High-dose chemotherapy with autologous stem cell transplantation for patients with extracranial germ cell tumors - experience of two Brazilian pediatric centers.

Malignant extracranial germ cell tumors (GCTs) are rare in pediatric patients and are usually extremely sensitive to chemotherapy. Relapsed or refractory tumors, although rare, established the need for second-line therapies, including high-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT). However, there are few data on its use in children with GCTs. We present a retrospective analysis of all patients diagnosed with extracranial GCTs who received HDCT/ASCT at two Brazilian pediatric cancer centers from May 1999 to December 2019. We identified a total of 34 patients with a median age at diagnosis of 2.8 years (range, 0 to 18.8), who received HDCT/ASCT. Most patients (73%) received carboplatin, etoposide and melphalan (CEM) as a HDCT regimen. Fourteen patients received a second-line conventional dose chemotherapy (CDCT), 14 received a third-line CDCT and five received even a fourth-line CDCT prior to HDCT/ASCT. After a median follow-up of 22.7 months (range, 0.3 to 198.1), 16 patients had died after tumor relapse/progression and 2 patients died from HDCT/ASCT toxicity. We observed a 5-year OS of 47.1% and 5-year EFS of 44.1%. The 5-year OS for patients referred for HDCT/ASCT with progressive disease was 10% compared to 62.5% for those who achieved disease control before HDCT/ASCT (p = 0.001). In our experience, heavily pretreated children and adolescents with extracranial GCTs achieved considerable survival rates with HDCT/ASCT since, at least, partial control of their disease was possible before starting HDCT/ASCT. The role of HDCT/ASCT in pediatric patients with GCTs should be investigated in prospective trials.

Influence of different adhesion strategies on glass fiber post retention.

Background: Failures in glass fiber post (GFP) retention may be associated with low adhesion achieved in root dentin. Material and Methods: 55 single-rooted premolars were endodontically treated and distributed according to different adhesion strategies (n=11): G1: RelyX ARC (3M ESPE; etch-rinse strategy); G2: Relyx Ultimate (3M ESPE; etch-rinse strategy); G3: AllCem (FGM; etch-rinse strategy); G4: Relyx Ultimate (3M ESPE; self-etching strategy); G5: RelyX U200 (3M ESPE; self-adhesive strategy). For Bonding Strength (BS) analysis, the roots were sectioned in slices (1.0mm thickness) corresponding to each root third and submitted to push-out test. The type of failure was assessed by scanning electron microscopy (SEM). Results: The highest BS averages were found in G2 and G3. However, in the middle and apical root thirds, G3 showed statistically similar results to G4 and G5. In the cervical and middle third, G1 was statistically similar to G4 and G5. The mixed type of failure was the most common in all groups. Conclusions: Self-etching (G4) and self-adhesive resin (G5) cements, showed similar BS results of immediate bonding in the cementation of GFP compared to conventional resin cements (G1, G2, G3). Key words:Dental Cements, Dentin-Bonding Agents, Post and Core Technique, Dental Bonding.

Use of Objective Outcomes Measures to Verify the Effects of ICF-Based Gait Treatment in Huntington's Disease Patient on Globus Pallidus Deep Brain Stimulation: A Case Report.

In advanced stages of in Huntington's disease (HD) gait impairments and severe chorea are usually medication-refractory. The long-term effects on gait in HD of physiotherapy ICF-based management post- globus pallidus deep brain stimulation (GPi DBS) are not well-established. Physiotherapy has been recognized as an essential element in HD treatment. Here, we present a case report of a 56-year-old woman with HD on the advanced stage and severe chorea medication-refractory after GPi-DBS. We performed multidisciplinary motor assessments ICF-based to identify the disability at clinical and home-setting, including environmental and personal factors before and after GPi-DBS surgery and at 11-time points follow-up. The surgery was very successful and directly post GPi-DBS, there were a significant improvement in chorea and a substantial decrease in medication dose. A framework ICF- based physiotherapy protocol with external cues was developed to improve gait was delivered post-surgery and was continued three times/week during 18-months. Physiotherapy sessions consisted of a personalized protocol of exercises with functional movements, balance, and gait training with external cues. Improvements in gait were observed in 3-months post-intervention and were more expressive in 6-months follow-up. Our patient improved substantially HD motor symptoms and her quality of life after GPi-DBS intervention and a physiotherapy program ICF-based. The objective outcomes measures used to assess gait have served as endpoints to assessing the patient's motor profile during the pre-operative period. Assessments were helpful to verify the efficacy of the multidisciplinary intervention in long-term. Conclusion: Periodically assessing function and disability using outcome improvements may support clinicians' decisions about DBS, medication adjustments and guide physiotherapists to personalize the ICF-based intervention.

Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis.

OBJECTIVE: This study aimed to develop two non-industrial food products as financially accessible options to prevent and treat malnutrition in hemodialysis (HD) patients. These food products were developed and intended for use as dialysis snacks. METHODS: This is a cross-sectional and multi-step study. First, 183 adult HD patients (55 ± 14 years; 50.8% males), replied to a questionnaire with their food preferences regarding taste (salty, sweet, bitter, sour) and consistency (liquid, solid, pasty) for a dialysis snack. Most patients preferred a food product with a solid consistency (90%) and a salty flavor (81.4%). Second, three muffin formulations of fine herbs were developed; one enriched with whey protein concentrate (WPC), a second with textured soy protein (TSP) and a third standard formulation without protein for comparison with the protein-enriched muffins, for which the chemical and nutritional compositions were analyzed. In the third step, 60 patients on HD (61 ± 15 years; 53% males) were enrolled in a sensory analysis by applying a 9-point structured hedonic scale, ranging from "extremely liked" (score 9) to "extremely disliked" (score 1). RESULTS: When compared with the standard formulation, the formulations enriched with WPC and TSP protein had a significantly higher amount of protein/serving (Standard: 5.9 ± 0.3 g vs WPC: 14.5 ± 0.9 g and TSP 10.8 ± 0.7 g; P < 0.05) but a lower amount of carbohydrate (Standard: 13.1 ± 2.2 g vs WPC: 5.6 ± 0.8 g and TSP 6.0 ± 1.2 g vs; P < 0.05). The mineral content/serving of the protein-enriched muffins was low in phosphorus (50 mg) and sodium (180 mg). The potassium content/serving was moderate for the WPC muffin (225.2 mg) and low for the TSP muffin (107.9 mg). The acceptability index (AI) for the enriched protein muffins was higher than 70% and similar to the standard formulation. CONCLUSION: The muffins with fine herbs and enriched with protein were well-accepted by all patients and appropriate to serve as dialysis snacks for HD patients.

Influence of nutritional assistance on mortality by COVID-19 in critically ill patients.

BACKGROUND & AIMS: Evidence suggests the existence of an association between the institution of nutritional therapy and clinical outcomes in patients with critical COVID-19. Thus, the aim of this study was to evaluate the influence of nutritional assistance on COVID-19 mortality in patients admitted to intensive care units (ICU). METHODS: This is a subset of the cohort "Influence of nutritional therapy on clinical prognosis in patients with COVID-19: a multicenter retrospective cohort study". Clinical and nutrition assistance information (type of assistance, evaluation of anthropometric status, and time of introduction of nutritional therapy) and presence of diabetes, hypertension and previous respiratory disease were collected from electronic medical records. To evaluate the association between the variables of interest and mortality, the hazard ratio was estimated. RESULTS: We evaluated 153 critically ill patients ≥18 years old, affected by COVID-19, with a rate of mortality of 77.8%. Among non survivors 58.8% were female, 52.9% aged <65 years, 66.4% had arterial hypertension, 46.2% diabetes mellitus and 81.5% had an early onset of nutritional support. Initiation of nutritional therapy after 48 h (HR: 2.57; 95% CI: 1.57-4.20) and the presence of obesity (HR: 1.55; 95% CI: 1.04-2.31) were associated with higher mortality, even after adjustment for potential confounders. CONCLUSIONS: Our data suggests that the provision of early nutritional therapy should be prioritized, with greater attention directed to obese patients, and the nutritional assistance can contribute favorably to the clinical evolution and prognosis of critically ill patients with COVID-19.

Evaluation of marginal sealing quality of restorations with low shrinkage composite resins.

