic back pain. Method: systematic review and meta-analysis carried out by two independent researchers in national and international databases. Reference lists of systematic reviews were also explored. The quality of evidence was assessed according to the Jadad scale. Results: 611 studies were identified, of which 16 were included in the qualitative analysis and 10 in the quantitative analysis. Cupping therapy has shown positive results on chronic back pain. There is no standardization in the treatment protocol. The main assessed outcomes were pain intensity, physical incapacity, quality of life and nociceptive threshold before the mechanical stimulus. There was a significant reduction in the pain intensity score through the use of cupping therapy (p = 0.001). Conclusion: cupping therapy is a promising method for the treatment of chronic back pain in adults. There is the need to establish standardized application protocols for this intervention.

RESUMO Objetivos: avaliar as evidências da literatura a respeito dos efeitos da ventosoterapia sobre a dor crônica nas costas em adultos, os desfechos mais utilizados para avaliar essa condição, o protocolo utilizado para aplicação da intervenção e investigar a eficácia da ventosaterapia sobre a intensidade dor crônica nas costas. Método: revisão sistemática e metanálise, realizadas por dois pesquisadores independentes, em bases de dados nacionais e internacionais. Listas de referências de revisões sistemáticas também foram exploradas. A qualidade das evidências foi avaliada através da escala Jadad. Resultados: foram identificados 611 estudos e 16 foram incluídos na análise qualitativa e 10 na análise quantitativa. A ventosaterapia demonstrou resultados positivos sobre a dor crônica nas costas. Não há uma padronização no protocolo de tratamento. Os principais desfechos avaliados foram a intensidade da dor, a incapacidade física, a qualidade de vida e o limiar nociceptivo perante o estímulo mecânico. Houve redução significativa do escore de intensidade da dor mediante uso da ventosaterapia (p=0.001). Conclusão: a ventosaterapia é um método promissor para o tratamento da dor crônica nas costas em adultos. Faz-se necessário estabelecer protocolos de aplicação padronizados para a intervenção.

RESUMEN Objetivos: evaluar las evidencias de la literatura al respecto de los efectos de la ventosoterapia sobre el dolor crónico en la espalda en adultos, los resultados más utilizados para evaluar esa condición, el protocolo utilizado para la aplicación de la intervención e investigar la eficacia de la ventosaterapia sobre la intensidad de dolor crónico en la espalda. Método: revisión sistemática y metanálisis, realizadas por dos investigadores independientes, en bases de datos nacionales e internacionales. Listas de referencias de revisiones sistemáticas también fueron exploradas. La calidad de las evidencias fue evaluada por la escala Jadad. Resultados: fueron identificados 611 estudios y 16 fueron incluidos en el análisis cualitativo y 10 en el análisis cuantitativo. La ventosaterapia demostró resultados positivos sobre el dolor crónico en la espalda. No hay una estandarización en el protocolo de tratamiento. Los principales resultados evaluados fueron la intensidad del dolor, la incapacidad física, la calidad de vida y el umbral nociceptivo frente al estímulo mecánico. Hubo reducción significativa del puntaje de intensidad del dolor mediante uso de la ventosaterapia (p=0.001). Conclusión: la ventosaterapia es un método promisor para el tratamiento del dolor crónico en la espalda en adultos. Es necesario establecer protocolos de aplicación estandarizados para la intervención.

Qualidade de ovos produzidos e submetidos à diferentes condições de armazenamento na Amazônia Ocidental, Acre - Brasil / Quality of eggs produced and submitted to different storage conditions in the western Amazon, Acre - Brazil / Calidad de huevos producidos y sometidos a diferentes condiciones de almacenamiento en Amazonia Ocidental, Acre ­ Brasil

O objetivo deste trabalho foi analisar a influência de diferentes tempos e condições de armazenamento sobre a qualidade de ovos produzidos na cidade de Rio Branco, Acre. Seis condições de armazenamento, "Temperatura ambiente, refrigerado, a vácuo, vácuo + sílica, vácuo + absorvedor de O2, vácuo + sílica + absorvedor de O2" foram analisados em sete períodos (zero, sete, 14, 21, 28, 35 e 42 dias). Avaliou-se a Unidade Haugh, Índice de gema, pH da clara e da gema. As condições e os períodos de armazenamento influenciaram de forma significativa na redução dos valores de unidade Haugh e índice de gema, e aumento do pH da clara. Os ovos sofreram menores influências das características analisadas, quando armazenados sob o sistema de refrigeração e embalados a vácuo. Os valores médios do pH da gema apresentaram certa estabilidade, variando de 6,14 até 6,78 oscilando os valores entre os períodos de armazenamento. O armazenamento a vácuo independente de ser acompanhado ou não por sílica ou absorvedor de oxigênio, apresentou resultados superiores quando comparados aqueles submetidos à temperatura ambiente.(AU)

