REVIEW OF ARTICULATED ELBOW ORTHOTICS FOR JOINT STIFFNESS REHABILITATION.

Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Review of articulated elbow orthotics for joint stiffness rehabilitation / Revisão de órteses articuladas de cotovelo para reabilitação de rigidez articular

ABSTRACT Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

RESUMO A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Perfil epidemiológico de pacientes queimados internados em centro de referência na cidade de São Paulo / Epidemiological profile of burning patients admitted to a reference center in the São Paulo city

OBJETIVO: Determinar o perfil epidemiológico de pacientes vítimas de queimaduras internados em um centro de tratamento de queimaduras da cidade de São Paulo. MÉTODO: Trata-se de um estudo transversal retrospectivo descritivo de abordagem quantitativa, baseado na análise dos prontuários físicos e do livro de registro do centro de tratamento de queimaduras de um hospital geral da zona norte da cidade de São Paulo, de janeiro de 2014 a dezembro de 2020. Os dados foram coletados por instrumento semiestruturado quanto a etiologia, sexo, faixa etária, classificação de grau de extensão e gravidade de queimaduras definida pelo Ministério da Saúde na Portaria Regulamentadora nº 1274, de 20 de novembro de 2000. RESULTADOS: A amostra foi de 892 pacientes, com 67% do sexo masculino. A faixa etária entre 16 e 59 anos correspondeu a 80,83%. Os agentes etiológicos mais frequentes foram fogo/inflamável, com 57,4%, seguido por escaldo em 26,23%. As queimaduras classificadas como "pequenas" corresponderam a 12,44%, as "médias" 34,42 % e as "grandes" 53,14%. CONCLUSÃO: O estudo demonstrou um perfil epidemiológico compatível com centros especializados em queimaduras, ressaltando a importância destes estudos para a definição e implantação de estratégias com principal foco na educação populacional, resultando na prevenção para a redução progressiva da prevalência das queimaduras.

OBJECTIVE: To determine the epidemiological profile of burn victim patients admitted to a burn treatment center in the São Paulo city. METHODS: This is a descriptive retrospective cross-sectional study with a quantitative approach, based on the analysis of the physical records and the record book of the burn treatment center at a general hospital in the northern part of the city of São Paulo, from January 2014 to December 2020. Data were collected using a semistructured instrument regarding etiology sex, age group, degree of corporal extent and severity classification of burns defined by the Ministry of Health through Regulatory Ordinance No. 1274 of November 20, 2000. RESULTS: The sample consisted of 892 patients, with 67% male. The age group between 16 and 59 years corresponded to 80.83%. The most frequent etiological agents were fire / flammable with 57.4%, followed by scald in 26.23%. Burns classified as "small" corresponded to 12.44%, "medium" 34.42% and "large" "53.14%. CONCLUSION: The study demonstrated an epidemiological profile compatible with specialized burn centers, emphasizing the importance of these studies for the definition and implementation of strategies with a main focus on population education, resulting in the prevention for progressive reduction in the prevalence of burns.

Instrumento de Marcação de Abdominoplastia / Abdominoplasty Marking Instrument

Introdução: A abdominoplastia, um dos procedimentos de cirurgia plástica mais comuns no Brasil, ficou em quarto lugar no ranking mundial, segundo dados da International Society of Aesthetic Plastic Surgery. Diversas técnicas cirúrgicas visam restaurar o contorno abdominal. A indicação da técnica utilizada deve visar a melhoria da deformidade individual presente no abdome. A marcação da abdominoplastia se faz por meio de régua, transferidor, compasso, fio de náilon, palito, canetas e/ou azul de metileno, de acordo com a preferência do cirurgião. O objetivo é produzir um instrumento cirúrgico com a finalidade de otimizar o tempo de marcação no procedimento de abdominoplastia. Métodos: O estudo foi aprovado pelo Comitê de Ética em Pesquisa, foram desenvolvidos desenhos gráficos para identificar cada uma das partes do instrumento, foi realizada a busca de anterioridade e, posteriormente, realizado o pedido de patente. Resultados: Foi desenvolvido um instrumento para marcação da abdominoplastia, que configura uma régua horizontal que recepciona uma régua vertical no seu ponto médio e duas réguas pivotantes com transferidor basal, todas essas peças milimetradas e com vazado central, que permitem o risco nessa região com o azul de metileno ou caneta afim e, por conseguinte, a marcação do procedimento de abdominoplastia. Além disso, também funciona como compasso e de cujas laterais derivam réguas pivotantes com transferidor de grau basal. Conclusão: O instrumento desse estudo foi criado para minimizar a quantidade de material utilizado e otimizar o tempo da marcação da abdominoplastia.