BACKGROUND: This study compared the quality of marginal sealing in the gingival wall of class II preparations of two low-shirinkage resins of the bulk fill type with a conventional resin isolated or associated with a glass ionomer cement (GIC). MATERIAL AND METHODS: 40 human molars were divided into 4 groups and 80 occlusal-mesial and occlusal-distal restorations were performed with the following materials: SureFil SDR flow, Filtek Bulk Fill Posterior, Z250 resins and Riva Light Cure GIC. 40 restorations were evaluated in Scanning Electron Microscopy (SEM) with Elemental Microanalysis Spectrometry (EDS) initially and the remainder after a period of 6 months of aging in a 37 ± 5°C oven. An average of the silver penetration at each restoration was obtained in the two evaluations and the results were statistically analyzed in a descriptive and inferential way, through the paired t-Student and one-way ANOVA F-test. RESULTS: There were no significant statistical differences between the materials with respect to silver nanoinfiltration, except for the Bulk Fill Posterior/3M ESPE resin compared to the GIC and conventional resin in the final evaluation. CONCLUSIONS: The low shrinkage resins showed a similar behavior in relation to the marginal sealing quality observed in the GIC or composite resin with the incremental technique, also presenting the advantage of simplicity in the technique of confection of the restorations and reduction of the time of work. Key words:Resin composites, Bulk fill, dental restorations, marginal quality, adhesion.

Color stability of Bulk-Fill composite restorations.

BACKGROUND: The color stability of the composite resin is an important property that influences its clinical longevity, which remains an inherent challenge to the material. Thus, the purpose of this study was to evaluate the color stability of bulk-fill resins when exposed to dye. MATERIAL AND METHODS: Cavities were prepared in 80 bovine incisors, which were randomly assigned into 4 groups (n = 20) according with the resin composite used: P60 (Control Group - Filtek P60, 3M/ESPE), FP (Filtek Bulk-Fill Posterior, 3M/ESPE), SDR (SDR, Dentsply) and FF (Filtek Bulk Fill Flow, 3M/ESPE). All restorations were performed according to the protocol of each manufacturer, the control group was restored using the incremental technique, and the other groups using single-increment technique. The color of each restoration was measured using a portable digital spectrophotometer (Easyshade-Vita) according to the CIELab system, and then the teeth were submerged in red wine for 07 days, kept in a biological oven at 37ºC. New color registration was performed to measure the ΔE index of color variation. RESULTS: The P60 group had the lowest average ΔE (16.96), while the FF group had the highest average (28.09) and ranged from 21.19 to 26.28 in the FP and SDR groups. CONCLUSIONS: Analysis of the color variation showed that the control group had better color stability than the Bulk-Fill resins evaluated. Key words:Dental restoration failure, Food coloring agents, polymerization.

Influence of different thermopolymerization methods on composite resin microhardness.

BACKGROUND: Additional heat polymerization in composite resins allows greater effective-ness of microhardness, flexural strength, fracture tough-ness, wear resistance, and increased color stability. MATERIAL AND METHODS: 150 composite resin specimens were made using a 4 mm diameter and 2 mm thick bipartite steel matrix. Five resins composed of different compositions were tested (Brilliant Everglow/Coltene, Filtek One BulkFill/3M, Filtek P60/3M, Filtek Z350XT/3M, Filtek Z250XT/3M), and for each of them three types of polymerization were tested: light curing only (n=50); photopolymerization + autoclave thermopolymerization (n=50) and photopolymerization + microwave thermopolymerization (n=50). Each specimen was submitted to three indentations by means of the Vickers microhardness test, applying a load of 300gf, associated with the time of 15s. Data were analyzed descriptively by means of statistics, standard deviation and coefficient of variation and inferentially by the F test (ANOVA) in the comparison between groups. The margin of error used in statistical test decisions was 5%. RESULTS: The highest vicker microhardness averages were from the Control group (light curing only) on P60 (82.16) and Z250 XT (79.61) resins. The lowest averages were all verified on Brilliant Everglow resin in all polymerization methods studied: Photopolymerization (37.32), with microwave (43.80) and autoclave (45.12), followed by Bulk Fill 3M resin, ranged from 52.23 to 59.15. CONCLUSIONS: Both autoclave and microwave thermopolymerization methods showed similar behavior on the microhardness of the composites studied. Considering the resin type, there was a varied behavior compared to thermopolymerization, which increased the microhardness values for Brilliant Everglow resins (Coltene) and Filtek One Bulkfill (3M) and decreased for Filtek P60, Filtek Z350XT and Filtek Z250XT resins. Key words:Dentistry, composite resins, polymerization.

The influence of violet LED light on tooth bleaching protocols: In vitro study of bleaching effectiveness.

