Tratamento cirúrgico de queloides: Ressecção total ou parcial? / Surgical treatment of keloids: Total or partial resection?

Introdução: Atualmente, a aplicação de triancinolona intralesional com a excisão cirúrgica é considerada o tratamento mais satisfatório para queloides, com baixa taxa de recorrência. Método: Realizado estudo de casos contemplando cirurgias reparadoras de pacientes com queloides em lóbulos de orelhas bilateralmente, operados pelo mesmo cirurgião plástico no período de julho de 2018 a janeiro de 2021 no Hospital Regional de Sobradinho em Brasília-DF. Ressecou-se parcialmente a cicatriz queloideana (intralesional), deixando margens de queloide na ferida operatória e comparou-se com a resposta após ressecção total (justalesional) de uma outra cicatriz em um mesmo paciente. Foi realizada aplicação de triancinolona no pré-operatório, com total de 4 aplicações a intervalos de 4 semanas entre cada sessão e no pós-operatório imediato, mantendo aplicação a cada 30 dias por 6 meses. Nenhum paciente havia realizado tratamentos prévios para queloides. As cicatrizes foram avaliadas no pós-operatório pelo cirurgião principal por um período de 12 meses. Resultados: Quatro de 11 pacientes tiveram algum tipo de recidiva, totalizando 36% de recidiva em nosso trabalho. A excisão total do queloide (orelha esquerda) teve mais recidivas do que o lado contralateral em que foi deixada margem de 1mm de queloide na cicatriz (orelha direita). Conclusão: No presente estudo observamos que, quando associada ao tratamento com triancinolona no pré, intra e pós-operatório, a excisão parcial do queloide apresentou menores taxas de recidiva local quando comparada à excisão total do queloide.

Introduction: Currently, the application of intralesional triamcinolone with surgical excision is considered the most satisfactory treatment for keloids, with a low recurrence rate. Method: A case study was carried out covering reconstructive surgeries for patients with bilateral earlobe keloids, operated by the same plastic surgeon from July 2018 to January 2021 at the Hospital Regional de Sobradinho in Brasília-DF. The keloid scar (intralesional) was partially resected, leaving keloid margins in the surgical wound, and compared with the response after total resection (juxtalesional) of another scar in the same patient. Triamcinolone was applied preoperatively, with a total of 4 applications at intervals of 4 weeks between each session and in the immediate postoperative period, maintaining application every 30 days for 6 months. No patient had undergone previous treatments for keloids. Scars were evaluated postoperatively by the primary surgeon over a period of 12 months. Results: Four of 11 patients had some type of recurrence, totaling 36% of recurrence in our study. Total excision of the keloid (left ear) had more recurrences than the contralateral side where a 1mm margin of keloid was left in the scar (right ear). Conclusion: In the present study, we observed that when associated with treatment with triamcinolone pre-, intra-, and postoperatively, partial excision of the keloid presented lower rates of local recurrence when compared to total excision of the keloid.

Sistematização de flancoplastia baseada na anatomia cirúrgica / Flankplasty systematization based on surgical anatomy

Introdução: O estudo explora a cirurgia de contorno corporal em pacientes submetidos a cirurgias bariátricas. Nos últimos anos, esse tipo de intervenção cirúrgica ganhou destaque devido ao aumento na busca por procedimentos reparadores após significativa perda de peso. O texto enfatiza a importância da flancoplastia, técnica que visa melhorar o contorno corporal. Métodos: Foi realizada revisão da literatura para elucidação da anatomia da gordura profunda da fáscia toracolombar, e feito um paralelo com a técnica de flancoplastia utilizada em nosso serviço em pacientes pós-bariátricos submetidos a abdominoplastia 360° ou 270° no Hospital Daher Lago Sul, em Brasília- DF. Resultados: A lipoaspiração profunda dos flancos, muitas vezes necessária em cirurgias de contorno corporal, pode não ser suficiente para retirar a gordura profunda à fáscia toracolombar e durante esse procedimento observa-se risco aumentado de lesões retroperitoneais. No entanto, a flancoplastia, que envolve a ressecção da gordura profunda à fáscia toracolombar, demonstrou proporcionar resultados satisfatórios e minimizar esses riscos. Conclusão: O estudo enfoca a importância do conhecimento anatômico preciso, destacando a relevância da flancoplastia como uma técnica valiosa para melhorar os resultados estéticos e reduzir complicações em pacientes pós-bariátricos, complementando a cirurgia bariátrica e melhorando a qualidade de vida do paciente.

