Surgical Correction of Low-positioned Umbilicus after Mini-abdominoplasty.

Background: The umbilicus detachment and reinsertion in umbilical float mini-abdominoplasty results in its lower position with or without shape distortion. This event creates a stigmatizing look, elongating the upper abdomen and creating variable grades of infra umbilical/pubis bulging. This lack of proportion causes an unpleasant, artificial look, and is very difficult to fix. The study aimed to describe a sequence of abdominoplasty and combined upper abdomen horizontal muscle plications to correct umbilicus malposition after a mini-abdominoplasty. Methods: Over a period of 24 months, 12 patients underwent a liposuction (suction-assisted liposuction) and abdominoplasty with horizontal supraumbilical muscle plication. All patients underwent objective measurements before and after the procedure, using digital image measurements by Mirror Image software, version 6.0 (Fairfield, N.J.). The follow-up evaluation was performed 12 months postoperatively. Statistical analysis was performed using IBM SPSS Statistics V26. Results: Over 24 months, 12 patients (100%), who underwent abdominoplasty combined with horizontal plication in the upper abdominal wall, have shown adequate umbilicus elevation (2.98 ± 0.242 cm; 95% confidence level), restoring the abdominal muscle wall proportion at 12 months follow-up. One patient (8%) had a seroma, and one (8%) had a small muscular hernia (1.5 cm) in the lower abdomen. Conclusions: The combination of abdominoplasty and upper horizontal muscle plication can fix the malpositioned umbilicus, restoring the aesthetic and anatomic proportions in those patients who underwent an umbilical float mini-abdominoplasty.

Surgical Correction of Abdomen Irregularities after Liposuction: Case Series.

Background: The occurrence of surface irregularities in the abdomen after liposuction is frequent and can be due to the fact that more liposuctions are being done nowadays, and perhaps, the fact that more noncore surgeons are doing it could be an important factor. These superficial changes compromise the aesthetic results of surgery, and their correction is a major technical challenge. Methods: The author presents a systematized approach for surgical treatment of fibrosis and post liposuction irregularities. Twenty-three patients underwent liposuction and abdominoplasty or mini abdominoplasty by a single surgeon (G.B.B.) over a period of 24 months to correct superficial abdominal wall irregularities after previous liposuction. All patients underwent evaluation through digital photography by two independent senior plastic surgeons according to an objective aesthetic outcome scale, 12 months after the operation. Results: All 23 patients showed an improvement in the appearance of the abdominal wall according to the aesthetic outcome scale used. Eighty-seven percent of the patients operated on in this series had previously undergone liposuction using technologies and 4.3% underwent liposuction alone. The overall minor complication rate was 26%. No major complications were noted. Conclusions: The combination of liposuction, direct fibrosis removal, and flap tensioning (abdominoplasty or mini abdominoplasty) could correct in this series the multiple factors (fibrosis, skin laxity, residual fat deposits post liposuction) related to abdominal wall surface irregularities in a safe, effective, and reproducible manner.

Medium Definition Liposuction Abdominoplasty.

Not all patients who exercise regularly and follow a balanced diet will obtain a well-defined abdomen. Medium definition liposuction, together with the removal of abdominal skin, can recreate an adequate connection between the skin/subcutaneous components and the myo-aponeurotic layer, resulting in the perception of muscle definition. Methods: Over a period of 36 months, 351 patients underwent medium definition liposuction associated with abdominoplasty performed by a single surgeon (G.B.). All patients underwent an evaluation through digital photographs by two independent senior plastic surgeons, using an objective grading system for aesthetic outcomes proposed by Strasser, 12 months after the operation. Results: According to the Strasser Scale, 326 patients (93%) were considered to have good and excellent results. Twenty-two patients (6.2%) had moderate/mediocre results' and three patients (0.8%) had poor results. The overall complication rate was 4.8%. Conclusion: Medium definition liposuction associated with abdominoplasty has been shown to be effective, safe, and reproducible for most patients.

End-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation.

BACKGROUND: The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration. METHODS: A total of 20 adult male Wistar rats were randomly assigned to 5 groups, and, in each one, a different treatment was performed: besides the control group, and end-to-end or end-to-side graft with motor or sensorial nerves was performed. Silastic sheet was used as a mechanical barrier to prevent innervation from adjacent nerves. After 16 weeks, the specimens were histologically assessed and wet weight was evaluated as a direct parameter of atrophy. RESULTS: The end-to-end neurorrhaphy group presented the best results in terms of mass preservation, but it did not differ significantly from the control group. Motor nerves presented similar results in muscular atrophy. The end-to-side neurorrhaphy group with sensory nerve as donor showed the worst results. CONCLUSIONS: The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.

