Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications.

OBJECTIVE: The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS: The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS: There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524). CONCLUSIONS: It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.

Effects of cryotherapy on the regeneration process and muscular mechanical properties after lacerative injury model.

Cryotherapy is a therapeutic modality widely used for the treatment of muscle injuries to control pain and inflammatory processes. This study aimed to investigate the effects of cryotherapy on the inflammatory and oxidative stress parameters and mechanical properties of, and pain in, the skeletal muscles of rats with lacerative muscle injury. The rats were anesthetized with 4% isoflurane and subjected to gastrocnemius muscle laceration injury. After injury, all animals in the intervention groups received cryotherapy treatment for 20 minutes using plastic bags containing crushed ice. The protocol comprised three daily applications at 3-hour intervals on the day of injury, with reapplication 24 hours later. Seventy-two male Wistar rats were divided into three groups: sham, muscle injury (MI), and MI + cryotherapy (MI + cryo). Muscle mechanical properties were analyzed by mechanical tensile testing on day 7 after injury. The MI + cryo group showed reduced TNF-α, IFN-γ, and IL1ß levels; elevated IL4, IL6, and IL10 levels; reduced oxidant production and carbonyl levels; and elevated sulfhydryl contents. Animals that underwent tissue cooling showed superoxide dismutase activity and glutathione levels close to those of the animals in the sham group. The MI and MI + cryo groups showed reduced values of the evaluated mechanical properties and lower mechanical thresholds compared to those of the animals from the sham group. Our results demonstrated that the proposed cryotherapy protocol reduced the inflammatory process and controlled oxidative stress but did not reverse the changes in the mechanical properties of muscle tissues or provide analgesic effects within the time frame analyzed.

Uso de cola cirúrgica no reparo de lacerações perineais intraparto: estudo série de casos / Uso de pegamento quirúrgico para reparar desgarros perineales intraparto: estudio serie de casos / Use of surgical glue to repair intrapartum perineal lacerations: a case series study

Resumo Objetivo Descrever o uso da cola cirúrgica no reparo do trauma perineal no parto normal. Métodos Estudo série de casos realizado em três momentos (até 2 horas, 12-24 horas e 36-48 horas após o parto), em Itapecerica da Serra, SP. Foram incluídas mulheres que tiveram parto normal com trauma perineal com indicação de sutura (laceração de primeiro ou segundo graus e episiotomia). O trauma perineal foi reparado exclusivamente com cola cirúrgica Glubran-2®. Avaliou-se: intensidade da dor perineal (Escala Visual Numérica com 11 pontos), processo de cicatrização (escala REEDA de 15 pontos), satisfação com o reparo (escala Likert de 5 pontos). Os dados foram analisados de forma descritiva e inferencial comparando os três momentos. Resultados A técnica de aplicação da cola e a quantidade necessária foram definidas em uma amostra de 19 mulheres. Destas, 78,9% tiveram laceração de primeiro grau, 15,8% de segundo grau e 5,3% episiotomia. Os desfechos nos momentos 1, 2 e 3, foram respectivamente: ausência de dor (73,6%, 94,7% e 89,4%); escore ≤1 na escala REEDA (94,7%, 78,9% e 84,2%); 100% satisfeitas com o reparo em todos os momentos. Não houve diferença pelo teste de Friedman para dor e satisfação. O processo de cicatrização mostrou diferença, porém sem confirmação no pós-teste hoc. Conclusão A aplicação da cola mostrou-se viável para avaliação em uma amostra maior de mulheres, pois os resultados sugerem boa aceitação pelas mulheres e dor de baixa intensidade ou ausente, cicatrização adequada e alta satisfação com o reparo nas primeiras 48 horas após o parto.

