Mantle cell lymphoma involving the oral and maxillofacial region: a study of 20 cases.

OBJECTIVE: To investigate the clinicopathologic features of mantle cell lymphoma (MCL) involving the oral and maxillofacial region. METHODS: The MCL cases were retrieved from the pathosis database of 6 pathology laboratories. Original hematoxylin and eosin slides and immunohistochemical reactions were reviewed for confirmation of the initial diagnosis. Clinical data of the cases were obtained from the patients' pathosis and/or medical charts. RESULTS: Twenty cases were included in the study, showing a male predominance and a mean age of 66 years. The oral cavity (12 cases) and the oropharynx (5 cases) were the most commonly involved subsites. Most cases presented as asymptomatic swellings, with 2 cases showing bilateral involvement of the palate. The classic histologic variant predominated (12/20 cases). All cases expressed CD20 with nuclear cyclin D1 positivity. SOX11 was seen in 9/13 cases, CD5 in 6/16 cases, Bcl2 in 16/19 cases, CD10 in 2/20 cases, and Bcl6 in 4/16 cases. Ki67 showed a mean proliferation index of 40.6%. The Epstein-Barr virus (EBV) was negative in all cases investigated. Follow-up data was available for 7 patients, with 5 currently alive and 2 deceased. CONCLUSION: Mantle cell lymphoma, albeit rare, may manifest in the oral and maxillofacial region. Its histologic heterogeneity demands a high degree of diagnostic skill from pathologists.

Disjunção do anel mitral: modalidades diagnósticas, implicações clínicas e evolução prognóstica / Mitral annulus disjunction: diagnostic modalities, clinical implications, and prognostic progression

A disjunção do anel mitral (DAM) é uma inserção anormal da linha de flexão do anel mitral na parede atrial. O anel mostra uma separação (disjunção) entre a junção folheto posterior-parede atrial e a crista miocárdica ventricular esquerda.1 A DAM foi descrita pela primeira vez há mais de 30 anos em estudo de autópsia, estando relacionada com prolapso da valva mitral (PVM) em 92% dos casos.2 Desde então, foram realizados diversos estudos, sendo a prevalência de DAM em pacientes com PVM reportada de forma variável, podendo ou não estar associada à insuficiência mitral. O ecocardiograma transtorácico (ETT) faz parte da avaliação inicial do prolapso valvar mitral, permitindo o diagnóstico e a avaliação de complicações relacionadas. Com a evolução de novos métodos diagnósticos, a ressonância magnética cardíaca (RMC) e o ecocardiograma transesofágico (ETE) passaram a aprimorar a avaliação dessa patologia, bem como de sua extensão e localização. Contudo, as características fenotípicas do PVM que estão mais associadas a DAM permanecem incertas, sobretudo devido ao número limitado de pacientes, nos estudos clássicos sobre o tema. Portadores de DAM podem desenvolver sintomas relacionados a arritmias ventriculares, configurando a síndrome arrítmica da DAM (SDAM), podendo evoluir para morte súbita. Na literatura, os dados prognósticos ainda são conflitantes entre os diversos estudos acerca do tema, indo desde critérios claros de diagnóstico, o melhor método de imagem a ser aplicado, o tratamento e o prognóstico. Esta revisão descreve as características da DAM associada ou não ao prolapso valvar, auxiliando no diagnóstico e na conduta dessa importante patologia. (AU)

Mitral annulus disjunction (MAD) is an abnormal insertion of the flexion line of the mitral annulus into the atrial wall. The annulus presents a separation (disjunction) between the posterior leaflet­atrial wall junction and the left ventricular myocardial crest.1 MAD was first described more than 30 years ago in an autopsy study and is reportedly related to mitral valve prolapse (MVP) in 92% of cases.2 Since then, several studies have been conducted, and reports on the prevalence of MAD in patients with MVP have varied. Ultimately, it may or may not be associated with mitral regurgitation. Transthoracic echocardiography is part of initial MVP assessment, allowing its diagnosis and the assessment of related complications. As new diagnostic methods emerged, cardiac magnetic resonance imaging and transesophageal echocardiography improved the assessment of this pathology in terms of its diagnosis, extension, and location. However, the phenotypic characteristics of MVP that are more closely associated with MAD remain uncertain mainly due to the limited number of patients in classic studies on the subject. Patients with MAD may develop symptoms related to ventricular arrhythmias, configuring the MAD arrhythmic syndrome, which may progress to sudden death. The literature presents conflicting prognostic data among several studies on the subject from clear diagnostic criteria and best imaging method to be used to treatment and prognosis. This review describes MAD characteristics associated (or not) with valve prolapse to improve the diagnosis and management of this important pathology. (AU)

Mantle cell lymphoma, malt lymphoma, small lymphocytic lymphoma, and follicular lymphoma of the oral cavity: An update.

