Alternativas para onfaloplastia em cirurgia estética do abdome: Revisão da Revista Brasileira de Cirurgia Plástica e apresentação da experiência com técnica em H / Alternatives to omphaloplasty in aesthetic surgery of the abdomen: Review of the Revista Brasileira de Cirurgia Plástica and presentation of the experience with the technique in H

Introdução: A abdominoplastia está entre os procedimentos estéticos mais procurados na cirurgia plástica nos últimos anos. Dentro da perspectiva da imagem corporal, a confecção do neoumbigo é peça chave, e sua ausência, distorção ou má cicatrização comprometem o resultado cirúrgico. Diversas técnicas foram descritas, mas todas com suas limitações. O objetivo foi reunir um resumo das possibilidades cirúrgicas apresentadas na Revista Brasileira de Cirurgia Plástica (RBCP), além de reapresentar a técnica em H. Método: Foi realizada revisão qualitativa da literatura publicada na RBCP no período de 2000 a 2021. Foram incluídos artigos que descrevessem uma proposta de umbilicoplastia, referindo número de pacientes, idade, tempo de seguimento, avaliação da satisfação dos pacientes e complicações; sendo excluídas publicações sem fins estéticos ou pacientes pós grandes perdas ponderais. Resultados: Foram encontrados 38 artigos, sendo excluídos 7 pela análise dos títulos e resumos. Os demais artigos foram revisados por dois autores independentes, sendo realizada a exclusão de mais 20 artigos. No final, 11 artigos foram incluídos nesta revisão. Conclusão: A onfaloplastia em abdominoplastias pode ser realizada de várias formas, possibilitando uma gama variável de alternativas para os cirurgiões. A técnica em H é mais uma dessas ferramentas, podendo ser amplamente utilizada e trazendo resultados consistentes.

Introduction: Abdominoplasty has been among the most popular cosmetic procedures in plastic surgery in recent years. From the perspective of body image, making the new navel is a key part, and its absence, distortion, or poor healing compromises the surgical result. Several techniques have been described, but all with their limitations. The objective was to gather a summary of the surgical possibilities presented in the na Revista Brasileira de Cirurgia Plástica (RBCP), in addition to reintroducing the technique in H. Method: A qualitative review of the literature published in the RBCP in the period from 2000 to 2021 was carried out. Articles were included that described a proposal for umbilicoplasty, referring to the number of patients, age, follow-up time, assessment of patient satisfaction, and complications, excluding publications without aesthetic purposes or patients after major weight loss. Results: 38 articles were found, 7 of which were excluded by analyzing the titles and abstracts. Two independent authors reviewed the other articles, excluding another 20. In the end, 11 articles were included in this review. Conclusion: Omphaloplasty in abdominoplasties can be performed in several ways, providing surgeons with various alternatives. The H technique is one of these tools which can be widely used and bring consistent results.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Analysis of the curative effect of transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy / 中国医师进修杂志

Objective:To investigate the safety and curative effect of transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy.Methods:The clinical data of 105 patients underwent laparoscopy ovarian cystectomy in Fujian Maternity and Child Health Hospital from June 2018 to December 2021 were retrospectively analyzed. Among them, 45 patients underwent transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy (observation group), and 60 patients underwent multi-port laparoscopy for ovarian cystectomy (control group). The operative time, intraoperative bleeding, conversion to open surgery, cyst rupture, surgical collateral injury, postoperative exhaust time, postoperative hospital stays, hospitalization cost and postoperative infection, etc were recorded. The face rating scale (FRS) was used to evaluate the pain at 6 and 24 h after operation; the incision satisfaction was evaluated by the Kiyak satisfaction scale at 2 months after operation.Results:The operation was carried out successfully in both groups without surgical collateral injury or conversion to open surgery. There were no significant differences in operative time, intraoperative bleeding, postoperative hospital stays, hospitalization cost, cyst rupture rate and postoperative infection rate between 2 groups ( P>0.05); the postoperative exhaust time and FRS 6 and 24 h after operation in observation group were significantly less than those in control group: (22.1 ± 3.5) h vs. (23.9 ± 3.8) h, 1 (0, 2) scores vs. 2 (1, 4) scores and 1 (0, 1) scores vs. 1 (0, 2) scores, the incision satisfaction score was significantly higher than that in control group: 5 (4, 5) scores vs. 4 (3, 4) scores, and there were statistical differences ( P<0.05 or <0.01). Conclusions:Transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy is safe and feasible, with concealed incision and high patient satisfaction, and has good clinical application value.