Role of N-acetylcysteine on fibrosis and oxidative stress in cirrhotic rats.

BACKGROUND: Hepatic cirrhosis is the final stage of liver dysfunction, characterized by diffuse fibrosis which is the main response to the liver injury. The inhalatory carbon tetrachloride is an effective experimental model that triggers cirrhosis and allows to obtain histological and physiological modifications similar to the one seen in humans. AIM: To investigate the effects of N-acetylcysteine (NAC) on the fibrosis and oxidative stress in the liver of cirrhotic rats, analyzing liver function tests, lipoperoxidation, activity of glutathione peroxidase enzyme, collagen quantification, histopathology, as well as the nitric oxide role. METHODS: The animals were randomly in three experimental groups: control (CO); cirrhotic (CCl4) and CCl4 + NAC. Evaluate the lipid peroxidation, the glutathione peroxidase enzyme, the collagen and the expression of inducible nitric oxide synthase (iNOS). RESULTS: The cirrhotic group treated with N-acetylcysteine showed trough the histological analysis and collagen quantification lower degrees of fibrosis. This group has also shown less damage to the cellular membranes, less decrease on the glutathione peroxidase levels and less expression of inducible nitric oxide synthase when matched with the cirrhotic group without treatment. CONCLUSION: N-acetylcysteine seams to offer protection against hepatic fibrosis and oxidative stress in cirrhotic rat livers.

Symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele.

We report the first case of symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele. A 49-year-old man sought treatment for progressive loss of strength in the lower extremities ten months after full neurological recovery for a thoracic (T11) intradural-extramedullary schwannoma. Magnetic resonance imaging revealed a postsurgical thoracic (T11-T12) pseudomeningocele. The surgical approach showed an inadequate dural closure with spontaneous cerebrospinal fluid fistula. The defect was sealed with suture, muscle and biological glue covering. The patient had a good recovery. Pseudomeningocele must take part of the differential diagnosis of myelopathy after thoracic spine surgery.

Intracranial intrasellar kissing carotid arteries: case report.

Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.

Early surgical treatment of nonsyndromic craniosynostosis.

BACKGROUND: Craniosynostosis, a premature fusion of cranial sutures, can happen as an isolated defect (nonsyndromic) or as part of a syndrome. It may lead to raised intracranial pressure and deformity of both the cranial and facial skeletons. Early surgery is usually the best treatment choice. The aim of this study was to review the experience of a multidisciplinary staff with the surgical treatment of nonsyndromic craniosynostosis. METHODS: All the nonsyndromic craniosynostosis cases treated surgically from 1991 to 2005 at 2 neurosurgical centers were reviewed. The variables analyzed were sex, age, weight, type of deformity, estimated volemia, surgical technique, surgical time, blood loss, PO hospitalization time, and complications. All data were stored in a database and analyzed with Microsoft Access (Microsoft Corp, Seattle, WA) and SPSS V11.0 (SPSS, Inc, Chicago, IL). RESULTS: The sample consisted of 120 patients (70 males, 50 females). Six patients were excluded because of their atypical timing of treatment (average age, 72 months). The final average age was 7.08 months (variation, 1-18), and the average weight was 7.8 kg. The types of deformities found were scaphocephaly (n = 54, 45%), plagiocephaly (n = 27, 22%), trigonocephaly (n = 19, 16%), brachycephaly (n = 16, 13%), and oxycephaly (n = 4, 3%). The mean surgical time was 186 minutes and the mean PO hospitalization time was 6.8 days. The mortality on this series was 2.6% (3 patients). In the last operated cases, a significant improvement in morbid-mortality was observed. CONCLUSION: A multidisciplinary approach, including neurosurgeons, neurologists, and pediatricians, and appropriate training of the clinical surgical staff can minimize the risks and decrease the complications in the treatment of craniosynostosis, leading to a satisfactory outcome.

Stereotactic computed tomography-guided brain biopsy: diagnostic yield based on a series of 170 patients.

