Lateral Gradual Opening Osteotomy of the Tibia With Monolateral External Fixator for Correcting the Valgus Deformity of the Tibia.

The valgus deformity in the tibia requires correction because it places increased pressure on the lateral compartment of the knee, intensifying the degenerative process. Correction strategies are diverse and depend on patient profile, age, and soft-tissue conditions as well as the orthopaedic surgeon's experience with different surgical materials. Deformity size and location are the primary factors contributing to material and shape choice, whether gradual or acute. The only gradual correction approach involves the use of a monolateral or circular external fixator. This is the only indication for correction in cases of excellent deformity, soft-tissue involvement, and a history of bone infection. This study aimed to present a gradual correction technique for tibial valgus deformity using a monolateral external fixator as well as its postoperative follow-up. This technique has the advantages of greater patient acceptance, lighter assembly, and briefer distraction owing to the use of a single piece as well as the ability of the operated limb to bear a load the day after the surgical procedure and dynamic outpatient follow-up.

Controlled Double Gradual Opening Osteotomy for the Treatment of Severe Varus of the Knee-Blount's Disease.

Varus deformity of the knee can lead to early degeneration of the medial tibiofemoral joint. Pediatric patients can be pathologically affected with this deformity known as Blount disease. The cause of this pathology is still uncertain, but some risk factors are well established, such as obesity and family history. The diagnosis is made through clinical history, physical examination, and the radiographic analysis after the age of 2.5 years. The analysis of the metaphyseal-diaphyseal angle, described by Levine and Drennan, is also commonly used for prognosis. When this angle is greater than 16°, it is considered to be grossly abnormal. Possible options for correcting the generated angular deformity are epiphysiodesis, osteotomy (acute or gradual correction), and gradual correction by distraction of the physis. In this surgical technique, we performed a double tibial osteotomy with controlled gradual opening using monolateral external fixator (Orthofix, Verona, Italy). Our technique proved to be an effective way to correct the adolescent tibia vara and is practical and reproducible. Moreover, the use of gradual opening osteotomy allowed a more accurate outcome.

Minimally Invasive Quadricepsplasty.

A modification of range of motion of the knee can significantly change a patient's quality of life. In general, range of motion of 0° to 125° is adequate for most activities of daily life. The rate of knee arthrofibrosis after ligament reconstruction is reported to be between 0% and 4%; after tibial fracture due to high-energy trauma, the rate is about 7%, with an undetermined incidence after limb lengthening. The purpose of this study was to describe a modification of the operative technique of Judet. We describe minimally invasive quadricepsplasty in 4 steps, aiming to obtain an end result with an arc of movement of at least 120° to 130°. We believe that our technique is a good option for the treatment of the stiff knee, having low morbidity and being an easy method to perform.

Complete Sequences of Two Plasmids Found in a Brazilian Bacillus thuringiensis Serovar israelensis Strain.

Plasmids play a crucial role in the evolution of bacterial genomes by mediating horizontal gene transfer. In this work, we sequenced two plasmids found in a Brazilian Bacillus thuringiensis serovar israelensis strain which showed 100% nucleotide identities with Bacillus thuringiensis serovar kurstaki plasmids.

Selection and characterization of Bacillus thuringiensis isolates with a high insecticidal activity against Spodoptera frugiperda (Lepidoptera: Noctuidae) / Seleção e caracterização de isolados de Bacillus thuringiensis com Alta atividade inseticida contra Spodoptera frugiperda (Lepidoptera: Noctuidae)

Spodoptera frugiperda (SMITH, 1797) (Lepidoptera: Noctuidae) affects diverse crops of great economic interest, for instance, it can cause severe yield losses in maize, rice and sorghum. In this study, a selection and characterization of Bacillus thuringiensis (BERLINER, 1911) isolates with a high insecticidal activity against S. frugiperda was performed. Fifty-two crystal-forming B. thuringiensis isolates that were identified from 3384 Bacillus-like colonies were examined and screened by PCR for the presence cry genes (cry1, cry1Aa, cry1Ab, cry1Ac, cry1D, cry2 and cry2Ab). Four isolates that showed high toxicity towards S. frugiperda were shown to harbor cry2 genes. The crystals were analyzed by electron microscopy and showed bipyramidal and cuboidal shapes. Furthermore, these four isolates had lethal concentration (LC50) values of 44.5 ng/cm2 (SUFT01), 74.0 ng/cm2 (SUFT02), 89.0 ng/cm2 (SUFT03) and 108 ng/cm2 (SUFT 04) to neonate S. frugiperda larvae. An ultrastructural analysis of midgut cells from S. frugiperda incubated with the SUFT01 spore-crystal complex showed disruptions in cellular integrity and in the microvilli of the midgut columnar cells. The isolates characterized in this work are good candidates for the control of S. frugiperda, and could be used for the formulation of new bioinsecticides.

Spodoptera frugiperda (SMITH, 1797) (Lepidoptera: Noctuidae) afeta diversas culturas de grande interesse econômico, por exemplo, pode causar severas perdas em milho, arroz e sorgo. Neste estudo, foi realizada uma seleção e caracterização de isolados de Bacillus thuringiensis (BERLINER, 1911) com elevada atividade inseticida contra S. frugiperda. Cinquenta e dois isolados formadores de cristal B. thuringiensis que foram identificados a partir de 3384 colônias foram examinados e testados por PCR para a presença dos genes cry (cry1, cry1Aa, cry1Ab, cry1Ac, cry1D, cry2 e cry2Ab). Quatro isolados que apresentaram alta toxicidade contra S. frugiperda foram mostrados para abrigar os genes cry2. Os cristais foram analisados por microscopia eletrônica e mostraram formas bipiramidais e cúbicas. Os valores da concentração letal (CL50) destes quatro isolados foram de 44,5 ng / cm2 (SUFT01), 74,0 ng / cm2 (SUFT02), 89,0 ng / cm2 (SUFT03) e 108 ng / cm2 (suft 04) para larvas recém-eclodidas de S. frugiperda. Uma análise ultra-estrutural das células do intestino médio de S. frugiperda incubadas com complexo esporo-cristal do isolado SUFT01 mostrou rupturas na integridade celular e microvilosidades das células cilíndricas do intestino médio. Neste estudo, o alto nível de atividade inseticida de isolados os torna excelentes candidatos para o controlo de S. frugiperda, e pode proporcionar alternativas no controle destas populações de pragas, bem como a formação de novos bioinsecticidas.

