Tratamiento de fístulas perianales complejas mediante tapón de colágeno piramidal. ¿en la geometría está la solución? / Treatment of complex perianal fistulas with pyramidal collagen plug: is geometry the solution?

Introducción: Las fístulas perianales complejas siguen siendo un auténtico desafío terapéutico en nuestros días, dada la ausencia de una terapia universal y los resultados a largo plazo, ya que el porcentaje de complicaciones o recidivas no es desdeñable. Entre las opciones terapéuticas encontramos los tapones biológicos, siendo respetuosos con los esfínteres, pero con resultados dispares. Objetivos: Evaluar los resultados a largo plazo tras la colocación de un tapón de colágeno piramidal en dos pacientes con fístula perianal compleja. Materiales y Método: Se presentan 2 pacientes con fístula perianal compleja intervenidos mediante colocación de tapón biológico cumpliendo estrictos criterios de inclusión. Discusión: Dentro del arsenal terapéutico disponible actualmente, los tapones biológicos prometen una solución definitiva para determinadas fístulas perianales, evitando una posible incontinencia. Con resultados dispares en la bibliografía, en nuestros dos casos los pacientes han evolucionado de forma excelente, con resolución completa de la enfermedad fistulosa sin complicaciones ni recidiva a largo plazo. Conclusiones: Dados los excepcionales resultados obtenidos en nuestros dos primeros casos con este tipo de tapón, nos planteamos si la morfología del mismo puede ser determinante en su éxito.

Introduction: Complex perianal fistulas continue to be a real therapeutic challenge today, given the absence of universal therapy and long-term results, since the percentage of complications or recurrences is not negligible. Among the therapeutic options we find biological plugs, being respectful with the sphincters but with disparate results. Aim: To evaluate the long-term results after the placement of a pyramidal collagen plug in two patients with complex perianal fistula. Materials and Method: We present two patients with complex perianal fistula who were operated on by placing a biological plug, meeting strict inclusion criteria. Discussion: Within the therapeutic arsenal currently available, biological plugs promise a definitive solution for certain perianal fistulas, avoiding possible incontinence. With different results in the literature, in our two cases the patients have evolved excellently, with complete resolution of the fistulous disease without complications or long-term recurrence. Conclusions: Considering the exceptional results obtained in our first two cases with this type of plug, we wonder if its morphology can be a determining factor in its success.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations / Efeitos do tempo de permanência de splints intranasais sobre a colonização bacteriana, complicações no pós-operatório e desconforto do paciente após septoplastia

Abstract Introduction: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. Objective: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Methods: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. Results: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Conclusions: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Resumo Introdução: A principal razão para a colocação de tampões nasais em septoplastias é a prevenção de hemorragia pós-operatória, enquanto o objetivo secundário é a estabilização interna após cirurgias que envolvam o esqueleto cartilaginoso do nariz. Os splints intranasais de silicone são tão eficazes como outros materiais para o controle de hemorragias do septo no pós-operatório. A possibilidade de manter os splints intranasais por longos períodos ajuda a estabilizar o septo na linha média. No entanto, não há nada na literatura sobre quanto tempo esses splints podem ser mantidos na cavidade nasal sem aumentar o risco de infecção, complicações no pós-operatório e causar desconforto ao paciente. Objetivos: O presente estudo teve como objetivo avaliar a associação entre o tempo de tamponamento com splints intranasais e colonização bacteriana, complicações no pós-operatório e desconforto do paciente. Método: Os pacientes submetidos a septoplastia foram divididos em três grupos, de acordo com o dia da remoção dos splints de silicone. Os splints foram removidos no 5°, 7° e 10° dias de pós-operatório, e a seguir, cultivados microbiologicamente. Complicações precoces e tardias foram avaliadas, incluindo infecções locais e sistêmicas, necrose do tecido, formação de granulomas, crostas na mucosa, sinéquias e perfuração do septo. O desconforto do paciente no pós-operatório foi avaliado com o uso de pontuação dos níveis de dor e de obstrução nasal. Resultados: Nenhuma diferença significante foi encontrada na taxa de colonização bacteriana entre os diferentes grupos. Diminuições da formação de crostas na mucosa e de sinéquias foram detectadas com tempos mais longos de uso de splints de silicone. A dor e a obstrução nasal também diminuíram no terceiro dia de pós-operatório. Conclusões: O uso de splints de silicone foi bem tolerado pelos pacientes, e seus efeitos negativos sobre o conforto do paciente no pós-operatório foram limitados. De fato, o tempo prolongado de uso teve um efeito redutor sobre as complicações tardias. O uso prolongado de splint nasal de silicone é um método confiável, eficaz e pouco desconfortável em pacientes com lesão excessiva da mucosa e naqueles cuja estabilização óssea e cartilaginosa do septo a longo prazo é essencial.