Introduction: Data from the International Society of Aesthetic Plastic Surgery indicate that abdominoplasty is the fourth most common plastic surgery performed worldwide. Several surgical techniques aim to restore the abdominal contour. The indication for the technique used should aim to improve any individual deformity present in the abdomen. Abdominoplasty marking is done using a ruler, protractor, compass, nylon thread, toothpick, pen, and/or methylene blue, according to the surgeon's preference. Here we aimed to produce a surgical instrument that optimizes the abdominoplasty marking procedure. Methods: The study was approved by the ethics research committee. Graphic designs were developed to identify each part of the instrument, a precedence search was performed, and a patent application was requested. Results: We developed an abdominoplasty marking instrument consisting of a horizontal ruler that receives a vertical ruler at its midpoint, two pivotal rulers with a basal protractor, all marked in millimeters, and a central area that allows marking in this region with methylene blue or a pen. Moreover, it acts as a compass and features side pivotal rulers derived from a basal grade protractor. Conclusion: The instrument developed in this study was designed to minimize the amount of material used and optimize abdominoplasty marking time.

Ventilatory function and intra-abdominal pressure in patients who underwent abdominoplasty with plication of the external oblique aponeurosis.

BACKGROUND: After correction of rectus diastasis there is a change in the values obtained by spirometry in the first few postoperative days. In specific cases, a plication of the external oblique aponeurosis in addition to plication of the anterior rectus sheath is indicated. Therefore, the aim of this study was to evaluate ventilatory function and intra-abdominal pressure (IAP) in patients who underwent abdominoplasty with the plication of the anterior rectus sheath, associated with an "L-shaped" plication of the external oblique aponeurosis. METHODS: Eighteen female patients, classified as Nahas type III or B, were selected. Spirometry was performed preoperatively and on the 2nd, 7th, and 15th days after surgery. Intraoperatively, the IAP was measured at five points in the surgical procedure: (1) before skin incision, (2) after the plication of the rectus abdominis muscle, (3) after the L-plication of the aponeurosis of the external oblique, (4) after skin closure, and (5) after the use of a compressive garment. RESULTS: There was a significant reduction in spirometry values after surgery. There was no correlation between body mass index (BMI), pain, the increase of IAP, and the width of diastasis and changes in spirometry (p ≤ 0.05) in any of the postoperative evaluations. CONCLUSION: Spirometric parameters change on the 2nd and 7th postoperative days and tend to normalize on the 15th day. Postoperative pain, BMI, and increased IAP are not related to these changes. The use of compressive garments increases the IAP.

Effect of nasal deviation on quality of life.

BACKGROUND: Nasal deviation is a common complaint in otorhinolaryngology and plastic surgery. This condition not only causes impairment of nasal function but also affects quality of life, leading to psychological distress. The subjective assessment of quality of life, as an important aspect of outcomes research, has received increasing attention in recent decades. Quality of life is measured using standardized questionnaires that have been tested for reliability, validity, and sensitivity. The aim of this study was to evaluate health-related quality of life, self-esteem, and depression in patients with nasal deviation. METHODS: Sixty patients were selected for the study. Patients with nasal deviation (n = 32) were assigned to the study group, and patients without nasal deviation (n = 28) were assigned to the control group. The diagnosis of nasal deviation was made by digital photogrammetry. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey questionnaire; the Rosenberg Self-Esteem/Federal University of São Paulo, Escola Paulista de Medicina Scale; and the 20-item Self-Report Questionnaire. RESULTS: There were significant differences between groups in the physical functioning and general health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (p < 0.05). Depression was detected in 11 patients (34.4 percent) in the study group and in two patients in the control group, with a significant difference between groups (p < 0.05). CONCLUSIONS: Nasal deviation is an aspect of rhinoplasty of which the surgeon should be aware so that proper psychological diagnosis can be made and suitable treatment can be planned because psychologically the patients with nasal deviation have significantly worse quality of life and are more prone to depression. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.(Figure is included in full-text article.).