The purpose of this paper was to analyze the influence of different storage times and conditions on the quality of eggs produced in the city of Rio Branco, in the state of Acre. Six storage conditions, namely ­ At room temperature, Refrigerated, Vacuum, Vacuum + Silica, Vacuum + O2 absorber, Vacuum + Silica + O2 absorber ­were analyzed in seven periods (zero, seven, 14, 21, 28, 35 and 42 days). Haugh Unit, Yolk Index, White and Yolk pH were evaluated. Conditions and storage periods significantly influenced the reduction of Haugh unit values and yolk index, as well as increasing the pH of the egg white. The eggs were less affected when stored under refrigeration and packed under vacuum. The pH values of the yolk presented certain stability, varying from 6.14 to 6.78, oscillating between the storage periods. Vacuum storage, whether or not accompanied by silica or oxigen absorber, presented superior results when compared to those submitted to room temperature.(AU)

El objetivo de este estudio ha sido analizar la influencia de diferentes tiempos y condiciones de almacenamiento sobre la calidad de huevos producidos en la ciudad de Rio Branco, Acre. Seis condiciones de almacenamiento, "Temperatura ambiente, refrigerado, a vacuo, vacuo + sílice, vacuo + absolvedor de O2, vacuo + sílice + absolvedor de O2" fueron analizados en siete períodos (cero, siete, 14, 21, 28, 35 y 42 días). Se evaluó la Unidad Haugh, Índice de yema, pH de la clara y de la yema. Las condiciones y los períodos de almacenamiento influyeron de forma significativa en la reducción de los valores de unidad Haugh e índice de yema, y aumento del pH de la clara. Los huevos sufrieron menores influencias de las características analizadas, cuando almacenados bajo el sistema de refrigeración y empaquetados a vacuo. Los valores medianos del pH de la yema presentaron cierta estabilidad, variando de 6,14 hasta 6,78, oscilando los valores entre los periodos de almacenamiento. El almacenamiento a vacuo independiente de ser acompañado o no por sílice o absolvedor de oxigero, presentó resultados superiores cuando comparados a los sometidos a temperatura ambiente.(AU)

Characterization of the spoilage lactic acid bacteria in “sliced vacuum-packed cooked ham”

The lactic acid bacteria are involved with food fermentation and in such cases with food spoilage. Considering the need to reduce the lactic acid bacteria growth in meat products, the aim of this work was to enumerated and investigated the lactic acid bacteria present on sliced vacuum-packed cooked ham stored at 4 °C and 8 °C for 45 days by phenotypic and molecular techniques. The quantification showed that the lactic acid bacteria were present from the first day with mean count of 1.98 log cfu/g for the four batches analyzed. The lactic acid bacteria grew rapidly on the samples, and plate counts around 7.59 log cfu/g and 8.25 log cfu/g were detected after 45 days of storage at 4 °C and 8 °C, respectively; storage temperatures studied showed significant influence on the microorganism in study growth. The predominant lactic acid bacteria associated with the spoilage samples at one day of storage includes Lactobacillus sp., the phenotypic overlap Leuconostoc/Weissella sp. and Enterococcus sp. At 45 days of storage at 4 and 8 °C the mainly specie was Lactobacillus curvatus, following by Lactobacillus sakei and Leuconostoc mesentereoides; the Enterococcus sp. was not present in the samples.