Resumen Objetivo Describir el uso de pegamento quirúrgico para reparar traumas perineales en partos vaginales. Métodos Estudio serie de casos realizado en tres momentos (hasta 2 horas, de 12 a 24 horas y de 36 a 48 horas después de parto), en Itapecerica da Serra, estado de São Paulo. Se incluyeron mujeres que tuvieron parto vaginal con trauma perineal e indicación de sutura (desgarro de primer o segundo grado y episiotomía). El trauma perineal fue reparado exclusivamente con pegamento quirúrgico Glubran-2®. Se evaluó la intensidad del dolor perineal (Escala Visual Numérica de 11 puntos), el proceso de cicatrización (Escala REEDA de 15 puntos) y la satisfacción respecto a la reparación (Escala Likert de 5 puntos). Los datos fueron analizados de forma descriptiva e inferencial, comparando los tres momentos. Resultados La técnica de aplicación del pegamento y la cantidad necesaria fueron definidas en una muestra de 19 mujeres. De ellas, el 78,9 % tuvieron un desgarro de primer grado, el 15,8 % de segundo grado y el 5,3 % episiotomía. Los resultados de los momentos 1, 2 y 3 fueron, respectivamente: ausencia de dolor (73,6 %, 94,7 % y 89,4 %); puntuación ≤1 en la escala REEDA (94,7 %, 78,9 % y 84,2 %); 100 % satisfechas con la reparación en todos los momentos. No se observó diferencia de dolor y satisfacción con la prueba de Friedman. El proceso de cicatrización mostró diferencia, pero sin confirmación en la prueba post hoc. Conclusión La aplicación del pegamento demostró ser viable para un análisis con una muestra mayor de mujeres, ya que los resultados sugieren buena aceptación por parte de las mujeres, dolor de baja intensidad o ausente, cicatrización adecuada y alta satisfacción respecto a la reparación en las primeras 48 horas después del parto.

Abstract Objective To describe the use of surgical glue to repair perineal trauma during normal delivery. Methods This is a case series study, which was carried out in three moments (up to 2 hours, 12-24 hours and 36-48 hours after delivery) in Itapecerica da Serra, SP. Women who had a normal delivery with perineal trauma with a suture (first or second degree laceration and episiotomy) were included. Perineal trauma was repaired exclusively with Glubran-2® surgical glue. Perineal pain intensity (11-point Visual Numeric Scale), healing process (15-point REEDA scale), satisfaction with repair (5-point Likert scale) were assessed. Data were analyzed in a descriptive and inferential way comparing the three moments. Results The technique of applying the glue and the required amount were defined in a sample of 19 women. Of these, 78.9% had first-degree lacerations, 15.8%, second-degree lacerations and 5.3%, episiotomy. The outcomes at moments 1, 2 and 3 were absence of pain (73.6%, 94.7% and 89.4%), score ≤1 on the REEDA scale (94.7%, 78.9% and 84, two%); 100% were satisfied with the repair at all times. There was no difference by the Friedman test for pain and satisfaction. The healing process showed a difference, but without confirmation in the hoc post-test. Conclusion The glue application proved to be viable for assessment in a larger sample of women, as the results suggest good acceptance by women and low or no pain, adequate healing and high satisfaction with the repair in the first 48 hours after delivery.

Utilização de creme de extrato de calêndula em ferida lacerante em equino / Use of calender extract cream in equine lacerate wound

Background: Wounds and lacerations are constant in the clinical routine of horses. The treatment of wounds by the secondintention is the most common in the equine clinic; it consists in addition to surgical debridement, the use of allopathic orphytotherapeutic healing. In this context, several phytotherapics used in folk medicine have been used with promisingresults in the equine species, especially marigold (Calendula officinalis L.), recognized by the German scientific committee as antiseptic and healing. The objective of this study was to evaluate the efficacy of the nonionic cream of Calendulaofficinalis at 2% in an extensive lacerating wound in an equine.Case: A 6-month-old female Quarter Horse, weighing 160 kg, a lacerating wound in the pectoral region of unknowntraumatic origin, was treated in the large animal sector of the Veterinary Hospital of Universidade Paranaense (UNIPAR).Clinical examination revealed an exudative wound in the pectoral region, complicated by the presence of environmentalorganic matter and myiasis, involving transverse pectoral and descending pectoral muscles, with a large tissue separationand exposure of part of the first sternum. After an initial evaluation, a trichotomy was performed around the wound, removalof myiasis and sanitization of the wound with water and PVP-I, which was filled with sterile dressings and covered with adressing using a tubular mesh. Antibiotic therapy was instituted, along with anti-inflammatory medication and antitetanicserum (5,000 IU). Due to the need for surgical debridement, after previous fasting and general anesthesia followed bysite antisepsis, surgical debridement was performed, followed by reduction of dead space with application of standard“Wolf” sutures, for re-approximation of the wound edges was applied suture in Wolf pattern captonated with segmentsof equipment. In the post-surgical period, topical treatment with nitrofurazone ointment and crystal...(AU)