BACKGROUND: Stereotactic CT-guided biopsy is a valuable and safe procedure for diagnosing intracranial lesions. The objectives of this article are to analyze the diagnostic yield in a series of stereotactic CT-guided brain biopsies and to evaluate whether predictive factors may influence diagnostic yield. METHODS: The medical records of a series of patients who underwent stereotactic CT-guided brain biopsy from 1993 to 2005 in a neurosurgical center were reviewed. Clinical data were stored and analyzed with Microsoft Access (Microsoft Corp, Seattle, WA) and SPSS V11.0 software (SPSS, Inc, Chicago, IL). The following variables were analyzed: age, sex, anatomopathologic diagnosis, lesion topography and volume, postsurgical complications, and predictive factors that may affect diagnostic yield. RESULTS: One hundred seventy patients (102 males, 68 females; average age, 48.5 years) were analyzed. Stereotactic CT-guided biopsies allowed diagnosis in 157 cases (92%). The most frequent anatomopathologic diagnoses were high-grade glioma (n = 45), low-grade glioma (n = 31), nonspecific inflammatory lesions (n = 19), metastasis (n = 10), and lymphoma (n = 10). The most frequent topographies were frontal (n = 42), basal ganglia (n = 40), and parietal (n = 27) and front-parietal lobes (n = 9). Complications occurred in 5 patients (2.9%). Mortality rate was 1.2% (2 patients). Age had a positive impact, whereas female sex negatively affected diagnostic yield. All other predictive factors analyzed were not significant. CONCLUSION: Stereotactic CT-guided brain biopsies performed presented acceptable anatomopathologic diagnostic rate. Age had a positive impact, whereas female sex negatively affected diagnostic yield in this series.

Prospective and Bidirectional Cross-Sectional Associations between Body Mass Index and Physical Activity following Liposuction: A Cohort Study.

BACKGROUND: It has been speculated that the immediate decrease in body fat following liposuction may affect body composition by feedback mechanisms of body fat regain. Physical activity has both short- and long-term impacts on health. Although the lay public often associates higher levels of physical activity with body fat distribution changes, studies on the association between physical activity and body fat distribution present inconsistent results. The aim of this study was to investigate the cross-sectional and prospective associations between physical activity and body mass index following liposuction. METHODS: This is a prospective, bidirectional, cross-sectional study, including 526 liposuction patients, who were followed up at a mean of 11.7 and 24.3 months after surgery. RESULTS: The sum of skinfolds at 11.7 months was highly correlated with skinfolds at 24.3 months (rho = 0.74, p < 0.001). More than 85 percent of participants remained in the same quintile or changed by not more than one quintile during the 13.6-month period. Tracking of physical activity was considerably lower but still significant; the correlation was 0.24 (p < 0.001), and 61.4 percent of the patients moved one or less quintiles. In fully adjusted models, no significant cross-sectional or longitudinal associations were found between physical activity and body mass index. CONCLUSIONS: The authors provide evidence of tracking of physical activity and particularly body mass index following liposuction. The authors' results do not support the hypothesis that physical activity and fatness are strongly related following liposuction.

O pioderma gangrenoso como diagnóstico diferencial de complicações isquêmicas e infecciosas após abdominoplastia: um relato de caso / Pyoderma gangrenosum as a differential diagnosis of ischemic and infectious complications after abdominoplasty: a case report

Introdução: A abdominoplastia é um procedimento com índice considerável de complicações, ainda que, em sua maioria, de bom prognóstico. Algumas complicações, entretanto, podem ser catastróficas, como a necrose extensa de pele e as complicações infecciosas graves. Dentre as causas incomuns de perda extensa de pele no pós-operatório, podemos citar o pioderma gangrenoso (PG), doença de curso crônico, recidivante, com comportamento imprevisível e de etiologia ainda desconhecida. No âmbito da cirurgia plástica, essa doença pode mimetizar clinicamente complicações pós-operatórias isquêmicas ou infecciosas, cujos tratamentos diferem por completo do tratamento do PG. Relato de Caso: Paciente feminina, 41 anos, previamente hígida, foi submetida à abdominoplastia associada à lipoaspiração e mamoplastia de aumento com colocação de próteses mamárias. Evoluiu com edema, calor hiperemia e dor em incisão de abdominoplastia, além de comprometimento clínico sistêmico. Submetida a desbridamentos cirúrgicos e tratamento sistêmico, com piora progressiva das lesões. Diante do insucesso dos tratamentos propostos, aventada a hipótese diagnóstica de pioderma gangrenoso. Conclusão: O PG, apesar de raro, deve ser aventado como diagnóstico diferencial em casos de complicações pós-operatórias com perda e necrose de pele que não respondem às medidas iniciais de tratamento, além de quadros aparentemente infecciosos que não respondem às terapias antibióticas adotadas.

