Stents in the femoropopliteal territory: prevalence of fractures and their consequences.

OBJECTIVE: Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. To evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. METHOD: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. RESULTS: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). CONCLUSION: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.

Stents in the femoropopliteal territory: prevalence of fractures and their consequences / Stents no território fêmoro-poplíteo: prevalência de fraturas e suas consequências

ABSTRACT Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. Objective: to evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. Method: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. Results: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). Conclusion: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.

RESUMO Os tratamentos endovasculares para a doença arterial obstrutiva fêmoro-poplítea tornaram os procedimentos de revascularização menos invasivos, porém os stents metálicos autoexpansíveis utilizados podem sofrer grande desgaste em artérias com extrema mobilidade. Objetivo: avaliar a prevalência de fraturas em stents implantados no segmento fêmoro-poplíteo, identificar fatores predisponentes e possíveis consequências sobre a patência arterial. Métodos: entre março a junho de 2019, trinta pacientes previamente operados por obstrução fêmoro-poplítea realizaram RX dos stents em incidências ântero-posterior e perfil para detectar fraturas e eco Doppler para analisar a patência arterial. Resultados: observamos 12 casos com fraturas (33,3%): 1 do tipo I (2,8%), 3 do tipo II (8,3%), 5 do tipo III (13,9%), 3 do tipo IV (8,3%) e nenhuma tipo V. Segundo a classificação TASC II, tivemos 1 no grupo B (8,3%), 6 no grupo C (50%) e 5 no grupo D (41,6%) p<0,004. O número de stents por membro foi de 3,1 (±1,3) nos casos de fratura contra 2,3 (±1,3) nos casos sem fratura (p = 0,08). A extensão tratada foi 274,17mm (±100,94) nos casos de fratura e 230,83mm (±135,44) nos casos sem fratura (p=0,29). No Doppler tivemos: 17 pacientes (47,2%) sem estenose, 9 pacientes (25%) com estenose>50% e 10 pacientes (27,8%) com oclusão (p=0,37). Não houve correlação entre fratura e obstrução arterial (p=0,33). Conclusão: as fraturas de stents são um achado frequente no setor fêmoro-poplíteo (33,3%) sendo mais prevalentes nos casos de doença mais avançada TASC II C e D. Não houve associação entre o achado de fratura e obstrução arterial.

Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State.

INTRODUCTION: Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS: Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS: Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS: Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.

Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State

Abstract INTRODUCTION: Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS: Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS: Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.

Ninfoplastia em estrela: técnica para redução dos pequenos lábios vulvares / Star nymphoplasty: a surgical technique for labia minora hypertrophy

Introdução: O cirurgião plástico tem sido consultado com frequência, nos últimos anos, sobre a forma e as dimensões dos pequenos lábios vulvares e outras estruturas circunvizinhas, não só pela questão estética, mas também pela funcional, da dispareunia. Os autores apresentam uma técnica de tratamento estético e funcional da genitália externa feminina, a vulva, com o intuito de corrigir a hipertrofia dos pequenos lábios (ninfas), sem alterar­lhes a forma. Método: A técnica consiste na abordagem do pequeno lábio vulvar, com uma incisão em forma de estrela, produzindo um encurtamento das ninfas tanto ântero-posteriormente como crânio-caudalmente. O estudo é de tipo retrospectivo de um período de 15 anos, com seguimento clínico e cirúrgico de 64 pacientes de sexo feminino, com uma faixa etária entre 14 e 58 anos, todas submetidas à ninfoplastia em estrela, técnica proposta neste estudo. Resultados: Os resultados foram obtidos da ficha dos pacientes operados no período compreendido entre janeiro de 1996 e dezembro de 2011, no Hospital da Lagoa e na Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro-RJ. Alto índice de satisfação das pacientes com o tamanho e o formato estético da genitália. Houve uma baixa taxa de complicações e queixas residuais. Conclusão: Este ato cirúrgico é feito com o objetivo de remanejar a estrutura tecidual hipertrófica dos pequenos lábios vulvares. De um ponto de vista técnico, pode-se considerar como um procedimento simples e eficaz no tratamento tanto funcional como estético da genitália feminina.

Introduction: In recent years, women have been frequently consulting the plastic surgeon concerning the shape and dimensions of the labia minora and other surrounding structures, not only for aesthetic but also functional reasons, e.g., dyspareunia. The authors present a technique for the aesthetic and functional treatment of the external female genitalia, the vulva, with the purpose of correcting hypertrophy of the labia minora (nymphs), without changing their form. Method: This technique consists in the incision in the shape of a star leading to a shortening of nymphs both anteroposteriorly and craniocaudally. This is a 15-year retrospective study, with clinical and surgical follow-up of 64 female patients with an age range between 14 and 58 years, all submitted to star nymphoplasty, the technique proposed in this study. Results: The results were obtained from the patients operated from January 1996 to December 2011, at the Hospital da Lagoa and at Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro, RJ. A high rate of patient satisfaction with the size and aesthetic shape of the genitalia was achieved. There was a low rate of complications and remaining complaints. Conclusion: This surgical procedure is done with the objective of reshaping the tissue structure of the hypertrophic labia minora. From a technical point of view, it can be considered as a simple and effective functional and aesthetic treatment of the female genitalia.

The eutrophic rhytidoplasty: Subdermal tunneling and minimal skin undermining.