BACKGROUND: Employing violet LED on tooth bleaching is a recent but promising technique. This study aimed to assess the bleaching effectiveness of violet light-emitting diodes (LEDs) associated or not with bleaching gels containing hydrogen peroxide (HP) or carbamide peroxide (CP). METHODS: seventy bovine incisors were randomly assigned into 7 groups (n = 10) according to the technique and whitening product used. Group C: Artificial saliva (placebo); Group HP L-: three sessions of HP at 35 % without light activation; Group CP L-: three weeks of CP at 16 % for 4 h/day; Group HP CP L-: three sessions of HP at 35 % without light activation + 2 weeks of CP at 16 %, for 4 h/day; Group LED: four sessions with violet LED; Group HP L+: three sessions with HP at 35 % + violet LED; Group CP L+: three weeks with CP at 16 % for 4 h/day + violet LED. Color changes (ΔE and ΔL) were measured with a portable digital spectrophotometer. RESULTS: The results were similar between the groups of bleaching protocols, demonstrating that the use of the violet LED did not influence bleaching effectiveness when using HP 35 % or CP 16 % after 3 sessions. In addition, the use of the violet LED alone obtained ΔE values ​​similar to the protocols with the use of peroxides, however less variation of ΔL was observed for this group. CONCLUSIONS: The use of violet LEDs associated or not with bleaching gels was effective for tooth whitening. In addition, it was also concluded that the physical lightening technique with violet LED used alone produced less variation in dental brightness.

Does comsumption of staining drinks compromise the result of tooth whitening?

BACKGROUND: After dental bleaching procedures dentists commonly advise patients to reduce the consumption of beverages that may cause the teeth to stain, however, the effectiveness of teeth whitening may not be directly affected by diet. MATERIAL AND METHODS: It was evaluated through in vitro study whether contact with dyes through in-office bleaching sessions with 35% hydrogen peroxide would influence the effectiveness of treatment. Sixty bovine incisors were randomly assigned into 5 groups (n = 12) according to contact frequency and type of dye solutions. All dental elements received three in-office bleaching sessions with 35% hydrogen peroxide one week apart. Except for GCTRL (control), all experimental groups were submerged in dyes (coffee or wine) for 5 min once a day. In groups GC24 and GW24 contact with the dyes was made from 24 hours after each bleaching session, while in groups GC72 and GW72, from 72 hours. The color was measured with a digital spectrophotometer. Data were expressed as statistics: mean and standard deviation. RESULTS: Contact with dyes during in-office bleaching treatment with 35% hydrogen peroxide did not influence the staining averages after three bleaching sessions. The speed of the whitening effect was influenced by contact with coffee from 24 hours after the sessions and with wine from 24 hours and 72 hours after the whitening session. The whitening result was reversed after one week for all groups, especially for groups that came in contact with red wine either 24 hours or 72 hours after session and coffee after 24 hours. CONCLUSIONS: Contact with dyes during in-office bleaching treatment did not influence the final staining averages after three bleaching sessions although there was influence on speed of the whitening effect between the sessions. Key words:Tooth bleaching, hydrogen peroxide, spectrophotometry.

In vivo optical coherence tomographic imaging to monitor gingival recovery and the adhesive interface in aesthetic oral rehabilitation: A case report.

The available methods for veneer evaluation are limited to clinical and radiographic examinations, which may not allow the appropriate identification of failure. In this report, we demonstrate the use of optical coherence tomography (OCT) as a noninvasive diagnostic and follow-up method to evaluate gingival recovery and the adhesive interface in aesthetic oral rehabilitation involving periodontal plastic surgery and ceramic laminate veneers. OCT was efficient for evaluating both soft and hard tissues, as well as the quality of the adhesive interface. In conclusion, OCT was found to be a promising approach for the professional evaluation of aesthetic oral rehabilitation, as it was capable of generating images that enabled the analysis of gingival recovery and the adhesive interface.

Pemphigus vulgaris: a therapeutic option for disease control.

Pemphigus vulgaris (PV) is an autoimmune intra-epithelial dermatologic disease that is characterized by epithelial blistering and affected cutaneous and/or mucosal surfaces. The disease is caused by circulating immunoglobulin G (IgG) antibodies directed against desmosomes. These antibodies interfere with keratinocyte adhesion, causing acantholysis, which results in blister formation. At present, death from pemphigus infection is unusual; however, morbidity and mortality from chronic corticosteroid use remain considerable, indicating a need for additional therapies. This article presents a case of PV in a female patient that was treated with conventional corticosteroid therapy and discusses recent adjuvant therapy.

