Efecto epitelizante y analgésico del sevoflurano tópico en el tratamiento de las úlceras por presión grado I-III no infectadas Hospital Obrero N°1 de La Paz Bolivia / Epithelializing and analgesic effect of topical sevoflurane in the treatment by pressure of uninfected grade I-III ulcers Hospital Obrero (workers´ Hospital) N°1 of La Paz Bolivia

INTRODUCCIÓN: las úlceras por presión constituyen un importante problema de salud por su frecuencia, carácter crónico, costes económicos y una merma en la calidad de vida en pacientes internados en las unidades de cuidados especiales. MATERIAL Y MÉTODOS: el objetivo del estudio fue evaluar el efecto epitelizante y analgésico del sevoflurano aplicado tópicamente en úlceras por presión grado I-III no infectadas de pacientes internados. El tipo de estudio fue Ensayo clínico aleatorizado. Un total de 16 pacientes fueron incluidos en el estudio y fueron divididos aleatoriamente en 2 grupos: grupo A (8 pacientes), en los que se realizó la curación con sevoflurano tópico más povidona yodada y, grupo B (8 pacientes) curación solo con yodopovidona. La valoración de la evolución de la úlcera se realizó mediante la Escala PUSH, que valora superficie, cantidad de exudado y tipo de tejido del lecho. RESULTADOS: durante la realización de la curación, el dolor manifestado por los integrantes del Grupo A (1.6 ± 0.7), fue mucho menor que el observado el Grupo B (7.2 ± 1). No se encontró diferencias significativas en la superficie de la úlcera y en la cantidad de exudado; si se encontró una diferencia significativa en el tipo de tejido existente en el lecho ulceroso, en los pacientes del Grupo A se evidenció la presencia de tejido de granulación y epitelial a partir de la tercera semana de tratamiento, lo cual, en los pacientes del Grupo B, se observó a partir de la cuarta semana.

INTRODUCTION: pressure ulcers constitute an important health problem due to their frequency, chronic nature, economic costs and a reduction in the quality of life in patients hospitalized in special care units. MATERIAL AND METHODS: the aim of the study was to evaluate the epithelializing and analgesic effect of sevoflurane applied topically in uninfected grade I-III pressure ulcers of hospitalized patients. The type of study was Randomized Clinical Trial. A total of 16 patients were included in the study and were randomly divided into 2 groups: group A (8 patients), in which the cure was performed with topical sevoflurane plus povidone iodine, and group B (8 patients) only with povidone iodine. The evaluation of the evolution of the ulcer was performed using the PUSH Scale, which assesses surface area, amount of exudate and type of bed tissue. RESULTS: during the healing, the pain manifested by the members of Group A (1.6 ± 0.7), was much lower than that observed in Group B (7.2 ± 1). No significant differences were found on the surface of the ulcer and in the amount of exudate; If a significant difference was found in the type of tissue existing in the ulcer bed, in Group A patients the presence of epithelial and granulation tissue was evidenced starting the third week of treatment, which, in Group A patients B, was observed starting the fourth week.

Avaliação clínica de pacientes com úlceras de perna acompanhados em ambulatório / Evaluación clínica de pacientes con úlceras de piernas en tratamiento ambulatorio / Clinical evaluation of patients with leg ulcers attended in outpatient clinic

RESUMO Objetivo realizar avaliação clínica e sociodemográfica de pacientes com úlceras de perna. Método estudo transversal, quantitativo, com 105 pacientes com úlceras de perna em ambulatórios da rede pública de Niterói/RJ, aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense. Os dados foram coletados no período de janeiro a agosto de 2019, analisados por estatística descritiva e dispostos em tabelas. Resultados pacientes do sexo masculino (57,1%), de 60 a 80 anos (60%), com ensino fundamental incompleto (45,7%), renda de até 1 salário mínimo (64,8%). A maioria das lesões foi de etiologia venosa (76,2%), de tempo igual ou superior a 40 meses (54,3%), com tamanho maior que 10cm2 (53,3%), apresentando exsudato seroso (91,4%) em pequena quantidade (40%) e predominância de tecido granulado (36,2%). A dor foi um achado frequente, relacionada com a posição do membro (31,4%). Conclusão e implicações para a prática o conhecimento do perfil da população acompanhada e das características clínicas das lesões favorece a otimização do tratamento, permitindo um planejamento específico da assistência de enfermagem.

RESUMEN Objetivo realizar evaluación clínica y sociodemográfica de pacientes con úlceras de piernas. Método estudio transversal, cuantitativo, con 105 pacientes con úlceras de piernas en clínicas públicas en Niterói/RJ, aprobado por el Comité de Ética en Investigación de la Facultad de Medicina de la Universidade Federal Fluminense. Los datos fueron recolectados de enero a agosto de 2019, analizados por estadística descriptiva y presentados en tablas. Resultados pacientes del sexo masculino (57.1%), de 60 a 80 años (60%), con educación primaria incompleta (45.7%), ingresos de hasta 1 salario mínimo (64.8%). La mayoría de las lesiones fueron de etiología venosa (76,2%), con una duración de 40 meses o más (54,3%), con un tamaño superior a 10 cm2 (53,3%), presentando exudado seroso (91,4%) en pequeña cantidad (40%) y predominio de tejido granulado (36,2%). El dolor fue un síntoma frecuente, relacionado con la posición del miembro (31,4%). Conclusión e implicaciones para la práctica el conocimiento del perfil de la población monitoreada y las características clínicas de las lesiones favorecen la optimización del tratamiento, lo que permite una planificación específica de la atención de enfermería.