Endometriosis cutánea primaria umbilical: a propósito de un caso / Umbilical Primary Cutaneous Endometriosis: A Case Report / Endometriose cutânea primária umbilical: relato de caso

Introducción: la endometriosis es una de las patologías ginecológicas más frecuentes, que se entiende como la implantación intrapélvica de tejido endometrial, sensible, en la gran mayoría de casos, al influjo hormonal. Extrauterinamente, se caracteriza por la presencia de glándulas y estroma endometrial en órganos o tejidos no ginecológicos. Sin embargo, la piel corresponde a uno de los sitios con menor fre-cuencia de implantación, ya sea de forma primaria o secundaria. Se calcula la incidencia de endometrio-sis cutánea en la zona umbilical en menos del 1 % de los casos. Presentación del caso: mujer de 36 años de edad, quien consulta con Cirugía General por un cuadro clínico de dos años de evolución, consistente en lesiones sobrelevantadas de la piel en la región umbilical, de color café oscuro, las cuales describe como dolorosas y sangrantes en el momento del ciclo menstrual. A pesar de haber sido resecadas en dos ocasiones, se encontró persistencia del cuadro. Discusión: la endometriosis cutánea primaria umbilical representa del 0.5 al 1.0 % de todas las pacientes con endometriosis ectópica, y el ombligo es uno de los sitios menos comunes de implantación. Esta condición afecta alrededor del 5 al 15 % de mujeres en edad fértil, y del 3 al 5 % de mujeres en edad menopaúsica. La presentación clínica más común se basa en una masa palpable, sangrado umbilical y dolor regular o irregular abdominal. Al asociar la endometriosis extrapélvica con la presencia de endometriosis pélvica, solamente alrededor del 20 % de las pacientes presentará esta última

Introduction: Endometriosis is one of the most frequent gynecological pathologies, understood as an intrapelvic implantation of endometrial tissue, sensitive to hormonal influence in most cases. At the extrauterine level, it is characterized by the presence of endometrial glands and stroma in the non-gy-necological organs or tissues. However, the skin corresponds to one of the sites with the least frequency of implantation, either primary or secondary, with the incidence of cutaneous endometriosis being calculated at the umbilical level in <1% of the cases. Case presentation: A 36-year-old female patient presented to the General Surgery department with a two-year history of dark brown, raised skin lesions in the umbilical region, which she described as painful, and bleeding at the time of the menstrual cycle. Despite having been resected twice, the condition still persisted. Discussion: Umbilical primary cutane-ous endometriosis represents 0.5%­1.0% of all patients with ectopic endometriosis, with the navel being one of the least common implantation sites. This condition affects about 5%−15% of women of childbear-ing age, and 3%−5% women of menopausal age. The most common clinical presentation is based on the palpable mass, umbilical bleeding, regular or irregular abdominal pain. Associating extrapelvic endo-metriosis with the presence of pelvic endometriosis, only about 20% of the patients will have the latter

Introdução: a endometriose é uma das patologias ginecológicas mais frequentes, entendida como o implante intrapélvico de tecido endometrial, sensível na grande maioria dos casos à influência hor-monal. No nível extrauterino, é caracterizada pela presença de glândulas e estroma endometriais em órgãos ou tecidos não ginecológicos. Porém, a pele corresponde a um dos locais com menor frequência de implantação, seja ela primária ou secundária, calculando-se a incidência de endometriose cutânea ao nível umbilical em menos de 1% dos casos. Apresentação do caso: paciente do sexo feminino, com 36 anos de idade, que consulta para Cirurgia Geral devido a quadro clínico de 2 anos de evolução, cons-tituído por lesões cutâneas elevadas na região umbilical, de coloração marrom-escura, que descreve como dolorosas e com sangramento no momento do ciclo menstrual. Apesar de ter sido ressecado em 2 ocasiões, o quadro era persistente. Discussão: a endometriose cutânea primária umbilical representa 0.5%-1.0% de todas as pacientes com endometriose ectópica, sendo o umbigo um dos locais de implan-tação menos comuns. Essa condição afeta cerca de 5% a 15% das mulheres em idade reprodutiva e 3% a 5% das mulheres em menopausa. A apresentação clínica mais comum baseia-se em massa palpável, sangramento umbilical, dor abdominal regular ou irregular. Ao associar a endometriose extrapélvica à presença de endometriose pélvica, apenas cerca de 20% das pacientes a apresentarão

