Clinical and physiological efficacy of the application of autologous fat with platelet rich plasma in treating faecal incontinence / Eficácia clínica e fisiológica da aplicação de gordura autóloga com plasma rico em plaquetas no tratamento da incontinência fecal

Abstract Purpose: Faecal incontinence (FI) is a frequent condition that can occur due to different causes; with negative impact on self-esteem and quality of life, secondary morbidity, disability and significant costs. For its treatment there is a wide range of options, being medical treatment, hygienic dietary modifications and biofeedback, the first line of treatment; reserving surgery for patients who do not respond or with severe FI; this with variable success rates and high cost. This study has the primary aim to assess the efficacy and describe the Technique of Application of Autologous Fat with Platelet Rich Plasma (AFPRiP) in patients with faecal incontinence as well as secondary endpoints of quality of life, manometric and ultrasound evaluation, safety of implantation, and complications. Methods: A single-centre prospective, experimental study, was conducted from January 2017 to February 2018 in Domingo Luciani Hospital. Wexner and FIQL scores were filled preoperative and compared at follow-up at 3, 6 and 12 months as well as anorectal manometry and endoanal ultrasound were performed before and 6 months after surgery. Results: Twelve patients were operated, mean time 43 min, no major complications. Wexner finding continence improvement from 10.4 pre to 4 in the 3rd month (p = 0.066) 4.74 at the 6th month (p = 0.001) and 5 at one year (p = 0.001); that is, improvement of >50% in 83.4%. FIQL 50.9 prior to 98.6 at 3rd month (p = 0.001) 95.5 to 6th month (p = 0.001) and 91.3 a year (p = 0.066). Conclusions: We conclude that AFPRiP is innovative, safe and with adequate results.

Resumo Objetivo: A incontinência fecal é uma condição frequente que pode ocorrer devido a diferentes causas, com impacto negativo na autoestima e qualidade de vida, morbidade secundária, incapacidade e custos significativos. Existem várias opções para o manejo da incontinência fecal; o tratamento médico, as modificações higiênicas da dieta e o biofeedback, são os de primeira linha. A cirurgia é recomendada apenas para pacientes que não respondem ao tratamento de primeira linha ou aqueles com incontinência fecal grave; as taxas de sucesso são variáveis e o custo do tratamento cirúrgico é elevado. Este estudo teve como objetivo principal avaliar a eficácia e descrever a técnica de aplicação de gordura autóloga com plasma rico em plaquetas (AFPRiP) em pacientes com incontinência fecal; o estudo também avaliou parâmetros secundários de qualidade de vida, manométricos e ultrassonográficos, bem como a segurança da implantação e suas complicações. Métodos: Um estudo experimental prospectivo, de centro único, foi realizado de janeiro de 2017 a fevereiro de 2018 no Hospital Domingo Luciani. A escala de Wexner e o FIQL foram preenchidos no pré-operatório e comparados no seguimento de três, seis e 12 meses; manometria anorretal e ultrassonografia endoanal foram realizadas antes e seis meses após a cirurgia. Resultados: Doze pacientes foram operados; o tempo médio da cirurgia foi de 43 minutos, sem maiores complicações. Na escala de Wexner, observou-se melhora na continência: de 10,4 pré-operatório a 4 no terceiro mês (p = 0,066), 4,74 no sexto mês (p = 0,001) e 5 em um ano (p = 0,001), uma melhoria de 83,4%. Já o FIQL evoluiu de 50,9 no período pré-operatório para 98,6 no terceiro mês (p = 0,001), 95,5 no sexto mês (p = 0,001) e 91,3 em um ano (p = 0,066). Conclusões: A AFPRiP é uma técnica inovadora, segura e que apresenta resultados adequados.

Sublethal effects of spirodiclofen on biological and demographic parameters of the citrus leprosis mite Brevipalpus yothersi (Acari: Tenuipalpidae).

BACKGROUND: Brevipalpus yothersi Baker is one of the main vectors of citrus leprosis. Knowing the biology of this mite species when under chemical control is extremely important to understand its population dynamics, and then to solve problems of management of this pest. Therefore, we assessed the effects of one sublethal dose of spirodiclofen (0.48 ppm) on biological and demographic parameters of B. yothersi under laboratory and greenhouse conditions, comparing them with non-exposed mite population. RESULTS: Under laboratory conditions, where citrus fruits were used as a substrate, the duration of developmental stages (pre-egg-laying and egg-laying) and mite longevity showed no differences between treatments. However, the number of laid eggs increased in acaricide-treated fruits. In the greenhouse experiment, where citrus plants were used as a substrate, the instantaneous growth rate (ri) of mites was positive in all untreated plots. In contrast, in treated plants, ri was negative in 12 experimental units, and mite populations were suppressed in five of them. Moreover, mite population dynamics had a positive ri in three treated plants. CONCLUSIONS: Spirodiclofen sublethal dose had no negative effect on the offspring of B. yothersi females. However, it is not safe for citrus leprosis mite since it may increase egg number per female in some conditions. Biological and demographic differences could influence mite population dynamics in the field, requiring appropriate management strategies to improve citrus leprosis control. © 2019 Society of Chemical Industry.