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery / Sutura transeptal - uma alternativa custo-benefício para tamponamento nasal em cirurgia do septo

ABSTRACT INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Resumo Introdução: O tamponamento nasal é usado rotineiramente na cirurgia septal para evitar sangramentos no pós-operatório. Objetivo: Demonstrar a possibilidade de se realizar uma sutura transeptal como alternativa eficaz e segura ao tamponamento nasal, com melhora na eficiência da intervenção. Método: Este é um estudo prospectivo, descritivo e de custo inferencial, compreendendo 92 pacientes. Dois grupos aleatórios foram estudados: um com tamponamento nasal e o outro com sutura transeptal. Resultado: No grupo de sutura transeptal, nenhum paciente experimentou sangramento no pós-operatório, tendo sido estatisticamente demonstrada uma significante redução de cefaléia e dor. Ao mesmo tempo, houve melhora na eficiência da intervenção, com economia no custo de material. Conclusões: A sutura transeptal é uma alternativa eficaz e segura ao tamponamento nasal clássico. Além do mais, melhora a eficiência da intervenção, economizando no custo de material.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations.

INTRODUCTION: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. OBJECTIVE: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. METHODS: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. RESULTS: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. CONCLUSIONS: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery.

INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Assessment of mucosal changes associated with nasal splint in a rabbit model / Avaliação sobre alterações na mucosa, associadas ao uso de splints nasais, utilizando coelhos como cobaias

INTRODUCTION: There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation. OBJECTIVES: To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model. METHODS: No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored. RESULTS: Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D. CONCLUSIONS: Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations. .

INTRODUÇÃO: Não existe consenso acerca do tempo de permanência de splints nasais no pós-operatório de cirurgias no septo. A pressão causada pelos mesmos na mucosa nasal pode causar necrose e perfurações septais. OBJETIVOS: Investigar mudanças histopatológicas da mucosa nasal causadas por splints nasais em coelhos. MÉTODO: Nenhum splint foi utilizado no grupo A. Splints de silicone foram utilizados por 5, 10 e 15 dias nos grupos B, C e D, respectivamente. Biópsia da mucosa nasal foi realizada após a remoção dos mesmos. Avaliações histopatológicas foram realizadas, e a gravidade e a profundidade do processo inflamatório foram medidas. RESULTADOS: Grupo A apresentou uma aparência histológica normal. Comparações de resultados entre os grupos B, C e D com o grupo A demonstraram diferenças estatísticas relevantes na gravidade histopatológica. Não houve diferenças estatísticas relevantes entre os grupos B e D, assim como entre os grupos C e D. CONCLUSÃO: De acordo com os resultados, quanto maior a duração no uso de splints nasais maior o risco de perfuração septal. Portanto, a remoção de splints nasais deve ser realizada assim que possível, prevenindo potenciais perfurações. .

Assessment of mucosal changes associated with nasal splint in a rabbit model.

INTRODUCTION: There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation. OBJECTIVES: To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model. METHODS: No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored. RESULTS: Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D. CONCLUSIONS: Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations.

Septoplasty with or without postoperative nasal packing? Prospective study.

UNLABELLED: Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

Septoplastia com ou sem tamponamento pós-operatório? Estudo prospectivo / Septoplasty with or without postoperative nasal packing? Prospective study

O tamponamento nasal anterior é efetuado num grande número de cirurgias nasais, nomeadamente na septoplastia. Contudo, não é um procedimento inócuo pelo que o seu benefício tem vindo a ser questionado. OBJETIVO: Avaliar a necessidade do tamponamento nasal anterior e a qualidade de vida nos doentes submetidos à septoplastia. MÉTODO: Doentes submetidos à septoplastia, com ou sem turbinoplastia inferior, foram randomizados para a colocação ou não de tamponamento nasal anterior no pós-operatório. Foram registados e comparados os dados relativos ao pós-operatório (dor, hemorragia). A qualidade de vida foi avaliada no pré e pós-operatório. Estudo prospetivo randomizado. RESULTADOS: Foram incluídos 73 doentes (37 tamponados e 36 não tamponados) com seguimento mínimo de 3 meses. Nos doentes tamponados, a dor nasal e as cefaleias no pós-operatório imediato foram superiores. Destes doentes, 75,7% referiram dor moderada/intensa no destamponamento. Nos doentes não tamponados, a hemorragia foi mais frequente, mas apenas um doente necessitou tamponamento. Houve melhoria da qualidade de vida em todos os doentes. CONCLUSÃO: A septoplastia melhora a qualidade de vida do doente com desvio do septo e obstrução nasal. O uso por rotina do tamponamento nasal anterior deve ser questionado por não apresentar benefício comprovado.

Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

[Experience with a biological plug for biological in complex anal fistula]. / Experiencia con el Tapón Biológico para Fístula Anal Compleja.

Treatment of complex anal fistula is a surgical challenge because the risk of sphincter injury with the possibility of developing fecal incontinence. There are many techniques for the treatment of anal fistulas such as fistulotomy, fistulectomy, seton, endorectal advancement flap and fibrin glue, with different rates of recurrence and fecal incontinence. The biologic plug Surgisis® AFP it's being used since 2006 and produces the closure of the fistula in approximately 12 weeks, without surgery, by replacement of the fistulous tract by cells of the patient, apparently having advantages over other techniques.We retrospectively reviewed the results of 46 patients with complex anorectal fistula treated with the biological plug over a period of 4 years. Of these, 34 were men (73.9%) and 12 women, the mean age was 47.2 years. According the type of fistula, 41 were recurrent fistulas (89.1%) and 5 high transsphincteric fistulas (10.8%). Patients underwent surgery on average 2.2 times previously. The anal fistula plug was successful in 73.9% of cases with a median follow-up 29.8 months. Use of anal fistula plug Surgisis® AFP is a new alternative with acceptable results in terms of recurrence comparable to other techniques, but with no incontinence.

Desfecho clínico de pacientes tratados por epistaxe com tamponamento nasal após a alta hospitalar / Clinical outcome of patients with epistaxis treated with nasal packing after hospital discharge

Aepistaxe é uma condição clínica frequente, e na maioria dos hospitais públicos, o tamponamento nasal e internação são as condutas iniciais mais comuns. Entretanto, pouco se sabe sobre o seguimento destes pacientes após a alta hospitalar. Objetivo: Verificar o desfecho clínico de pacientes tratados por epistaxe após a alta hospitalar. Material e método: Foram avaliados prontuários de pacientes internados por epistaxe não-traumática no período de março de 2006 a março de 2007, e todos os pacientes foram solicitados a responder um questionário padrão. Forma de estudo: Coorte histórica longitudinal. Resultados: De um total de 87 pacientes, 54 responderam ao questionário. A epistaxe recidivou em 37 por cento dos pacientes após a alta. Desses, 70 por cento eram hipertensos, 35 por cento faziam uso de AAS e 55 por cento eram tabagistas. Quarenta por cento apresentaram novo episódio de sangramento na primeira semana pós-alta hospitalar. Destes, 55 por cento retornaram à emergência, sendo que 70 por cento necessitaram de novo tratamento para controle da epistaxe. Conclusão: A recorrência da epistaxe parece não ser incomum, com tempo relativamente curto entre a alta e a recidiva. Estes dados sugerem a necessidade de uma reavaliação do modelo atual de manejo da epistaxe nos hospitais públicos.

Epistaxis is a common clinical condition and in most public hospitals these patients received nasal packing and were admitted to the hospital as initial management strategies. However, little is known about the follow-up of these patients after they leave the hospital. AIM: To identify the clinical outcome of patients treated for epistaxis following discharge. Materials and methods: We analyzed the results of questionnaires from patients hospitalized for non-traumatic epistaxis between March 2006 and March 2007. Study design: Cohort longitudinal. Results: Fifty-four of eighty-seven patients answered (62 percent). Epistaxis recurred in 37 percent of the patients. Of the patients who had recurrent bleeding, 70 percent were hypertensive, 35 percent were chronic users of acetylsalicylic acid, and 55 percent used tobacco. Forty per cent of the recurrences occurred in the first week after discharge, and fifty per cent needed to return to the emergency room. Seventy per cent of those who returned to the emergency room required a second treatment. Conclusions: Recurrence after epistaxis treatment is common and may occur soon after the initial discharge. Although our sample was small, this data suggests the need for a reevaluation of the current treatment mode of patients with epistaxis in the emergency rooms of public hospitals.

Clinical outcome of patients with epistaxis treated with nasal packing after hospital discharge.