Introduction: Abdominoplasty is a procedure with a considerable rate of complications, even though, for the most part, it has a good prognosis. Some complications, however, can be catastrophic, such as extensive skin necrosis and serious infectious complications. Among the unusual causes of extensive skin loss in the postoperative period, we can mention gangrenous pyoderma (PG), a chronic, recurrent disease with unpredictable behavior and an unknown etiology. In the field of plastic surgery, this disease can clinically mimic ischemic or infectious postoperative complications, whose treatments differ completely from the treatment of PG. Case Report: A 41-year-old female patient, previously healthy, underwent abdominoplasty associated with liposuction and breast augmentation with the placement of breast implants. The patient evolved with edema, hyperemia and pain in an abdominoplasty incision, in addition to systemic clinical involvement. She was submitted to surgical debridement and systemic treatment, with progressive worsening of the lesions. In view of the failure of the proposed treatments, the diagnostic hypothesis of gangrenous pyoderma was raised. Conclusion: PG, although rare, should be considered as a differential diagnosis in cases of postoperative complications with skin loss and necrosis that do not respond to initial treatment measures, in addition to apparently infectious conditions that do not respond to adopted antibiotic therapies.

Mesenchymal stem cells combined with an artificial dermal substitute improve repair in full-thickness skin wounds.

Autografts represent the gold standard for the treatment of full thickness burns. Factors such as lack of suitable donor sites and poor skin quality, however, have led to the development of artificial dermal substitutes. The investigation of mechanisms leading to enhanced functionality of these skin substitutes has been attracting great attention. This study aimed to investigate the effect of autologous stem cells on the integration and vascularization of a dermal substitute in full-thickness skin wounds, in a murine model. Two cell populations were compared, whole bone marrow cells and cultivated mesenchymal stem cells, isolated from mice transgenic for the enhanced green fluorescent protein, which allowed tracking of the transplanted cells. The number of cells colonizing the dermal substitute, as well as vascular density, were higher in mice receiving total bone marrow and particularly mesenchymal stem cells, than in control animals. The effect was more pronounced in animals treated with mesenchymal stem cells, which located primarily in the wound bed, suggesting a paracrine therapeutic mechanism. These results indicate that combining mesenchymal stem cells with artificial dermal substitutes may represent an important potential modality for treating full thickness burns, even in allogeneic combinations due to the immunoregulatory property of these cells.

Implicações da mamoplastia de aumento via transaxilar na pesquisa de linfonodo sentinela: revisão da literatura / Implications of transaxillary breast augmentation in the sentinel lymph node detection: literature review

A pesquisa do linfonodo sentinela é o tratamento padrão para o estadiamento da axila em pacientes com câncer de mama precoce, e sua identificação pode evitar um esvaziamento axilar desnecessário. A incidência de câncer de mama vem aumentando a cada ano, concomitantemente, a mamoplastia de aumento transaxilar vem ganhando cada vez mais adeptos. Objetivo: Revisão bibliográfica com vistas a avaliar se a mamoplastia de aumento transaxilar poderia modificar a drenagem linfática e prejudicar a identificaçãodo linfonodo sentinela. Método: Revisão da literatura. Conclusão: A maioria dos estudos tende a excluir a hipótese de que a mamoplastia de aumento transaxilar possa afetar a identificação do linfonodo sentinela no futuro.

The sentinel lymph node biopsy is the gold-standard technique for axillary staging in patients with early breast cancer, and its identification can avoid an unnecessary axillary lymph node dissection. The incidence of breast cancer is increasing each year; concomitantly, cosmetic transaxillary breast augmentation is gaining much more followers. Objective: We conducted a literature review in order to evaluate if transaxillary breast augmentation can modify the lymphatic drainage and impair the identification of sentinel lymph node. Methods: Review of the literature. Conclusion: The majority of the studies tend to exclude the hypothesis that the transaxillary breast augmentation could affect the identification of sentinel lymph node in the future.