Clinical efficacy of umbilical therapy with herbal cakes of different dosages for damp-heat diarrhea in young children / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang prescription of different dosages in treating damp-heat diarrhea in young children. Methods: Seventy-two kids with diarrhea of damp-heat pattern were recruited and divided into a high-dosage group and a low-dosage group using the random number table method, with 36 cases in each group. They all received conventional antidiarrheal treatment and umbilical application with herbal cakes. However, the herbal cakes for the high-dosage group were made of the mixture of Ge Gen Qin Lian Tang powder and water, and those for the low-dosage group consisted of 10％ Ge Gen Qin Lian Tang powder and 90％ auxiliary materials (corn starch) plus water. The treatment duration was 3 d. The clinical efficacy, antidiarrheal rate, effective rate for symptoms and signs of traditional Chinese medicine (TCM), TCM symptoms score, and safety indicators were compared between the two groups. Results: After the treatment, the TCM symptoms scores dropped significantly in both groups (P<0.01) and were lower in the high-dosage group than in the low-dosage group (P<0.05). The clinical efficacy was more significant in the high-dosage group than in the low-dosage group after the treatment, and the between-group difference was statistically significant (P<0.05); the antidiarrheal rate was markedly higher in the high-dosage group than in the low-dosage group (P<0.05). Regarding the TCM symptoms and signs, the high-dosage group showed better results in improving the greasy and yellowish tongue coating, bowel movement frequency, watery excrement, short and dark urine, red tongue body, red anus, vomiting, bowel sounds, and abdominal bloating compared with the low-dosage group, and the between-group differences were statistically significant (P<0.01). Conclusion: Umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang is safe, reliable, and effective in treating damp-heat diarrhea in young children; the high-dosage herbal cakes produce more significant efficacy than the low-dosage ones and are worth further investigation.

Clinical advantages of transumbilical single-site laparoscopy in surgery for giant ovariotubal cysts / 中国医师杂志

Objective:To observe the efficacy and safety of single-port laparoscopy for giant ovariotubal cysts.Methods:38 patients with giant ovarian and fallopian tube cysts in Ruijin Hospital Affiliated to Shanghai Jiaotong University Hospital from January 2018 to June 2019 were retrospectively analyzed. They were divided into transumbilical single-port laparoscopy group (18 cases) and traditional laparoscopy group (20 cases). The perioperative related indexes such as operation time, intraoperative bleeding and the number of analgesic cases were compared between the two groups.Results:All 38 patients successfully completed the operation without conversion to laparotomy, and no auxiliary hole was added in the single-port laparoscopy group; There were no postoperative complications and no cystic fluid leakage. In the single-port laparoscopy group, 18 patients were satisfied with the concealment of umbilical scar. There was no statistically significant difference in operation time [(51.67±13.72)min vs (55.50±14.59)min], intraoperative blood loss [(52.22±24.38)ml vs (61.50±28.88)ml] and first postoperative anal exhaust time [(25.77±8.59)h vs (27.60±6.67)h] between single-port laparoscopy group and traditional laparoscopy group (all P>0.05); The number of cases requiring postoperative analgesia in the single-port laparoscopy group (2 cases vs 12 cases) was less than that in the traditional laparoscopy group ( P<0.05); The out of bed activity time [(20.95±3.65)h vs (26.95±5.43)h] and postoperative discharge time [(3.11±0.68)h vs (4.30±1.21)h] were shorter than those in the traditional laparoscopy group (all P<0.05). All 38 patients were followed up in the gynecological clinic for 6-24 months. The incision healed well without recurrence. Conclusions:Transumbilical single-port laparoscopic surgery for giant ovarian and fallopian tube cysts is reliable and safe when the possibility of malignant ovarian and fallopian tube tumors was excluded before operation.