ABSTRACT Objective to perform clinical and sociodemographic evaluation of patients with leg ulcers. Method cross-sectional study with a quantitative approach, performed with 105 patients with leg ulcers in public outpatient clinics located in Niterói/RJ, approved by the Research Ethics Committee of the Medical School of Universidade Federal Fluminense. Data were collected from January to August 2019, analyzed by descriptive statistics and organized in tables. Results most were male patients (57.1%), aged between 60-80 years (60%), with incomplete primary education (45.7%) and monthly income up to 1 minimum wage (64.8%). Most ulcers were of venous etiology (76.2%), present for 40 months or more (54.3%), with size greater than 10cm2 (53.3%), having serous exudate (91.4%) in small quantity (40%) and predominance of granulation tissue (36.2%). Pain was a frequent finding, related with the leg position (31.4%). Conclusion and implications for practice the knowledge of the population profile and clinical characteristics of wounds favors treatment optimization, allowing specific nursing care planning.

Heberprot P en lesión grave de la mano e injerto bipediculado al abdomen. Presentación de caso / Heberprot P in serious hand injury and bipedicular graft to the abdomen. Case report

RESUMEN Fundamento: El Heberprot P es una terapia que contribuye a la reparación de tejidos dañados. Su utilización en las lesiones ortopédicas de los miembros superiores es muy reciente y de escasa publicación. Objetivo: Describir la evolución de una paciente con lesión grave del dorso de la mano derecha en el que se utilizó el Heberprot P, seguido de injerto pediculado. Presentación de caso: Paciente que sufrió accidente con lesión grave en la mano derecha. Se realizó diagnóstico clínico e imagenológico con pérdida de piel, tejido celular subcutáneo y fractura del cuarto y quinto metacarpianos, se le aplicó procedimiento quirúrgico. Evolucionó de forma tórpida con infección profunda, pérdida de tendones extensores y exposición ósea, se decidió iniciar tratamiento con Heberprot P para incentivar tejido de granulación; 21 días después se logró cubrir las estructuras óseas, se operó los tendones y cobertura cutánea con injerto bipediculado al abdomen con evolución favorable. La paciente se reincorporó a su actividad social y laboral a los 10 meses. Conclusiones: El Heberprot P aceleró la cicatrización de tejidos, asociado a colgajos a distancia facilitó una evolución satisfactoria y evitó la amputación, disminuyó estadía hospitalaria, asimismo propició la reincorporación a la vida social y laboral.

ABSTRACT Background: Heberprot P is a therapy that contributes to the repairing of damaged tissues. Its use in orthopedic injuries of the upper limbs is very recent and of little publication. Objective: To describe the evolution of a patient with a serious injury to the back of the right hand in which the Heberprot P was used, followed by a pedicle graft. Case report: Patient who suffered an accident with a serious right hand injury. Clinical and imaging diagnosis was made with skin loss, subcutaneous cellular tissue and fracture of the fourth and fifth metacarpals, a surgical procedure was applied. It evolved torpidly with deep infection, loss of extensor tendons and bone exposure, it was decided to start treatment with Heberprot P to stimulate granulation tissue; 21 days later, the bone structures were covered, the tendons and skin coverage were operated with a bipedicular graft to the abdomen with a favorable evolution. The patient returned to her social and work activity at 10 months. Conclusions: Heberprot P accelerated tissue healing, associated with remote flaps, facilitated a satisfactory evolution and avoided amputation, decreased hospital stay, and also favored return to social and work life.

Cirurgia do periápice para remoção de lesões granulomatosas: relato de caso / Periapical surgery to remove granulomatous lesion

Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.

Granuloma periapical é um termo histológico que refere-se à formação de uma massa de tecido granulomatoso ao redor do ápice de um dente, decorrente da inflamação e necrose do tecido pulpar. É constituído por um infiltrado de células inflamatórias como macrófagos, plasmócitos e linfócitos, além de fibroblastos, fibras colágenas e capilares. A cirurgia do periápice é uma alternativa para preservação do dente na cavidade bucal nos casos em que a inflamação periapical é persistente mesmo após tratamento dos canais radiculares. O objetivo desse trabalho é relatar um caso clínico no qual a técnica cirúrgica do periápice foi utilizada para remoção de lesões granulomatosas de uma paciente, do sexo feminino, com histórico de abscesso periapical recidivante sem sintomatologia dolorosa na região dos dentes anteriores superiores 11, 12 e 13. O exame histopatológico demonstrou a presença de um tecido granulomatoso com intenso infiltrado inflamatório misto, permeado com linfócitos e elevado número de plasmócitos, confirmando o diagnóstico de granuloma periapical. O tratamento foi considerado exitoso, visto que a paciente se manteve asintomática e houve incorporação do enxerto ósseo bovino inorgânico e início da neoformação óssea na região periapical.