Mechanical stimulation improves survival in random-pattern skin flaps in rats.

This was a study on the effects of 3-MHz ultrasound at 16- and 100-Hz pulse repetition frequencies on angiogenesis and viability of random-pattern skin flaps in rats. A cranially-based dorsal skin flap was raised in 60 EPM-Wistar rats, which were randomly divided into four groups: control, sham, 16-Hz and 100-Hz groups. The mean percentage of necrosis was as follows: control, 42% ± 13%; sham, 18% ± 13%; 16-Hz group, 13% ± 10%; and 100-Hz group, 15% ± 7%, with significant differences between the control and the other groups (p < 0.001). The mean vascular density was as follows: control, 5% ± 2%; sham, 7% ± 2%; 16-Hz group, 21% ± 4%; and 100-Hz group, 24% ± 10%, with significant differences between control and ultrasound groups, and between the sham and ultrasound groups (p < 0.001). Both ultrasound treatments (16- and 100-Hz PRFs) induced angiogenesis, and sham and ultrasound treatments improved viability of random-pattern skin flaps in rats.

Effect of low-level laser therapy (GaAlAs) on bone regeneration in midpalatal anterior suture after surgically assisted rapid maxillary expansion.

OBJECTIVE: The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME). METHODS: Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software. RESULTS: Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group. CONCLUSION: Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements.

Nicotine on rat TRAM flap.

PURPOSE: The transverse rectus abdominis myocutaneous (TRAM) flap is one of the preferential techniques used in breast reconstruction following mastectomy. Nicotine has a detrimental effect on cutaneous flap survival; although there are no experimental studies proving this effect on musculocutaneous flaps. The aim of this study is to verify the effect of nicotine on the rat TRAM flap. METHODS: 30 Wistar EPM-1 rats were randomly distributed in two groups: control and experimental. The animals of the control group received saline solution injected subcutaneously, in a volume of 0.2 ml, twice a day, during 28 days in the preoperative period. The animals of the experimental group were treated with nicotine, injected subcutaneously, in a dose of 2 mg/kg twice a day, during 28 days in the preoperative period. All the animals were submitted to the caudally based, right unipedicled TRAM flap. 48 hours after the procedure, a study of the viable area of the flap was done through photographic documentation. Statistical analysis was performed with nonparametric Mann-Whitney's test. RESULTS: The experimental group had significantly greater area of necrosis when compared with the control group (p<0.001). CONCLUSION: Nicotine increased the area of necrosis of the TRAM flap, in rats.

Nicotine on rat TRAM flap / Nicotina em retalho TRAM em ratos

PURPOSE: The transverse rectus abdominis myocutaneous (TRAM) flap is one of the preferential techniques used in breast reconstruction following mastectomy. Nicotine has a detrimental effect on cutaneous flap survival; although there are no experimental studies proving this effect on musculocutaneous flaps. The aim of this study is to verify the effect of nicotine on the rat TRAM flap. METHODS: 30 Wistar EPM-1 rats were randomly distributed in two groups: control and experimental. The animals of the control group received saline solution injected subcutaneously, in a volume of 0.2 ml, twice a day, during 28 days in the preoperative period. The animals of the experimental group were treated with nicotine, injected subcutaneously, in a dose of 2 mg/kg twice a day, during 28 days in the preoperative period. All the animals were submitted to the caudally based, right unipedicled TRAM flap. 48 hours after the procedure, a study of the viable area of the flap was done through photographic documentation. Statistical analysis was performed with nonparametric Mann-Whitney's test. RESULTS: The experimental group had significantly greater area of necrosis when compared with the control group (p<0.001). CONCLUSION: Nicotine increased the area of necrosis of the TRAM flap, in rats.

