Mucocutaneous diseases with manifestations in the head and neck region: 24 years of experience in a Dermatology service.

BACKGROUND: This study aimed to evaluate the clinicopathological features of mucocutaneous diseases with manifestation in the head and neck region. MATERIAL AND METHODS: A retrospective analysis of a dermatology reference center database was carried out. Over 24 years. Clinicopathological data were collected from medical records and the data was analyzed by descriptive statistics. RESULTS: A total of 11.538 medical records were analyzed, being 152 cases of mucocutaneous diseases with manifestations in the head and neck region. Cutaneous lupus erythematosus was the most prevalent diagnosis (66.4%). Face (44.1%), females (79.6%), and patients with 45 years mean age were the most common features. In the oral cavity, the most affected region was the buccal mucosa (37.5%). CONCLUSIONS: Mucocutaneous diseases with head and neck manifestation were rare in the sample analyzed (1.3%), with cutaneous lupus erythematosus and lichen planus being the most common lesions in this region.

Some technical contributions to the treatment of buried penis.

Buried penis is a rare condition in which the preputial skin and the fat in the hypogastric area cause the body of the organ to be involved in such a way as to convey the impression that the patient has a micro penis. We present a few technical contributions to the surgical treatment of buried penis, suggesting modifications that may be of help in the treatment of those patients.

Estimating the TNT equivalence of a 15-ton single base powder explosion through damaged building profiles analyses.

Back in 1964 President Vargas Works was the only place in the country which processed single base powder for the Brazilian Armed Forces. Then its industrial activity was quite strong and around 4:45 a.m. of 23rd September an intense decomposition of nearly 15 ton of that material took place in one of the production lines workshops. The consequences of this explosion were the destruction and extensive damage to the workshops around its epicenter. At that time pictures of all affected buildings were taken and their damages fully described. This led to the present work which consists in the evaluation of the TNT equivalent charge of the explosion using the concept of damage category developed by UK engineers based on the WWII damaging bombing data.

[Rhinofacial entomophthoromycosis due to Conidiobolus coronatus. A report of a case treated successfully with fluconazole]. / Entomoftoromicose rinofacial por Conidiobolus coronatus. Registro de um caso tratado com sucesso pelo fluconazol.

A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30-years-old male from São Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.

Optical spectroscopy on in vitro fungal diagnosis.

The growing incidence of microbial infections and the increasing ability of such organisms to acquire resistance to antimicrobial treatment lead the requirement of fast bacteria and fungi identification methods. In this work we explored optical spectroscopic techniques on fungal identification. We show that some fungal infections can be identified by ultraviolet optical excitation of fungi fluorescence followed by the spectral analysis of the emitted light. Moreover, we demonstrate that ultraviolet LED and LASER could be applied in fungal identification and a new device for fungal diagnosis is proposed.

Sigmoid reconfigured vaginal construction in children.

PURPOSE: We present a modified technique of sigmoid neovaginal construction in children that protects the sigmoid pedicle from traction, allows easy adjustment of caliber and reorients the mucosal fold in a longitudinal direction. MATERIALS AND METHODS: From 1997 to 2000, 10 genetically male (46 XY) children 1 to 13 years old underwent construction of a neovagina with sigmoid, incorporating the Yang-Monti concept of intestinal reconfiguration. The diagnosis was androgen insensitivity in 7 patients, congenital adrenal hyperplasia in 2 due to 17 alpha-hydroxylase deficiency and 3 beta-hydroxysteroid dehydrogenase deficiency, respectively, and bladder exstrophy in 1 who required sex reassignment. RESULTS: Eight children had an adequate caliber neovagina after an initial period of systematic dilation. In 1 case a relevant stricture required reoperation using the same technique and the outcome was good. In another child a stricture developed in the middle of the reconfigured sigmoid segment and a regular dilation schedule is still being followed after 23 months of followup. CONCLUSIONS: The new sigmoid reconfiguration technique enables the use of smaller dimension intestinal segments and construction of a long vaginal conduit of adequate caliber. Its optimal adequacy for penetration must be assessed in the future after these patients begin sexual activity.

Gastrocystoplasty and chronic renal failure: an acid-base metabolism study.