Flap bipedicular no tratamento de lesão cutânea traumática em membro torácico de gato: relato de caso / Bipedicular flap in the treatment of traumatic skin injury in cat thoracic member: case report

O objetivo do presente estudo é relatar a construção de um retalho direto de bolsa bipediculada com fixação apendicular à região torácica para o tratamento de lesões extensas no membro torácico direito de um gato. Foi tratado no Hospital Veterinário Unicesumar Maringá - Paraná, um felino de 1 ano de idade, apresentando lesão no membro torácico, após história de briga com outro animal da mesma espécie. Ao exame físico, apresentava fístula e edema no membro torácico direito. O paciente foi anestesiado e foi realizado o desbridamento das áreas desvitalizadas. Como terapia inicial, a lesão foi tratada como ferida aberta, até a formação de tecido de granulação, para posterior correção do defeito empregando retalho bipediculado em bolsa direta, com fixação temporária do membro à parede torácica. Após duas semanas, o membro foi desimplantado e os pontos foram removidos 21 dias após a aplicação do retalho. O uso do retalho permitiu completa cicatrização da ferida, sem ocorrência de hematomas, necrose ou deiscência de sutura. Conclui-se que a utilização do retalho bipedicular é aplicável ao tratamento de feridas traumáticas em membro torácico de felinos.

The aim of the present study is to report the construction of a direct bipedicled pouch flap with appendicular fixation to the thoracic region for the treatment of extensive lesions in the right thoracic limb of a cat. He was treated on Hospital Veterinário Unicesumar Maringá - Paraná, a 1-year-old feline, presenting injury to the thoracic limb after a history of fighting with another animal of the same species. On physical examination, he presented fistula and edema in the right thoracic limb. The patient was anesthetized and debridement of the devitalized areas was performed. As an initial therapy, the lesion was treated as an open wound until granulation tissue was formed for subsequent correction of the defect using a direct pouch bipedicled flap, with temporary fixation of the limb to the chest wall. After two weeks, the limb was unimplanted and the stitches were removed 21 days after flap application. The use of the flap allowed complete wound healing without bruising, necrosis or suture dehiscence. It is concluded that the use of bipedicular flap is applicable to the treatment of traumatic wounds in feline thoracic limb.

Evaluación de cicatrización en zonas donantes de injerto de piel parcial con uso de xenoinjerto en comparación con sustituto dérmico sintético de celulosa / Evaluation of healing in partial skin graft donor sites using a xenograft compared to a synthetic cellulose skin substitute

Objetivo: Realizar una evaluación de la cicatrización en la zona donante de injerto de piel parcial con uso de sustituto dérmico comparado con xenoinjerto, en pacientes con lesiones diversas que requirieron injerto de piel parcial. Materiales y métodos: Se presenta el reporte de 20 pacientes entre 19 y 65 años de la Unidad de Cirugía Plástica del Hospital María Auxiliadora de Lima Metropolitana-Perú, entre diciembre 2017 y junio 2018, donde se evaluó la cicatrización en zonas donantes de injerto de piel parcial. El estudio es de tipo intervención, analítico, prospectivo y longitudinal. Emplea el diseño doble ciego para controlar posibles sesgos. Para analizar la significancia estadística se usaron pruebas no paramétricas con un nivel de confianza 95 %. Resultados: Con el uso del sustituto dérmico se aprecia una mejor calidad de cicatrización de zonas donantes de epitelización en comparación con el xenoinjerto. Ambas técnicas se evaluaron con la escala de Vancouver que considera cinco aspectos (cicatrización, vascularidad, pigmentación, flexibilidad y altura), de los cuales, la cicatrización tuvo resultados significativos (p<0,05). Al estimar el riesgo de evolución de cicatrización según el modelo de riesgos proporcionales de Cox, se obtuvo un H=0,60 (IC95% 0,46-0,78), lo cual indica que el menor tiempo de cicatrización se encontró en el grupo en que se empleó el sustituto dérmico. Conclusiones: El sustituto dérmico es una alternativa importante que favorece buena calidad de la cicatrización en las zonas donantes. El sustituto dérmico es más eficiente que el xenoinjerto convencional al ser evaluado y comparado en la escala de cicatrización de Vancouver.

Objective: To evaluate healing in partial skin graft donor sites using a skin substitute compared to a xenograft in patients with different diseases requiring partial skin grafting. Materials and methods: This paper presents a report of 20 patients between 19 and 65 years from the Plastic Surgery Unit of the Hospital María Auxiliadora in Lima Metropolitan Area, Peru, between December 2017 and June 2018, where healing was evaluated in partial skin graft donor sites. An interventional, analytical, prospective and longitudinal study was conducted using a double-blind design to control possible biases. For the statistical significance analysis, nonparametric tests with a 95 % confidence interval were used. Results: Using a skin substitute, a better healing quality of donor sites of epithelialization was seen compared with xenografting. Both techniques were evaluated with the Vancouver scale, which considers five aspects (healing, vascularity, pigmentation, flexibility and height), out of which healing showed significant results (p<0.05). Estimation of the risk in the healing process according to the Cox proportional hazards model showed that H = 0.60 (95 % CI 0.46- 0.78), which indicates that the shortest healing time was found in the skin substitute group. Conclusions: Skin substitutes are an important alternative that favors the good quality of healing in donor sites. skin substitutes proved to be more effective than conventional xenografting when evaluated and compared using the Vancouver healing scale.

