Evaluation of the poly-L-lactic acid implant for treatment of the nasolabial fold: 3-year follow-up evaluation.

The search for an ideal filler for soft tissue augmentation still continues. Because aging changes are continuous, temporary fillers should be preferred against permanent ones. Since 1999, the poly-L-lactic acid filler (PLA) has been marketed in Europe as Newfill. As a synthetic biocompatible polymer, PLA originally was used in suture materials and screws. In 2004, the U.S. Food and Drug Administration approved PLA under the name of Sculptra for the treatment of human immunodeficiency virus-related facial lipoatrophy. This study aimed to evaluate a 3-year follow-up investigation into the effect of PLA implant injection for the treatment of sunken nasolabial folds. Between October 2003 and February 2004, 10 women with a median age of 54 years (range, 43-60 years) were injected with polylactic acid hydrogel (Newfill) in the nasolabial fold area for aesthetic reasons. All the patients underwent three injections: one injection per month for 3 months. Evaluation of the results based on clinical examination and photography was performed at each session, at 6 months, and then 36 months after the third session. Injectable PLA was able to correct nasolabial folds successfully with a more lasting result than absorbable fillers commonly used in clinical practice, such as hyaluronic acid and collagen. Careful and standardized photographic documentation is indispensable.

Estudo anatômico e morfométrico do retalho peritoneal da artéria epigástrica inferior profunda / Anatomic and morphometric study of the peritonal branch of the deep inferior epigastric artery

As reconstruções de defeitos de mucosa, nas regiões da cabeça e pescoço e região vaginal, assim como as lesões em mão e membros inferiores secun- dárias à ressecção de tumores, traumas e infecções, entre outros, constituem um desafio para o cirurgião plástico. Em 1990, Mixter descreveu a utilização do retalho composto fascioperitoneal, baseado no ramo perfurante peritoneal da artéria epigástrica inferior profunda (AEIP). Este retalho pode ser dissecado junto com o músculo reto abdominal e/ou associado a uma ilha de pele. O peritônio tem grande capacidade de metaplasia escamosa e é resistente à exposição à secreções gástricas e radiação. Foi realizado um estudo anatômico em 17 cadáveres, totalizando 34 regiões anatômicas, com os objetivos de determinar os parâmetros de dissecção deste retalho e o território vascular anatômico do ramo peritoneal da AEIP. Assim mesmo, foi realizado o estudo morfométrico do vaso. O retalho peritoneal da AEIP possui um pedículo vascular constante, de localização anatômica relativamente fixa, com um bom arco de rotação, e pode ser dissecado em dimensões que permitem a cobertura de defeitos de mediano e grande porte.

The reconstruction of mucosal defects in the regions of head and neck, and vaginal region, and secondary hand and lower limb defects after tumor resection, trauma and infections, among others, represent a challenge for the plastic surgeon. In 1990, Mixter described the use of the composed fascioperitoneal flap, based in the peritoneal branch of the deep inferior epigastric artery (DIEA). This flap can be dissected together with the rectus abdominis muscle and/or associate to a skin island. Peritoneum has great capacity of squamous metaplasia and is resistant to gastric secretions and radiation exposure. An anatomical study in 17 cadavers was carried through, totalizing 34 anatomical regions, with the objective to determine the dissection parameters of this flap and the anatomical vascular territory of the DIEA peritoneal branch. A morphometric study of the vessels was also done. The peritoneal branch of the DIEA has one constant vascular pedicle, with relatively permanent anatomical localization, with a good arc of rotation, and can be dissected in dimensions that allow coverage of medium and great size defects.

Parenteral lipid emulsions and phagocytic systems.

Lipid emulsions (LE) for parenteral use are complex emulsions containing fatty acids, glycerol, phospholipids and tocopherol in variable amounts and concentrations. In clinical practice, LE have been employed for more than 30 years. Fatty acids may have different impacts on phagocytic cells according to their structure. Experimental and clinical studies have consistently shown that LE modify monocyte/macrophage and polymorphonuclear phagocytosis. The inhibitory effect of LE on the functional activity of the phagocytic system, although still clinically controversial, may have a harmful impact because total parenteral nutrition with lipids may be recommended in hypercatabolic conditions where inflammation and infection are present. LE based on triglycerides containing long chain fatty acids (termed long chain triglycerides or LCT) are the main parenteral fat source and are typically rich in n-6 polyunsaturated fatty acids. They may have adverse effects on the immune system, especially when given in high doses over a short period of time. However when administered properly they can be used safely. LE containing medium chain triglycerides (MCT) may have some advantages because of their positive effects on polymorphonuclear cells, macrophages, and cytokine production, particularly in critically ill or immunocompromised patients. New parenteral LE containing n-3 polyunsaturated fatty acids or monounsaturated olive oil are already available in Europe. Judicious use of these new LE is mandatory especially relating on their potential impact on the immune system. New experimental and clinical studies are required to further establish the role of LE in clinical nutrition.

[Technical and histological standardization of experimental colitis with trinitrobenzenosulfonic acid (TNBS)]. / Padronização técnica e histológica de colite experimental com ácido trinitrobenzenosulfônico (TNBS).

Attempts to reproduce inflammatory colitis have created many experimental models. Since the pioneer work of Morris et al. (1989), trinitrobenzenosulfonic (TNBS) solutions have been used with different dosages. The aims of this work were standardize the induction of colitis, evaluate the clinical and intestinal effects of different doses and verify the reproducibility of the intestinal inflammatory process. Wistar rats were inoculated endo rectally with 2.5 ml solutions of different concentrations of TNBS and ethanol, and the rats were sacrificed after 14 days. According to the solution concentrations of TNBS (mg) and ethanol (%), six groups of animals were established: Control (saline), 30 mg/30%, 30 mg/40%, 30 mg/50%, 50 mg/10% and 50 mg/30%. Statistical analysis of food ingestion showed no differences between groups (p = 0.247). The 30/50 group presented greater weight loss when compared to 50/10 and 50/30 groups (p = 0.012). Groups 30/50 and 30/40 showed greater degrees of macroscopic lesion than control and 50/10 group (p < 0.05). Histologic lesion was not uniform to all rats regardless of the solution employed. Group 50/10 presented the less severe histologic alterations; on the other hand, 30/40 and 30/50 groups had important changes on mucosal thickness, on vascularization and ulceration. The authors conclude that experimental colitis with TNBS 1) cause intestinal lesions that are not uniform to all animals, although they may be reproduced in many of them; 2) with the same doses of TNBS, the increase in ethanol concentrations leads to a greater inflammatory process, intestinal thickness, vascularization, abscess formation and intestinal ulceration; 3) 50/10 and 50/30 solutions make less severe lesions when compared to 30/40 and 30/50 solutions; 4) 30/50 solution was the best one, as it produces inflammation 90% of the animals, increases in wall thickness in 50%, abscess in 70% and ulceration in 38%.