OBJETIVOS: O retalho musculocutâneo transverso do músculo reto do abdome (TRAM) é uma das principais opções na reconstrução do relevo mamário pós-mastectomia. A nicotina tem efeito deletério na viabilidade de retalhos cutâneos; porém, não foram encontrados trabalhos experimentais comprovando este efeito em retalhos musculocutâneos. O objetivo deste trabalho é investigar o efeito da nicotina na viabilidade do retalho TRAM, em ratos. MÉTODOS: Foram utilizados 30 ratos da linhagem Wistar EPM-1. Os animais foram distribuídos aleatoriamente em dois grupos: controle e experimento. Os animais do grupo controle foram tratados com solução salina injetada no tecido celular subcutâneo num volume de 0,2 ml, duas vezes ao dia, durante 28 dias no período pré-operatório. Os animais do grupo experimento foram tratados com nicotina injetada no tecido celular subcutâneo em uma dose de 2mg/kg/2 vezes ao dia, durante 28 dias no período pré-operatório. Todos os animais foram submetidos ao procedimento do retalho TRAM de base caudal unilateral à direita (pedículo não dominante). 48 horas depois, foi feita a avaliação da área viável de superfície do retalho, por documentação fotográfica. Para análise dos resultados foram utilizados testes não paramétricos: Mann-Whitney. RESULTADOS: O grupo experimento apresentou uma área de necrose maior, quando comparado com o grupo controle (p<0,001). CONCLUSÃO: A nicotina aumentou a área de necrose do retalho TRAM, em ratos.

Effect of nicotine treatment and withdrawal on random-pattern skin flaps in rats.

BACKGROUND: Tobacco use is associated with a high incidence of skin necrosis after surgery. The ideal timing for the cessation of tobacco use before plastic surgery has not, however, been precisely determined. The aim of this work was to define the ideal duration of nicotine withdrawal prior to random-pattern skin flap surgery in rats. METHODS: Groups of 11 animals were subcutaneously injected with saline or nicotine (2mg/kg) twice a day and subjected to random-pattern skin flap surgery according to the following protocol: Group I: continuously injected with saline 4 weeks before and 1 week after the surgery; Group II: injected with nicotine for 4 weeks until the day of the surgery; Group III: injected with nicotine for 4 weeks until one day before the surgery; Group IV: injected with nicotine for 4 weeks until 5 days before the surgery; Group V: injected with nicotine for 4 weeks until 10 days before the surgery; Group VI: continuously injected with nicotine for 4 weeks before and 1 week after the surgery. McFARLANE skin flaps were performed on the dorsal skin, and the rats were sacrificed 1 week after the surgery. RESULTS: The necrotic area was smaller in group I (8.85cm2) than in group II (12.15cm2), III (12.88cm2) and VI (14.84cm2) (ANOVA p<0.0001). There was no difference between groups I, IV (10.13cm2) and V (9.27cm2). CONCLUSIONS: In conclusion, 5 days before surgery was considered the ideal time for nicotine withdrawal in this experimental model.

[Impact of obesity on the functional capacity of women]. / Impacto da obesidade na capacidade funcional de mulheres.

OBJECTIVE: The aim of this study was to evaluate the functional capacity of obese, overweight and eutrophic women. METHODS: An analytical cross study involved 90 adult women from 40 to 60 years of age, distributed in three groups: eutrophic (n=30), overweight (n=30) and obese (n=30).Patients were interviewed by means of the specific health related quality of life questionnaire, Stanford Health Questionnaire (HAQ-20). They were also submitted to an exercise test to compare the maximal oxygen uptake (VO2max) among the three groups. Statistical analysis included the chi-square test, the Kruskal Wallis variance analysis and the Spearman and Pearson correlations for p= 0.05. RESULTS: The group of obese women presented HAQ-20 (0.375) score rates significantly higher (p<0.05) than the other groups (0), reflecting lesser functional capacity. The obese group presented VO2max score rates (25.8+/-5.0ml/kg/min), significantly lower (p<0.001) than the overweight (29.9+/-6.1ml/kg/min) and eutrophic (33.8+/-4,1ml/kg/min) groups, indicating a poorer cardio respiratory aptitude. There was no significant difference between the eutrophic and overweight VO2max and HAQ-20 score rates. Hypertension was more frequent among obese women (p=0.012) who also presented a lower level of schooling p= 0.026). CONCLUSION: Obese women presented a poorer physical aptitude and lesser functional capacity in relation to those in the eutrophic and overweight groups Furthermore, the obese also exhibited a worse prognosis for cardiovascular disease.

