Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care.

Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.

Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use.

BACKGROUND: This study compared the healing rates of lesser tuberosity osteotomy (LTO) for anatomic total shoulder arthroplasty (TSA), repaired with either standard knot tying or a tensionable construct. Second, we evaluated LTO healing in stemmed and stemless prostheses and identified the patient characteristics associated with healing. METHODS: An analysis of consecutive primary TSAs approached with an LTO performed by a single surgeon between 2016 and 2020 was conducted. In the first two years of the study period, the LTOs were repaired with four #2 polyblend sutures passed through drill tunnels and around a short press-fit stem, followed by manual knot tying. Subsequently, a tensionable construct with suture tapes (TCB) was universally adopted. The radiographic appearance of the LTO was evaluated at a minimum of six months postoperatively. RESULTS: A total of 340 patients met the study criteria, including 168 with manual knot tying, 84 TCB repairs with a stemmed implant, and 88 TCB repairs with a stemless implant. There was no difference in the baseline demographics between the groups. The LTO healing rate of the manual knot tying group (85%) was lower than that of the stemmed (95%) and stemless (98%) TCB groups (p < 0.001). When directly comparing the LTO healing between the stemmed and stemless TCB groups, the differences were not significant (p = 0.44). Across all constructs, the body mass index (BMI) was higher in the displaced nonunion group (p = 0.04), with a failure rate of 9.4% for a BMI between 30 and 40, 12.5% for a BMI between 40 and 50, and 28.6% for a BMI > 50. The rate of tobacco use was higher in the displaced nonunion group (p = 0.037). CONCLUSION: A tensionable construct improves LTO healing compared to manual knot tying, irrespective of the implant type. In addition to the surgical technique, the patient factors that influence tuberosity healing include a greater BMI and tobacco use. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Chin Wing Osteotomy for Improving Mandible Projection and Contour in Patients with Normal Occlusion: Case Reports.

Aim: To present a chin wing osteotomy in two patients who had undergone a virtual surgical planning workflow for surgical procedures and were followed up for 4 years. Case reports: Two retrognathic patients with normal occlusion were evaluated by means of dental and facial photographs, cone beam computed tomographs and digitization of dental arches. Virtual surgical planning was performed by using the Dolphin Imaging software to simulate the chin wing osteotomy. Next, three-dimensional models were imported into computer-aided design system (Rhino 6) for designing two hybrid (dental-bone supported) cutting and repositioning guides. Chin wing osteotomies were carried out by using the cutting guides and the osteotomized segments were placed by using L-shaped plates and screws assisted by the repositioning guides. Bone grafts were interposed in the mandibular angle region bilaterally. In both cases, the patients reported aesthetically and functionally favorable outcomes. Conclusion: Chin wing osteotomy is an appropriate treatment for retrognathic mandible in patients with normal occlusion and no additional discrepancies as the technique provided chin advancement and improvement in facial contour. The post-operative outcomes showed reliable workflow of virtual planning and surgical procedures, which could be adopted as an alternative in similar cases.

Large calcifying odontogenic cyst in the posterior maxilla / Extenso cisto odontogênico calcificante em maxila posterior

RESUMEN La aparición de un quiste odontogénico calcificante (QOC) en la región posterior de la maxila es infrecuente; hay pocos informes descritos en la literatura. Presentamos el caso de una paciente de 13 años que presentó una lesión extensa en la maxila izquierda (> 7,5 cm). La radiografía panorámica mostró una lesión radiolúcida unilocular bien delimitada, que se extendía desde el maxilar posterior izquierdo hasta el seno maxilar. La paciente fue sometida a descompresión, seguida de de la extirpación quirúrgica conservadora de la lesión. El análisis histológico de la pieza quirúrgica confirmó el diagnóstico de QOC. Después de un año, no se observaron recurrencias. La paciente permanece en seguimiento regular.