Utilização de creme de extrato de calêndula em ferida lacerante em equino / Use of calender extract cream in equine lacerate wound

Background: Wounds and lacerations are constant in the clinical routine of horses. The treatment of wounds by the secondintention is the most common in the equine clinic; it consists in addition to surgical debridement, the use of allopathic orphytotherapeutic healing. In this context, several phytotherapics used in folk medicine have been used with promisingresults in the equine species, especially marigold (Calendula officinalis L.), recognized by the German scientific committee as antiseptic and healing. The objective of this study was to evaluate the efficacy of the nonionic cream of Calendulaofficinalis at 2% in an extensive lacerating wound in an equine.Case: A 6-month-old female Quarter Horse, weighing 160 kg, a lacerating wound in the pectoral region of unknowntraumatic origin, was treated in the large animal sector of the Veterinary Hospital of Universidade Paranaense (UNIPAR).Clinical examination revealed an exudative wound in the pectoral region, complicated by the presence of environmentalorganic matter and myiasis, involving transverse pectoral and descending pectoral muscles, with a large tissue separationand exposure of part of the first sternum. After an initial evaluation, a trichotomy was performed around the wound, removalof myiasis and sanitization of the wound with water and PVP-I, which was filled with sterile dressings and covered with adressing using a tubular mesh. Antibiotic therapy was instituted, along with anti-inflammatory medication and antitetanicserum (5,000 IU). Due to the need for surgical debridement, after previous fasting and general anesthesia followed bysite antisepsis, surgical debridement was performed, followed by reduction of dead space with application of standard“Wolf” sutures, for re-approximation of the wound edges was applied suture in Wolf pattern captonated with segmentsof equipment. In the post-surgical period, topical treatment with nitrofurazone ointment and crystal...

Development of a Manual for the Prevention and Treatment of Skin Tears.

A skin tear is a partial-thickness wound whose main characteristic is the presence of a skin flap. There are many contributing factors to skin tears, but few practical guidelines are available in the literature for their prevention and management. OBJECTIVE: The aim of this study is to develop a manual for the prevention and treatment of skin tear injuries. METHODS: A literature review on skin tears was conducted. The manual was organized into 7 chapters of topics of interest to health care professionals. Its content validity was assessed in 2 rounds of consultation by 7 health professionals with a master's or doctoral degree who were experienced in skin lesions. RESULTS: The manual was successfully validated for content by the expert panel. The content validity index (CVI) was 0.96 for the topic Objective, 0.96 for Structure and Presentation, and 0.93 for Relevance. The final version of the manual showed an excellent overall CVI of 0.95. CONCLUSIONS: A content-validated manual for the prevention and treatment of skin tears was created to guide nursing professionals in the management of patients with skin tears, which contributes to the identification of risk factors and development of preventive measures.

Implementation of care practices to prevent and repair perineal trauma in childbirth. / Implementação de práticas assistenciais para prevenção e reparo do trauma perineal no parto.

OBJECTIVE: To implement care practices for perineal trauma prevention and repairing in normal birth. METHOD: Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3. RESULTS: Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin. CONCLUSION: The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management.