BACKGROUND: Patients submitted to rhytidectomy usually relay their desire for briefer surgical procedures and a shorter post-operative period with faster recovery. In view of this, a technique in which the skin of the cervico-mandibular region is not undermined but only detached by blunt dissection was developed. METHODS: A retrospective study of the senior author's experience in eutrophic rhytidoplasty (EUR), the technique proposed herein, for facial rejuvenation was conducted. Patients submitted to EUR over a 10-year period were included in this study. A total of 224 interventions were performed. The procedure consists of using subdermal tunneling, performed with a cannula along the neck region and the midface area (combined or not with liposuction in certain areas, as needed), thus preserving nervous and vascular connections. The conventional skin undermining is minimal, just 4 cm around the auricular pavilion. Data were collected from the patients' medical records at Interclínica-Centroplástica Clinic in Rio de Janeiro, Brazil. RESULTS: Due to the skin eutrophic conditions, the operated patients, using the EUR technique, presented promising esthetical results. The mean rate of complications associated with the proposed technique was 1.7 %. The author found that this technique offers very promising results, a fact evidenced by the lower rate of complications among patients submitted to it. CONCLUSIONS: The EUR is a reliable option for facial rejuvenation due to the fact that it is less invasive, with a low morbidity and rate of complications. Its surgical time is reduced by 50 %, it has a shorter down-time, and yields natural results. Level of Evidence: Level IV, therapeutic study.

Lipofacelift: plástica facial com descolamento mínimo da pele / Lipofacelift: facelift with minimal skin undermining

Introdução: Procedimentos cirúrgicos menos extensos, com tempo de recuperação maiscurto, têm atualmente sido mais solicitados pelos pacientes candidatos à ritidoplastiafacial. Objetivo: Apresentar procedimentos cirúrgicos menos invasivos, que atinjamos objetivos dos pacientes e dos cirurgiões com o menor tempo de recuperação, narealização de ritidoplastias. Método: Dissecação mínima do tegumento cutâneo daface, restrita ao redor da orelha num raio de 4 cm. As restantes áreas do segmento médioda face e cérvico-mandibular são “tunelizadas” mediante cânula de lipoaspiração,somente aspirando o tecido adiposo nos depósitos submentoniano e submandibularquando necessário, mantendo as conexões vásculo-nervosas da pele com o planosubjacente. Foram comparados 309 pacientes operados de ritidoplastias, dos quais 89foram submetidos à técnica proposta e os restantes 220 à técnica convencional de ampladissecação e tratamento do SMAS. Resultados: Os pacientes operados pela técnicaproposta apresentaram melhores resultados estéticos, com preservação da textura e dotrofismo da pele. Conclusões: A técnica proposta permite diminuir o tempo cirúrgicoem 50%, por ser um procedimento menos invasivo e apresentar menor morbidade, alémde melhorar a qualidade do resultado.

Introduction: Less extended surgical procedures with short recovery post-operativeperiod of time have been requested by patients submitted to rhitidectomies. Objective:Study of minimal invasive surgical procedures in facelift that offer the desiredresults in less post-operative recovery period. Method: Four centimeters ratio skinundermining around the ear combined with cannula skin tunneling along the mid-faceand neck regions with or without liposuction according to the necessity, preservingthe nervous-vascular connections with the deep skin plane. 309 patients submitted tofacelift, 89 were operated by this technique and the other 220 patients operated throughconventional procedures by extensive skin undermining and SMAS treatment. Results:Patients operated by the proposed technique presented better aesthetic results due to skinconnection preservation, less secondary skin fibrosis and better skin trophic conditions.Conclusion: These less invasive technical procedures reduce 50% of the surgical time,maintaining the quality of the results with minor morbility.

Síndrome da pálpebra superior flácida / Floppy eyelid syndrome

A Floppy eyelid syndrome é uma desordem de etiologia desconhecida, pouco divulgada em nosso meio, sendo seu conhecimento importante para o diagnóstico diferencial de conjuntivites crônicas de difícil resolução. Afeta predominantemente homens obesos, sendo caracterizada por pálpebras superiores flácidas e facilmente eversíveis, associada à conjuntivite papilar crônica. 0 acometimento é geralmente assimétrico e mais grave no lado sobre o qual o paciente costuma dormir. 0 tratamento cirúrgico consiste no encurtamento horizontal da pálpebra ou na confecção de retalho tarsal. 0 objetivo deste trabalho é fazer uma breve revisão dos dados da literatura existentes, ressaltando os aspectos clínicos, patológicos, diagnósticos e terapêuticos, demonstrando, por meio do relato de um caso clínico, o tratamento cirúrgico recomendado pelos autores.

Histórico da reconstruçäo do nariz: enfoque pessoal ao tema / History of nose reconstruction: personal approach to the theme

O autor apresenta uma revisäo bibliográfica do histórico da cirurgia de reconstruçäo nasal. Dá enfoque pessoal ao tema, valendo-se de sua experiência clínica com 11 retalhos frontais, ponderando sobre a validade atual das cirurgias de reconstruçäo nasal e sua filososfia

Cirurgia reconstrutora da orelha: pós-traumatismo, técnicas de reconstruçäo / Reconstructive surgery of the ear: post-traumatic, reconstruction technics

O autor exemplifica técnicas de reconstruçäo pós-traumática da orelha, apresentando casos de sua experiência pessoal. Dentre os quais, um caso de reconstruçäo total de orelha em zona cutânea desfavorável, enxerto com prótese de Silastic tipo Cronin. É feita discussäo sobre o caso e outros, tecendo comentários sobre outras condutas