PURPOSE: To verify in an experimental model whether gastrocystoplasty may protect patients with chronic renal failure from acid loading associated acidosis a wedge-shaped portion of the middle stomach was used to improve bladder capacity in animals with chronic renal failure. MATERIALS AND METHODS: An experimental model was used to study 112 adult female Wistar rats (EPM-1) weighing between 156 and 259 gm. The animals were randomly assigned to groups, including 41 controls, 24 undergoing five-sixths nephrectomy to create chronic renal failure, 26 undergoing gastrocystoplasty and 21 undergoing gastrocystoplasty and five-sixths nephrectomy to create renal failure. To provide an acid overload a 5% NH(4)Cl diet was administered to a subgroup of each group. Two months after surgery 24-hour urine was collected, and volume and pH were measured as well as the amount of bicarbonate, ammonium, titratable acidity and chloride. The animals were then exsanguinated through an abdominal aorta puncture. The blood was used for blood gas analysis and to measure sodium, potassium, chloride, ionized calcium and creatinine. RESULTS: When undergoing an acid overload, the animals with gastrocystoplasty had no acidosis since acid radicals were eliminating in the urine as NH(4)Cl. When given the same acid overload, metabolic acidosis developed in the animals with gastrocystoplasty and chronic renal failure. CONCLUSIONS: Gastrocystoplasty protected healthy rats from acidosis when they were given an acid overload but failed to protect the rats with chronic renal failure under the same conditions.

A posterior-based omega-shaped flap vaginoplasty in girls with congenital adrenal hyperplasia caused by 21-hydroxylase deficiency.

OBJECTIVE: To describe a technical modification for constructing a vagina in girls with congenital adrenal hyperplasia caused by 21-hydroxylase deficiency, using a narrower skin base but rich subcutaneous tissue, aiming to obtain both longer and larger vaginal segments with better cosmesis of the external genitalia. PATIENTS AND METHODS: From August 1997 to February 2001, 28 girls (aged 5 months to 17 years) had a neovagina constructed using a posterior-based omega-shaped flap. Twenty-six patients had a low vagina entering into the urogenital sinus and two had a high vagina that entered the urogenital sinus. In those with a high vagina the flap procedure was combined with the Passerini-Glazel technique. All the patients were scheduled for vaginal "calibrations" during the first year after surgery and, according to the result, would then undergo vaginal dilatation. RESULTS: Six children were re-operated; five had plastic surgery to correct genital folds that had regained a scrotal aspect, whereas one with a high vagina developed a urethral stricture, with urinary dribbling and infection, and had the urethra reconstructed. These six children are currently well. No hormone therapy was given to one child for 1 year who is scheduled for further surgery for a re-virilized clitoris. Two patients were lost to follow-up. Up to the last visit, 19 girls had not developed a vaginal stricture and the cosmesis of their external genitalia was deemed good. CONCLUSION: The posterior-based omega-shaped flap enabled both the construction of wider vaginal segments with a low risk of developing stenosis in those with a low vagina, and increased vaginal dimension when associated with the Passerini-Glazel technique for those with a high vagina. However, despite good cosmesis of the external genitalia, the follow-up is too short to confirm whether this technique will meet all the expectations.

The exstrophy-epispadias complex: is aesthetic appearance important?

OBJECTIVE: To show the relevance of cosmetic appearance in the adequate treatment of patients with exstrophy-epispadias complex (EEC), and to indicate that surgery by experienced teams can improve the long-term treatment forecast and the patient's body image. PATIENTS AND METHODS: From 1978 to 2002, 71 patients diagnosed with EEC were treated in the authors' institution; 24 (aged 2-23 years) were selected to undergo different surgical procedures. The criterion for surgery considered interviews conducted by the psychology team with the parents and children. The plastic surgery and paediatric urology teams carried out the procedures jointly; the follow-up was 0.33-7 years. RESULTS: Five female patients and six male had abdominoplasty to treat multiple scars; eight had intermittent catheterization conduits repositioned from the right iliac fossa to the umbilicus. Six female patients had plastic surgery of the external genitalia and three had a broad mobilization of the urogenital sinus. Thirteen male patients had a small penis and had the corpora cavernosa fully mobilized and the penis reconstructed. Five female patients and one male had anterior osteotomy. One patient with no left testis had it replaced and one patient with uterine prolapse had the uterus fixed to the posterior abdominal wall. Six patients had a second procedure, in two because the outcome of the initial operation was poor and in the others to complement the initial treatment. In all but one patient there was an improvement in the objective criteria, e.g. school absences, difficulty in establishing long-lasting social relationships and refusal to participate in sports activities. However, none of the patients would attempt sexual intercourse. CONCLUSIONS: Body image, self-esteem, sexuality, sexual function and fertility are deemed crucial by adolescents; in patients with EEC customised surgical procedures can give a satisfactory aesthetic outcome, and be a further reason for adequately following occasional urinary complications and renal function, to avoid loss to follow-up.

Posterior urethral injuries and the Mitrofanoff principle in children.