Quantitative analysis of somatostatin receptor subtype (SSTR1-5) gene expression levels in somatotropinomas and non-functioning pituitary adenomas.

OBJECTIVE: It is believed that the variable effectiveness of somatostatin analogs in post-surgical management of somatotropinomas and non-functioning pituitary adenomas (NFPA) may be due in part to variable expression of somatostatin receptor isoforms (SSTR1-5), within and between pituitary tumor types. DESIGN AND METHODS: Quantitative real-time RT-PCR was used to compare absolute mRNA copy numbers for all five SSTR isoforms in 23 somatotropinomas and 19 NFPA. RESULTS: Somatostatin receptor subtype 5 mRNA was present at the highest level in somatotropinomas, followed by SSTR2>SSTR3>>SSTR1>>>SSTR4. In contrast, SSTR3 mRNA was present at the highest level in NFPA, followed by SSTR2, while SSTR1, SSTR4, and SSTR5 transcripts were only detectable in select tumors. Among somatotropinomas, a positive correlation was found between SSTR2 mRNA levels and the percent decrease of GH (%GH) after 3 and 6 months of therapy with octreotide long acting repeatable (LAR) (r=0.51 and r=0.66; P=0.05 and P=0.008). Also the percent decrease of IGF-I (%IGF-I) after 3 months of octreotide LAR was negatively correlated with SSTR5 and %IGF-I after 6 months of octreotide LAR was positively correlated with SSTR2. CONCLUSIONS: The present report is a large series examining SSTR mRNA levels in somatotropinomas and NFPA. These initial findings suggest that detailed knowledge of the SSTR mRNA expression profile in somatotropinomas can help to predict the hormonal response to therapy with LAR. Also, it appears that SSTR3 in NFPA may be a potential target for SSTR3 preferential or universal ligands such as pasireotide.

Dental Whitening: Self-Referred Needs versus Professional Indication

Abstract Objective: To analyze the self-reported need of patients compared to professional indications for tooth whitening. Material and Methods: Initially, 58 undergraduate students responded to a form that highlighted the question: "Do you think you need to have your teeth whitened?" Among those who answered positively to the previous question, ten individuals were photographed with their smiles. In addition, they were asked to point out, on the Vita 3D-Master scale, which color they believed their teeth had, a value that was compared to the actual color obtained by a spectrophotometer. Finally, the photographs were presented to dentists, who were asked about the indication or not of the whitening treatment. Results: Most interviewees (63.8%) self-reported the need for whitening, as well as there was a greater incidence of a positive indication among professionals (53.9%). Pearson's Chi-square test revealed a relationship between patient gender and the training course on the desire to have teeth whitened. Among the professionals, the specialty, as well as time since graduation, interfered in the indication for whitening. Conclusion: Professionals and patients share the aesthetic ideal directly related to light teeth; most patients self-perceive the color of their teeth darker than it actually is; the opinion about the color of the teeth has an extremely subjective character and varies greatly from one professional to another (AU).

Evaluation of different composite resin finishing and polishing protocols by confocal laser scan microscopy

Aim This study aimed to analyze the influence of finishing and polishing (F/P) protocols on resin surface through roughness (Ra) values and laser scan microscopy observations. Methods Forty-eight (n=48) resin specimens were sorted into four groups (n=12), according to the type of resin used: Filtek Z250 (Z250), Filtek Z350 (Z350), Filtek One Bulk Fill (BF), Filtek P60 (P60). The specimens were sorted into six groups according to the type of F/P system used (n=2/group): Control group, Diamond bur (KG Sorensen), Soflex Pop-On Discs (3M ESPE), Soflex Spiral (3M ESPE), Dura Gloss (American Burs), and Praxis (TDV). Results The highest roughness values (Ra) were attributed to BF group for all F/P systems, except for the Soft-Lex PopOn discs. The Soft-Lex PopOn, Spiral, and Praxis discs presented a better performance for the surface treatment of the tested composite resins. Regardless of the restorative material, the use of diamond bur or single-step abrasive rubber (Dura Gloss) were associated with the highest Ra values. Conclusion The effect of F/P systems on Ra is material-dependent and instrument or system-dependent.