Introduction: The study explores body contouring surgery in patients undergoing bariatric surgery. In recent years, this type of surgical intervention has gained prominence due to the increase in the search for reparative procedures after significant weight loss. The text emphasizes the importance of flankplasty, a technique that aims to improve body contour. Methods: A literature review was carried out to elucidate the anatomy of the deep fat of the thoracolumbar fascia, and a parallel was made with the flankplasty technique used in our service in post-bariatric patients undergoing 360° or 270° abdominoplasty at Daher Lago Sul Hospital, in Brasília-DF. Results: Deep liposuction of the flanks, often necessary in body contouring surgeries, may not be sufficient to remove fat deep into the thoracolumbar fascia and during this procedure, there is an increased risk of retroperitoneal injuries. However, flankplasty, which involves resection of fat deep into the thoracolumbar fascia, has been shown to provide satisfactory results and minimize these risks. Conclusion: The study focuses on the importance of precise anatomical knowledge, highlighting the relevance of flankplasty as a valuable technique to improve aesthetic results and reduce complications in post-bariatric patients, complementing bariatric surgery and improving the patient's quality of life.

National Registry of Acute Coronary Syndrome in Paraguay (RENASCA-PY).

OBJECTIVE: To determine the initial management and in-hospital mortality of patients with acute coronary syndrome who attended referral hospitals in Paraguay. METHOD: Observational, multicenter study, in patients over 18 years with a confirmed diagnosis of acute coronary syndrome. RESULTS: 780 patients were included from May 2015 to February 2016; the mean age was 64.1 ± 12.3 years, 64.1% male. The clinical presentation was acute coronary syndrome with ST elevation in 40.1% and without elevation in 59.9%. In patients with ST elevation there is a high percentage of late attendance, more than 12 h of evolution in 49.8%; those with less than 12 h of evolution underwent reperfusion in 52.2% of the cases, received fibrinolytics in 36.3% of the cases, and primary percutaneous coronary intervention 15.9%. In-hospital mortality for acute coronary syndrome was 10.3%, with ST-segment elevation was 12.8%, and without ST-segment elevation was 8.6%. CONCLUSIONS: The management of acute coronary syndrome in Paraguay needs a comprehensive approach, which promotes earlier care, and increases the implementation of reperfusion therapies in the health services network, in order to improve the therapeutic response rates and decrease hospital mortality.

OBJETIVO: Determinar el tratamiento inicial y la mortalidad intrahospitalaria de pacientes con síndrome coronario agudo que acudieron a centros hospitalarios de referencia de Paraguay. MÉTODO: Estudio observacional y multicéntrico en pacientes mayores de 18 años con diagnóstico confirmado de síndrome coronario agudo. RESULTADOS: Se incluyó a 780 pacientes desde mayo de 2015 hasta febrero de 2016; la edad media fue de 64.1 ± 12.3 años y el género masculino representó el 64.1%. La presentación clínica fue la de síndrome coronario agudo con elevación del ST en 40.1% y sin elevación del ST en 59.9%. En pacientes con elevación del ST se observó un alto porcentaje de consultas tardías, mayor de 12 h de evolución en 49.8%; en aquéllos con menos de 12 h de evolución se indicó la reperfusión en 52.2%, el 36.3% recibió fibrinolíticos y 15.9% intervención coronaria percutánea primaria. La mortalidad hospitalaria del síndrome coronario agudo fue de 10.3%, con elevación del segmento ST en 12.8% y sin elevación del segmento ST en 8.6%. CONCLUSIONES: El tratamiento del síndrome coronario agudo en el Paraguay requiere un abordaje integral, que promueva consultas más tempranas y aumente la institución de tratamientos de reperfusión en la red de servicios de salud; el objetivo es mejorar los índices de respuesta terapéutica y disminuir la mortalidad hospitalaria.

Seven-Coordinate Tb3+ Complexes with 90% Quantum Yields: High-Performance Examples of Combined Singlet- and Triplet-to-Tb3+ Energy-Transfer Pathways.