Clinical performance of class I occlusal composite resin restorations: a multicenter double-blinded randomized clinical trial / Performance clínica de restaurações oclusais classe I em resina composta: ensaio clínico randomizado duplo-cego e multicêntrico

Objective: To evaluate the 6-month clinical performance of class I occlusal composite resin restorations through a multicenter, randomized, double-blind, clinical trial. Material and Methods: Two hundred and eighty class I occlusal restorations were performed in 70 patients (aged between 17 to 50 years). The restorations were divided into four groups: G1 (Filtek P60/3M ESPE); G2 (Rok/SDI); G3 (Filtek™ P90/3M ESPE); G4 (Evolux/Dentsply). Two pre-calibrated dental practitioners performed and evaluated the restorative procedures regarding to color match, marginal discoloration, recurrent caries, wear (anatomic form) and marginal integrity according to the USPHS criteria. Results: In 85.8% of the evaluated restorations was observed the ideal score (A) for color match; 91.4% for marginal discoloration; 100% for recurrent caries; 87.7% for wear (anatomic form) and 99.3% for marginal integrity. Conclusion: The composite resins used in this study presented satisfactory and similar clinical performance in a 6-month clinical evaluation. (AU)

Objetivos: Avaliar através de um ensaio clínico randomizado duplo-cego e multicêntrico o desempenho clínico de restaurações classe I oclusais realizadas em dentes posteriores. Material e Métodos: Foram realizadas duzentas e oitenta restaurações em 70 pacientes dos gêneros masculino e feminino (entre 17 e 50 anos). As restaurações foram divididas em 4 grupos: G1 (Filtek P60/3M ESPE); G2 ( Rok/SDI); G3 Filtek TM P90/3M ESPE); G4 (Evolux/Dentsply). Dois operadores précalibrados avaliaram os procedimentos restauradores em relação a reprodução da cor, descoloração marginal, incidência de cárie, desgaste e integridade marginal de acordo com os critérios da USPHS. Resultados: De um total de restaurações avaliadas, 85,8% receberam score ideal (A) para reprodução da cor; 91,4% para descoloração marginal; 100% para incidência de cárie; 87,7% para contorno e 99,3% para integridade marginal. Conclusão: Os materiais empregados neste estudo apresentaram desempenho clínico satisfatório e semelhante após avaliação clínica de 06 meses. (AU)

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes.

BACKGROUND: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. PURPOSE: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. RESULTS: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. CONCLUSION: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

Sleep-disordered breathing following mandibular setback: a systematic review of the literature.

INTRODUCTION: A mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing. OBJECTIVES: An evidence-based literature review was conducted to identify the effect of mandibular setback on the respiratory function during sleep. METHODS: The authors performed a systematic review of pertinent literature published up to 2014. A structured search of literature was performed, with predefined criteria. A survey of the PubMed, ScienceDirect, and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals was accomplished. Potentially relevant studies then had their full-text publication reviewed. RESULTS: A total of 1,780 publications were evaluated, through which nine papers (seven case series and two case-control studies) were selected for the final review. No evidence of sleep disorder after six months was related in 223 patients. In one study, two patients developed obstructive sleep apnea syndrome after surgery, and in another two studies, seven patients presented an increase of obstructive apneas/hypopneas events and oxygen desaturation index. Most of the patients analyzed were young and thin. CONCLUSION: There was no evidence of postoperative sleep apnea syndrome after a mandibular setback surgery. However, one should always consider a potential reduction of the upper airway space during the treatment plan. Obese patients and those submitted to large amounts of mandibular setbacks present a higher chance to develop obstructive sleep apnea syndrome.

Fijacion minimamente invasiva con doble boton de fracturas de clavicula distal en deportistas / Minimally invasive double button fixation for lateral clavicle fractures in athletes

Introducción: La unión temprana y el rápido retorno a la función previa son la prioridad en los atletas jóvenes con fracturas desplazadas de clavícula distal. Además es esencial evitar la pseudoartrosis en este grupo de pacientes ya que la misma se asocia a dolor persistente, restricción del movimiento y pérdida de la fuerza y resistencia del hombro Diseño: Serie de casos Nivel de evidencia IV Materiales y Métodos: Un total de 21 deportistas con fracturas desplazadas de clavícula distal fueron tratados con reducción cerrada y fijación con doble botón a través de un abordaje mínimamente invasivo entre marzo de 2008 y octubre de 2013. Los pacientes respondieron un cuestionario focalizado en el tiempo de vuelta al deporte. Los resultados funcionales se evaluaron con el score de Constant y la versión corta del score de Discapacidad del brazo, del hombro y de la mano (Quick DASH). El dolor se evaluó con la escala visual análoga. (EVA). Se evaluaron las radiografías postoperatorias para identificar tiempo de consolidación, pseudoartosis y consolidaciones viciosas. Resultados: De los 21 pacientes, 20 retornaron al deporte. Todos retornaron al mismo nivel. El tiempo promedio de vuelta al deporte fue de 78 días (rango 41 -120 días). Cuatro pacientes (19%) volvieron al deporte antes de las seis semanas luego de la cirugía, 14 (67%) retornaron entre las seis y las 12 semanas luego de la cirugía y tres (14%) retornaron luego de las 12 semanas. El score de Constant promedio fue 89,1 ± 4,2 (rango, 79-100). El Quick-DASH promedio fue 0,4 ± 2,6 (rango, 0-7,1). El dolor según la EVA fue de 0,4 ± 1,0 (rango, 0-3) al final del seguimiento. La única complicación fue una pseudoartrosis asintomática. No se requirió retiro del material en ningún paciente. Conclusiones: La reducción cerrada y la fijación con doble botón de las fracturas desplazadas de clavícula a travé...