Retalho de Rieger: resultados estéticos e satisfação dos pacientes / Rieger’s flap: aesthetic results and patient satisfaction

O retalho de Rieger foi descrito por seu epônimo, em 1967, como sendo uma boa opção para cobertura de defeitos de partes moles em dorso nasal. Objetivo: Avaliar resultado estético e grau de satisfação dos pacientes após reconstrução nasal usando retalho de Rieger. Método: Análise retrospectiva de 10 casos operados em 2009. Foram avaliados resultado estético por meio de fotografia de 6 meses de pós-operatório e grau de satisfação dos pacientes que receberam o retalho de Rieger. Resultados: A média de idade dos pacientes foi de 67 anos. Um total de 7 homens e 3 mulheres foram operados em 2009. O escore geral do resultado estético avaliado por fotografia foi de 8,9; o grau de satisfação dos pacientes foi de 9,0. Conclusão: O retalho de Rieger é uma boa opção para tratamento de defeitos em terço médio/inferior do dorso nasal de até 2,0 cm. de diâmetro. Quando realizado em pacientes selecionados, o retalho de Rieger é um procedimento previsível e de apenas um estágio cirúrgico.

The Rieger’s flap was first described by its eponym, in 1967, as a good option for coverage of dorsal nasal soft-tissue defects. Objectives: To evaluate aesthetic results and patient satisfaction after nasal reconstruction with Rieger’s flap. Methods: Retrospective analysis of 10 patients who underwent the procedure in 2009. We evaluated the aesthetic results using photographic analysis and satisfaction score according to the patients’ complaints. Results: The mean age was 67 years old. A total of 7 men and 3 women underwent the procedure in 2009. The overall photographic aesthetic result score was 8.9; the overall satisfaction score was 9.0. Conclusion: The Rieger’s flap is a good option for cover age of defects of the medium/distal nasal dorsum that are less than 2.0 cm. in diameter. When performed on selected patients, the Rieger’s flap is an aesthetically predictable one-stage procedure.

Avaliação da satisfação a longo prazo dos pacientes submetidos a rinoplastia no Serviço de Cirurgia Plástica da Santa Casa de Misericórdia de Porto Alegre / Assessment of long-term patient satisfaction after rhinoplasty performed at the Plastic Surgery Department of Santa Casa de Misericórdia de Porto Alegre

INTRODUÇÃO:A rinoplastia, assim como diversos procedimentos estéticos, apresenta parcos estudos objetivos quanto à satisfação dos pacientes. O objetivo do presente estudo é avaliar o grau de satisfação a longo prazo dos pacientes submetidos a rinoplastia na Santa Casa de Misericórdia de Porto Alegre, em um estudo retrospectivo, utilizando questionário validado. MÉTODO: Foram selecionados todos (n = 119) os pacientes submetidos a rinoplastia no Serviço de Cirurgia Plástica da Santa Casa de Misericórdia de Porto Alegre, nos anos de 2007, 2008 e 2009, para aplicação de um questionário validado, com o objetivo de avaliar o grau de satisfação pós-operatória. RESULTADOS: Foram contatados 60 (50,42 por cento) pacientes no estudo. Quanto à satisfação global com o resultado estético-funcional da rinoplastia, 85,48 por cento dos pacientes afirmaram estar satisfeitos. Estratificando esse valor, foi observado que 88,3 por cento dos pacientes estavam muito ou completamente satisfeitos com o aspecto estético pós-operatório do nariz; quanto à função nasal pós-operatória, 83,3 por cento reportaram estar muito ou completamente aptos a respirar pelo nariz; quanto à impressão de amigos e familiares sobre o aspecto final do nariz, 93,3 por cento afirmaram estar muito ou completamente satisfeitos com o resultado; 93,3 por cento afirmaram que raramente ou nunca tiveram limitação das atividades sociais ou profissionais em decorrência do aspecto nasal pós-operatório; 75 por cento afirmaram estar muito ou completamente confiantes de que a aparência de seu nariz era a melhor possível de ser obtida; 76,7 por cento afirmaram que definitivamente não gostariam de alterar a aparência do nariz com outra cirurgia; e 83,4 por cento afirmaram que definitivamente não gostariam de alterar a função nasal com outra cirurgia. CONCLUSÕES: Constatou-se que a rinoplastia realizada no Serviço de Cirurgia Plástica da Santa Casa de Misericórdia de Porto Alegre apresentou alto índice de satisfação dos pacientes.