Seven-coordinate, pentagonal-bipyramidal (PBP) complexes [Ln(bbpen)Cl] and [Ln(bbppn)Cl], in which Ln = Tb3+ (products I and II), Eu3+ (III and IV), and Gd3+ (V and VI), with bbpen2- = N,N'-bis(2-oxidobenzyl)-N,N'-bis(pyridin-2-ylmethyl)ethylenediamine and bbppn2- = N,N'-bis(2-oxidobenzyl)-N,N'-bis(pyridin-2-ylmethyl)-1,2-propanediamine, were synthesized and characterized by single-crystal X-ray diffraction analysis, alternating-current magnetic susceptibility measurements, and photoluminescence (steady-state and time-resolved) spectroscopy. Under a static magnetic field of 0.1 T, the Tb3+ complexes I and II revealed single-ion-magnet behavior. Also, upon excitation at 320 nm at 300 K, I and II presented very high absolute emission quantum yields (0.90 ± 0.09 and 0.92 ± 0.09, respectively), while the corresponding Eu3+ complexes III and IV showed no photoluminescence. Detailed theoretical calculations on the intramolecular energy-transfer rates for the Tb3+ products indicated that both singlet and triplet ligand excited states contribute efficiently to the overall emission performance. The expressive quantum yields, QLnL, measured for I and II in the solid state and a dichloromethane solution depend on the excitation wavelength, being higher at 320 nm. Such a dependence was rationalized by computing the intersystem crossing rates (WISC) and singlet fluorescence lifetimes (τS) related to the population dynamics of the S1 and T1 levels. Thin films of product II showed high air stability and photostability upon continuous UV illumination, which allowed their use as downshifting layers in a green light-emitting device (LED). The prototypes presented a luminous efficacy comparable with those found in commercial LED coatings, without requiring encapsulation or dispersion of II in host matrixes. The results indicate that the PBP environment determined by the ethylenediamine (en)-based ligands investigated in this work favors the outstanding optical properties in Tb3+ complexes. This work presents a comprehensive structural, chemical, and spectroscopic characterization of two Tb3+ complexes of mixed-donor, en-based ligands, focusing on their outstanding optical properties. They constitute good molecular examples in which both triplet and singlet excited states provide energy to the Tb3+ ion and lead to high values of QLnL.

Electrochemical, mechanistic, and DFT studies of amine derived diphosphines containing Ru(II)-cymene complexes with potent in vitro cytotoxic activity against HeLa and triple-negative breast cancer cells MDA-MB-231.

Complexes with general formula [RuCl(η6-p-cymene)(P-NR-P)]X (R = CH2Py (Py = pyridine) - [1a]+, CH2Ph (Ph = phenyl) - [1b]+, Ph - [1c] and p-tol (p-tol = p-tolyl) - [1d]+; X = PF6- or BF4-) were evaluated as cytotoxic agents against two cancer cell lines (HeLa and MDA-MB-231). All metal complexes are active in the range of concentrations tested (up to 100 µmol L-1). The IC50 (µmol L-1) values for the metal complexes are lower than that found for cisplatin. The activities are up to 6- and 15-fold higher than cisplatin for HeLa and MDA-MB-231 cancer cell lines, respectively. Studies of DNA binding and DNA cleavage were performed. DNA binding studies revealed a modest hypochromic shift in the metal complexes electronic spectra, indicating a weak interaction with Kb values in the range of 1.7 × 103-1.6 × 104. Although the cleavage tests revealed that in the dark DNA is not a biological target for these metal complexes, upon blue light irradiation they are activated causing DNA cleavage. Electrochemical studies showed the presence of two independent redox processes, one attributed to the oxidation process of Ru2+ → Ru3+ (EC process) and the other one to the reduction of Ru2+ → Ru1+, which is further reduced to Ru0 (ECE mechanism). In both processes, coupled chemical reactions were observed. DFT calculations were performed to support the electrochemical/chemical behavior of the complexes. The reactivity of complex [1b]BF4 with CH3CN was evaluated and two complexes were isolated [2b]BF4 and [3b]BF4. The complex mer-[RuCl(CH3CN)3(P-NCH2Ph-P)]BF4 ([2b]BF4) was isolated after refluxing the precursor [1b]BF4 in CH3CN. Isomerization of [2b]BF4 in CH3CN resulted in the formation of fac-[RuCl(CH3CN)3(P-NCH2Ph-P)]BF4. An attempt to isolate the fac-isomer by adding diethyl ether was unsuccessful, and the complex [3b]BF4 was observed as the major component. The complex [Ru2(µ-Cl3)(CH3CN)2(P-NCH2Ph-P)2]BF4 ([3b]BF4) proved to be very stable and can be obtained from both the mer- and the fac-isomers. The molecular structures of [1b]BF4 and [3b]BF4 were solved by single-crystal X-ray diffraction.