Impacto da obesidade na capacidade funcional de mulheres / Impact of obesity on the functional capacity of women

OBJETIVO: Avaliar a capacidade funcional em mulheres eutróficas, com sobrepeso e obesas. MÉTODOS: Estudo transversal analítico envolvendo 90 mulheres adultas com idade entre 40 e 60 anos, alocadas em três grupos de acordo com a classificação do índice de massa corporal: eutróficas (n=30), sobrepeso (n=30) e obesas (n=30). As pacientes foram entrevistadas usando um instrumento de avaliação de qualidade de vida específico para capacidade funcional o Stanford Health Assessment Questionnaire (HAQ-20). Também foram submetidas a teste de esforço para comparação do consumo máximo de oxigênio (VO2max) entre os três grupos. Para análise estatística foram usados o teste do Qui quadrado, a análise de variância de Kruskal-Wallis e as correlações de Spearman e Pearson para p= 0,05. RESULTADOS: As mulheres obesas apresentaram escores do HAQ-20 (0,375) significantemente maiores (p<0,05) do que os outros grupos (0), refletindo pior capacidade funcional. O grupo obesas apresentou valores de VO2max (25,8±5,0ml/kg/min) significantemente menores (p<0,001) que sobrepeso (29,9±6,1ml/kg/min) e eutróficas (33,8±4,1ml/kg/min), indicando pior aptidão cardiorrespiratória. Não houve diferença significante entre eutróficas e sobrepeso para VO2max e escores do HAQ-20. A hipertensão arterial foi mais freqüente nas mulheres obesas (p=0,012) que também apresentaram menores níveis de escolaridade (p= 0,026). CONCLUSÃO: As mulheres obesas apresentaram redução da aptidão física e da capacidade funcional em relação às eutróficas e sobrepeso, o que vem se somar ao pior prognóstico para doenças cardiovasculares dessas pacientes.

OBJECTIVE: The aim of this study was to evaluate the functional capacity of obese, overweight and eutrophic women. METHODS: An analytical cross study involved 90 adult women from 40 to 60 years of age, distributed in three groups: eutrophic (n=30), overweight (n=30) and obese (n=30).Patients were interviewed by means of the specific health related quality of life questionnaire, Stanford Health Questionnaire (HAQ-20). They were also submitted to an exercise test to compare the maximal oxygen uptake (VO2max) among the three groups. Statistical analysis included the chi-square test, the Kruskal Wallis variance analysis and the Spearman and Pearson correlations for p= 0.05. RESULTS: The group of obese women presented HAQ-20 (0.375) score rates significantly higher (p<0.05) than the other groups (0), reflecting lesser functional capacity. The obese group presented VO2max score rates (25.8±5.0ml/kg/min), significantly lower (p<0.001) than the overweight (29.9±6.1ml/kg/min) and eutrophic (33.8±4,1ml/kg/min) groups, indicating a poorer cardio respiratory aptitude. There was no significant difference between the eutrophic and overweight VO2max and HAQ-20 score rates. Hypertension was more frequent among obese women (p=0.012) who also presented a lower level of schooling p= 0.026). CONCLUSION: Obese women presented a poorer physical aptitude and lesser functional capacity in relation to those in the eutrophic and overweight groups Furthermore, the obese also exhibited a worse prognosis for cardiovascular disease.

Dimethyl sulfoxide as a block to the deleterious effect of nicotine in a random skin flap in the rat.

BACKGROUND: In plastic surgery, a causal relationship between heavy smoking and flap necrosis has been shown. The deleterious effect of nicotine in random skin flaps in rats has also been proven, being related to vasoconstriction and possibly reactive oxygen species. This study aimed to verify the capacity of dimethyl sulfoxide, an antioxidant, to block the deleterious effect of nicotine in a random skin flap. METHODS: Fourteen adult male Wistar-EPM rats were distributed at random into two groups of seven animals. The nicotine group received this drug subcutaneously (1.2 mg/kg/day), for 1 week before flap elevation. The nicotine plus dimethyl sulfoxide group followed the same routine. Five minutes before the surgical procedure, rats in the nicotine group received distilled water orally and rats in the nicotine plus dimethyl sulfoxide group received dimethyl sulfoxide orally (2 ml/kg). Blood and skin tissue samples were collected to allow determination of malondialdehyde levels. RESULTS: The nicotine group had a mean value of 40.2 percent and the nicotine plus dimethyl sulfoxide group had a mean value of 20.6 percent necrosis (p = 0.009). Malondialdehyde levels in both serum and skin samples were lower in the animals that received dimethyl sulfoxide. CONCLUSION: The deleterious effect of nicotine was effectively blocked by dimethyl sulfoxide.