BACKGROUND: Although uncommon, mature small B-cell lymphomas may arise in the oral/maxillofacial area and oral pathologists must be aware of the key characteristics of these neoplasms to perform an accurate diagnosis. In this manuscript, we attempted to integrate the currently available data on the clinicopathological features of follicular lymphoma (FL), mantle cell lymphoma (MCL), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT-L), and chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) affecting these anatomical regions. METHODS: An updated descriptive literature review was carried out and a detailed electronic search was done in multiple databases to gather all cases affecting the oral/maxillofacial region and palatine tonsils. RESULTS: We observed that MALT-L was the most frequently reported subtype, followed by FL, MCL, and CLL/SLL. The palate was affected in a high proportion of cases and the most usual clinical presentation was an asymptomatic swelling. MALT-L and CLL/SLL neoplastic cells were strongly associated with small salivary glands. FL showed no gender preference, while MCL and CLL/SLL were more prevalent in males and MALT-L in females. Overall, cases were more common in elderly individuals. Patients' treatment and outcome varied, with MCL being the most aggressive neoplasm with a dismal prognosis in comparison to FL and MALT-L. CONCLUSION: Despite the poor documentation in many of the cases available, especially regarding the microscopic and molecular features of tumors, this review demonstrated that the oral mature small B-cell lymphomas investigated share similar clinical presentation, but carry different prognostic significance, demanding an accurate diagnosis.

Avaliação estabilométrica, eletromiográfica e qualidade de vida em pacientes com fibromialgia / Stabilometric and electromyographic evaluation and quality of life in patients with fibromyalgia

Introdução: A fibromialgia é uma síndrome crônica não inflamatória, tendo como característica a dor difusa, seu diagnóstico é efetuado na presença de dor generalizada, sensibilidade à palpação em 11 pontos pré-determinados. Objetivo: Avaliar o equilíbrio, controle motor e a qualidade de vida em pacientes com fibromialgia. Métodos: Estudo controlado, duplo cego e inferencial de abordagem quantitativa, foi realizado com 11 voluntários com idade entre 18 e 75 anos. Avaliação eletromiográfica, estabilométrica, e aplicação dos questionários de qualidade de vida SF-36, Escala de Epworth e Escala de Depressão de Beck foram realizados. Resultados: Os participantes tinham idade média de 45,5 anos. Na Escala de Epworth apresentaram sonolência grave (54,54%), na Escala de Depressão de Beck apresentaram-se sem depressão ou depressão leve (36,36%), no Questionário SF-36 obtiveram pontuações próximas a 0. Na eletromiografia, encontrou-se pouca contração muscular para glúteo médio (35,03), supraespinhoso (135,5) e trapézio (176,08). Na estabilometria, obteve-se área de oscilação de 1,68 cm², velocidade anteroposterior e médio-lateral (1,50 e 1,21, respectivamente). Conclusão: Conclui-se que os pacientes com fibromialgia apresentaram redução na contração das musculaturas afetadas, desequilíbrio anterior e à direita com grande oscilação de área na plataforma de força e alteração no tempo de reação ao desequilíbrio. (AU)