Application of transumbilical single-port laparoscopy with self-made approach in common gynecological operations / 中国医师杂志

Objective:To explore the clinical application of transumbilical single-port laparoscopy with self-made approach in common gynecological operations.Methods:105 cases of transumbilical single-port laparoscopic surgery with self-made approach successfully (single-port laparoscopic group) carried out in Karamay Central Hospital from January 2018 to September 2020 were retrospectively collected, and 105 cases of multi-port laparoscopic surgery (multi-port laparoscopic group) with matching conditions were selected. The operation time, intraoperative blood loss, postoperative first exhaust time, postoperative first out of bed activity time, postoperative 24-h pain score, postoperative satisfaction score of patients 3 months after operation, incision cosmetic score of doctors 3 months after operation, postoperative hospital stay, intraoperative surgeon′s feeling score and intraoperative and postoperative complications were compared between the two groups.Results:All operations were successfully completed under laparoscopy, without conversion to laparotomy, without auxiliary holes, and no obvious complications occurred during the operation. The operation time and intraoperative blood loss in the single-port laparoscopic group were greater than those in the multi-port laparoscopic group (all P<0.05). The incision cosmetic score of single-port laparoscopic group was significantly better than that of multi-port laparoscopic group ( P<0.05). The intraoperative surgeon′s feeling score in multi-port laparoscopic group was better than that in single-port laparoscopic group ( P<0.05). There was no significant difference between the two groups in the first postoperative exhaust time, the first postoperative out of bed activity time, 24-hour postoperative pain score, surgical satisfaction score and postoperative hospital stay (all P>0.05). The operation time and intraoperative blood loss of ovarian cyst stripping, hysteromyomectomy and total hysterectomy in the multi-port laparoscopic group were less than those in the single-port laparoscopic group (all P<0.05). There was no significant difference between the two groups in the operation time and intraoperative blood loss of salpingectomy and adnexectomy (all P<0.05). The feeling of doctors in multi-port laparoscopic group was better than that in single-port laparoscopic group (all P<0.05). Conclusions:Under the condition of appropriate case selection, laparoendosopic single-port surgery with self-made approach is feasible in common gynecological operations. The prominent advantage of laparoendosopic single-port surgery is postoperative cosmetic effect.

Brief analysis on GAO Shu-zhong's qiguan theory and its clinical application / 中国针灸

The paper introduces professor GAO Shu-zhong's experience in qiguan (umbilicus pass) theory and its clinical application. Professor GAO believes that the umbilicus is the "pass" where the primary qi of sanjiao transported from the lower jiao to the middle jiao. It is the general pivot of qi transformation of yin and yang, as well as the place for qi ascending, descending, exiting and entering in the human body. Hence, the umbilicus is called qiguan (umbilicus pass). In clinical practice, associated with observation, palpation and pulse diagnosis, the qiguan theory is conductive to disease diagnosis. Moreover, the therapeutic methods for promoting qiguan is generated, i.e. umbilicus-acupuncture therapy and umbilicus-moxibustion therapy. In the umbilicus-acupuncture therapy, Gao 's umbilicus five points (umbilicus heart, umbilicus stomach, umbilicus liver, umbilicus kidney and umbilicus lung) are commonly selected. With the umbilicus- moxibustion therapy, the isolated moxibustion with different herbal materials is exerted at the umbilicus, in which, the herbal materials with drastic medical action, pungent and fragrant in flavor and warm in property are specially selected.

Professor YANG Ji-guo's experience in treatment of functional gastrointestinal diseases with acupuncture combined with umbilicus moxibustion / 中国针灸

Professor YANG Ji-guo's clinical experience in treatment of functional gastrointestinal diseases was summerized. Professor YANG Ji-guo believes that this disease is caused by the deficiency of six fu organs. Dysfunction of six fu organs in descending transportation is the basic pathogenesis. The principle of acupoint selection includes benefiting gastrointestinal functions, unblocking and purging six fu, soothing liver qi and calming down the mind. In treatment, acupuncture is combined with umbilicus moxibustion. In acupuncture, the deqi promoting technique by rotating and trembling needle is adopted. Focusing on the deficiency of six fu organs, umbilicus moxibustion is adopted to benefit the spleen and stomach and harmonize the functions of six fu organs for both biao (symptoms) and ben (root cause).