Tratamento de feridas lacerantes em membros pélvicos comparando enxerto em malha e cicatrização por segunda intenção / Treatment of lacerating wounds in pelvic members comparing mesh enzyme and healing for second intention

The efficiency of the mesh graft used in lacerating wound was evaluated when comparedto another wound treated by second intention. The debridement of the wound wasperformed, the necrotic tissue was removed for subsequent granulation tissue formationand graft application. The transplanted skin was collected from the thoracic region with thesame measures of the defect to be corrected. The preparation of the graft consisted of theremoval of adipose tissue, and later, with the use of the scalpel blade, several rectilinearcuts were made, leaving it with mesh pattern. The graft was fixed to the wound with theuse of a separate single suture. After the surgical procedure, a bandage with hydrogel wasapplied to the limb of the animal, where the dressing change occurred at intervals of fourdays. We concluded that the wound treatment in the MTE using the graft was efficient withtotal wound healing when compared to the non-grafted MTD treatment.Palavras-chaves: cirurgia reconstrutiva; plástica; cão.(AU)

Tratamento de feridas lacerantes em membros pélvicos comparando enxerto em malha e cicatrização por segunda intenção / Treatment of lacerating wounds in pelvic members comparing mesh enzyme and healing for second intention

The efficiency of the mesh graft used in lacerating wound was evaluated when comparedto another wound treated by second intention. The debridement of the wound wasperformed, the necrotic tissue was removed for subsequent granulation tissue formationand graft application. The transplanted skin was collected from the thoracic region with thesame measures of the defect to be corrected. The preparation of the graft consisted of theremoval of adipose tissue, and later, with the use of the scalpel blade, several rectilinearcuts were made, leaving it with mesh pattern. The graft was fixed to the wound with theuse of a separate single suture. After the surgical procedure, a bandage with hydrogel wasapplied to the limb of the animal, where the dressing change occurred at intervals of fourdays. We concluded that the wound treatment in the MTE using the graft was efficient withtotal wound healing when compared to the non-grafted MTD treatment.Palavras-chaves: cirurgia reconstrutiva; plástica; cão.

Ultrasound biomicroscopy and claudication test for in vivo follow-up of muscle repair enhancement based on platelet-rich plasma therapy in a rat model of gastrocnemius laceration.

PURPOSE: To track the regeneration process of lateral gastrocnemius due to a muscle laceration in rats, and to treatment with plateletrich plasma (PRP). METHODS: Ultrasound (40 MHz) images were used for measuring pennation angle (PA), muscle thickness (MT) and mean pixel intensity, along with claudication scores, of treated (PRPG) and non-treated (NTG) groups of rats. RESULTS: NTG showed a PA increase for the non-injured leg (p<0.05) and a tendency of MT to increase, whereas for PRPG there were no differences. There was a progressive reduction of the claudication score for the PRPG group throughout the entire period, with an immediate difference after seven days (p<0.05), whereas the NTG had a significant reduction only at day 28 (p<0.05). CONCLUSION: It was observed a compensatory hypertrophic response due to the overload condition imposed to healthy leg for NTG that did not occur in PRPG, suggesting an accelerated repair process of the injured leg due to treatment, anticipating its use.

Ultrasound biomicroscopy and claudication test for in vivo follow-up of muscle repair enhancement based on platelet-rich plasma therapy in a rat model of gastrocnemius laceration

PURPOSE: To track the regeneration process of lateral gastrocnemius due to a muscle laceration in rats, and to treatment with plateletrich plasma (PRP). METHODS: Ultrasound (40 MHz) images were used for measuring pennation angle (PA), muscle thickness (MT) and mean pixel intensity, along with claudication scores, of treated (PRPG) and non-treated (NTG) groups of rats. RESULTS: NTG showed a PA increase for the non-injured leg (p<0.05) and a tendency of MT to increase, whereas for PRPG there were no differences. There was a progressive reduction of the claudication score for the PRPG group throughout the entire period, with an immediate difference after seven days (p<0.05), whereas the NTG had a significant reduction only at day 28 (p<0.05). CONCLUSION: It was observed a compensatory hypertrophic response due to the overload condition imposed to healthy leg for NTG that did not occur in PRPG, suggesting an accelerated repair process of the injured leg due to treatment, anticipating its use.