Introduction: Fibromyalgia is a chronic non-inflammatory syndrome, characterized by diffuse pain; its diagnosis is made in the presence of generalized pain, sensitivity to palpation in 11 predetermined points. Objective: To evaluate balance, motor control and quality of life in patients with fibromyalgia. Methods: A double-blind, inferential, quantitative approach was performed with eleven volunteers aged 18-75 years. An electromyographic, stabilometric, and SF-36 quality of life questionnaire, Epworth scale, and Beck Depression Scale were carried out. Results: Participants had a mean age of 45.5 years. In the Epworth Scale they presented severe drowsiness (54.54%), in the Beck Depression Scale they presented no depression or mild depression (36.36%), in the Questionnaire SF-36 they obtained scores close to 0. At electromyography, they found there was little muscle contraction for the gluteus medius (35.03), supraspinatus (135.5) and trapezius (176.08). In the stabilometry, it obtained an oscillation area of 1.68 cm², anteroposterior and mid-lateral velocity (1.50 and 1.21, respectively). Conclusion: It is concluded that patients with fibromyalgia have a reduction in the contraction of the affected muscles, anterior and right imbalance with great oscillation of the area on the force platform and change in the time of reaction to the imbalance. (AU)

Acute effect of partial body weight suspension on the level of cocontraction and gait biomechanics in women with knee osteoarthritis / Efeito agudo da suspensão parcial de peso corporal no nível de cocontração e biomecânica da marcha em mulheres com osteoartrite de joelho / Efecto agudo de la suspensión parcial de peso corporal en el nivel de co-contracción y biomecánica de la marcha en mujeres con osteoartritis de rodilla

Abstract Introduction: Knee osteoarthritis (OAK) is one of the most prevalent rheumatic diseases in the population, characterized by functional limitation and gait difficulties with profound clinical relevance, as walking is the most frequently performed daily activity. These functional limitations may be more pronounced when the disease is associated with obesity. Objective: To investigate the effect of different body weight suspension percentages on gait biomechanical variables and co-contraction percentages in women with OAK. Method: Fourteen women aged 50-75 years, with a body mass index between 26 and 35 and radiological diagnosis of OAK participated in the study. On the first day, anamnesis and familiarization with gait on the treadmill was performed. On the second day, treadmill gait assessment was performed using partial body weight support (SPPC) in three conditions-15%, 30%, and 45% suspension. During the evaluation, electromyographic and kinematic data were collected. The variables analyzed were percentage of hip (gluteus maximus/rectus femoris), knee (femoral biceps/vastus lateralis), and ankle (anterior tibial/lateral gastrocnemius), and length and step widths. A one-way analysis of variance was conducted, with a significance level of p < 0.05. Results: There was no significant difference in the length and step width and the level of co-contraction between the running conditions analyzed. Conclusion: Body weight suspension using SPPC during treadmill running did not alter the biomechanical variables of the gait of women with OAK.

Resumo Introdução: A osteoartrite de joelho (OAJ) é a uma das doenças reumáticas mais prevalentes na população, caracterizada por causar limitação funcional, sendo as dificuldades de marcha de grande relevância clínica por ser a atividade diária mais realizada. Essas limitações funcionais podem ser mais acentuadas quando a doença está associada a obesidade. Objetivo: Investigar o efeito de diferentes porcentagens de suspensão do peso corporal no percentual de cocontração e nas variáveis biomecânicas da marcha em mulheres com OAJ. Método: Estudo transversal no qual participaram do estudo 14 mulheres com idade entre 50-75 anos, IMC entre 26-35, com diagnóstico radiológico de OAJ. No primeiro dia foi realizado anamnese e familiarização da marcha na esteira. No segundo dia, foi realizado avaliação da marcha em esteira utilizando suporte parcial de peso corporal (SPPC) em três condições: 15%, 30% e 45% de suspensão. Durante a avaliação foram coletados dados eletromiográficos e cinemáticos. As variáveis analisadas foram: percentual de cocontração do quadril (glúteo máximo/reto femoral), joelho (bíceps femoral/vasto lateral) e tornozelo (tibial anterior/gastrocnêmio lateral); comprimento e largura do passo. Para análise estatística foi aplicado o teste Anova One Way, com nível de significância de p<0,05. Resultados: Não houve diferença significativa para o comprimento e largura de passo, assim como para o nível de cocontração entre as condições de marcha analisadas (p>0.05). Conclusão: A suspensão do peso corporal usando SPPC durante a marcha em esteira não altera o percentual de cocontração e as variáveis biomecânicas da marcha de mulheres com OAJ.