Sistema a vácuo na circulação extracorpórea: vantagens e desvantagens / Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

Revisão sistemática sobre drenagem assistida a vácuo na circulação extracorpórea, demonstrando seus benefícios, desvantagens, por relatos de casos e evidências sobre seus efeitos na microcirculação. Realizou-se pesquisa sistemática, no período de 1997-2012, nas bases de dados do PubMed-Medline, Lilacs e SciELO. Termos: "circulação extracorpórea", "vácuo", "drenagem", "cirurgia cardíaca" e suas correspondentes traduções, em condições variadas. Dos 70 artigos selecionados, 26 foram incluídos na revisão. Embora a drenagem assistida a vácuo possua potencial significante de complicações e exija tecnologia e profissionalismo respectivo adequado, prevaleceu na literatura revisada o conceito de que a drenagem assistida a vácuo contribuiu na redução no índice de transfusões, hemodiluições, melhor campo operatório, não aumento de hemólise significativa, redução de complicações pós-cirúrgicas, uso de menor prime e uso de cânulas de menor calibre.

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

Biopsias mamarias bajo resonancia magnética, experiencia preliminar / Breast biopsies performed under MRI, preliminary experience

La resonancia magnética (RM) mamaria se está convirtiendo en una herramienta de trabajo frecuentemente utilizada en nuestro medio. Existe un grupo de lesiones que sólo pueden ser identificadas por esta técnica, RMI only. Entre 14 a 20 por ciento de ellas serán malignas, según las diferentes series publicadas. Este tipo de lesiones requieren de biopsia guiada bajo RM. Pacientes y Métodos: se realizó revisión retrospectiva descriptiva de las biopsias asistidas por vacío realizadas en nuestra institución (período entre agosto de 2008 y junio de 2013). Resultados: El 0,3 por ciento (11) de las biopsias realizadas en nuestra institución fueron realizadas bajo RM, en 9 mujeres. En el 55 por ciento de los casos la indicación de la resonancia en la que se detectó la lesión biopsiada, fue etapificación de cáncer mamario recientemente diagnosticado; en el 100 porciento de los casos se realizó ultrasonido de segunda mirada, las lesiones tenían un tamaño promedio de 15 mm (4-29), un 63,6 por ciento fueron nódulos y el resto captaciones tipo no masa. La duración de la biopsia varió entre 40 y 130 minutos, un 27,2 por ciento resultaron lesiones malignas; 36,4 por ciento lesiones de alto riesgo; y 36,4 por ciento benignas. En el 45,5 por ciento el resultado de la biopsia bajo resonancia cambia la conducta quirúrgica. De las 7 lesiones operadas hubo subestimación en un caso de cáncer ductal in situ, que resultó cáncer ductal infiltrante. En el resto la histología quirúrgica fue idéntica a la de la biopsia bajo resonancia. Conclusión: Las biopsias bajo resonancia son infrecuentes, consumen un tiempo considerable, su correlación histológica es muy confiable y cambia la conducta quirúrgica casi en la mitad de los casos, lo cual tiene implicancias en el pronóstico de la paciente.

Abstract. Breast MRI is becoming a frequently used working tool in our environment. A group of lesions exist that can only be identified by this technique, "MRI only". Between 14-20 % of these will be malignant, according to various published series. Such lesions require biopsy guided under MRI. Patients and Methods: A descriptive retrospective review of vacuum-assisted biopsies was performed at our institution (period between August 2008 and June 2013). Results: 0.3 % (11) of the biopsies performed at our institution were done so under MRI, in 9 women. In 55% of the cases the resonance indication in which the biopsied lesion was detected, was newly diagnosed staging of breast cancer; in 100% of the cases a second-look ultrasound was performed, the lesions had an average size of 15 mm (4-29), 63.6% were nodules and the remainder other non-mass type deposits. The duration of the biopsy varied between 40 and 130 min, 27.2% were malignant lesions, 36.4 % high-risk lesions, and 36.4 % benign. In 45.5% the result of the biopsy performed under MRI changed the surgical procedure. Of the 7 operated lesions there was an underestimation in one case of ductal carcinoma in situ, which resulted being invasive ductal carcinoma. In the remainder, the surgical histology was identical to that of the biopsy performed under magnetic resonance. Conclusion: Biopsies performed under MRI are infrequent, they take considerable time, their histological correlation is very reliable and it changes the surgical procedure in almost half of the cases, which has implications in the prognosis of the patient.