Carcinoma basocelular umbilical en paciente con sospecha de endometriosis en la pared abdominal. Reporte de un caso y revisión bibliográfica / Umbilical basal cell carcinoma in a patient with suspected abdominal wall endometriosis. Case report and review of the literature

Resumen ANTECEDENTE: La endometriosis es una enfermedad inflamatoria que llega a afectar incluso a 15 a 44% de las mujeres fértiles; sin embargo, su localización en la pared abdominal es excepcional. Las diferentes lesiones que pueden encontrarse ahí dificultan el diagnóstico preoperatorio. OBJETIVOS: Reportar el caso de una paciente con carcinoma basocelular umbilical en quien se sospechó endometriosis en la pared abdominal y revisar la bibliografía al respecto, en particular la importancia del diagnóstico diferencial. CASO CLÍNICO: Paciente de 45 años con un carcinoma basocelular en torno de la zona umbilical. La situación anatómica y la induración dolorosa y sangrante en el área umbilical favorecieron un diagnóstico erróneo inicial de endometriosis umbilical. Esta tumoración, de un subtipo histológico de alto riesgo, requiere una técnica quirúrgica agresiva, con control de los márgenes afectados. En las revisiones posoperatorias la paciente permaneció asintomática, sin lesiones aparentes de recidiva. De la búsqueda bibliográfica se incluyeron 14 artículos de reportes de casos y revisiones de endometriosis en la pared abdominal y carcinoma basocelular. El acceso quirúrgico mediante la cirugía micrográfica de Mohs se estableció como el método más recomendado en la actualidad. CONCLUSIONES: La sospecha de endometriosis en la pared abdominal suele estar fundamentada en la aparición de una lesión con variaciones cíclicas sobre el lecho de una incisión quirúrgica. Las diferentes lesiones que pueden encontrarse en la pared abdominal dificultan el diagnóstico preoperatorio y solo el estudio histológico es el que finalmente lo establece.

Abstract BACKGROUND: Endometriosis is an inflammatory disease that affects up to 15-44% of fertile women, however its location at the level of the abdominal wall is a rare entity. The different lesions that can settle at this level make preoperative diagnosis difficult OBJECTIVES: To report the case of an umbilical basal cell carcinoma in a patient with suspected endometriosis of the abdominal wall and to review the literature, especially on the importance of differential diagnosis. CLINICAL CASE: A 45-year-old woman who presented a basal cell carcinoma at the umbilical level. The anatomical situation and the painful and bleeding induration at the umbilical level, led to an initial misdiagnosis of umbilical endometriosis. This tumor of a high-risk histological subtype requires optimal management, based on an aggressive surgical technique with control of the affected margins. In postoperative check-ups, the patient remains asymptomatic, with no apparent lesions of recurrence. A bibliographic search was carried out and 14 articles were included on case reports and literature reviews of abdominal wall endometriosis and basal cell carcinoma. The surgical approach using Mohs micrographic surgery has been established as the most recommended method at present. CONCLUSIONS: The suspicion of abdominal wall is usually based on the appearance of a lesion with cyclical variations on the bed of a surgical incision. The different lesions that can settle at the level of the abdominal wall make preoperative diagnosis difficult, with the histological study finally being the one that yields the definitive result.

Clinical study on Tuina plus umbilical therapy for senile functional constipation / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) plus umbilical therapy for senile functional constipation due to Qi deficiency of lung and spleen.Methods: A total of 60 patients who met the inclusion criteria were randomly divided into a control group and an observation group by the random number table method, with 30 cases in each group. The patients in the control group were given lactulose oral solution, while the patients in the observation group were treated with Tuina and umbilical therapy. After two weeks of treatment, the scores of the Wexner continence grading scale (WCGS) and patient assessment of constipation-quality of life questionnaire (PAC-QOL) were observed. The effective rates in the two groups were compared. Results: After two weeks of treatment, the total effective rate in the observation group was 90.0％, while that in the control group was 76.7％, presenting a significant difference between the two groups (P<0.05). There were no significant differences in the WCGS and PAC-QOL scores between the two groups before treatment (P>0.05). After two weeks of treatment, the WCGS and PAC-QOL scores of both groups decreased significantly compared with those before treatment (P<0.05), and the two scores in the observation group were lower than those in the control group (P<0.05). Conclusion: The efficacy of Tuina plus umbilical therapy for senile functional constipation is confirmed. This method can improve patients' quality of life. Its efficacy is better than that of taking lactulose oral solution.