Tratamiento exitoso con gel de silicona de heridas que no cicatrizan en el cuero cabelludo / Successful silicone gel treatment of wounds that do not heal on the scalp

La silicona podría tener propiedades ideales para estimular la cicatrización de heridas abiertas. Se presentan cuatro casos de heridas en el cuero cabelludo que no cicatrizaban y en todas se observaba tejido de granulación abundante y falta de migración epidérmica. La aplicación de un gel a base de silicona (Stratamed, Stratpharma, Basilea, Suiza), que forma una película directamente sobre la herida, a modo de monoterapia se asoció con una mejor cicatrización de la herida

The silicone could have ideal properties to stimulate the healing of open wounds. We present four cases of wounds on the scalp that did not heal and in all of them there was abundant granulation tissue and lack of epidermal migration. The application as a monotherapy of a silicone-based gel (Stratamed, Stratpharma, Basel, Switzerland), which forms a film directly on the wound, was associated with better wound healing

Clinical characteristics of patients with leiomyoma who undergo surgery after high intensity focused ultrasound (HIFU)

OBJECTIVE: We evaluated the clinical characteristics of patients who underwent surgery after high intensity focused ultrasound (HIFU) to treat uterine leiomyoma. METHODS: From June 2016 to September 2017, patients at our hospital who underwent HIFU to treat uterine leiomyoma prior to surgery were enrolled. All patients underwent pelvic magnetic resonance imaging (MRI) before and after HIFU. If 6 months had passed since the last pelvic MRI was performed, imaging was performed again before the operation. RESULTS: A total of 12 patients were analyzed. The median age was 45 (range, 28–51) years. The median body mass index was 24.9 (range, 18.1–29.2) kg/m2. The median size of the leiomyoma was 10.1 (range, 7.8–14.0) cm before HIFU, which changed to 8.75 (range, 5.9–14.8) cm after HIFU. The median size increased to 9.1 (range, 5.9–18.0) cm before the operation. Surgery was planned for several reasons, including an increase in the leiomyoma size (n=6), persistent symptoms (n=4), and newly developed lesion (n=2). The median interval between HIFU and surgery was 7 (range, 3–32) months. Ten of the 12 patients underwent laparoscopic surgery, while the others underwent laparotomy; 6 patients also underwent laparoscopic myomectomy, and 4 underwent hysterectomy. Histopathologic findings showed infarction-type necrosis surrounded by granulation tissue with the infiltration of lymphocytes and macrophages in all patients. CONCLUSION: Treatment of leiomyoma with operative procedures should be considered in selected patients with tumor size greater than 10 cm, multiple tumors, and persistent symptoms after HIFU treatment.

Use of vacuum-assisted closure in massive puerperal genital hematoma

Puerperal genital hematomas are rare but life-threatening complications of obstetric emergencies. A pregnant patient (39 weeks) underwent a mediolateral episiotomy during a vaginal delivery. An afterbirth hematoma (approximately 20 cm in diameter) was evacuated, but the use of a vacuum-assisted wound closure system was applied after the sutures opened on the 7th postoperative day. On the 10th day of the vacuum-assisted closure (VAC) application, the wound was completely closed. VAC is an alternative treatment modality that can drain an infection and increase the proportion of granulation tissue in humid and irregular surfaces such as the perineum.

Laryngeal granulomas in patients after two-jaw surgery: Four cases report

BACKGROUND: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it.CASE: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature.CONCLUSIONS: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.

Comparison of vacuum-assisted closure therapy and conventional dressing on wound healing in patients with diabetic foot ulcer:a randomized controlled trial

Background: Vacuum-assisted closure (VAC) therapy has been shown to be beneficial in a variety of wounds. However, evidence of its benefit in diabetic foot ulcers (DFUs), especially with respect to Indian population, is sparse. Methodology: This randomized controlled trial included DFUs of Wagner's Grades 1 and 2. Patients were further stratified with respect to DFU size <10 cm and ≥10 cm. Patients with vascular disease, osteomyelitis, and bilateral DFUs were excluded from the study. The enrolled patients were randomized to receive VAC therapy or conventional dressing. The time to wound healing, granulation tissue formation, and complications such as pain, infection, and bleeding were compared between the two groups. Results: A total of sixty patients were randomized, of which 27 in each group were analyzed. The mean time to healing in days was significantly less in VAC group (22.52 vs. 3.85; P < 0.0001). Mean time to achieve 75%­100% granulation tissue cover was significantly less in VAC group (23.33 vs. 32.15; P < 0.0001). Rate of granulation tissue formation was also found to be significantly better in VAC group (2.91 cm2/day vs. 2.16 cm2/day; P = 0.0306). There was no difference between the two groups with respect to wound infection and bleeding which are commonly attributed to VAC therapy. VAC therapy group had significantly lesser pain at week 3 (Visual Analog Scale score 3 vs. 4; P = 0.004). Conclusion: VAC therapy significantly decreases the time to complete wound healing, hastens granulation tissue formation, and reduces the ulcer area compared to conventional dressing. The study did not find any significant increase in the bleeding and infection in the VAC therapy group

Effect of Qufu Shengji ointment(QFSJO) on promoting the healing of infectious wounds / 中国骨伤