Auto-estima em pacientes com carcinomas de pele / Self-esteem outcomes among non melanoma skin cancer patients

OBJETIVO: Avaliar a auto-estima de pacientes com carcinomas de pele da face e do pescoço. MÉTODOS: Foram estudados 100 pacientes, com idades entre 30 e 90 anos (mediana = 55 anos), sendo 44 eram do gênero masculino e 56 do gênero feminino. O Grupo Estudo foi composto por 50 pacientes portadores de carcinomas de pele na face e no pescoço, com tamanho igual ou maior a 10 mm no seu maior eixo e com diagnóstico confirmado por biópsia prévia. O Grupo Controle consistiu de 50 indivíduos da população geral. Para avaliação da auto-estima, utilizou-se a Escala de Auto-estima de Rosenberg / UNIFESP-EPM. A análise estatística utilizou com o teste de Mann-Whitney e a Análise de Variância de Kruskal Wallis. RESULTADOS: Os pacientes portadores de câncer de pele e os da população geral não apresentaram diferenças significantes em relação à idade (p=0,331), gênero e escolaridade. O tamanho médio do tumor foi 20,9 + 2 mm. Os pacientes com câncer de pele apresentaram auto-estima significantemente mais baixa, com escore médio de 6,84 e 3,90 para o Grupo Controle (p=0,002). CONCLUSÃO: Os pacientes com câncer de pele na face e no pescoço apresentaram auto-estima menor do que os pacientes sem câncer.

BACKGROUND: To evaluate self-esteem among patients with skin cancer of the face and the neck area. METHODS: One hundred patients were studied, with ages ranging between 30 and 90 years old (median = 55 years old). There were 44 males and 56 females. We divided them in two groups. One group had fifty patients with skin cancers, equal or larger than 10mm in the greater axis, and the pathological status was confirmed by previous biopsy. The control group had 50 patients without skin cancer. Rosenberg/UNIFESP-EPM's Self-esteem Scale was used to evaluate self-esteem. Data were analyzed by Mann - Whitney's test and Kruskal Wallis test. RESULTS: There was no significant difference between the two groups in relation to age (p = 0.331), sex and education. The mean tumor size was 20.9 ± 2 mm. Skin cancer patients presented significantly lower self-esteem, with average score of 6.84 and 3.90 for the control group (p = 0.002). CONCLUSION: Patients with skin cancer of the head and neck presented lower self-esteem than individuals without cancer.

Ultrasonography for measuring rectus abdominis muscles diastasis.

PURPOSE: Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. METHODS: Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. RESULTS: There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. CONCLUSION: Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.

Ultrasonography for measuring rectus abdominis muscles diastasis

PURPOSE: Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. METHODS: Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. RESULTS: There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. CONCLUSION: Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.

OBJETIVO: Estudos radiológicos pré-operatórios podem ser úteis para determinar a posição dos músculos retos do abdome antes de sua correção. O objetivo deste estudo é avaliar a acurácia da ultra-sonografia para medir a largura da diástase dos músculos retos do abdome. MÉTODOS: A diástase dos músculos retos foi medida pela ultra-sonografia, no pré-operatório em 20 mulheres. A diástase dos retos foi medida em sete níveis da bainha anterior dos retos foram examinados com ultra-som após inspiração profunda sustentada e após expiração. A diástase dos retos, nos mesmos níveis, foi também medida após sua exposição durante a abdominoplastia, por dois observadores independentes, usando compasso cirúrgico. As medidas foram comparadas usando o teste estatístico de Wilcoxon para dados não independentes. RESULTADOS: Não houve diferença significante entre as medidas ultra-sonográficas e intra-operatórias nos níveis supra-umbilicais e na cicatriz umbilical. Todavia, inferiormente à cicatriz umbilical, essas medidas diferiram significantemente sendo as ultra-sonográficas menores nestes pontos. CONCLUSÃO: A ultra-sonografia é um método acurado para medir a diástase de retos na região supra- umbilical e no nível do umbigo.