Implementação de práticas assistenciais para prevenção e reparo do trauma perineal no parto / Implementación de prácticas asistenciales para la prevención y reparación de trauma perineal en el parto / Implementation of care practices to prevent and repair perineal trauma in childbirth

RESUMO Objetivos Implementar práticas assistenciais para prevenção e reparo do trauma perineal no parto normal. Métodos Estudo quase-experimental, realizado no Hospital da Mulher Mãe-Luzia, Macapá, AP. Realizaram-se 74 entrevistas com enfermeiros e médicos e 70 com puérperas, e analisaram-se dados de prontuários (n=555). O desenvolvimento da pesquisa se deu em três fases: pré-auditoria e auditoria de base (fase 1); intervenção educativa e implementação de boas práticas assistenciais (fase 2); auditoria pós-implementação (fase 3); a análise foi pela comparação das fases 1 e 3. Resultados Após a intervenção educativa, menos profissionais incentivavam puxos dirigidos, realizavam episiotomia e suturavam lacerações de primeiro grau; mais mulheres informaram que o parto foi em posição litotômica; mais registros nos prontuários indicaram o uso de Vicryl® na sutura da mucosa e pele. Conclusões A intervenção educativa melhorou os cuidados e os desfechos perineais, porém há lacunas na implementação das evidências e inadequações no manejo do cuidado perineal.

RESUMEN Objetivo Implementar prácticas asistenciales para la prevención y reparación del trauma perineal en el parto. Método Estudio casi experimental, conducido en el Hospital da Mulher Mãe-Luzia, Macapá, AP. Se realizaron 74 entrevistas con médicos y enfermeras y 70 con puérperas y se analizaron los datos de registros médicos (n=555). La investigación se desarrolló en tres fases: preauditoría y auditoría de base (fase 1); intervención educativa e implementación de buenas prácticas asistenciales (fase 2); auditoría posimplementación (fase 3); el análisis fue comparando las fases 1 y 3. Resultados Después de la intervención educativa, menos profesionales incentivaban pujo dirigido, realizaban episiotomía y suturaban desgarros de primer grado; más mujeres tuvieron el parto en posición litotomía; más registros indicaban uso de Vicryl® para suturar la mucosa y piel. Conclusión La intervención educativa ha mejorado el cuidado y los resultados perineales, pero hay lagunas en la implementación de evidencias y deficiencias en el cuidado perineal.

ABSTRACT Objective To implement care practices for perineal trauma prevention and repairing in normal birth. Method Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3. Results Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin. Conclusion The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management

[Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela]. / Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela.

OBJECTIVE: Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. METHODS: This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. RESULTS: There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. CONCLUSION: The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela / Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela

Objetivo Determinar la exposición laboral accidental a fluidos biológicos por contacto percutáneo en el personal Bioanalista de Laboratorios Clínicos públicos, sus factores asociados y el cumplimiento de medidas post exposición biológica. Métodos Se realizó un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clínicos del área metropolitana del estado Zulia. Para la recolección de datos se aplicó un instrumento de escalas que exploró la exposición percutánea, los factores vinculados y el cumplimiento de medidas post exposición biológica. Resultados Se evidenció exposición por accidentes percutáneos, representados principalmente por pinchazos y cortaduras, detectados en razón de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutánea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en áreas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición. Existe relación entre la exposición percutánea con el nivel de cumplimiento detectado para el manejo post exposición p <0,001. Conclusión La magnitud y características de la exposición a fluidos biológicos detectada en este colectivo laboral reviste una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Objective Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. Methods This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. Results There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. Conclusion The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Alternative treatment modalities for immature intruded permanent incisors: report of 2 cases.

Intrusion of permanent teeth is one of the most severe types of traumatic injuries. Different treatment strategies have been proposed, and the best approach for each case depends on the stage of root development, severity of the intrusive luxation, presence of alveolar fracture and number of intruded teeth. The purpose of this paper is to describe the treatment management of 2 cases of severely intruded immature permanent maxillary central incisors in 7 1/2- and 8-year-old children. In case 1, the traumatized tooth was treated by surgical repositioning, while in case 2 watchful waiting for spontaneous re-eruption was the treatment of choice. Treatment strategies were successful in both cases, as demonstrated by the continuation of root development, maintenance of pulp vitality, and absence of signs of periapical pathosis during the follow-up period. Regardless of the treatment strategy traumatically intruded teeth should undergo periodical clinical and radiographic surveillance on a long-term basis to allow early detection of possible complications.