Resumen Introducción: Una de las enfermedades reumáticas más prevalentes en la población, la osteoartritis de rodilla (OAJ) se caracteriza por causar limitación funcional, siendo las dificultades de marcha de gran relevancia clínica por ser la actividad diaria más realizada. Estas limitaciones funcionales pueden ser más intensas en asociación con la obesidad. Objetivo: Investigar el efecto de diferentes porcentajes de suspensión de peso corporal sobre las variables biomecánicas de la marcha y el porcentaje de cocontracción en mujeres con OAJ. Método: Participaron en el estudio 14 mujeres con edad entre 50-75 años, IMC entre 26-35, con diagnóstico radiológico de OAJ. En el primer día se realizó anamnesis y familiarización de la marcha en la cinta de correr. En el segundo día, se realizó una evaluación de la marcha en la cinta utilizando soporte parcial de peso corporal (SPPC) en tres condiciones: 15%, 30% y 45% de suspensión. Durante la evaluación se recogieron datos electromiográficos y cinemáticos. Las variables analizadas fueron: porcentaje de cocontración de la cadera (glúteo máximo/recto femoral), rodilla (bíceps femoral/vasto lateral) y tobillo (tibial anterior/gastrocnémio lateral); longitud y anchura del paso. Para el análisis estadístico se aplicó la prueba Anova One Way, con un nivel de significación de p <0,05. Resultados: No hubo diferencia significativa para la longitud y anchura del paso, así como para el nivel de cocontración entre las condiciones de marcha analizadas. Conclusión: La suspensión del peso corporal con SPPC durante la marcha en cinta no alteró las variables biomecánicas de la marcha de mujeres con OAJ.

Editorial / Editorial / Editorial

Editorial do volume 8, número 3.

Editorial volume 8, number 3.

Editorial volumen 8, número 3.

Evaluation of tensile strength of tissue adhesives made of fibrin and cyanoacrylate used as reinforcement of colon suture in "ex vivo" swine

ABSTRACT Aim: To evaluate rupture pressures of tissue adhesives of cyanoacrylate (Omnex®) and fibrin (Evicel®), used as reinforcement in colonic suture from "ex vivo" swine. Methods: Surgical procedures were performed in the Surgical Technique Laboratory. From a division in segments of 10 cm of descending colon and sigmoid colon from three "ex vivo" female swine, Landrace breed, which were resected in less than six hours after the slaughter time, 30 segments were selected, 10 of each animal. They were stored in saline solution 0.9% at 36 °C, being randomly allocated in three groups (Control, Evicel and Omnex), each one containing 10 segments. Results: The lower and higher pressure values found in the groups Control, Evicel and Omnex were 36 mmHg and 41 mmHg, 70 mmHg and 90 mmHg, 90 mmHg and 120 mmHg, respectively. Containing statistical significance (p-value <0.0001) concerning the 2 to 2 comparisons (Control, Evicel and Omnex) with 95% trusting rate based on the application of the Turkey Method. Conclusion: One concludes that the use of tissue adhesives in anastomoses colonic in an experimental animal model of "ex vivo" swine increased the anastomoses rupture pressures. Among the tested adhesives, cyanoacrylate presented higher rupture pressure in relation to fibrin adhesive.

RESUMO Objetivo: Avaliar as pressões de ruptura dos adesivos teciduais de Cianoacrilato (Omnex®) e de Fibrina (Evicel®), usados como reforço em suturas colônicas de suínos "ex-vivo". Métodos: Os procedimentos cirúrgicos realizados foram realizados no Laboratório de Técnica Cirúrgica. A partir da divisão em segmentos de 10 cm do colo descendente e colo sigmoide de três suínas fêmeas ex-vivo, da raça Landrace, ressecados em tempo inferior a seis horas em relação ao momento do abate, foram selecionados 30 segmentos, 10 de cada animal. Foram armazenados em soro fisiológico 0,9% a 36 °C, alocando-se aleatoriamente esses segmentos em três grupos (Controle, Evicel e Omnex) com 10 segmentos cada. Resultados: Os menores e maiores valores pressóricos encontrados nos grupos Controle, Evicel e Omnex foram 36 mmHg e 41 mmHg, 70 mmHg e 90 mmHg, 90 mmHg e 120 mmHg, respectivamente. Com significância estatística (Valor-p < 0,0001) para as comparações 2 a 2 (Sutura, Evicel e Omnex) com um intervalo de confiança de 95% construído a partir da aplicação do método de Turkey. Conclusão: A partir desse estudo conclui-se que o uso de adesivos teciduais em anastomoses colônicas, em modelo experimental animal de suíno ex-vivo, aumentou as pressões de ruptura das anastomoses. Dentre os adesivos testados, o adesivo de Cianoacrilato apresentou maiores pressões de ruptura em relação ao adesivo de Fibrina.