UNLABELLED: Epistaxis is a common clinical condition and in most public hospitals these patients received nasal packing and were admitted to the hospital as initial management strategies. However, little is known about the follow-up of these patients after they leave the hospital. AIM: To identify the clinical outcome of patients treated for epistaxis following discharge. MATERIALS AND METHODS: We analyzed the results of questionnaires from patients hospitalized for non-traumatic epistaxis between March 2006 and March 2007. STUDY DESIGN: Cohort longitudinal. RESULTS: Fifty-four of eighty-seven patients answered (62%). Epistaxis recurred in 37% of the patients. Of the patients who had recurrent bleeding, 70% were hypertensive, 35% were chronic users of acetylsalicylic acid, and 55% used tobacco. Forty per cent of the recurrences occurred in the first week after discharge, and fifty per cent needed to return to the emergency room. Seventy per cent of those who returned to the emergency room required a second treatment. CONCLUSIONS: Recurrence after epistaxis treatment is common and may occur soon after the initial discharge. Although our sample was small, this data suggests the need for a reevaluation of the current treatment mode of patients with epistaxis in the emergency rooms of public hospitals.

Effectiveness of hypopharyngeal packing during nasal and sinus surgery in the prevention of PONV.

OBJECTIVE: Evaluate the hypopharyngeal packing effectiveness on prevention of postoperative nausea and vomiting (PONV) in nasal surgery. STUDY DESIGN AND SETTING: A randomized clinical trial was conducted from July 2004 to October 2005. The intervention group was submitted to hypopharyngeal packing after orotracheal tube placement. The control group had no hypopharyngeal packing. Occurrence of nausea, vomiting, use of antiemetic drugs, and throat pain were checked blindly on recovery period. RESULTS: One hundred forty-four patients were included in the study. There was no difference related to postoperative nausea (RR 1.34; CI 0.72-2.48), vomiting (RR 0.52; CI 0.19-1.47), use of antiemetic drugs (RR 1.54; CI 0.80-2.95), and throat pain (RR 0.91; 0.62-1.34) between both groups. A beta error could not be excluded. CONCLUSION: Results suggest there is no benefit in hypopharyngeal packing on PONV prevention in nasal surgery. New studies with a greater number of patients should be carried out in order to confirm these results.

[Perfluoroctane liquid as a short-term vitreous-retinal tamponade in the postoperative period in patients with retinal detachment due to giant tears]. / Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante.

PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90 masculine to 210 masculine were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80%) after a mean follow-up of 16.2 +/- 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10%) case, and there was no attachment of the retina in two (20%) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50%) cases. CONCLUSION: Good results (80%) and improvement of the visual acuity (50%) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Perfluoroctano líquido como tamponante vitreorretiniano de curta duração no pós-operatório de portadores de descolamento de retina por ruptura gigante / Perfluoroctane liquid as a short-term vitreous-retinal tamponade in the postoperative period in patients with retinal detachment due to giant tears

OBJETIVOS: Relatar os resultados de vitrectomia via pars plana com utilização de perfluocarbono líquido (Perfluoroctano-Ophtalmos®), como tamponante vítreo-retiniano de curta duração, no pós-operatório de portadores de descolamento de retina, por ruptura gigante. MÉTODOS: Estudaram-se dez desses pacientes. Todos os casos eram complicados por vitreorretinopatia proliferativa grau B ou pior com rupturas que variavam em extensão de 90° a 210°. O perfluorocarbono líquido foi introduzido, por via pars plana, com o volume necessário para ultrapassar o limite posterior da ruptura, permanecendo no pós-operatório por cinco dias, estando os pacientes em decúbito dorsal. Após esse período submetiam-se a segunda intervenção para troca do perfluorocarbono líquido para gás ou óleo de silicone. RESULTADOS: Após período de acompanhamento médio de 16,2 ± 12,4 meses (2 a 43 meses), 80 por cento das retinas estavam aplicadas, sendo necessária a repetição desta técnica em 1 caso (10 por cento) caso e em 2 casos (20 por cento) não houve reaplicação da retina por vitreorretinopatia avançada. Houve melhora da acuidade visual em 5 casos (50 por cento). CONCLUSÃO: Observaram-se bons resultados quanto à aplicação da retina (80 por cento) e melhora da acuidade visual (50 por cento) quando do uso do perfluorocarbono líquido como tamponante vitreorretiniano de curta duração no pós-operatório de cirurgias de descolamento de retina por rupturas gigantes.

PURPOSE: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients. METHODS: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90° to 210° were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil. RESULTS: The retinas of eight patients were attached (80 percent) after a mean follow-up of 16.2 ± 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10 percent) case, and there was no attachment of the retina in two (20 percent) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50 percent) cases. CONCLUSION: Good results (80 percent) and improvement of the visual acuity (50 percent) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Midfacial degloving--access to nasal cavity and paranasal sinuses lesions.

