A responsabilização de empresas por acidentes de trabalho no judiciário trabalhista de São Paulo - TRT15 / The liability of companies for work accidents in the São Paulo labor judiciary - TRT15

Resumo A teoria do risco ou da responsabilidade objetiva dispensa a comprovação da culpa ou do dolo e tem como requisitos a ocorrência do dano e o nexo causal. Embora a constituição disponha a responsabilidade por acidente de trabalho como subjetiva, se tem observado na doutrina e no judiciário a adoção da responsabilidade objetiva em alguns casos de acidentes e doenças ocupacionais. Este estudo tem por objetivo analisar decisões do Tribunal Regional do Trabalho da 15ª Região - São Paulo para conhecer em que situações a corte tem utilizado a responsabilidade objetiva. A pesquisa quanti-qualitativa, de caráter exploratório e descritivo, foi desenvolvida com base em análise documental e revisão bibliográfica. A pesquisa documental foi realizada em acórdãos que continham o descritor "acidente de trabalho", disponíveis na base de dados do Tribunal Regional do Trabalho da 15ª Região, julgados no período entre 11/11/2015 e 10/11/2017. Os resultados indicaram que, do total de 559 casos julgados, em 275 a decisão foi de procedência, sendo 15% por responsabilidade objetiva. Considerando apenas os casos procedentes, a responsabilidade objetiva apareceu em 30,5% deles. Esse percentual revela que já é expressiva nessa corte a tomada de decisão com base na noção de responsabilidade objetiva, e que tal adoção tem potencial para afetar práticas de prevenção de acidentes.

Abstract The risk theory or objective liability dispenses proof of guilt or intent and requires only the occurrence of damage and the causal link. Although the constitution establishes the responsibility for work accidents as subjective, it has been observed in the doctrine and in the judiciary the adoption of objective liability in some cases of accidents and occupational diseases. This study aims to analyze the decisions of the Regional Labor Court of the 15th Region - São Paulo to know in which situations the court has used objective liability. The quantitative-qualitative, exploratory and descriptive research was developed based on document analysis and literature review. The document research was carried out in judgments that contained the descriptor "work accident," available in the database of the Regional Labor Court of the 15th Region, judged between 11/11/2015 and 10/11/2017. The results indicated that, of the total of 559 cases judged, in 275 the decision was founded, being 15% by objective liability. Considering only the founded cases, objective liability appeared in 30.5% of them. This percentage reveals that decision-making based on the notion of objective liability is already expressive in this court, and that such adoption has the potential to affect accident prevention practices.

Uterine Inflammatory Response After Prostaglandin E1 (Misoprostol) Infusion Prebreeding or Immediately After Embryo Flushing in Commercial Donor Mares.

Misoprostol, a synthetic PGE1, is becoming a common therapy for mares with suspected uterine tube obstruction. Recently, there have been concerns that uterine administration of misoprostol induces exacerbated uterine inflammation; however, this has not been critically evaluated. This study aimed to assess the inflammatory response and potential systemic reactions after uterine administration of misoprostol, either during prebreeding or immediately after postembryo flushing. Privately owned embryo donor mares (n = 11) were randomly assigned in a crossover design to receive misoprostol (3 mL +200 µg) or sham (3 mL of lactate Ringer's solution) infusions, bilaterally deposited via deep-horn, at least 72 hours prebreeding (experiment 1) or immediately after embryo flushing (experiment 2). Each mare had one cycle for misoprostol and sham in both experiments and a breeding cycle (no sham or misoprostol) between experiments. Uterine edema, fluid accumulation, and the number of uterine PMN were assessed before each infusion and then daily for 72 hours. Uterine lavage was performed the day after each infusion across groups and experiments. Ovulation was hastened with a GnRH agonist and confirmed at 24 hour-intervals. Mares were bred with semen from one of six stallions per owner's choice. Embryo flushing was performed 8 to 9 days postovulation. In either experiment, misoprostol did not affect uterine edema or fluid accumulation (P > .05). However, both the sham and misoprostol infusions increased the number of PMN up to 48 hours postinfusion in both experiments. Embryo recoveries were similar between sham (45%, 5/11) and misoprostol cycles in experiments 1 (45%, 5/11; P > .05) and 2 (sham, 68%, 7/11; misoprostol, 45%, 5/11; P > .05). In conclusion, misoprostol did not induce exacerbated uterine inflammation in mares or systemic adverse reactions when infused prebreeding or immediately after embryo flushing.