Relato de caso: acompanhamento cardiológico durante 26 anos de atleta de alto nível / Case report: 26-year cardiological follow-up of a high-level athlete

RESUMO: O coração do atleta engloba um conjunto de alterações adaptativas resultantes da prática de exercício físico intenso e prolongado, promovendo alterações clínicas, eletrocardiográficas e ecocardiográficas. As alterações mais relevantes são a hipertrofia miocárdica, o alargamento das cavidades cardíacas e o aumento da massa cardíaca. Em alguns casos, essas alterações podem ser consideradas extremas, exigindo que as condições patológicas sejam eliminadas. Por meio de um relato de caso de um atleta de basquetebol de alto nível cuja única alteração no exame físico era a presença de bradicardia sinusal, persistente ao longo de 26 anos de acompanhamento clínico, investigada através de ecocardiograma, Holter e teste de esforço, demonstrando caráter benigno e fisiológico, apresentamos e discutimos a importância da avaliação cardiovascular por médico com experiência na análise de atletas, capaz de distinguir as condições patológicas das adaptações fisiológicas frente ao exercício de alta intensidade ao qual o atleta é submetido, evitando exames invasivos ou tratamento do coração do atleta. (AU)

ABSTRACT: The athlete's heart performs a set of adaptive changes resulting from the practice of intense and prolonged physical exercise, resulting in clinical, electrocardiographic and echocardiographic alterations. The most relevant changes are myocardial hypertrophy, enlargement of the cardiac cavities, and an increase in cardiac mass. In some cases, these changes can be considered extreme, requiring the elimination of pathological conditions. Through a case report of a high-level basketball player, whose only change in the physical examination was the presence of sinus bradycardia, persistent over 26 years of clinical follow-up, which was investigated through echocardiogram, Holter test and stress test, demonstrating benign and physiological characteristics, we present and discuss the importance of cardiovascular evaluation by a physician with experience in analyzing athletes, capable of distinguishing pathological conditions from physiological adaptations to the high-intensity exercise to which the athlete is subjected, avoiding invasive examinations or treatment of the athlete's heart. (AU)

Relato de caso: acompanhamento cardiológico durante 26 anos de atleta de alto nível / Case report: 26-year cardiological follow-up of a high-level athlete

O coração do atleta engloba um conjunto de alterações adaptativas resultantes da prática de exercício físico intenso e prolongado, promovendo alterações clínicas, eletrocardiográficas e ecocardiográficas. As alterações mais relevantes são a hipertrofia miocárdica, o alargamento das cavidades cardíacas e o aumento da massa cardíaca. Em alguns casos, essas alterações podem ser consideradas extremas, exigindo que as condições patológicas sejam eliminadas. Por meio de um relato de caso de um atleta de basquetebol de alto nível cuja única alteração no exame físico era a presença de bradicardia sinusal, persistente ao longo de 26 anos de acompanhamento clínico, investigada através de ecocardiograma, Holter e teste de esforço, demonstrando caráter benigno e fisiológico, apresentamos e discutimos a importância da avaliação cardiovascular por médico com experiência na análise de atletas, capaz de distinguir as condições patológicas das adaptações fisiológicas frente ao exercício de alta intensidade ao qual o atleta é submetido, evitando exames invasivos ou tratamento do coração do atleta.