OBJECTIVE@#To explore the clinical effect of Qufu Shengji ointment(QFSJO) in promoting the wound healing after trauma.@*METHODS@#From January 2014 to June 2018, 60 patients with soft tissue injury, skin defect and wound infection caused by violent trauma were admitted, including 32 males and 28 females, aged from 18 to 65 years, with an average age of 41.3 years. Among them, 30 patients were treated with QFSJO (QFSJO group) and 30 patients were treated with normal saline iodophor (control group). The reduction rate of wound area, the days of decayed flesh, the time of new epithelium and the recovery rate of 28 days after dressing change were compared between the two groups.@*RESULTS@#In the QFSJO group, after using large dose of QFSJO, the pus of the wound increased, the granulation grew, and the new epithelium appeared on the edge of the wound, showing a rapid healing phenomenon. The wound healing rate of QFSJO group was higher than that of the control group at all time points, and the time of decaying flesh and new epithelium appeared in QFSJO group was earlier than that of the control group. The recovery rate of QFSJO group was significantly higher than that of the control group(<0.05). All the patients were followed up, and the duration ranged form 6 to 12 months, with an average of 9.4 months. The exposed areas of bone and teadon were covered well. The vital signs of the two groups were stable and no adverse reactions occurred.@*CONCLUSIONS@#QFSJO can promote the growth of granulation tissue, promote the production of new skin, and accelerate the healing of infectious wound after trauma.

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Abstract Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998-2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.

Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo? / 대한평형의학회지

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

Application of a paste-type acellular dermal matrix for coverage of chronic ulcerative wounds

BACKGROUND: Chronic wounds occur due to failure of the normal healing process, associated with a lack of deposition of cellular components and a suitable microenvironment such as the extracellular matrix (ECM). Acellular dermal matrix (ADM) is viewed as an ECM substitute, and a paste-type ADM has recently been introduced. We hypothesized that CGPaste, an injectable paste-type ADM, could serve as a scaffold and promote wound healing. METHODS: We retrospectively studied seven patients in whom CGPaste was applied between 2017 and 2018, who had pressure ulcers, necrotizing fasciitis, diabetic foot ulcers, traumatic defects, and osteomyelitis. The goal of applying CGPaste was to achieve complete wound healing with re-epithelialization or growth of granulation tissue, depending upon the wound bed status. CGPaste was injected based on the wound size along with the application of a dressing. RESULTS: Four of the seven patients showed granulation tissue on their wound bed, while the other three patients had a bony wound bed. The mean wound area was 453.57 mm2 and the depth was 10.71 mm. Wound healing occurred in five of the seven patients (71.43%). The mean duration of complete healing was 2.4 weeks. Two patients showed failure due to paste absorption (29.57%); these patients had wound beds comprising bone with relatively large and deep wounds (40×30 and 30×20 mm2 in area and 15 and 10 mm in depth). CONCLUSIONS: CGPaste is an effective option for coverage of small and deep chronic wounds for which a flap operation or skin grafting is unfeasible.

Effects of renal dysfunction on healing of colonic anastomosis: experimental study in wistar rats / Efeitos da disfunção renal na cicatrização de anastomoses colônicas: estudo experimental em ratos wistar

ABSTRACT Background: Chronic kidney disease affects more than 500 million people worldwide. In this context, the uremic toxins present are related to worsening in tissue healing. Aim: Evaluate on healing of colonic anastomosis in uremic rats, serum and anatomopathological indicators, which may be related to the change tissue repair process. Methods: Twenty Wistar rats, were randomly separated into two groups. In the sham group they were submitted to 5/6 nephrectomy simulation in left kidney, simulation right nephrectomy, median laparotomy, colotomy and colorraphy. In the uremia group, they were submitted to 5/6 nephrectomy of the left kidney, total nephrectomy of the right kidney and median laparotomy, colotomy and colorraphy. Were collected for serum urea, creatinine and CRP dosages and the colonic segments were studied for evaluation of granulation tissue, collagen maturation, microvascular and myofibroblasts density, and cell viability. Through histochemical processing, microvascular density was evaluated by anti-CD34 monoclonal antibody marking, cell viability by cell proliferation nuclear antigen screening and myofibroblasts density with monoclonal anti-α-actin antibody. Computerized histometry was used for evaluations of collagens type I and III by the coloration of picrosirius. Results: The group submitted to nephrectomy 5/6, compared to the sham group, show urea increase (p<0.0000) and higher C reactive protein (p=0.0142). Decrease of granulation tissue formation (border reepithelialization p=0,0196, angiofibroblast proliferation p=0.0379), mean collagen I (p=0,0009) and collagen III (p=0,016), microvascular density (p=0,0074), cell proliferation nuclear antigen (p<0,0000) and myofibroblasts (p<0,0001). Conclusion: The uremia induced by nephrectomy 5/6 model establishes negative impact in the colonic wound healing.