Background: Early union and rapid return to prior function is the priority in young athletes with lateral clavicular fractures. Furthermore it is essential to avoid nonunion in this subgroup of patients since it is frecuently associated with persistent pain, restriction of movement and loss of strength and endurance of the shoulder. Purpose: The aim of this study was to analyze the time to return-to-sport, functional outcomes and complications of a group of athletes with displaced lateral clavicular fractures treated using close reduction and minimally invasive double button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicle fractures were treated with closed reduction and minimally invasive double button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion. Results: Of the 21 patients, 20 returned to sports after closed reduction and minimally invasive double button fixation; 100 % returned to the same level. The mean time to return to play was 78 days (range, 41 - 120 days). Four patients (19%) returned to sports in less than 6 weeks after surgery Fourteen (67%) returned to sports between 6 and 12 weeks after surgery and three (14%) returned to sports after 12 weeks. The mean Constant was 89.1 ± 4.2 (range, 79-100) The average Quick-DASH was 0.4 ± 2.6 (range, 0-7.1). Pain was 0.4 ± 1.0 (range, 0-3) at final follow-up according to VAS. The only...

Complicaciones postoperatorias de la reparación de manguito rotador artroscópica sin acromioplastía / Postoperative complications of arthroscopic rotator cuff repair without acromioplasty

El desarrollo y refinamiento del instrumental y las técnicas quirúrgicas ha llevado a muchos cirujanos a abandonar las técnicas tradicionales abiertas a favor de técnicas artroscópicas. Junto con el incremento de la popularidad de la artroscopia también ha habido un incremento en las complicaciones. El objetivo del siguiente trabajo fue analizar las complicaciones en un grupo de pacientes a los que se les realizó la reparación artroscópica del manguito rotador sin acromioplastía. Materiales y Métodos: Se realizó una evaluación retrospectiva de 273 reparaciones artroscópicas del manguito rotador sin acromioplastía. Todos los pacientes fueron evaluados a la primera y segunda semanas postoperatoria y al primer, segundo, tercer y sexto mes postoperatorio. Se registraron todas las complicaciones. Múltiples variables fueron evaluadas como factores de riesgo como ser: la edad, sexo, tamaño de ruptura, antecedente traumático, rigidez articular previa asociada (capsulitis adhesiva) y los procedimientos asociados. Resultados: En 273 hombros operados hubo 13 complicaciones postoperatorias (4.8%). Las complicaciones fueron 10 rigideces articulares, 2 trombosis venosa profunda y una retención urinaria. La rigidez preoperatoria ha mostrado una asociación significativa con la pérdida de movilidad en el pop (p<0.05). De los procedimientos asociados durante la cirugía la única variable que mostró ser un factor de riesgo para la complicación fue la coracoplastia (p<0.05). Conclusiones: La reparación artroscópica del manguito rotador sin acromioplastia representa un procedimiento seguro con una baja tasa de complicaciones a corto plazo. La rigidez preoperatoria y la coracoplastia parecieran estar implicadas en una mayor predisposición a complicaciones, sin embargo otro factores como la edad, sexo, tamaño de la ruptura no mostraron estar asociadas. Nivel de Evidencia: IV...