BACKGROUND: There are currently few studies assessing patient satisfaction after rhinoplasty or other aesthetic procedures. This is a retrospective study of patient satisfaction after rhinoplasty performed at the Plastic Surgery Department of Santa Casa de Misericórdia de Porto Alegre. METHODS: All (n = 119) patients who underwent rhinoplasty at the Plastic Surgery Department of Santa Casa de Misericórdia de Porto Alegre between 2007 and 2009 were requested to fill out a validated questionnaire to assess the degree of postoperative satisfaction. RESULTS: Sixty (50.42 percent) patients were included in the study. The global satisfaction index with respect to the aesthetic and functional results showed that 85.48 percent of the patients were satisfied; 88.3 percent of patients were pleased with the aesthetic results, and 83.3 percent reported satisfactory functional results and could breathe easily. Regarding the impression of the patients' family and friends, 93.3 percent reported that they were completely pleased; 93.3 percent reported that the postoperative nasal form rarely or never limited social or professional activities; 75 percent of the patients were completely confident that nasal appearance was the best possible, while 76.7 percent reported that their nasal appearance could not be changed by another surgery and 83.4 percent did not believe that nasal function could be changed with another surgery. CONCLUSIONS: Rhinoplasty performed at the Plastic Surgery Department of Santa Casa de Misericórdia de Porto Alegre resulted in a high level of patient satisfaction.

Cordoma Sacrococcígeo gigante: relato de caso / Giant Sacrococcygeal chordoma: case report

Cordoma sacrococcígeo é uma neoplasia maligna rara que se origina de remanescentes da notocorda. A localização crítica, comportamento localmente agressivo, reconhecida resistência à radioterapia, significativa morbimortalidade cirúrgica e elevada taxa de recidiva tornam seu tratamento um desafio. Descrevemos um caso de cordoma sacrococcígeo gigante.

Sacrococcygeal chordoma is a rare malignant neoplasm arised from the remmants of the notochord. The critical localization, locally aggressive behavior, well-known resistance to radiation therapy, meaningful surgical morbimortality and increased recurrence rate become its treatment a challenge. We describe a case of a giant unresectable sacrococcygeal chordoma.

Role of N-acetylcysteine on fibrosis and oxidative stress in cirrhotic rats / Papel da N-acetilcisteína na fibrose e estresse oxidativo em ratos cirróticos

BACKGROUND: Hepatic cirrhosis is the final stage of liver dysfunction, characterized by diffuse fibrosis which is the main response to the liver injury. The inhalatory carbon tetrachloride is an effective experimental model that triggers cirrhosis and allows to obtain histological and physiological modifications similar to the one seen in humans. AIM: To investigate the effects of N-acetylcysteine (NAC) on the fibrosis and oxidative stress in the liver of cirrhotic rats, analyzing liver function tests, lipoperoxidation, activity of glutathione peroxidase enzyme, collagen quantification, histopathology, as well as the nitric oxide role. METHODS: The animals were randomly in three experimentals groups: control (CO); cirrhotic (CCl4) and CCl4 + NAC. Evaluate the lipid peroxidation, the glutathione peroxidase enzyme, the collagen and the expression of inducible nitric oxide synthase (iNOS). RESULTS: The cirrhotic group treated with N-acetylcysteine showed trough the histological analysis and collagen quantification lower degrees of fibrosis. This group has also shown less damage to the cellular membranes, less decrease on the glutathione peroxidase levels and less expression of inducible nitric oxide synthase when matched with the cirrhotic group without treatment. CONCLUSION: N-acetylcysteine seams to offer protection against hepatic fibrosis and oxidative stress in cirrhotic rat livers.