Influência da hipertrofia mamária na capacidade funcional das mulheres / Influence of breast hypertrophy in the women's functional capacity

OBJETIVO: investigar a influência da hipertrofia mamária no sistema musculoesquelético por meio da avaliação da capacidade funcional das mulheres. MÉTODO: foram avaliadas 50 mulheres com hipertrofia mamária, e os resultados foram comparados com os de 50 mulheres com mamas normais. Para avaliação da capacidade funcional, utilizou-se o STANFORD HEALTH ASSESSMENT QUESTIONNAIRE 20 (HAQ-20), que consiste de 20 questões sobre atividades do cotidiano em que a entrevistada tem quatro opções de resposta, que são pontuadas. Quanto menor a pontuação, melhor a capacidade funcional. RESULTADOS: a média dos escores do grupo-controle foi 0,10 e do grupo-hipertrofia foi igual a 0,71. Esses escores submetidos ao teste de Mann-Whitney mostraram que o grupo-hipertrofia apresentou valores significantemente maiores do que o grupo-controle (p < 0,00). CONCLUSÃO: mulheres com hipertrofia mamária apresentam menor capacidade funcional, ou seja, mais dificuldade para realizar atividades comuns da vida diária.

OBJECTIVE: to investigate the influence of breast hypertrophy in the musculoskeletal-system through the evaluation of the functional capacity in women. METHOD: 50 women with breast hypertrophy were studied and the results were compared to the 50 women without breast hypertrophy. The STANFORD HEALTH ASSESSMENT QUESTIONNAIRE 20 (HAQ-20) was applied to assess the functional capacity. It contains 20 questions about daily activities in which the patient has four answer options, which are scored. Lower scores indicate better functional capacity. RESULTS: the mean score in the control group was 0.10, while in the breast hypertrophy group it was 0.71. When Mann-Whitney test was run, hypertrophy group showed statistically higher scores (p < 0.00). CONCLUSION: breast hypertrophy patients have more difficulties to perform common activities of the daily life.

Transcutaneous electrical nerve stimulation in viability of a random skin flap in nicotine-treated rats.

BACKGROUND: Skin flaps are extensively used in plastic surgery, the main postoperative problems being ischemia and necrosis. Nicotine has acute vasoconstrictive properties, diminishing blood flow and increasing the risk of flap necrosis. Transcutaneous electrical nerve stimulation (TENS) was effective in reducing necrosis in random skin flaps in rats. Therefore, the authors decided to test the efficacy of TENS to reduce necrosis in the presence of nicotine. METHODS: Sixteen adult male Wistar-Escola Paulista de Medicina (EPM) rats were distributed, at random, in 2 groups of 8 animals. The nicotine group (NG) received this drug subcutaneously (1.2 mg/kg/d), for 1 week before flap elevation. The nicotine plus TENS group (NTG) followed the same routine. Immediately after the operative procedure and on the next 2 postoperative days, the treatment group (NTG) was submitted to TENS during an hour under anesthesia. NG animals were sham exposed. After 7 days, the percentages of necrosis were determined. RESULTS: The NG had a mean value of 45% and the NTG, 21% of necrosis, a difference statistically significant (P < 0.001). CONCLUSION: TENS was effective in the reduction of necrosis in this flap model.

Acetylcysteine in random skin flap in rats.

PURPOSE: Analyze the ability of Acetylcysteine to reduce distal necrosis in a random skin flap, in the rat. METHODS: The present study utilized 28 adult male Wistar-EPM rats distributed, at random, in two groups of 14 animals. Control group rats (CG) received distilled water and Acetylcysteine group animals (NACG) received NAC (300 mg/kg) by oral infusion, 15 minutes before flap elevation. On the seventh postoperative day, percentage of distal necrosis was determined and skin samples collected in order to allow determination of MDA levels. RESULTS: The mean necrotic area in CG group (control) was 66% and in NACG group (Acetylcysteine) 52%, a statistically significant difference according to the Mann-Whitney test (U calc = 25; U crit = 45). MDA levels were lower in the CG flap skin samples than in the NACG samples (U calc = 24; U crit = 45), the oposite being true in the normal skin samples (U calc = 10; U crit = 45). CONCLUSION: Acetylcysteine was effective, according to the model used, reducing the percentage of distal necrosis in NACG rats.