RESUMO Racional: A doença renal crônica atinge mais de 500 milhões de pessoas em todo o mundo. Neste contexto, as toxinas urêmicas estão relacionadas ao comprometimento da cicatrização tecidual. Objetivo: Avaliar, na cicatrização de anastomoses colônicas de ratos urêmicos indicadores séricos e anatomopatológicos que possam estar relacionados com alteração do processo de reparação tissular. Métodos: Utilizaram-se 20 ratos Wistar divididos aleatoriamente em dois grupos. No grupo simulação eles foram submetidos à simulação da nefrectomia 5/6 do rim esquerdo, simulação de nefrectomia total do rim direito, laparotomia mediana, colotomia e colorrafia. No grupo uremia, eles foram submetidos à nefrectomia 5/6 do rim esquerdo, nefrectomia total do rim direito, laparotomia mediana, colotomia e colorrafia. Coletaram-se amostras de sangue para dosagens séricas da ureia, creatinina e proteína C reativa, e do cólon para processamentos histológicos e histoquímicos na avaliação do tecido de granulação, maturação de colágeno, densidade microvascular e de miofibroblastos, viabilidade celular cicatricial. Empregou-se a histometria computadorizada para as avaliações de colágenos tipos I e III, densidade microvascular pela marcação com anticorpo monoclonal anti-CD34, viabilidade celular pela pesquisa do antígeno nuclear de proliferação celular e a densidade de miofibroblastos com anticorpo monoclonal anti-α-actina. Resultados: O grupo submetido à nefrectomia 5/6, em comparação ao grupo simulação, demonstraram aumentos da ureia sérica (p<0,0000) e proteína C reativa (p=0,0142), redução da formação de tecido de granulação (reepitelização de bordas p=0,0196, proliferação angiofibroblástica p=0,0379), porcentagens de colágeno I (p=0,0009) e colágeno III (p=0,016), densidade microvascular (p=0,0074) e miofibroblastos (p<0,0001) e antígeno nuclear de proliferação celular (p<0,0000). Conclusão: A uremia induzida pelo modelo de nefrectomia 5/6 determina impacto negativo no processo de cicatrização colônico.

The Clinical Efficacy of Silicone Stents for Endoscopic Dacryocystorhinostomy: A Meta-Analysis

We evaluated the effect of silicone stent use during endoscopic dacryocystorhinostomy on postoperative morbidities in comparison with versus without a silicone stent. Two authors independently searched six databases (PubMed, Embase, Scopus, the Web of Science, the Cochrane library, and Google Scholar) from inception of article collection to July 2017. The analysis included prospective randomized studies that compared intraoperative silicone stent insertion (silicone group) with no application of a silicone stent (control group), in which the outcomes of interest were success rate (lacrimal passage patent check with syringing, symptom relief, or endoscopic confirmation of fluorescein dye from the opening of Hasner's valve) and morbidities (e.g., postoperative bleeding, rhinostomy closure, granulation tissue, synechia, and eyelid problems) after certain follow-up periods (over 10 weeks). Nine studies involving a total of 587 participants were included. Functional success rates tended to be higher in the silicone group than in the control, but there was no statistically significant difference in success rates (odds ratio, 1.45; 95% confidence interval, 0.77 to 2.73). According to the surgical type such as mucosal removal and mucosal flap surgery, the results from types didn't demonstrate any significant effect, but the mucosal flap technique seemed to be more beneficial. Regarding postoperative morbidities, although the outcomes of the groups did not present any statistically significant difference, eyelid problems and postoperative bleeding tended to occur more frequently in the silicone group, but rhinostomy closure tended to occur more frequently in the control group. Success and morbidity rates showed no difference between the silicone stent group and control group in the meta-analysis. However, additional analyses revealed that the success rate of endonasal dacryocystorhinostomy using silicone intubation with mucosal flap has shown an improving trend, and morbidities such as granulation and synechia showed decreasing trends compared with the group without silicone intubation.

Evaluation of the Possible Neurotoxic Effect of the Bone Cement on the Facial Nerve: An Experimental Study

OBJECTIVES: To investigate neurotoxic effect of bone cement (BC) on facial nerve by using electrophysiological and histopathological methods. METHODS: This study included 20 male albino Wistar rats, divided into four equal groups. Group A was designed as the control group, while group B was sham group. In the group C, BC solution was dropped onto the facial nerve trunks of rats and washed with physiological saline after 5 seconds. In the group D, BC solution was dropped onto the facial nerve trunks of rats and after allowing 5 minutes to dry, wounds were closed. Pre- and postoperative (on 4th week) evoked electromyography (EMG) measurements were done. For histopathological assessments, the rats were euthanized and tissue samples of facial nerve and surrounding areas were collected. RESULTS: According to the wave amplitude levels of evoked EMG, postoperative amplitude levels of group D were significantly decreased, compared to preoperative amplitude levels (P=0.043). We found no statistically significant difference in inflammation among the groups. In none of the groups, foreign body reaction and granulation tissue were not detected in any of the groups. In addition, degeneration in axon, myelin, or perineural nets was not detected in any of the groups. CONCLUSION: This study results suggest that BC has no direct toxicity on facial nerve, while it has indirect effects, by decreasing amplitude. Therefore, we conclude that direct contact of BC with nerve should be avoided, and the area should be cleaned by aspiration or washing with physiological saline in case of contact.