Impact of the Health Gym Program on mortality from Systemic Arterial Hypertension in Pernambuco state, Brazil. / Impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil.

The aim of this paper was to analyze the impact of the Health Gym Program (HGP) on the Systemic Arterial Hypertension mortality rate in Pernambuco state, Brazil. This public policy impact analysis used a quasi-experimental approach which consisted of the application of Propensity Score Matching in the years 2010 and 2017. Socioeconomic, demographic, and epidemiological data of 89 municipalities that implemented HGP (treated) and 54 that did not (controls) were collected from the Brazilian Health Data Department, Brazilian Institute of Geography and Statistics, and other databases. The impact of HGP on hypertension mortality rate was estimated through a logit model using the Kernel algorithm. Treated municipalities presented a decrease of 12.8% in global hypertension mortality rate, 12.5% in brown-skinned people and 13.1% in those over 80 years of age. The balancing test attests to the robustness of the estimated model to explain the impact of the program on mortality due to hypertension. The implementation of the program proved to be effective in decreasing the mortality rate in the treated municipalities, indicating that it seems to contribute to controlling the progress of chronic non-communicable diseases.

O objetivo deste artigo foi avaliar o impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil. Este estudo quase-experimental configura-se como uma avaliação de impacto de políticas públicas, desenvolvida através da aplicação do método do Pareamento por Escore de Propensão, nos anos de 2010 e 2017. Utilizou-se dados socioeconômicos, demográficos e epidemiológicos dos 89 municípios que implantaram o programa (tratados) e de outros 52 que não implantaram (controles). Os dados são oriundos do Departamento de Informática do SUS, Instituto Brasileiro de Geografia e Estatística e outras bases. O impacto do programa foi estimado através de um modelo logit, com o uso do algoritmo de pareamento Kernel. Os municípios tratados tiveram uma diminuição global de 12,8% na taxa de mortalidade por hipertensão, de 12,5% entre as pessoas de cor parda e de 13,1% em maiores de 80 anos. O teste de balanceamento atesta a robustez do modelo para explicar o impacto do programa sobre a mortalidade. A implementação do programa se mostrou efetiva para diminuir a taxa de mortalidade nos municípios tratados, indicando que o mesmo parece estar contribuindo para controlar o avanço das doenças crônicas não transmissíveis.

Impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil / Impact of the Health Gym Program on mortality from Systemic Arterial Hypertension in Pernambuco state, Brazil

Resumo O objetivo deste artigo foi avaliar o impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil. Este estudo quase-experimental configura-se como uma avaliação de impacto de políticas públicas, desenvolvida através da aplicação do método do Pareamento por Escore de Propensão, nos anos de 2010 e 2017. Utilizou-se dados socioeconômicos, demográficos e epidemiológicos dos 89 municípios que implantaram o programa (tratados) e de outros 52 que não implantaram (controles). Os dados são oriundos do Departamento de Informática do SUS, Instituto Brasileiro de Geografia e Estatística e outras bases. O impacto do programa foi estimado através de um modelo logit, com o uso do algoritmo de pareamento Kernel. Os municípios tratados tiveram uma diminuição global de 12,8% na taxa de mortalidade por hipertensão, de 12,5% entre as pessoas de cor parda e de 13,1% em maiores de 80 anos. O teste de balanceamento atesta a robustez do modelo para explicar o impacto do programa sobre a mortalidade. A implementação do programa se mostrou efetiva para diminuir a taxa de mortalidade nos municípios tratados, indicando que o mesmo parece estar contribuindo para controlar o avanço das doenças crônicas não transmissíveis.