Use of the inverted "T" incision to approach a plantar nodular lesion.

Knowledge of the inverted "T" incision--used in plastic, oncologic and orthopedic surgery--has allowed its adaptation for the diagnostic assessment and therapeutical approach of acral, nodular lesions. The authors describe the use of this technique for the surgical approach of a patient with a plantar nodular lesion, further diagnosed as a calcified angioleiomyoma.

Case for diagnosis.

We report the case of an 11-year-old male patient with a histopathological and immunohistochemical diagnosis of dermatofibroma with an atypical clinical presentation on the right forearm. Although dermatofibroma is considered a benign skin tumor, some of its differential diagnoses, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, are truly aggressive. Lesions with atypical clinical aspects and topology associated with specific histopathological variants are some of the criteria for complete tumor excision.

Case for diagnosis

We report the case of an 11-year-old male patient with a histopathological and immunohistochemical diagnosis of dermatofibroma with an atypical clinical presentation on the right forearm. Although dermatofibroma is considered a benign skin tumor, some of its differential diagnoses, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, are truly aggressive. Lesions with atypical clinical aspects and topology associated with specific histopathological variants are some of the criteria for complete tumor excision.

Eritema pigmentar fixo simulando herpes labial relacionado ao uso de fluconazol / Fixed drug eruption simulating herpes labialis related to fluconazole

O eritema pigmentar fixo geralmente representa uma reação cutânea adversa a medicamentos caracterizada pelo surgimento de lesões eritematosas arredondadas ou ovais que recorrem no mesmo sítio em minutos a horas após uma nova exposição ao medicamento previamente utilizado. As lesões podem ser únicas ou múltiplas e esmaecem em poucos dias deixando pigmentação hipercrômica residual, sendo os anti-inflamatórios e antibióticos, frequentes causadores. Já o herpes labial é causado principalmente pelo HSV1 e se manifesta com vesículas agrupadas sobre base eritematosa com posterior evolução para crostas e pode ser desencadeado por estresse, trauma etc. O objetivo do presente trabalho é demonstrar um caso de eritema pigmentar fixo simulando herpes labial, relacionado ao uso de fluconazol, visto que existem relativamente poucos relatos desta associação na literatura médica...

Estudo etnográfico e de satisfação de profissionais e usuários do Programa de Saúde da Família em Samambaia, Distrito Federal / Ethnographic study and the satisfaction of Professionals and users of the Family Health Program in Samambaia, Federal District, Brazil

Avaliar o nível de satisfação dos usuários e dos profissionaisdo PSF na área de abrangência do Centro de Saúde n.º03, emSamambaia, Distrito Federal.

Assess the level of users and professional’s satisfaction of FHP in the area covered by the Health Centre No.03 in Samambaia, Distrito Federal.

Epifisiólise proximal do fêmur: análise da fixação profilática do quadril contralateral / Slipped capital femoral epiphysis: prophylactic pinning of the contralateral hip analysis

Vinte e um pacientes foram submetidos à fixação profilática do quadril contralateral na epifisiólise proximal do fêmur, utilizando um único parafuso AO 6,5mm no mesmo ato cirúrgico da fixação do quadril acometido. Obteve-se o fechamento da placa fisária em todos os casos, não tendo ocorrido nenhuma complicação. Em razão dos elevados índices de bilateralidade, na maioria das vezes assintomática, e das possíveis seqüelas, os autores recomendam a fixação profilática como rotina.

Epifisiólise proximal do fêmur: estudo da fixaçäo "in situ" com um parafuso esponjosa AO 6.5mm / Slipped capital femoral epiphysis: a study of fixation with a single AO 6.5 mm screw

Foram estudados 46 quadris com diagnóstico de epifisiólise proximal do fêmur submetidos à fixaçao in situ através da colocaçao de um único parafuso tipo esponjosa AO de 6,5mm de diâmetro. Através do estudo radiográfico, avaliaram-se o posicionamento dos parafusos e o fechamento da placa fisária, assim como foi pesquisada a presença de escorregamento adicional. Os resultados funcionais foram avaliados pelos critérios de Heyman & Herndon, tendo sido encontrados 90 por cento de bons resultados no grupo de quadris com escorregamento do tipo I, II e III (pré-escorregamento, leve e moderado). Conseguiu-se o fechamento da placa fisária, evitando-se escorregamento adicional em todos os pacientes analisados, tendo sido relatados como complicaçoes do atos cirúrgicos o hematoma na ferida operatória, a penetraçao nao-diagnosticada do parafuso na articulaçao, a quebra da broca durante o ato cirúrgico, a condrólise e a necrose avascular da cabeça femoral. Em razao dos resultados apresentados, é recomendada a fixaçao in situ com um único parafuso esponjosa AO de 6,5 mm de diâmetro nos casos leves, moderados e nos pré-escorregamentos. Nos escorregamentos graves (tipo IV), outros procedimentos devem ser considerados.