Nonsurgical technique for incomplete earlobe cleft repair.

BACKGROUND: Earlobe cleft is a common problem caused by the wearing of jewelry or decorative objects. Incomplete earlobe clefts are usually bilateral and are often converted to complete clefts as part of the surgical repair procedure. OBJECTIVE: We present a nonsurgical procedure for incomplete earlobe cleft repair using trichloroacetic acid 90%. METHODS AND MATERIALS: We assessed 32 patients with a total of 53 earlobes to be noninvasively repaired. RESULTS: Complete treatment varied from 2 to 50 days, an average of 15 days between the first and last application of trichloroacetic acid 90%. No recurrences were observed during 1 year of follow-up. All of the clefts were totally repaired, and all of the patients were satisfied with the aesthetic results. CONCLUSIONS: Considering the surgical limitations, the noninvasive procedure described here may be considered to be a good option for incomplete earlobe cleft repair because of its good functional and cosmetic results, low cost, minimum risk, and easy application.

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial.

OBJECTIVE: to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery. DESIGN: double-blind, randomised-controlled trial. SETTING: a birth centre, in the city of Sao Paulo, Brazil. PARTICIPANTS: from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group). INTERVENTIONS: an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5ml) and to suture spontaneous lacerations (1ml), followed by repeated doses (1ml) until pain was completely inhibited. MEASUREMENTS AND FINDINGS: the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1ml, 95% confidence interval (CI) 0.4-1.6) and second-degree (3.7ml, 95% CI 1.6-5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3ml (95% CI 1.5-2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1-2ml in 95% and 3-4ml in 50% of first-degree lacerations, respectively, and 1-6ml in 88% and 7-15ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15ml, regardless of anaesthetic solution used. KEY CONCLUSIONS: our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.

Endovascular repair of accidental ligation of the right coronary artery during cardiorrhaphy for penetrating heart wound.

We report a patient with a cardiac penetrating wound who underwent cardiorrhaphy which resulted in accidental ligation of the proximal right coronary artery (RCA), producing a postoperative acute inferior wall myocardial infarction. Although the option of surgical relief of the suture over the RCA was discussed, a repeat operation was considered to be of very high risk. Therefore, an endovascular attempt to recanalize the vessel was chosen. The external constriction around the RCA was successfully relieved with percutaneous transluminal coronary angioplasty (PTCA) and stenting. To our knowledge, this particular situation has not yet previously been published.

A survey of cutlass ("Collins") injuries seen in the emergency department of the Queen Elizabeth Hospital in Barbados.

For the period March to November 1998 inclusive, a prospective survey was conducted of all patients who sustained injuries with a cutlass or machete and were admitted to the Accident and Emergency Department of the Queen Elizabeth Hospital. Of the 77 patient admissions, 81% (62/77) were male. The average age was 28.8 years (range 8 to 73 years; standard deviation 13.1). Twenty-two per cent of the patients were less than 20 years old. The most common locations of the lacerations were upper extremity (59 lacerations) and scalp (16 lacerations). Thirty-four per cent of the patients (26/77) sustained lacerations to two or more anatomical locations. There were 23 fractures in 21 patients; skull fractures were the most common fractures (11). Of the 63 patients who responded to the question on whether they knew the identity of their assailants, 51 reported that they were attacked by someone known to them; eight were assaulted by a spouse or known family member. Eighty-six per cent of patients (66/77) were treated in the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating theatre. The average length of stay was 3.6 days. There were no amputations or deaths. One patient sustained loss of vision in one eye. In Barbados, most victims of cutlass injuries are males who know their assailants and the morbidity is most often related to head injuries and to short-term physical disability due especially to lacerations of the hand and forearm.