Estudio comparativo con membranas multifuncionales y apósitos húmedos a seco, en pacientes con heridas crónicas difíciles de curar. Ensayo clínico aleatorizado / RCT of Multfunctonal Membranes vs Traditional Methods for Chronic or Hard-to-Heal Wounds

Introducción: Conocida la dificultad en el tratamiento de heridas crónicas de difícil curación, nos hemos propuesto evaluar las diferencias del progreso de la cicatrización tras intervención con métodos avanzados (Membranas Multifuncionales) y métodos tradicionales (apósitos de gasa húmedos a seco), durante un período de estudio de 12 semanas. Metodología: Un total de 380 pacientes que se presentaron a la Clínica de Curaciones de Consulta Externa del Departamento de Cirugía del Hospital Roosevelt, con heridas crónicas difíciles de curar, fueron distribuidos para su tratamiento en entorno ambulatorio a uno de dos grupos: a. con métodos avanzados (Membranas Multifuncionales) y b. con métodos tradicionales (apósitos de gasa húmedos a seco). La distribución en cada grupo se realizó mediante aleatorización simple según la secuencia de presentación: casos impares, para tratamientos avanzados con Membranas Multifuncionales y casos pares: con curas tradicionales (apósitos húmedos a secos). El principal resultado de interés fue determinar la eficacia en relación con la formación de tejido de granulación y/o tejido epitelial en el lecho de la herida con los dos métodos de tratamiento, utilizando para su valoración la escala modificada de Houghton y colaboradores (Photographic Wound Assessment Tool- PWAT por sus siglas en inglés-) Resultados: De enero a octubre de 2014, se seleccionaron 380 pacientes elegibles y se asignaron al azar a 190 pacientes en cada grupo. 129 pacientes (92 del grupo de apósito húmedo a seco y 37 de la Membrana Multifuncional), no concluyeron el ensayo por el incumplimiento/abandono del protocolo, permaneciendo en el estudio 251 pacientes para el seguimiento. El tiempo establecido para la recolección de datos fue en las semanas 4, 8 y 12. A las cuatro semanas, en la primera evaluación, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 50% de los casos, en comparación con el 28% de los apósitos húmedos a secos. A las ocho semanas, en la segunda evaluación, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 71% de los casos, en comparación con el 50% de apósitos húmedos a secos. En la evaluación final a las doce semanas, el grupo tratado con la Membrana Multifuncional presentó cicatrización completa o cercana al cierre en el 85% de los casos, en comparación con el 58% de los apósitos húmedos a secos. Conclusiones: En el presente estudio, en las heridas crónicas difíciles de curar, el grupo tratado con las membranas multifuncionales fue la alternativa que ofreció mayor éxito de cierre completo de la herida comparada con las lesiones tratadas con apósito húmedo a seco.

Introducton: Complicated chronic or difcult-to-heal wounds have led to propose the evaluaton between the diferences in progress of healing afer an interventon with advanced methods (Multfunctonal Membranes) and traditional methods (wet to dry gauze dressings), during a period of 12 weeks. Methods: From January to October 2014, 380 patents who presented at the Outpatient Wound Care Clinic of the Department of Surgery, Roosevelt Hospital, with chronic or difficult-to-heal wounds, were distributed for treatment in outpatient setting to one of two groups: a. with advanced methods (Multifunctional Membranes) and b. with traditional methods (wet-to-dry gauze dressings). The distribution in each group was made by simple randomization according to the presentation sequence: odd cases, for advanced treatments with Multifunctional Membranes and even cases: with traditional cures (wet to dry dressings). The main interest was to determine the efficacy in relation to the formation of granulation tissue and/or epithelial tissue in the wound bed with the two treatment methods, using for evaluation the modified scale of Houghton PWAT (Photographic Wound Assessment Tool). Results: 380 eligible patents were selected, and 190 patents were randomized in each group. 129 patents did not complete the trial due to noncompliance or dropout of the protocol, leaving 251 patents for follow-up. At four weeks, the group treated with the Multifunctional Membrane had completely healed or almost closed in 50% of cases, compared with 28% of wet to dry gauze dressings. At eight weeks, the group treated with the Multifunctional Membrane completely healed or almost closed in 71% of cases, compared with 50% of wet to dry gauze dressings. At twelve weeks, the group treated with the Multifunctional Membrane had completely healed or almost closed in 85% of cases, compared with 58% of wet to dry gauze dressings. Conclusions: The group treated with the multfunctonal membranes was the alternatve that ofered the greatest success of complete closure of the wound compared with the lesions treated with wet-to-dry dressing.

Efeitos do PDGF-BB na taxa de proliferação e na adesão de células derivadas da granulação óssea a fragmentos radiculares / Effects of PDGF-BB on the rate of proliferation and on the adhesion of human cells derived from bone granulation tissue to root fragments