The development, and refinement of arthroscopic instrumentation and surgical techniques have prompted many surgeons to abandon traditional open procedures in favor of arthroscopic techniques. As the popularity of arthroscopic surgery has increased there has also been an increase in complications. The purpose of this study was to analyze the complications in a group of patients who has undergone arthroscopic rotator cuff repair without acromioplasty. Materials and Methods: We retroprospectively evaluated 273 arthroscopic rotator cuff repairs without acromioplasty. All patients were evaluated at the first and second weeks and at the first, third and sixth month. All complications were recorded. Multiple variables such as gender, age, rupture size, traumatic history, adhesive capsulitis and associated procedures were analyzed. Results: There were 13 complications in 273 operated shoulders (4.8%). There were 10 frozen shoulders, two deep venous thrombosis and one urinary retention. Preoperative stiffness showed a significant association with the decrease in the postoperative range of motion (p<0.05). The only intraoperative procedure that was found to be a risk factor for complications was coracoplasty (p<0.05). Conclusions: Arthroscopic rotator cuff repair without acromioplasty represents a safe procedure with a low rate of complications. Preoperative stiffness and coracoplasty appear to be involved in a greater predisposition to complications. However other factors such as age, gender, and rupture size did not seem to be related. Level Evidence: IV...

Leishmaniose tegumentar americana na pálpebra: apresentação incomum / Cutaneous leishmaniasis americana on the eyelid: unusual presentation

Contexto: A leishmaniose tegumentar americana (LTA) é doença infecciosa da pele e mucosa, cujo agente etiológico é um protozoário do gênero Leishmania. No Brasil, é considerada endêmica, e a apresentação clínica típica é lesão tipo úlcera, única, em área exposta, porém raramente descrita na pálpebra. A importância do relato se deve ao fato de se tratar de caso incomum de LTA. Descrição do caso: Homem, de 75 anos, lavrador, procedente da zona rural de Itariri, São Paulo, com lesão palpebral, assintomática, há um ano. Ao exame: lesão ulce-rada de borda eritematosa e infiltrada com fundo granuloso. Histopatologia com estudo imunoistoquímico confirmou a hipótese de LTA e após, tratamento com antimoniato de N-metil glucamina por 21 dias, houve cura da dermatose. Discussão: A apresentação típica da LTA é uma úlcera indolor nas áreas expostas do tegumento, com apenas 2% a 5% das lesões restritas às pálpebras, uma vez que os movimentos palpebrais dificultam a picada do inseto transmissor. A diagnose diferencial da leishmaniose tegumentar é difícil pelo polimorfismo das lesões iniciais. Nesse paciente, pela idade, aspecto clínico e, particularmente, pela localização, os principais diagnósticos diferenciais foram com carcinoma basocelular, paracoccidioidomicose e esporotricose. Conclusões: Ressalta-se, nesta apresentação, a localização da lesão, sui-generis, raramente citada na literatura.

Lichen planus pigmentosus inversus.

Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months. Pathological examination showed hydropic degeneration of the basal layer, pigmentary incontinence and moderate inflammatory lymphocytic infiltrate in the dermis. Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter, with defined borders, affecting intertriginous areas, most commonly in the axillae and groin of Caucasian patients. It presents unique lichenoid histology. We report a case with typical clinical features, histology and evolution.

Lichen planus pigmentosus inversus / Liquen plano pigmentoso invertido

Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months. Pathological examination showed hydropic degeneration of the basal layer, pigmentary incontinence and moderate inflammatory lymphocytic infiltrate in the dermis. Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter, with defined borders, affecting intertriginous areas, most commonly in the axillae and groin of Caucasian patients. It presents unique lichenoid histology. We report a case with typical clinical features, histology and evolution.

Homem, 25 anos, com manchas acastanhadas, assintomáticas, nas regiões cervicais, axilares, inguinais e poplíteas há nove meses. Anatomopatológico com degeneração hidrópica da basal, incontinência pigmentar e infiltrado inflamatório linfocitário moderado na derme. O líquen plano pigmentoso invertido é um subtipo raro de líquen plano, caracterizado por máculas hipercrômicas, assintomáticas ou discretamente pruriginosas, de milímetros a centímetros de diâmetro, com limites nítidos, nas áreas intertriginosas, sendo mais comum nas flexuras axilares e inguinais de indivíduos de pele clara. Apresenta histologia liquenóide peculiar. Relata-se um caso com clínica, histologia e evolução típicas.

Breast carcinoma en Cuirasse--case report.

Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer, which can be manifested through papulonodular lesions, erysipeloid or sclerodermiform infiltration, en cuirasse. We report the case of a female patient, 78 years old, with papular, scaly and confluent lesions in the right breast for one year, progressing to edema and skin infiltration, reduction of breast volume and plaque en cuirasse, and similar lesions in the contralateral breast and abdomen for four months. The pathological diagnosis was invasive ductal breast carcinoma with Paget-like foci, epidermal skin metastases and lymphatic embolization.

Case for diagnosis: childhood granulomatous periorificial dermatitis.

Childhood Granulomatous Periorificial Dermatitis is an acneiform facial rash that affects the periorificial area in children. The clinical aspectare asymptomatic 1-3 mm papules of, monomorphic, erythematous or hypopigmented in periorificial areas - mouth, nose and eyes. It's a benign and self-limited disease that heals spontaneously without scarring and specific therapy. Differential diagnoses include perioral dermatitis, granulomatous-rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We present the case of a 4-year-old boy, presenting papules in periorificials areas. Due to its low incidence and low number of publications we report the present case.

Breast carcinoma en Cuirasse - case report / Carcinoma de mama em couraca - relato de caso

Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer, which can be manifested through papulonodular lesions, erysipeloid or sclerodermiform infiltration, en cuirasse. We report the case of a female patient, 78 years old, with papular, scaly and confluent lesions in the right breast for one year, progressing to edema and skin infiltration, reduction of breast volume and plaque en cuirasse, and similar lesions in the contralateral breast and abdomen for four months. The pathological diagnosis was invasive ductal breast carcinoma with Paget-like foci, epidermal skin metastases and lymphatic embolization.

A metástase cutânea é conseqüente à disseminação do tumor por embolização linfática, vascular, implantação direta durante cirurgias ou envolvimento da pele por contiguidade. Em mulheres, o tumor maligno primário que mais comumente metastatiza para a pele é o de mama, que tanto pode se expressar por lesões tumorais papulonodulares, infiltração erisipelóide ou esclerodermiforme, em couraça. Relatamos o caso de paciente do sexo feminino, 78 anos, apresentando lesões nodulares, descamativas e confluentes em mama direita, evoluindo com edema e infiltração cutânea, com redução do volume mamário e placa endurecida ilimitada. Invasão da mama contralateral e abdome ocorreram 4 meses após o início dos sinais. O diagnóstico histopatológico foi de adenocarcinoma ductal invasivo de mama com focos pagetóides epidérmicos e embolização linfática.

Case for diagnosis / Caso para diagnostico

Childhood Granulomatous Periorificial Dermatitis is an acneiform facial rash that affects the periorificial area in children. The clinical aspectare asymptomatic 1-3 mm papules of, monomorphic, erythematous or hypopigmented in periorificial areas - mouth, nose and eyes. It's a benign and self-limited disease that heals spontaneously without scarring and specific therapy. Differential diagnoses include perioral dermatitis, granulomatous-rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We present the case of a 4-year-old boy, presenting papules in periorificials areas. Due to its low incidence and low number of publications we report the present case.

A Dermatite Periorificial Granulomatosa da Infância é erupção facial acneiforme que afeta área periorificial do segmento cefálico de pré-puberes. Consiste em pápulas assintomáticas de 1 a 3 mm, monomorfas, eritematosas ou hipopigmentadas em áreas periorificiais - boca, nariz e olhos. A doença é benigna e auto-limitada, curando sem deixar cicatriz e por regra sem terapia específica. Diagnósticos diferenciais incluem a dermatite perioral, rosácea granulomatosa, sarcoidose e lúpus miliar da face. Relata-se paciente de 4 anos, masculino, com erupção papulosa há 2 anos em áreas periorificais. Devido à sua baixa incidência e o reduzido número de publicações relata-se o presente caso.

Condiçöes sanitárias da água de industria de sorvetes de Campo Grande / Sanitary conditions of the water used in ice cream industry of Campo Grande

Este estudo teve como objetivo, verificar as condiçöes sanitárias da água utilizada na fabricaçäo de sorvetes e gelos em estabelecimentos existentes em Campo Grande, Mato Grosso do Sul. As análises foram realizadas de acordo com o "Standard methods for the examination of water and wastewater". Foi observado que 47,4% das sorveterias utilizavam água fora dos padöes de potabilidade havendo os resultados sido encaminhados às autoridades competentes