RACIONAL: A cirrose é o estágio final da disfunção hepática, sendo caracterizada por fibrose difusa, que compõe a resposta principal do organismo ao dano hepático. O tetracloreto de carbono inalatório é um modelo experimental efetivo, que desencadeia a cirrose e permite obter modificações histológicas e fisiológicas similares às vistas em humanos. OBJETIVO: Investigar os efeitos da N-acetilcisteina (NAC) sobre a fibrose e o estresse oxidativo no fígado de ratos cirróticos, analisando as provas hepáticas, a lipoperoxidação, a atividade da enzima glutationa peroxidase, a quantificação do colágeno, a histopatologia, bem como o papel do óxido nítrico. MÉTODOS: Os animais foram divididos em três grupos experimentais: controle (CO); cirrótico (CCl4) e CCl4 + NAC. Foram avaliados a lipoperoxidação, a enzima glutationa peroxidase, a histologia hepática, a quantificação de colágeno e a expressão da óxido nítrico síntase induzível (iNOS). RESULTADOS: O grupo cirrótico tratado com a NAC demonstrou, através da análise histológica e da quantificação de colágeno, menores graus de fibrose. Este grupo demonstrou, ainda, menos dano às membranas celulares, menor decréscimo nos níveis de glutationa peroxidase e menor expressão da iNOS quando comparado com o grupo cirrótico sem tratamento. CONCLUSÃO: A NAC parece oferecer proteção contra a fibrose hepática e o estresse oxidativo no fígado de ratos cirróticos.

Symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele

We report the first case of symptomatic thoracic spinal cord compression caused by postsurgical pseudomeningocele. A 49-year-old man sought treatment for progressive loss of strength in the lower extremities ten months after full neurological recovery for a thoracic (T11) intradural-extramedullary schwannoma. Magnetic resonance imaging revealed a postsurgical thoracic (T11-T12) pseudomeningocele. The surgical approach showed an inadequate dural closure with spontaneous cerebrospinal fluid fistula. The defect was sealed with suture, muscle and biological glue covering. The patient had a good recovery. Pseudomeningocele must take part of the differential diagnosis of myelopathy after thoracic spine surgery.

Relatamos o primeiro caso de compressão medular torácica sintomática causada por pseudomeningocele pós-operatória. Paciente masculino, 49 anos, apresentou perda progressiva de força nas extremidades inferiores dez meses após recuperação neurológica completa de cirurgia para remoção de schwannoma intradural-extramedular torácico. A ressonância magnética dorsal revelou pseudomeningocele (T11-T12). A abordagem cirúrgica mostrou fechamento dural inadequado com fistula liquórica espontânea. O defeito foi corrigido com sutura, músculo e cola biológica. O paciente teve boa evolução pós-operatória. Pseudomeningocele deve fazer parte do diagnóstico diferencial de mielopatia surgida após cirurgia na coluna dorsal.

Intracranial intrasellar kissing carotid arteries: case report

Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.

Artérias carótidas intracranianas "que se beijam" representam rara variação da anatomia arterial, onde ambas as artérias carótidas internas desviam-se medialmente e tocam-se próximo à linha media dentro do seio esfenoidal ou do osso esfenóide, incluindo a sela túrcica. Essa anomalia é particularmente importante, pois pode causar ou simular doença pituitária e ainda pode complicar uma cirurgia transesfenoidal. Relatamos um raro caso de artérias carótidas intracranianas "que se beijam" em mulher de 57 anos, a qual foi investigada por angiotomografia por quadro de cefaléia súbita. Discutimos a relevância clínica desse achado radiológico.

Coloboma palpebral: relato de caso de tratamento cirúrgico / Congenital upper eyelid colobomas: case report of surgical treatment

Coloboma palpebral congênito é um raro defeito embriológico que ocasiona falhas no desenvolvimento palpebral. Pode afetar tanto a pálpebra superior quanto a inferior, uni ou bilateralmente. Sua importância clínica reside no fato de que, em sua localização mais comum, a pálpebra superior, tais defeitos provocam exposição da córnea, o que pode levar a ulcerações e, posteriormente, a cegueira. Existem várias técnicas cirúrgicas reparadoras dos colobomas de pálpebra superior, a escolha da técnica dependerá da extensão do defeito. O diagnóstico imediato e sua posterior reparação poderá evitar futuras complicações. O presente trabalho tem como objetivo a descrição de uma técnica cirúrgica simples e eficaz e uma revisão sobre coloboma palpebral.

Congenital eyelid coloboma is a rare embryonic defect that causes failure in eyelid development. It can affect both the upper and the lower eyelid, uni– or bilaterally. Its clinical significance lies in the fact that, in their usual location – the upper lid –, such defects cause exposure of the cornea, which can lead to ulceration and eventually blindness. There are several surgical techniques to repair upper eyelid colobomas, the choice of technique will depend on the extent of the defect. The immediate diagnosis and subsequent repair may prevent further complications. This paper aims at describing a simple and effective surgical technique and a review of eyelid coloboma.