Avaliação da capacidade funcional de adolescentes portadores de Mucopolissacaridose do tipo II / Assessment of functional capacity of teens who are Mucopolysaccharidosis type II carriers

[{"text": "Introdução: A Mucopolissacaridose II (MPS II) é uma doença genética, ligada ao cromossomo X e que\r\nafeta quase que exclusivamente o sexo masculino. Apresenta-se de forma multissistêmica, ocasionada pelo acúmulo progressivo de glicosaminoglicanos (GAG) em tecidos e órgãos, o que causa atraso no desenvolvimento neuropsicomotor, ocasionando limitações na realização de atividades de vida diária. Objetivo: O objetivo deste estudo foi a identificação das áreas de desempenho nas quais os portadores de MPS II apresentam maior comprometimento, além da análise do perfil socioeconômico da respectiva família. Método: A pesquisa se deu através de entrevista com a responsável por três irmãos adolescentes, A1-19 anos, A2-16 anos e A3-15anos, portadores de MPS II, no Estado de Alagoas. A coleta foi efetuada por profissional capacitado, utilizando a Medida de Independência Funcional (MIF) como questionário para identificação de perdas funcionais, e ABEP, para análise do perfil socioeconômico. Resultados: Os resultados\r\napontaram que, em termos socioeconômicos, a família está inserida na classe C1. Em relação ao desempenho, verificou-se que, entre os irmãos, A1 apresenta dependência total nas habilidades investigadas; A2 apresenta perdas funcionais mais incapacitantes, necessitando de auxílio moderado, e A3 possui boa parte das habilidades físicas e cognitivas preservada, porém possui dependência modificada. Conclusão: Diante das dificuldades identificadas neste estudo, foi analisada a importância do diagnóstico precoce e das terapias de reabilitação aliadas à terapia enzimática, para que haja um retardo na progressão da doença.", "_i": "pt"}, {"text": "Introduction: Mucopolysaccharidosis II (MPS II) is an X-linked genetic disease which almost exclusively\r\naffects males. The disease presents a multisystem form, caused by the progressive accumulation of glycosaminoglycans (GAGs) in tissues and organs. It causes developmental delays resulting in limitations on the performance of day-to-day activities. Objective: The aim of this study was to identify occupational performance areas in which people with MPS II have greater impairment and analyze their family's socioeconomic profile. Method: The research was done through interviews with an individual responsible for three adolescent brothers, (A1-19 years, A2-16 years and A3-15 years) who are MPS II carriers from Alagoas, Brazil. Data collection was performed by a trained professional using the Functional\r\nIndependence Measure (FIM) as a questionnaire to identify the functional losses and the ABEP for socioeconomic profile analysis. Results: The results showed that the family is included in the C1 socioeconomic class. Among the siblings, A1 presents total dependence on the investigated skills; A2 presents the most disabling functional losses requiring moderate assistance and A3 has much of his physical and cognitive skills preserved, but has modified dependence. Conclusion: Taking into consideration the difficulties identified in this study, we highlighted the importance of early\r\ndiagnosis and rehabilitation therapies combined with enzyme therapy, which can delay disease progression.", "_i": "en"}]

Fasceíte necrotizante facial causada por infecção odontogênica / Facial necrotizing fasciitis caused by odontogenic infection

Introdução: A Fasceíte necrotizante da região cérvico-facial é uma infecção rara que acomete geralmente os pacientes com doenças que levam à imunossupressão sistémica. É caracterizada por uma necrose extensa dos tecidos moles, com possível formação de gases nos tecidos subcutâneos, seguida por progressão rápida e fatal. Objetivo: Descrever um caso de Fasceíte Necrotizante com origem odontogênica, enfatizando o diagnóstico clínico e o tratamento desta patologia. Relato de caso: Paciente do gênero masculino, 42 anos, apresentou fasceíte necrotizante em decorrência de infecção odontogênica, sendo tratado por desbridamento cirúrgico e antibioticoterapia. Comentários finais: Fasceíte Necrotizante facial é uma infecção de progressão rápida, potencialmente fatal que requer o diagnóstico e tratamento adequado e imediato. O tratamento é composto por antibioticoterapia sistêmica, desbridamento cirúrgico e monitoramento intenso.