Abstract The aim of this paper was to analyze the impact of the Health Gym Program (HGP) on the Systemic Arterial Hypertension mortality rate in Pernambuco state, Brazil. This public policy impact analysis used a quasi-experimental approach which consisted of the application of Propensity Score Matching in the years 2010 and 2017. Socioeconomic, demographic, and epidemiological data of 89 municipalities that implemented HGP (treated) and 54 that did not (controls) were collected from the Brazilian Health Data Department, Brazilian Institute of Geography and Statistics, and other databases. The impact of HGP on hypertension mortality rate was estimated through a logit model using the Kernel algorithm. Treated municipalities presented a decrease of 12.8% in global hypertension mortality rate, 12.5% in brown-skinned people and 13.1% in those over 80 years of age. The balancing test attests to the robustness of the estimated model to explain the impact of the program on mortality due to hypertension. The implementation of the program proved to be effective in decreasing the mortality rate in the treated municipalities, indicating that it seems to contribute to controlling the progress of chronic non-communicable diseases.

Evolução clínica e sobrevida de pacientes neurocríticos / Evolución clínica y supervivencia de pacientes neurocríticos / Clinical evolution and survival of neurocritical patients

RESUMO Objetivo Avaliar a evolução clínica e sobrevida de pacientes neurocríticos em Unidades Hospitalares. Método Coorte com pacientes acompanhados no período de setembro de 2012 a junho de 2016, internados em hospitais públicos e privados. Os dados foram analisados inicialmente a partir da estatística descritiva e inferencial. Como forma de análise da sobrevida, foi aplicado o indicador de Kaplan-Meier. O modelo de regressão para riscos proporcionais de Cox foi empregado para a análise dos fatores prognósticos, calculando-se a razão de risco. Resultados Participaram do estudo 1.289 pacientes. Os que possuíam Escala de Coma de Glasgow com maior valor apresentaram maior sobrevida, e o incremento de um ponto no escore dessa Escala correspondeu a uma melhora de 42% em sua sobrevida. Na análise de sobrevida, o sexo e o uso de drogas vasoativas mostraram diferença significativa. Conclusão Pacientes do sexo feminino, que possuem melhor escore da Escala de Coma de Glasgow e em uso de drogas vasoativas apresentaram maior sobrevida.

RESUMEN Objetivo Evolución clínica y supervivencia de pacientes neurocríticos en Unidades Hospitalarias. Método Cohorte con pacientes seguidos en el período de septiembre de 2012 a junio de 2016, en estancia en hospitales públicos y privados. Los datos fueron analizados inicialmente mediante la estadística descriptiva e inferencial. Como modo de análisis de la supervivencia, se aplicó el indicador de Kaplan-Meier. El modelo de regresión para riesgos proporcionales de Cox fue empleado para el análisis de los factores pronósticos, calculándose la razón de riesgo. Resultados Participaron en el estudio 1.289 pacientes. Los que tenían Escala de Coma de Glasgow con mayor valor presentaron mayor supervivencia, y el incremento de un punto en el score de dicha Escala correspondió a un mejora del 42% en su supervivencia. En el análisis de supervivencia, el sexo y el uso de drogas vasoactivas mostraron diferencia significativa. Conclusión Pacientes del sexo femenino que tienen mejor score de la Escala de Coma de Glasgow y en uso de drogas vasoactivas presentaron mayor supervivencia.

ABSTRACT Objective To evaluate the clinical evolution and survival of neurocritical patients in Hospital Units. Method Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio. Results Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference. Conclusion Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.

Clinical evolution and survival of neurocritical patients. / Evolução clínica e sobrevida de pacientes neurocríticos.

OBJECTIVE: To evaluate the clinical evolution and survival of neurocritical patients in Hospital Units. METHOD: Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio. RESULTS: Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference. CONCLUSION: Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.

Avaliação de impacto do tratamento diretamente observado no controle da Tuberculose em Pernambuco / Impact assessment of the directly observed treatment in Tuberculosis control in Pernambuco

A tuberculose é uma das doenças infecciosas mais antigas no mundo, e até os dias atuais segue sendo considerada um sério problema para a saúde pública global. O tratamento diretamente observado (TDO) caracteriza-se como elemento-chave no fortalecimento da adesão ao tratamento da tuberculose e na prevenção do aparecimento de cepas resistentes aos medicamentos, uma vez que ainda existem taxas de cura inferiores à meta preconizada e um número ainda elevado de abandono do tratamento. Para tanto, esta pesquisa faz uma avaliação do impacto do TDO no controle da tuberculose no estado de Pernambuco, com base nos dados das fichas de notificação do Sistema de Informação de Agravos de Notificação (Sinan), para o período de 2005 a 2014. O método utilizado é o matching (pareamento) via propensity score (escore de propensão). Os resultados obtidos indicaram que os indivíduos submetidos ao TDO têm, em média, 23% de chances a mais de cura do que os que não são submetidos a esse tratamento, o que sugere que esta é uma importante ação para o combate e o controle da doença