The athlete's heart performs a set of adaptive changes resulting from the practice of intense and prolonged physical exercise, resulting in clinical, electrocardiographic and echocardiographic alterations. The most relevant changes are myocardial hypertrophy, enlargement of the cardiac cavities, and an increase in cardiac mass. In some cases, these changes can be considered extreme, requiring the elimination of pathological con - ditions. Through a case report of a high-level basketball player, whose only change in the physical examination was the presence of sinus bradycardia, persistent over 26 years of clinical follow-up, which was investigated through echocardiogram, Holter test and stress test, demonstrating benign and physiological characteristics, we present and discuss the importance of cardiovascular evaluation by a physician with experience in analyzing athletes, capable of distinguishing pathological conditions from physiological adaptations to the high-intensity exercise to which the athlete is subjected, avoiding invasive examinations or treatment of the athlete's heart

Comparison of Arterial Repair through the Suture, Suture with Fibrin or Cyanoacrylate Adhesive in Ex-Vivo Porcine Aortic Segment.

INTRODUCTION: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. OBJECTIVE: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. METHODS: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. RESULTS: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. CONCLUSION: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Preocupações brasileiras: futebol e saúde

O ensaio aborda a questão da alta rotatividade que atinge, no Brasil, técnicos de futebol e gestores do Sistema Único de Saúde (SUS), dois assuntos que estão permanentemente em voga no Brasil. Em média, um treinador de equipe de futebol no Brasil permanece na função, num mesmo time, apenas pela metade do tempo quando comparado a seus congêneres de países europeus com forte tradição no esporte. De maneira análoga, as sucessivas substituições dos gestores do SUS trazem o mesmo traço de transitoriedade nas funções de comando, aqui estudada a partir dos dados da gestão estadual. Foram cotejados os números encontrados entre os anos de 2015 e 2017, tanto para os técnicos de futebol dos times que disputaram o campeonato nacional, quanto para os secretários estaduais de saúde. Parece existir uma correlação entre a existência de fatores de pressão fora da governabilidade desses atores sociais e as razões de suas substituições, o que, no caso da gestão do sistema de saúde, traz inequívocos prejuízos à continuidade e ao aprofundamento de programas, políticas e ações que têm por escopo a resposta adequada às necessidades de saúde da população

Comparison of arterial repair through the suture, suture with fibrin or cyanoacrylate adhesive in ex-vivo porcine aortic segment

Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Selantes e adesivos tissulares utilizados em ressecções pulmonares e suas repercussões no período pós-operatório / Sealants and tissue adhesives used in thoracic surgery and its repercussions in the postoperative period

Objetivo ­ Verificar e comparar a eficácia do uso de selantes e adesivos cirúrgicos com técnicas convencionais de sutura após ressecções pulmonares. Métodos ­ Foi realizada uma revisão bibliográfica entre os períodos de 2005 e 2016 nos bancos de dados Lilacs, Scielo e Medline. Resultados ­ Foram identificados 939 estudos, tal que, 486 compreendiam o período entre 2005 e 2016 e destes 14 estudos se enquadraram para análise após os critérios de exclusão e inclusão. Conclusão ­ Este trabalho demonstrou que o uso de selantes ou adesivos teciduais de uma maneira geral é uma alternativa eficaz e segura na manutenção de aerostasia ou hemostasia quando comparada com técnicas ou procedimentos convencionais.

Objective ­ The aim of this study was to assess and compare the efficacy of sealants and adhesives with conventional surgical suture techniques after lung resection. Methods ­ A literature review was conducted between the periods of 2005 and 2016 in the databases Lilacs, Scielo and Medline. Results ­ 939 studies were identified, such that 486 comprised the period between 2005 and 2016 and from these 14 studies were selected for analysis after the exclusion and inclusion criteria. Conclusion ­ This study demonstrated that the use tissue adhesives or sealants in general is an effective and safe alternative in the maintenance of hemostasis and aerostasis when compared with conventional techniques of lung repair after its resection.

Estenose aórtica grave assintomática: um desafio clínico / Asymptomatic severe aortic stenosis: a clinical challenge

Ao se tratar de estenose aórtica, o surgimento de sintomas clássicos (dispneia, dor torácica e síncope) marca um cenário de pior prognóstico, com aumento substancial da mortalidade. A única medida que comprovadamente aumenta a sobrevida é a cirurgia de troca valva aórtica grave ainda permanece controverso. Apesar de historicamente o prognóstico dos pacientes nesse subgrupo ser considerado benigno, evidências atuais demonstram pior evolução clínica...

Collagen, fibrinogen and thrombin biological addesive is effective in treating experimental liver injuries.