Introduction: Cervicofacial necrotizing fasciitis is a rare infection that usually occurs in patients with systemic immusupression. Is characterized by extensive necrosis of soft tissues, with possible formation of gases in subcutaneous tissues, followed by rapidly progressive deadly. Objective: Report a case of Necrotizing Fasciitis with odontogenic origin, emphasizing the clinical diagnosis and treatment of this pathology. Case report: A 42 year-old-male, had necrotizing fasciitis due to odontogenic infection, which was treated by surgical debridement and antibiotic therapy. Final comments: Facial Necrotizing fasciitis is a rapidly progressive infection, potentially fatal condition requiring diagnosis and appropriate treatment immediately. The treatment consists of systemic antibiotics, surgical debridement and intensive monitoring.

Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation.

BACKGROUND: Defecography is the gold standard for assessing functional anorectal disorders but is limited by the need for a specific radiologic environment, exposure of patients to radiation, and inability to show all anatomic structures involved in defecation. Echodefecography is a 3-dimensional dynamic ultrasound technique developed to overcome these limitations. OBJECTIVE: This study was designed to validate the effectiveness of echodefecography compared with defecography in the assessment of anorectal dysfunctions related to obstructed defecation. DESIGN: Multicenter, prospective observational study. PATIENTS: Women with symptoms of obstructed defecation. SETTING: Six centers for colorectal surgery (3 in Brazil, 1 in Texas, 1 in Florida, and 1 in Venezuela). INTERVENTIONS: Defecography was performed after inserting 150 mL of barium paste in the rectum. Echodefecography was performed with a 2050 endoprobe through 3 automatic scans. MAIN OUTCOME MEASURES: The κ statistic was used to assess agreement between echodefecography and defecography in the evaluation of rectocele, intussusception, anismus, and grade III enterocele. RESULTS: Eighty-six women were evaluated: median Wexner constipation score, 13.4 (range, 6-23); median age, 53.4 (range, 26-77) years. Rectocele was identified with substantial agreement between the 2 methods (defecography, 80 patients; echodefecography, 76 patients; κ = 0.61; 95% CI = 0.48-0.73). The 2 techniques demonstrated identical findings in 6 patients without rectocele, and in 9 patients with grade I, 29 with grade II, and 19 patients with grade III rectoceles. Defecography identified rectal intussusception in 42 patients, with echodefecography identifying 37 of these cases, plus 4 additional cases, yielding substantial agreement (κ = 0.79; 95% CI = 0.57-1.0). Intussusception was associated with rectocele in 28 patients for both methods (κ = 0.62; 95% CI = 0.41-0.83). There was substantial agreement for anismus (κ = 0.61; 95% CI = 0.40-0.81) and for rectocele combined with anismus (κ = 0.61; 95% CI = 0.40-0.82). Agreement for grade III enterocele was classified as almost perfect (κ = 0.87; 95% CI = 0.66-1.0). LIMITATIONS: Echodefecography had limited use in identification of grade I and II enteroceles because of the type of probe used. CONCLUSIONS: Echodefecography may be used to assess patients with obstructed defecation, as it is able to detect the same anorectal dysfunctions found by defecography. It is minimally invasive and well tolerated, avoids exposure to radiation, and clearly demonstrates all the anatomic structures involved in defecation.

Colostomía perineal pseudocontinente / Pseudocontinent perineal colostomy

Presentar la técnica quirúrgica de la colostomía perineal continente, como una alternativa en la operación de Miles, realizada en el Servicio de Cirugía II del Hospital Domingo Luciani. IVSS-Caracas. Se trata de un paciente masculino de 63 años, quien consultó por sangrado rectal y trastornos evacuatorios. Al examen físico se evidenció una lesión exofítica y friable a 1,5 cms del margen anal y que ocupaba el 50 por ciento de la luz. La biopsia reportó un adenocarcinoma de recto moderadamente diferenciado infiltrante. Diagnóstico: adenocarcinoma del canal anal T3N2M0. Recibió neoadyuvancia. Se practicó en un primer tiempo quirúrgico resección abdónimo-perineal más una colostomía perineal y en un segundo tiempo la maduración de la colostomía. Evoluciona satisfactoriamente con un manejo adecuado de la colostomía. La colostomía perianeal es una buena alternativa en la operación de Miles. Se debe reservar para pacientes jóvenes o mayores, en buenas condiciones físicas, buen nivel cognoscitivo y sin radioterapia postoperatoria.