Tuberculosis (TB) is one of the oldest infectious diseases in the world, and it is still considered a serious problem for global public health. Directly Observed Treatment (DOT) is characterized as a key element in strengthening adherence to TB treatment and in preventing the emergence of drug resistant strains, since there are still cure rates below the recommended target and a still high number Cessation of treatment. This research evaluates the impact of the DOT on tuberculosis control in the State of Pernambuco, based on data from the Sinan notification sheets for the period from 2005 to 2014. The method used is the Matching via Propensity Score. The results obtained by Matching via the Propensity Score indicated that individuals submitted to DOT had an average of 23% more chances of cure, which suggests that DOT is an important strategy for combat And control of the disease.

La tuberculosis (TB) es una de las enfermedades infecciosas más antiguas en el mundo, y hasta los días actuales todavía se considera un serio problema para la salud pública global. El tratamiento directo observado (TDO) se caracteriza como elemento clave en el fortalecimiento de la adhesión al tratamiento de la tuberculosis y en la prevención de la aparición de cepas resistentes a los medicamentos, ya que todavía existen tasas de curación inferiores a la meta preconizada y un número aún elevado de abandono del tratamiento. Para ello, la investigación hace una evaluación del impacto del TDO en el control de la Tuberculosis en el estado de Pernambuco sobre la base de los datos de las fichas de notificación del Sinan para el período de 2005 a 2014. El método utilizado es el Matching vía Propensity Score. Los resultados obtenidos indicaron que los individuos sometidos al TDO tienen, en promedio, 23% de posibilidades más de curación, lo que sugiere que el TDO es una importante estrategia para el combate y control de la enfermedad.

La tuberculose (TB) est une des plus anciennes maladies infectieuses dans le monde, et à ce jour est toujours considéré comme un problème sérieux pour la santé publique mondiale. Le traitement directement observé (DOT) se caractérise comme un élément clé de la TB adhésion de renforcement et de prévenir l'émergence de souches résistantes aux médicaments, car il y a encore guérir des taux inférieurs à la cible recommandée et un nombre encore plus élevé cessation du traitement. Par conséquent, la recherche évalue l'impact de DOT dans la lutte contre la tuberculose dans l'état de Pernambuco à partir des données de formulaires de déclaration Sinan pour la période 2005 à 2014. La méthode utilisée est la Matching via Score de propension. Les résultats indiquent que les personnes soumises à TDO ont, en moyenne, 23% plus de chances de guérison, ce qui suggère que le TDO est une stratégie importante pour combattre et maîtriser la maladie.

CD4+CD45RA-FOXP3low Regulatory T Cells as Potential Biomarkers of Disease Activity in Systemic Lupus Erythematosus Brazilian Patients.

Heren, we analyzed Treg cells as potential biomarkers of disease activity in systemic lupus erythematosus (SLE) patients. Peripheral blood mononuclear cells from 30 SLE patients (15 active: SLEDAI > 6/15 SLE remission: SLEDAI< 6) and 15 healthy volunteers were purified. Treg immunophenotyping was performed using CD4, CD25, CD45, CD127, and FOXP3 markers. CD4+FOXP3+ Treg activation state was investigated based on CD45RA and FOXP3 expression. To increase the accuracy of our findings, a multivariate linear regression was performed. We showed a significant increase in the frequency of CD4+FOXP3+ Treg cells in SLE patients. However, unlike all other Treg cells phenotypes analyzed, only eTreg (CD4+FOXP3highCD45RA-) (p=0.01) subtype was inversely correlated with disease activity while Foxp3+nontreg (CD4+FOXP3lowCD45RA-) (p=0.003) exerted a direct influence in the outcome of the disease. Foxp3+nontreg cells were the most consistent SLE active indicator, confirmed by multiple linear regression analyses. In summary, our results demonstrate Foxp3+nontreg cells as new biomarkers in the search of an effective therapeutic strategy in SLE.