Terapia por pressão subatmosférica (VAC) em lesões traumáticas agudas extensas / Subatmospheric pressure therapy (VAC) in extensive acute traumatic lesions

CONTEXTO: Os princípios básicos do tratamento de feridas baseiam-se em limpeza, desbridamento, redução do odor, da dor e tratamento da infecção ou redução da colonização. Outro princípio importante da terapia tópica de feridas é a oclusão com as coberturas. Os produtos para tratamentos de feridas podem ser reunidos em dois grandes grupos: agentes tópicos e curativos. Os curativos úmidos são relatados como terapia tradicional ou convencional na literatura e os curativos interativos modernos são as espumas, alginatos de cálcio, hidrogéis, hidrocolóides e filmes. Agentes antibacterianos tópicos, antissépticos, antibióticos, novos curativos antimicrobianos e curativos por pressão negativa (vácuo)-também são usados para tratar a infecção, com vários questionamentos sobre a sua eficácia. TECNOLOGIA PROPOSTA: A Terapia por Pressão Negativa usa uma combinação de sucção a e protetores especiais para facilitar a drenagem e influenciar no crescimento de tecidos superficiais (figura 1). O líquido aspirado da ferida é coletado em um recipiente dentro da unidade de controle. Normalmente utiliza-se de 80 a 125 mmHg de pressão negativa, continuamente ou em ciclos. Essa terapia foi projetada com o objetivo de melhorar a cura, diminuindo a morbidade, o custo e a estadia prolongada dos pacientes com feridas crônicas e sem cura, sendo assim uma adjunção ao tratamento da ferida(5) Dentre as razões teóricas que justificam a melhora na cicatrização das feridas, estão: manutenção do ambiente úmido da ferida; aumento do fluxo sanguíneo local; remoção de exsudato da ferida; promoção da formação do tecido de granulação; redução da infecção; pressão mecânica no enxerto. Esta terapia pode ser usada como método primário no fechamento ou como um método de manutenção na ferida, como ponte até que a reconstrução cirúrgica seja possível. Pode ser utilizada no tratamento de feridas agudas como queimaduras, traumas e enxertos de pele, mas também é comumente usada para feridas crônicas ou complexas e sem cura, como por exemplo, as úlceras por pressão, destacando-se a pouca disponibilidade de evidências. EVIDÊNCIAS CIENTÍFICAS: Foi realizada uma busca nas bases de dados primárias Medline e Lilacs, que resultou em oito revisões sistemáticas, 14 ensaios clínicos e um estudo de caso-controle. Após análise, apenas dois estudos preencheram os critérios de inclusão. Um estudo demonstrou eficácia com redução do tempo de fechamento da lesão com o uso de dispositivo "caseiro". Não há evidencias de que o dispositivo comercial produza melhores resultados. RECOMENDAÇÃO DA CONITEC: A CONITEC, em sua 21ª reunião ordinária, no dia 4 de dezembro de 2013, recomendou a não incorporação no SUS da terapia por pressão subatmosférica (VAC) em lesões traumáticas agudas extensas. DELIBERAÇÃO FINAL: Na 25ª reunião da CONITEC, realizada no dia 08/05/2014, os membros do plenário deliberaram não recomendar a incorporação da terapia por pressão subatmosférica (VAC) em lesões traumáticas agudas extensas. DECISÃO: PORTARIA Nº 34, de 26 de setembro de 2014 - Torna pública a decisão de não incorporar a terapia por pressão subatmosférica (VAC) em lesões traumáticas agudas extensas no âmbito do Sistema Único de Saúde - SUS.

Fístula enteroatmosférica y uso del VAC: a propósito de un caso / Enteroatmospheric fistula and vaccum assited closure: report of a case

Las fístulas gastrointestinales asociadas con abdomen abierto posterior a cirugía abdominal mayor son una complicación grave. El manejo es extremadamente difícil y la mortalidad bastante alta a pesar de los modernos avances médicos. Aquellos pacientes que sobreviven al daño metabólico y fisiopatológico inicial, requieren en su mayoría cierre quirúrgico de la fístula lo cual es técnicamente complejo. Presentamos el caso de un paciente con una neoplasia de rectosigma que se abordó por laparoscopia y desarrolló una fístula enteroatmosférica sobre la incisión de Pfannestiel que se utilizó para la extracción de la pieza. Conclusión: El cierre asistido por vacío artesanal y el manejo nutricional adecuado permiten la mejoría en pacientes con fístulas complejas logrando las condiciones adecuadas para el cierre definitivo.