OBJECTIVE: To report our experience of children with trauma causing posterior urethral injury who at some stage underwent a Mitrofanoff intervention, as post-traumatic urethral injuries can demand long-term treatment which (regardless of the surgical intervention) requires a period of dilatation of the reconstructed urethra. PATIENTS AND METHODS: From 1992 to 2001, 14 patients with urethral injuries underwent a Mitrofanoff procedure. Thirteen had been run over by a motor vehicle and had severe hip injuries, and one had a direct non-penetrating perineal impact lesion (13 boys and one girl, aged 2-13 years at the time of the accident). In all cases the Mitrofanoff procedure involved interposing the appendix between the bladder and the umbilicus. Only one of the children (because of extremely high bladder filling pressures) also underwent an augmentation cystoplasty and closure of the bladder neck because there were bony fragments in the urethra. RESULTS: The Mitrofanoff technique was considered useful in most cases. All patients during a given period used the Mitrofanoff conduit to empty their bladder every 3 h; 10 of the 14 are currently voiding urethrally, with an adequate flow, and four are not, but emptying the bladder periodically via the appendicovesicostomy. The only girl in the group has a major hip deformity and is unlikely to undergo urethroplasty; two patients are expecting definitive treatment and the other, although having a patent urethra, has no urinary flow. He is currently 19 years old and has no erections. CONCLUSIONS: The treatment of posterior urethral injuries represents a challenge to surgical teams. Although primary suturing of the separated urethral ends is accepted as the best treatment, the construction of a temporary continent urinary diversion may be considered in the most severe cases.

Criptorquidia: ventajas de la cirugia temprana. / Cryptorchism: advantages of early surgery

Este trabajo informa la exeperiencia en el manejo de la criptorquidia con orquidopexia en ninos muy variadas edades.Se consideran especialmente las dificultades quirurgicas en relacion a la edad en que son intervenidos los pacientes y se senalan algunas de las complicaciones frequentes postoperatorias, sobre todo, las referentes a la involucion testicular.Se hace enfasis en la cirugia temprana, sobre todo por riesgo de atrofia testicular pero tambien por las difucultades tecnicas inherentes y mucho mayores conforme avanza la edad

Adenocarcinoma del colon en ninos.Estudio de un caso. / Adenocarcinoma of the colon children. Report of a case

Se presenta el caso de un nino de 12 anos de edad con diagnosticos de adenocarcinoma de colon transverso y pesima evolucion para llamar la atencion del cirujano pediatra hacia esta patologia, que aunque rara, exige una conducta inmediata y la mas adecuada posible. Estos tumores son muy raros en la ninez, lo que hace que el diagnostico sea insospechado, ya que ademas de su rareza, el cuadro clinico en la infancia no es caracteristico, predominando el dolor abdominal, constipacion intestinal, cuadros oclusivos y semioclusivos, que permiten una evolucion mas larga de la patologia antes de su diagnostico, con pronostico muy malo, lo que no ocurre en los adultos

Capacitaçäo e formaçäo do odontólogo em radioproteçäo no estado do Rio de Janeiro / Capacitation and formation of dentist in radiation protection in Rio de Janeiro state

O objetivo deste trabalho é mostrar a necessidade e a importância da capacitação e formação do odontólogo em radioproteção, que resultará em um melhor desempenho profissional na proteção de seus pacientes e de si mesmo. Apesar de todo desenvolvimento tecnológico, uma análise dos programas das disciplinas das escolas de odontologia do estado do Rio de Janeiro indica que elas mostram pouca ou nenhuma preocupação com proteção radiológica. Isto foi confirmado através de um questionário passado a estudantes e professores de odontologia. Este trabalho sugere a criação ou adptação de disciplinas já existentes, envolvendo radioproteção e qualidade de imagens em radiodiagnóstico, para melhorar, complementar, e uniformizar a formação de futuros dentistas, otimizando a solução dos problemas identificados.

Dermasoft: um sistema de instruçäo assistido por computador (CAI) para o ensino de dermatologia / Dermasoft: computer assisted instruction system (CAI) for dermatology lectures

Com o intuito de desenvolvimento novas técnicas de divulgação e ensino em dermatologia, os Setores de Biotecnologia e de Bioinformática do Laboratório de Imunopatologia Keizo Asami (LIKA) juntamente com o Departamento de Dermatologia da Universidade federal de Pernambuco (UFPE), está desenvolvendo através da tecnologia Computer Assisted Instuction (CAI), o DERMASOFT. Este software consiste na utilização integrada de bases de textos, imagens e casos clínicos no ambiente Windows com o objetivo de ser um instrumento de apoio ao ensino e de atualização para dermatologia e profissionais interessados na área.