Reconstrução de extenso defeito da parede torácica anterior pós-mediastinite com retalho de omento: relato de caso / Reconstruction of an extensive anterior chest wall defect after mediastinitis with an omentum flap: a case report

Apresentamos o caso de um paciente de 70 anos de idade que evoluiu com extenso defeito cutâneo em parede torácica anterior após ter sido submetido a revascularização do miocárdio e mediastinite pós-operatória. Pela impossibilidade de utilização de retalhos cutâneos e musculares da região, fizemos a reconstrução com a rotação de retalho de omento baseado na artéria gastroepiploica esquerda e enxerto de pele em malha.

We report the case of a 70-year-old patient who developed an extensive skin defect in the anterior chest wall after undergoing myocardial revascularization and postoperative mediastinitis. Owing to the impossibility of using cutaneous and muscular flaps on the region, we performed the reconstruction with an omentum flap based on the left gastroepiploic artery and meshed skin graft.

Increased IL17A, IFNG, and FOXP3 Transcripts in Moderate-Severe Psoriasis: A Major Influence Exerted by IL17A in Disease Severity.

Psoriasis is a chronic and recurrent dermatitis, mediated by keratinocytes and T cells. Several proinflammatory cytokines contribute to formation and maintenance of psoriatic plaque. The Th1/Th17 pathways and some of IL-1 family members were involved in psoriasis pathogenesis and could contribute to disease activity. Therefore, we sought to analyse skin transcript levels of IL17A, IL22, RORC, IL8, IFNG, IL33, IL36A, FOXP3, and IL10 and correlate with clinic of patients with plaque-type psoriasis. In order to conduct that, we collected punch biopsies from lesional skin and obtained tissue RNA. After reverse transcription, qRT-PCR quantified the relative mRNA expression. The main results revealed increased transcripts levels of IL17A, IFNG, and FOXP3 in moderate-severe patients. Despite this, only IL17A can increase the chance to worsen disease severity. We also observed many significant positive correlations between each transcript. In conclusion, IL17A is elevated in lesional skin from psoriasis patients and plays crucial role in disease severity.

Epidemiological study of penile cancer in Pernambuco: experience of two reference centers

Objectives To investigate and analyze the epidemiological profile of penile cancer in the state of Pernambuco and compare this information with other studies related to the issue. Material and Methods We conducted a retrospective, observational and descriptive study of all patients with penile cancer in two reference centers in Pernambuco - Brazil, from 2007 to 2012. The variables studied were: age, region from the state, socio-economic situation, previous postectomy, smoking, time from the beginning of injury to diagnosis, staging of the primary lesion, tumor differentiation, treatment performed and death due to cancer. Results The total number of patients was 88. The highest prevalence was seen in those aged between 66 and 75 years. About the socio-economic situation, 67% worked informally and 64.8% received up to two minimum wages. Of all patients, 57% were married and 50% illiterate. The Metropolitan Region of Recife was the one with the highest number of cases, 41%. Tobacco smoking was reported in 48.9% of cases and prior postectomy in 3.4%. Most often it was observed an average period of six months from the onset of symptoms to diagnosis. And when the lesion was diagnosed, it usually had 2 to 5 cm (64.7%), stage T2 in 50% and well differentiated in 79.6%. Partial penectomy was performed in 76.1% and total in 17%. Death was observed in 27.3%. Conclusion The clinical profile and epidemiological characteristics found in this study are similar to other national and international studies related to the issue, i.e., typical of underdeveloped or developing countries. .

Aproveitamento teórico-prático da disciplina anatomia humana do curso de fisioterapia / Students' theoretical-practical harnessing of the subject of human anatomy in physiotherapy courses