The gastrointestinal fistula associated to posterior open abdominal trauma or abdominal surgery implies severe complications. The handling of these cases is extremely hard and mortality is very high despite medical advances. Those patients who survive the initial metabolic and phisycopathological damages require, on most cases, a surgical closure of the fistula which is a very complex procedure technically. We describe the case of a patient with a rectosigmoid neoplasm that was addressed laparoscopically and enteroatmospheric fistula just developing on phannestiel incision was used to extract the neoplasm. Conclusion: The closure assisted by “hand made vacuum” and adequate nourishment allows recovering patients with complex fistulas to achieve adequate conditions for definitive closure.

Cleaning the apical third of curved canals after different irrigation protocols

This study evaluated the protocols of sonic and vacuum irrigation regarding the capacity of debris removal from root canal systems. Canal preparations were carried out on 30 mandibular first molars using the ProTaper Universal System. Teeth were divided into two experimental groups (n=15): Group 1: sonic irrigation and Group 2: vacuum irrigation protocol. Subsequently, the mesial roots were sectioned and observed by stereomicroscopy and scanning electron microscopy. Three independent examiners evaluated images of the apical thirds according to the following scores: 1= small presence of debris, 2= moderate presence of debris, and 3= dense presence of debris. Data were analyzed with ANOVA and Kruskal-Wallis tests (α=0.05). Comparison among the groups revealed that at the apical third, the root halves of Group 1 had significantly less surface debris (p=0.002) than those of Group 2. However, at 2 mm from the working length, Group 2's specimens showed less remaining debris in approximately 75% of the analyzed root canals. At the whole apical third, the sonic irrigation protocol removed significantly more debris than the vacuum protocol. However, in the region at 2 mm from the working length, the second irrigation method demonstrated a better performance.

Este estudo avaliou protocolos de irrigação sônica e a vácuo em relação à capacidade de remoção de debris do sistema de canais radiculares. Trinta primeiros molares mandibulares tiveram seus canais radiculares preparados pela utilização do Sistema ProTaper Universal. Os dentes foram divididos em dois grupos experimentais (n=15): Grupo 1: protocolo de irrigação sônica, e Grupo 2: protocolo de irrigação a vácuo. Posteriormente, as raízes mesiais foram seccionadas e observadas em lupa estereoscópica e microscopia eletrônica de varredura. Três examinadores independentes avaliaram as imagens do terço apical de acordo com as seguintes pontuações: 1. pequena presença de debris; 2: moderada presença de debris; e 3. densa presença de debris. Os dados foram analisados pelos testes estatísticos ANOVA e Kruskal-Wallis (α=0,05). A comparação entre os grupos revelou que, no terço apical, as hemissecções radiculares do Grupo 1 apresentaram debris remanescentes de forma significativamente menor (p=0,002) do que as do Grupo 2. No entanto, a 2 mm do comprimento de trabalho, as amostras do Grupo 2 mostraram menos debris remanescentes em aproximadamente 75% dos canais radiculares analisados. Considerando todo o terço apical, o protocolo de irrigação sônica removeu significativamente mais debris do que o protocolo de irrigação a vácuo. No entanto, na região a 2 mm do comprimento de trabalho, o segundo método de irrigação demonstrou um melhor desempenho.

Dinâmica microbiana em contrafilés bovinos embalados a vácuo: sistemas de terminação e tempo de estocagem / Microbial dynamics in the vacuum-packaged meat cuts: production system and storage period

A qualidade da carne embalada a vácuo é de grande importância para o comércio. Neste contexto, no presente estudo foi avaliada a dinâmica microbiana de cortes cárneos bovinos Longissimus dorsi, denominado comercialmente por contra filé, embalados a vácuo e armazenados a 0 ± 1 °C no estabelecimento de abate durante cinco períodos de estocagem. Foram analisadas amostras de cortes cárneos provenientes de bovinos anelorados, fêmeas, terminados em dois sistemas de produção, sendo 15 adultos criados a pasto, com média de 45 meses de vida e 15 bovinos jovens de 12 meses de idade em confinamento de alto desempenho. Procedeu-se a avaliação bacteriológica das carnes nos períodos de tempo correspondentes à zero, 30, 45, 60 e 75 dias após o abate e embalagem. A avaliação microbiológica foi efetuada pela contagem de aeróbios viáveis, bactérias ácido lácticas, Enterobacteriaceae, psicrotróficos, anaeróbios, determinaçãodo Número Mais Provável (NMP) de coliformes totais, coliformes termotolerantes e Escherichia coli, análise de pH e temperaturas dos cortes. O sistema de terminação influenciou parcialmente na dinâmica microbiana. As carnes embaladas a vácuo podem apresentar micro-organismos deteriorantes e patogênicos, provenientes de contaminação ambiental ou fecal. Quanto maior o período de estocagem dos cortes cárneos, a contagem de micro-organismos avaliados foi maior.