Common surgical approaches for medial maxillectomy include lateral rhinotomy and midfacial degloving. Lateral rhinotomy provides excellent surgical exposure but leaves a bulging scar on the face. Despite its own limitations, midfacial degloving has been preferred to lateral rhinotomy because it does not leave any external scar on the face(1). The aim of this study is to evaluate the cosmetic results and surgical exposure access of midfacial degloving. Treatment morbidity was evaluated through: post operative hospital stay length, blood transfusion needs, complications, pre and post operative hemoglobin levels, disease recurrence, nasal packing, type of suture and antibiotics. Retrospective study was carried out with sixteen patients treated at the Hospital Geral de Fortaleza SESA/SUS from December 1999 through November 2003. Based on the results, we may conclude that midfacial degloving is effective to treat extensive nasal cavity lesions and paranasal sinuses with reduced post operative morbidity.

Degloving médio-facial como via de acesso a tumores nasossinusais / Midfacial degloving - acess to nasal cavity and paranasal sinuses lesions

Abordagens cirúrgicas comuns para maxilectomia medial incluem a rinotomia lateral e a via de acesso degloving médio-facial. A rinotomia lateral fornece um excelente campo cirúrgico, mas deixa proeminentes cicatrizes na face. Já o degloving médio-facial tem sido superior à rinotomia lateral, pois não deixa nenhuma cicatriz externa, embora saibamos que este procedimento tem suas limitações¹. Este estudo tem o objetivo de descrever os resultados estéticos e de melhor acesso transoperatório de cirurgias nasossinusais via degloving, com avaliação da morbidade pós-operatória através das seguintes variáveis: hemoglobina pré e pós-operatória, necessidade de transfusão sangüínea, presença de complicações, uso de tampão nasal, uso de antibiótico, fio cirúrgico utilizado, tempo de internamento pós-operatório e presença de recidiva. Foi realizado um estudo retrospectivo a partir de 16 pacientes internados no Hospital Geral de Fortaleza SESA/SUS durante o período de dezembro de 1999 a novembro de 2003. Pelos dados obtidos, conclui-se que a via de acesso degloving é eficaz no tratamento de lesões nasossinusais extensas, com bons resultados estéticos e com reduzida morbidade pós-operatória.

Estudo comparativo da formação do tampão apical de dentina com e sem patência do forame usando a técnica de rotação alternada / Comparative study of dentin apical plug formation with and whiout foramen patency using reciprocating technique

A literatura endodôntica tem colocado que as raspas de dentina produzidas durante o preparo do canal podem se acumular nas suas porções finais formando um tampão apical de dentina. Verificou-se se esse fenômeno ocorre com o uso da técnica automatizada de rotação alternada. Vinte canais palatinos de molares superiores humanos extraídos foram preparados com o Endo-Gripper (Moyco Union Broach) e divididos em dois grupos. No Grupo I, a instrumentação foi realizada sem a manutenção da patência do fora me. No Grupo 11, a instrumentação foi feita intercalando-se a cada mudança de instrumento a lima K#10, com 1,O mm além do comprimento de trabalho, para manutenção da patência do fora me. Os resultados demonstram que o Grupo 11 promoveu menor formação de tampão apical.

[Surgical versus non-surgical treatment of posterior epistaxis]. / Comparación del manejo quirúrgico versus no quirúrgico en pacientes con epistaxis posterior.

A study was performed in order to compare the efficiency of surgical versus non-surgical treatment in patients hospitalized for epistaxis regarding the source of bleeding, and to identify failure-predicting factors related to specific treatments. 62 patients were included in the study, 36 (58%) of whom suffered from posterior epistaxis and 26 (42%) experienced anterior bleeding. The single factor associated with failure of the non-surgical treatment was the posterior source of the bleeding (p = 0.001). These patients were also hospitalized for a longer period (8, 17 days) than those with anterior epistaxis (4, 62 days) (p = 0.001). The percentage of success for the primary non-surgical treatment in patients with posterior epistaxis was 45% (14/31), significantly smaller (p = 0.0001) than the successful reached in the primary surgical procedure, 87% (13/15); endoscopic cauterization of the sphenopalatine artery. These results support endoscopic cauterization of the sphenopalatine artery as primary care in posterior epistaxis.

Avaliação do fluxo salivar e da capacidade tampão em pacientes da Clínica Integrada / Evaluation of salivary flow rate and buffer capacity in patients of the integrated clinic

A saliva tem propriedades importantes que mantêm a homeostase oral, entre as mais importantes estão a capacidade tampão e o fluxo salivar. Na análise destas propriedades da saliva estimulada de 70 pacientes em tratamento na Clínica Odontológica Integrada (COI), pode ser observado que os resultados estavam dentro dos padrões de normalidade