Effectiveness and Safety of Umbilicus Treatment with Modified Dinggui Powder () in Patients with Chronic Nonbacterial Prostatitis: A Randomized, Double-blind, Placebo-controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effectiveness and safety of Chinese herbal external umbilicus treatment with Modified Dinggui Powder (, MDGP) in patients with chronic nonbacterial prostatitis (CNP).@*METHODS@#A randomized, double-blind, placebo-controlled clinical trial was conducted among 72 patients with CNP. Participants were randomly allocated to a treatment group and a placebo group using computer software in a 1:1 ratio, and received either MDGP external umbilicus treatment (MDGP group, 36 cases) or placebo control groupl (36 cases) at acupoints Shenque (CV 8), twice a week for 4 weeks. In addtion, patients all received herbal medicine treatment twice a day for 4 weeks. The primary outcomes was the US National Institutes of Health Chronic Prostatitis Symptom Scores Index (NIH-CPSI) with a questionnaire at weeks 2 and 4. The secondary outcomes including prostatic fluid examination (white blood cells and lecithin bodies), the clinical efficacy evaluation, and the adverse events were also assessed during the entire trial.@*RESULTS@#The NIH-CPSI scores regarding pain or discomfort scores showed greater improvement in the MDGP group than placebo control group at weeks 2 (P0.001) and week 4 (P0.004), respectively. NIH-CPSI scores of symptom severity, total scores, the amount of leukocytes number in the prostatic fifluid in the MDGP group were significantly improved (P0.05). The clinical effective rate was 73.53% (25/34) in the MDGP group, which was significally higher than the placebo control group with 48.39% (25/31, P<0.05). Patients were blinded successfully, and no serious adverse effects were found during the trial.@*CONCLUSION@#A 4-week course of umbilicus treatment with modified Dinggui Powder seems to relieve pain and symptom severity effectively and increase the amount of leukocytes number in patients with CNP (Trial registration No. ChiCTR1800014687).

Correlation of neonatal gestational age with foot length and right nipple to umbilicus distance

Background: India contributes to one fifth of global live births and more than a quarter of neonatal deaths. A systematic analysis of global, regional and national causes of child mortality in 2013 identified preterm birth complications and infections to be the two major causes of neonatal deaths in India. So, there is need of a simple, easy to use and reliable screening tool for assessment of gestational age at peripheral level for early referral of a neonate to a tertiary care hospital, thereby reducing neonatal mortality.Methods: A hospital based observational cross-sectional study included 350 live new-borns within 48 hours of birth, from September 2018 to February 2019. Gestational age assessed by new ballard score, birth weight, foot length and right nipple to umbilicus distance were noted. Babies categorised as per the gestational age profile as small, appropriate and large for gestational age using fenton charts. Data analysis done, correlation coefficient, and p value calculated to obtain results.Results: Out of 350 babies, males (185) outnumbered females (165); 154 were LBW, 89 VLBW and 76 were ELBW. AGA neonates were 193, and 157 belonged to SGA. There were no post-term and large for gestational age newborns. Both foot length and right nipple to umbilicus distance correlated well with gestational age in all age groups (p<0.001).Conclusions: Foot length as well as right nipple to umbilicus distance can be used as a reliable tool for assessment of gestational age and birth weight of newborns by any health care professional to identify and refer high risk neonate.

Outras tendências na abdominoplastia: novo desenho e importância da lipomidiabdominoplastia na cirurgia do contorno corporal / Other trends in abdominoplasty: new design and importance of lipomid- abdominoplasty in body contour surgery

Introdução: Durante os últimos anos, os princípios cirúrgicos da abdominoplastia permaneceram inalterados. Portanto, muitos resultados observados apresentam desalinhamento, cicatrizes transversais altas e retas do abdome, levando ao posicionamento final da cicatriz umbilical a ser muito próximo da cicatriz transversal, o que dá a impressão de abdome curto. Propomos que a abdominoplastia modifique a concepção básica de sua marcação, pois acreditamos que é importante posicionar a cicatriz transversal mais baixa na região medial e púbica, e mais alta nas extremidades laterais, permitindo, no nível dos flancos, a rotação dos retalhos lombares no sentido anterior em direção inferomedial. Métodos: Foram analisados de forma retrospectiva 146 pacientes portadores de deformidades abdominais e os submetemos a lipomidiabdominoplastia, marcando com forte concavidade superior e orientando os lados da cicatriz em direção à linha transversa inferior do abdômen, 4cm equidistantes da raiz da coxa. Também associamos a lipoaspiração como um tratamento complementar ao contorno corporal. Resultados: Consideramos que os parâmetros da midiabdominoplastia são aplicáveis na maioria dos casos, obtendo resultados igualmente satisfatórios, tanto nos pacientes com flacidez e lipodistrofia abdominal supraumbilical, quanto nos pacientes com abdome em avental com importante flacidez e diástase dos retos abdominais. Conclusão: É importante determinar a área da deformidade abdominal e sua classificação, para estabelecer as estratégias do tratamento e associação de procedimentos complementares. Uma marcação mais baixa, respeitando as áreas de tratamento, permitirá uma melhor cicatriz estética e um contorno corporal harmônico, além de uma adequada colocação dos elementos: cicatriz umbilical, púbis e extremidades laterais da cicatriz abdominal transversa.