Infecções graves de partes moles: relato de caso de fasciíte necrotizante de face utilizando curativo a vácuo e revisão da literatura / Severe infections of soft tissue: case report of face necrotizing fasciitis using vacuum dressing and literature review

Fasciíte necrotizante da face é uma doença muito rara. Este artigo descreve, pela primeira vez, um caso clínico de um paciente com fasciíte necrotizante de face tratada com o curativo a vácuo desenvolvido na Universidade de São Paulo. Relato do Caso: A infecção do paciente iniciou-se na glândula parótida progredindo para os planos profundos na face, gerando repercussão sistêmica. O tratamento foi baseado em desbridamento cirúrgico seriado e colocação de curativo a vácuo. Após a preparação do leito com este curativo, um retalho de couro cabeludo foi realizado. Este estudo confirma a raridade do caso e expõe as peculiaridades do tratamento, enfatizando a importância do diagnóstico precoce e da abordagem cirúrgica, tanto imediata quanto agressiva para este tipo de infecção grave de partes moles. O paciente foi a óbito em decorrência de choque séptico e falência de múltiplos órgãos, embora a infecção da região cefálica tenha sido controlada e a ferida reduzida. Conclusão: O tratamento com curativo a vácuo pode ser implementado em fasciítes necrotizantes de face com benefícios. O vácuo USP [Universidade de São Paulo] mostrou-se efetivo em seu funcionamento, com menor custo. Contudo, maior número de casos deverá ser tratado com o vácuo USP para sua validação científica comparando-o como produto importado disponível no mercado.

Necrotizing fasciitis of the face is a very rare disease. This article describes for the first time a case report of a patient with an aggressive necrotizing fasciitis of the face treated with the vacuum dressing developed at the University of São Paulo. Case Report: The patient suffered an infection which began on parotid gland progressing to the deep planes in face causing systemic repercussion. The treatment was based on serial surgical debridement and placement of the vacuum dressing. After bed preparation with this dressing, a scalp flap was performed. This study confirms the rarity of the case and elucidates the peculiarities of the treatment, emphasizing the importance of the surgical debridement with early diagnosis and immediate and aggressive approach to this type of severe soft tissue infection. The patient evolved to death by septic shock and multiple organ failure although the infection of cephalic region had been controlled and the wound had been reduced. Conclusions: The treatment with vacuum dressing can be implemented for Necrotizing Fasciitis of the face with benefits. The vacuum USP [University of São Paulo] was effective in its performance, with low cost, but a greater number of cases should be treated with the vacuum USP for its scientific validation comparing with the imported product available.

Microbial deterioration of vacuum-packaged chilled beef cuts and techniques for microbiota detection and characterization: a review

Gas production from microbial deterioration in vacuum-packs of chilled meat leads to pack distension, which is commonly referred as blown pack. This phenomenon is attributed to some psychrophilic and psychrotrophic Clostridium species, as well as Enterobacteria. The ability of these microorganisms to grow at refrigeration temperatures makes the control by the meat industry a challenge. This type of deterioration has been reported in many countries including some plants in the Midwestern and Southeastern regions of Brazil. In addition to causing economic losses, spoilage negatively impacts the commercial product brand, thereby impairing the meat industry. In the case of strict anaerobes species they are difficult to grow and isolate using culture methods in conventional microbiology laboratories. Furthermore, conventional culture methods are sometimes not capable of distinguishing species or genera. DNA-based molecular methods are alternative strategies for detecting viable and non-cultivable microorganisms and strict anaerobic microorganisms that are difficult to cultivate. Here, we review the microorganisms and mechanisms involved in the deterioration of vacuum-packaged chilled meat and address the use of molecular methods for detecting specific strict anaerobic microorganisms and microbial communities in meat samples.