O objetivo deste estudo foi investigar o papel do fator de crescimento derivado de plaquetas-BB (PDGF-BB) na concentração de 300ng/ml na taxa de proliferação e adesão de células derivadas da granulação óssea humana a fragmentos radiculares periodontalmente comprometidos. Na primeira etapa do estudo, foi estabelecida cultura primária de células da granulação óssea de dois pacientes adultos, sistemicamente saudáveis, não fumantes. Após a expansão celular, as células foram caracterizadas para determinação do fenótipo por meio de ensaios de viabilidade celular, MTT, ensaio de atividade de fosfatase alcalina, ensaio de mineralização e caracterização imunohistoquímica por meio de citometria de fluxo (segunda etapa). Na terceira etapa do estudo, os efeitos da adição de PDGF-BB recombinante humano na concentração de 300ng/ml na taxa de proliferação e adesão de células derivadas da granulação óssea a superfícies radiculares periodontalmente comprometidas foram investigados. A taxa de proliferação celular estimulada pelo PDGF-BB (grupo teste) ou pelo meio de cultura (grupo controle) foi investigada por meio de contagem de células viáveis nos frascos de cultura após 1, 3, 5 e 7 dias do cultivo celular. Foram obtidos 30 fragmentos dentários a partir de dentes extraídos por razões periodontais. Os fragmentos foram raspados com curetas Gracey e condicionados com solução em gel de EDTA a 24% durante 3 minutos, lavados com solução de soro fisiológico, secos e posicionados em placas de 24 poços. Foram incubadas sobre os fragmentos tratados 1x104 células GO por 24 horas, seguido por fixação e preparo para análise por microscopia eletrônica de varredura (MEV). O número de células aderidas sobre os fragmentos foi analisado nas fotomicrografias. O padrão de crescimento das células GO foi compatível com células ósseas, com modificação do padrão do crescimento com o aumento do número de passagens. Houve atividade de fosfatase alcalina em meio osteogênico e convencional, com pico máximo aos 7 dias e atividade de mineralização estimulada ou não por meio osteogênico, com pico máximo aos 21 dias. A análise por meio de citometria de fluxo demonstrou que as células GO não expressaram CD105 e CD166 na 14a passagem, indicando sua diferenciação celular avançada nesse período. A adição de rhPDGF-BB resultou em mudança na taxa de proliferação celular, observando-se pico máximo de crescimento aos 7 dias, com diferenças estatisticamente significantes (p < 0.005; ANOVA post hoc Tukey) em relação aos períodos de 1, 3 e 5 dias. O ensaio de MTT demonstrou maior viabilidade celular no período de 48 hs, comparativamente aos períodos de 24 e 72 horas, quando a densidade óptica celular diminuiu de forma significativa (p< 0.05; Friedmann pósteste Dunn). No ensaio de adesão celular, pode-se observar que a adição de rhPDGFBB aumentou significativamente o número de células aderidas aos fragmentos dentários (p< 0.05; teste t não pareado com correção Welch), com alteração da morfologia celular. Esses resultados sugerem que as células GO tem características compatíveis com linhagem de células osteoblásticas, de fenótipo mais diferenciado após a 12a passagem. A adição de rhPDGF-BB (300ng/ml) resulta em aumento da taxa de proliferação das células GO e do número de células aderidas a fragmentos radiculares, indicando que, nesta concentração, o fator de crescimento é citocompatível, favorecendo a proliferação e adesão celular.(AU)

The goal of this study was to investigate the effects of recombinant human platelet derived growth factor (rhPDGF-BB) at the concentration of 300ng/ml in the proliferation and adhesion of human bone granulation cells to periodontally diseased root fragments. At the first stage of the study, the granulation tissue existent in healing sockets (21 days after its creation) was collected from two systemically healthy nonsmoking adults to the establishment of primary culture. The in vitro properties of bone granulation (BG) cell lineage were characterized by cell viability, MTT, alkaline phosphatase activity and mineralization assays. The effects of culture medium (control) and rhPGDF-BB 300ng/ml (test) in the proliferation and adhesion of BG cells were investigated. The rate of BG cells proliferation was investigated by the number of viable cells present at 1, 3, 5 and 7 days after platting. Thirty root fragments were obtained from teeth extracted for periodontal reasons. Root fragments were scaled and root planed, conditioned with EDTA 24% for 3 minutes, rinsed in saline solution, air-dryed and positioned in 24-well plates. Each fragment was seeded with 104 BG cells, fixated after 24 hours and prepared for analysis in SEM. The number of cells adhered to the fragments was analysed in photomicrographies. BG cells growth pattern was compatible with osteogenic cell lineage, showing modification with the increasing number of cell passage. GO cells expressed alkaline phosphatase activity in conventional and osteogenic culture medium, with maximum peak at 7 days, as well as mineralization activity stimulated or not by osteogenic or non-osteogenic culture medium, with maximum peak at 21 days. The analysis by flow cytometer showed that BG cells have not expressed CD105 and CD106 at the 14th passage, indicating its advanced cell differentiation. The addition of rhPDGF-BB resulted in modification of proliferation rate, with maximum peak observed at 7 days, significantly different from 1-, 3- and 5-day periods (p< 0.005; ANOVA post hoc Tukey). MTT assay showed greater cell viability after 48 hours than after 24 and 72 hours, when optical density has significantly diminished (p< 0.05; Friedmann post hoc Dunn). At cell adhesion assay, it could be observed that the adhesion of rhPDGF-BB has significantly increased the number of cells adhered to root fragments (p< 0.05; unpaired t test with Welchs correction), and alterations in cell morphology. These results suggest that BG cells present in vitro characteristics compatible with osteoblastic cell lineages, with a more differentiated phenotype after the 12th passage. The addition of rhPDGF-BB (300 ng/ml) results in increase of the rate of BG cell proliferation and in the number of cells adhered to root fragments, indicating that, at this concentration, the growth factor is compatible with BG cells and favors cells proliferation and adhesion.(AU)