Introduction: During the last few years, the surgical principles of abdominoplasty have remained unchanged. Therefore, many patients undergoing this technique have misalignment and high and straight transverse scars of the abdomen, with the final position of the umbilical scar being very close to the transverse scar, making the abdomen seem short. We propose modifying the basic concept of marking in abdominoplasty, because we believe it is important to position the transverse scar lower in the medial and pubic region and higher at the lateral ends, allowing anterior lumbar flap rotation in an inferomedial direction. Methods: We retrospectively analyzed 146 patients with abdominal defects and subjected them to lipo-mid-abdominoplasty, marking with strong upper concavity and guiding the sides of the scar towards the lower transverse line of the abdomen, 4 cm equidistant from the root of the thigh. We also define liposuction as a complementary treatment to body contouring. Results: We consider that midabdominoplasty parameters are applicable in most cases, obtaining satisfactory results both in patients with flatness and supraumbilical abdominal lipodystrophy and patients with an "apron" abdomen with considerable flaccidity and diastasis of the abdominal rectus. Conclusion: It is important to determine the area of the abdominal defect and its classification to establish treatment strategies and association with complementary procedures. A lower marking with respect to the treatment areas will allow a more aesthetic scar and a harmonic body contour as well as an adequate placement of the umbilical scar, pubis, and lateral ends of the transverse abdominal scar.

Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso / Simultaneous persistence of the urachus and vitelline ducts in an adult patient, case report / Persistência simultânea de úraco e do ducto onfalomesentérico em um paciente adulto: relato de caso

Introducción. La patología umbilical es un tema frecuente en el ámbito pediátrico, la presentación clínica de una fístula umbilical hace pensar en dos patologías mencionadas en la literatura de manera independiente; la primera es la persistencia del conducto onfalomesentérico y la segunda es la persistencia del remanente del uraco producto del fracaso en el cierre de las estructuras embrionarias. Su presencia en adultos es infrecuente y no existen datos estadísticos acerca de su presentación conjunta en población pediátrica o adulta, solo algunos pocos reportes de caso. El diagnóstico se basa principalmente en la sospecha clínica, depende en gran manera del examen físico al evidenciar secreción a través del ombligo al realizar esfuerzos o maniobras de Valsalva. Objetivo. Mostrar un caso infrecuente de la presentación simultánea del conducto de uraco y onfalomesentérico en un paciente adulto. Reporte de caso. Paciente femenina de 24 años de edad con antecedentes de infecciones urinarias y celulitis periumbilicales a repetición. Se sospecha un conducto persistente onfalomesentérico por lo que es sometida a un procedimiento quirúrgico en el que se encontró incidentalmente la persistencia simultánea del conducto onfalomesentérico y persistencia del uraco. Discusión. La persistencia del conducto onfalomesentérico o la persistencia del uraco de forma individual es poco frecuente en adultos, y es aún más raro la persistencia simultánea de ambos conductos; la presencia simultánea de ambos conductos es reportada principalmente en menores de dos años. Conclusiones. La persistencia de estos conductos es rara en adultos y representa un reto diagnóstico para el clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Introduction. Umbilical pathology is a common topic in the pediatric sphere. The clinical presentation of an umbilical fistula leads to the consideration of two pathologies independently reported in literature. The first is a persistent vitelline duct and the second is a persistent urachal remnant as a result of the embryonic structures' failure to close. They are uncommon in adults and there are no statistical data about their presentation together in the pediatric or adult population, only very few case reports. The diagnosis is mainly based on clinical suspicion. It largely depends on a physical examination noting secretion through the navel when straining or performing Valsalva maneuvers. Objective. Show an uncommon case of the simultaneous presentation of the urachus and vitelline ducts in an adult patient. Case report. Female patient aged 24 years with a background of repeated urinary tract infections and periumbilical cellulitis. A persistent vitelline duct is suspected. Therefore, the patient is subject to a surgical procedure in which the simultaneous persistence of the vitelline duct and the urachus was found incidentally. Discussion. The persistence of the vitelline duct or the persistence of the urachus individually is uncommon in adults, and the simultaneous persistence of both ducts is even rarer. The simultaneous presence of both ducts is reported mainly in infants aged under two years. Conclusions. The persistence of these ducts is rare in adults and poses a diagnostic challenge for clinicians. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