A Anatomia Humana estuda as estruturas do corpo humano e as relações entre elas. Assim, seu ensino a estudantes da área da saúde, incluindo alunos de Fisioterapia, é de extrema importância. É necessário um bom aproveitamento nesta disciplina para se tornar um bom profissional, porém as estratégias de ensino-aprendizagem nesta disciplina têm sido bastante discutidas. Com base nesta premissa, este estudo teve por objetivos avaliar o aproveitamento teórico-prático dos discentes do curso de Fisioterapia na disciplina Anatomia Humana, bem como descrever as facilidades e dificuldades enfrentadas e suas implicações durante o curso. Para tanto, foi elaborado um questionário específico e utilizada também a avaliação dos professores realizada pelo Colegiado de Fisioterapia. O tratamento estatístico foi composto por análise descritiva e correlação de Pearson, sendo os dados analisados pelos programas Microsoft Excel® 2007 e Graphpad Prism®. Não se observou correlação entre desempenho do aluno e grau de satisfação diante de diferentes parâmetros analisados neste trabalho. O estudo revelou que os alunos apresentam aproveitamento satisfatório, mas há grandes insatisfações quanto à forma como a disciplina é conduzida.

Human Anatomy is the study of the structures of the human body and the relationship between these structures. Its teaching to students in the healthcare field, including physiotherapy, is thus of utmost importance. A sound basis in the subject is necessary to becoming a sound professional, however strategies for the teaching of this subject and its learning have been the subject of much debate. Based on this prerogative, this study aimed to evaluate the subject's theoretical and practical use by physiotherapy students on the discipline's Human Anatomy course, as well as to describe the ease and difficulties experienced and their implications during the course. We therefore devised a questionnaire and used teacher assessment conducted by the College of Physiotherapy. Statistical analysis consisted of a descriptive analysis and Pearson correlation, and data was analyzed by Microsoft Excel ® 2007 and GraphPad Prism®. There was no correlation between student performance and satisfaction in terms of the different parameters analyzed in this work. The study revealed that students make satisfactory use of the subject, but that there is great dissatisfaction concerning the way the course is conducted.

Epidemiological study of penile cancer in Pernambuco: experience of two reference centers.

OBJECTIVES: To investigate and analyze the epidemiological profile of penile cancer in the state of Pernambuco and compare this information with other studies related to the issue. MATERIAL AND METHODS: We conducted a retrospective, observational and descriptive study of all patients with penile cancer in two reference centers in Pernambuco - Brazil, from 2007 to 2012. The variables studied were: age, region from the state, socio-economic situation, previous postectomy, smoking, time from the beginning of injury to diagnosis, staging of the primary lesion, tumor differentiation, treatment performed and death due to cancer. RESULTS: The total number of patients was 88. The highest prevalence was seen in those aged between 66 and 75 years. About the socio-economic situation, 67% worked informally and 64.8% received up to two minimum wages. Of all patients, 57% were married and 50% illiterate. The Metropolitan Region of Recife was the one with the highest number of cases, 41%. Tobacco smoking was reported in 48.9% of cases and prior postectomy in 3.4%. Most often it was observed an average period of six months from the onset of symptoms to diagnosis. And when the lesion was diagnosed, it usually had 2 to 5 cm (64.7%), stage T2 in 50% and well differentiated in 79.6%. Partial penectomy was performed in 76.1% and total in 17%. Death was observed in 27.3%. CONCLUSION: The clinical profile and epidemiological characteristics found in this study are similar to other national and international studies related to the issue, i.e., typical of underdeveloped or developing countries.

Treatment of severe gynecomastia (Grade III) by resection of periareolar skin.

BACKGROUND: The difficulty of treating severe gynecomastia lies in the resection of excess skin. This resection can result in extensive scars located in conspicuous sites. Several procedures have been proposed in an attempt to solve this problem. OBJECTIVE: The authors propose a new technique for treating severe gynecomastia using a periareolar approach, starting from the principle of vascularization of the nipple-areola complex (NAC) by way of the subdermal plexus. METHOD: The patient was marked preoperatively. Under general anesthesia, lipoplasty of the periglandular area was performed, followed by deepithelialization of excess skin. The glandular tissue was resected through a transdermal incision in the lower portion of the deepithelialized area. RESULTS: Twelve patients with severe gynecomastia underwent surgery over a 5-year period. No cases of partial or total necrosis of the NAC were observed. Complications included 1 case of unilateral hematoma, 1 case of bilateral seroma and 2 cases of decreased sensibility of the NAC. CONCLUSIONS: A new periareolar approach to correction of gynecomastia permits broad resection of excess skin and submammary tissue, while avoiding unattractive scars on the patient's chest.