Chikungunya associated vulvitis: case report and literature review / Vulvite associada a Chikungunya: relato de caso e revisão de literatura

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Introdução: O vírus Chikungunya está se espalhando pelo mundo por conta da migração e da globalização, podendo apresentar sintomas sistêmicos e incomuns. Objetivo: Relatar um caso de infecção pelo vírus detectado em uma mulher por ocasião do exame ginecológico em clínica de patologia vulvar. Relato do caso: Uma mulher caucasiana de 73 anos foi a uma clínica vulvar por causa de dispareunia e queimação vulvar. Úlceras foram observadas nos pequenos lábios e no períneo. O diagnóstico de Chikungunya foi realizado por soroconversão em espécimes pareados. Foi prescrita prednisolona 40 mg uma vez ao dia por dez dias. Após o tratamento com esteróides orais, a mulher não apresentou erupções ou lesões nos órgãos genitais. Conclusão: Este estudo enfatizou que quadros raros de vulvite com úlcera podem estar associados à infecção por Chikungunya.

A clinical evaluation of packable and microhybrid resin composite restorations: one-year report.

OBJECTIVE: The objective of this study was to evaluate the clinical performance of two packable and one microhybrid resin composites placed in occlusal cavities of posterior permanent teeth after 1 year. METHOD AND MATERIALS: Sixty occlusal restorations were placed in 18 male or female patients aged 21 to 44 years. The restorations were divided into three groups according to the restorative material: G1 (Surefil + Prime&Bond NT); G2 (Filtek P60 + Singlebond), and G3 (Suprafill + Suprafill). They were placed by two previously calibrated operators. The restorations were directly evaluated for color matching, marginal discoloration, secondary caries, wear, marginal adaptation, and postoperative sensitivity. RESULTS: Of the total restorations, 66.7% were scored A (ideal) for color matching; 98.2% for marginal discoloration; 100% for secondary caries; 92.6% for wear; and 92.6% for marginal adaptation. Postoperative sensitivity was reported in 5% of the restorations. Fisher's exact, McNamara's, and chi-square tests did not indicate statistical difference between the groups, related to the evaluated criteria. CONCLUSIONS: The packable (Filtek P60 and Surefil) and the microhybrid (Suprafill) resin composites exhibited excellent clinical performance after 1 year and may be considered possible materials for the restoration of posterior teeth.

[Acute test with subcutaneous octreotide as a predictor of the response to treatment with octreotide LAR]. / Teste agudo com octreotide subcutâneo como preditor de resposta ao tratamento com octreotide LAR.

Somatostatin analogues are frequently used to treat acromegaly. To determine the value of the acute test (AT) with subcutaneous (SC) octreotide as a predictor of the response to treatment with octreotide LAR, we analyzed data from 20 patients. For the AT, blood was drawn before and two hours after the SC administration of octreotide for measuring GH. GH levels before and after the AT were 21.9 ng/mL (2.3-143.4) and 3.1 ng/mL (0.3-61.3), respectively. Control of the disease was defined as: GH< 2.5 ng/mL and normal IGF-I anytime during treatment. Sensitivity, specificity, positive and negative predictive values of the AT were 0.9, 0.6, 0.69 and 0.86 for a reduction of 75% of the GH on the test. From our sample we conclude that a 75% reduction of the GH levels during the acute test was able to discriminate patients with a higher or lower chance of responding to treatment.

Retalho de pedículo subcutâneo em formato de tubarão na região perialar / Subcutaneous pedicle flap shaped like a shark on perinasal region

A região nasal é frequentemente acometida por neoplasias cutâneas, especialmente em indivíduos de fototipos baixos, em quem a incidência de carcinoma basocelular é elevada. Defeitos cirúrgicos na asa nasal e região perinasal constituem desafio à sua reconstrução, uma vez que envolve várias unidades cosméticas e preservação do sulco nasal. A preservação dos limites entre essas unidades mostra-se fundamental, portanto, para o bom resultado funcional e estético. Este artigo tem como objetivo mostrar a aplicação do retalho de pedículo subcutâneo em formato de tubarão para correção de defeitos em asa nasal e região perinasal.

The nasal region is often affected by cutaneous neoplasm, especially in individuals of low phototypes, where the incidence of basal cell carcinoma is high. Surgical defects in the nasal wing and perinasal region constitute a challenge to its reconstruction since it involves several cosmetic units and preservation of the nasal groove. The preservation of the limits between these units is thus fundamental for good functional and aesthetic results. This article aims to show the application of the Shark Island Flap for the correction of defects in the nasal and perinasal regions.