Introdução. A patologia umbilical é um tópico frequente no cenário pediátrico; a apresentação clínica de uma fístula umbilical faz pensar em duas patologias mencionadas na literatura de forma independente; a primeira é a persistência do ducto onfalomesentérico e a segunda é a persistência do úraco como resultado da falha no fechamento das estruturas embrionárias. É pouco frequente sua presença em adultos e não há dados estatísticos sobre sua apresentação conjunta em população pediátrica nem adulta, apenas alguns poucos relatos de caso. O diagnóstico baseia-se principalmente na suspeita clínica, dependendo em grande parte do exame físico ao evidenciar uma secreção pelo umbigo quando realizar esforço ou manobra de Valsalva. Objetivo. Mostrar um caso infrequente de apresentação simultânea do úraco e ducto onfalomesentérico em um paciente adulto. Relato de caso. Paciente do sexo feminino, 24 anos, com histórico de infecções urinárias e celulite periumbilical recorrentes. Suspeita-se de um ducto onfalomesentérico persistente, portanto ela é submetida a um procedimento cirúrgico no qual encontrou-se a persistência do ducto onfalomesentérico e a persistência de úraco simultaneamente. Discussão. A persistência do ducto onfalomesentérico e a persistência de úraco individualmente é rara em adultos, e a persistência simultânea de ambos os ductos é ainda mais rara; esta presença simultânea é relatada principalmente em crianças menores de dois anos de idade. Conclusão. A persistência desses ductos é rara em adultos e representa um desafio diagnóstico para o profissional de saúde clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.

The Naval Stone: A hidden culprit for umbilical abscess

A rarely encountered benign entity, the omphalolith has been endowed several names like omphalo-keratolith, umbilical bolus and naval stone. We hereby discuss two cases of omphalolith who presented with secondary infection and infra-umbilical sepsis.

Trans umbilical first trocar access during laparoscopic surgery

Background: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

Neonatal umbilical myiasis

Infestation is a state of being invaded or overrun by parasites. Myiasis is an infestation caused by dipterous fly. Even though human myiasis is a rare infestation particularly in newborn period unlike animal myiasis as neonate is just newly introduced to the environment and during this period neonate usually more protected and taken care by us. In rural areas of tropical countries where good hygiene conditions will not be there, authors are still identifying these cases. Risk factors for myiasis usually poor socioeconomic conditions and unhygienic environment. Finding cases of umbilical myiasis usually indicates poor environmental sanitary measures at that particular place. Here authors are presenting a case of neonatal umbilical myiasis caused by Chrysomya megacephala. These flies usually lay their eggs over the wounds or moisture dead necrotic tissues unlike other species of flies where they usually lay eggs over the animal fecus. But some other free-living flies(saprophagous) also cause myiasis due to accidental laying of eggs over dead necrotic tissues due to open defecation. In present case authors identified myiasis as early as third completed day of life, means infestation occurred at the time of delivery as incubation period for hatching eggs to larvae usually 4-8 days. These larvae able to survive inside deep tissue by breathing through a small hole. Even though myiasis usually have good prognosis it will become a focus for secondary infections. If deep-seated causes severe morbidity and even in extreme cases causes death also. Diagnosis is mainly clinical, authors can identify the species by microscopic examination of third stage larvae and finding age of the larvae also useful in identifying time of infestation. Treatments usually direct removal of larvae from the site by manipulation, irrigation, suffocation by ether and surgery if deep-seated. As they usually create nadir for infection by bacteria ruling out secondary infection and treatment is necessary. It is better to take preventive strategies like birthplace cleanliness and environmental sanitation. Tracking the case helpful in finding the places where authors need to improve sanitary measures it is better to give feedback to appropriate administrative officers to prevent home deliveries.