OBJECTIVE: : to evaluate the effectiveness of a collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injury in rats. METHODS: : the study included 30 Wistar rats randomly divided into three groups: A, B and C. All underwent standard liver traumatic injury. In group A the lesion was treated with the adhesive; in group B, with conventional absorbable suture; and in group C, there was no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS: : there was no statistical difference in relation to mortality (p = 0.5820). The group treated with the adhesive showed the lowest hemostasis times (p = 0.0573, odds ratio 13.5) and lower incidence of adhesions (p = 0.0119). Microscopic histological alterations of Groups A and B were similar, with foreign body granuloma formation separating the adhesive material or the suture from the hepatic stroma. CONCLUSION: : the adhesive of collagen associated with fibrinogen and thrombin was effective in the treatment of experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO: avaliar a eficácia de um adesivo à base de colágeno associado a fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS: foram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A a lesão foi tratada com o adesivo, no grupo B com sutura convencional com fio absorvível e no grupo C não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente, as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO: o estudo concluiu que o adesivo de colágeno associado a fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries.

OBJECTIVE: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. METHODS: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. CONCLUSION: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries / O adesivo biológico de colágeno, fibrinogênio e trombina é eficaz no tratamento de lesões hepáticas experimentais

ABSTRACT Objective: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. Methods: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. Conclusion: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.

RESUMO Objetivo: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. Métodos: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. Resultados: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. Conclusão: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

Subcutaneous Immunotherapy Improves the Symptomatology of Allergic Rhinitis

Introduction The relevance of allergic rhinitis is unquestionable. This condition affects people s quality of life and its incidence has increased over the last years. Objective Thus, this study aims to analyze the effectiveness of subcutaneous injectable immunotherapy in cases of nasal itching, sneeze, rhinorrhea and nasal congestion in allergic rhinitis patients. Methods In the present study, the same researcher analyzed the records of 281 patients. Furthermore, the researchers identified allergens through puncture cutaneous tests using standardized extracts containing acari, fungi, pet hair, flower pollen, and feathers. Then, the patients underwent treatment with subcutaneous specific immunotherapy, using four vaccine vials for desensitization, associated with environmental hygiene. The authors analyzed conditions of nasal itching, sneeze, rhinorrhea, and nasal congestion throughout the treatment, and assigned them with a score ranging from zero (0), meaning absence of these symptoms to three (3), for severe cases. The symptoms were statistically compared in the beginning, during, and after treatment. Results In this study, authors analyzed the cases distribution according to age and the evolution of symptomatology according to the scores, comparing all phases of treatment. The average score for the entire population studied was 2.08 before treatment and 0.44 at the end. These results represent an overall improvement of ±79% in symptomatology of allergic rhinitis in the studied population. Conclusion The subcutaneous immunotherapy as treatment of allergic rhinitis led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions.

Subcutaneous Immunotherapy Improves the Symptomatology of Allergic Rhinitis.

Introduction The relevance of allergic rhinitis is unquestionable. This condition affects people's quality of life and its incidence has increased over the last years. Objective Thus, this study aims to analyze the effectiveness of subcutaneous injectable immunotherapy in cases of nasal itching, sneeze, rhinorrhea and nasal congestion in allergic rhinitis patients. Methods In the present study, the same researcher analyzed the records of 281 patients. Furthermore, the researchers identified allergens through puncture cutaneous tests using standardized extracts containing acari, fungi, pet hair, flower pollen, and feathers. Then, the patients underwent treatment with subcutaneous specific immunotherapy, using four vaccine vials for desensitization, associated with environmental hygiene. The authors analyzed conditions of nasal itching, sneeze, rhinorrhea, and nasal congestion throughout the treatment, and assigned them with a score ranging from zero (0), meaning absence of these symptoms to three (3), for severe cases. The symptoms were statistically compared in the beginning, during, and after treatment. Results In this study, authors analyzed the cases distribution according to age and the evolution of symptomatology according to the scores, comparing all phases of treatment. The average score for the entire population studied was 2.08 before treatment and 0.44 at the end. These results represent an overall improvement of ∼79% in symptomatology of allergic rhinitis in the studied population. Conclusion The subcutaneous immunotherapy as treatment of allergic rhinitis led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions.