A comparison of the efficacy of autologous fibrin glue/platelet-poor plasma versus suction drainage in preventing hematoma and seroma in rhytidectomy: A randomized, double-blind, controlled study.

BACKGROUND: One of the most feared complications of rhytidectomy is the formation of hematoma and seroma, which may harm patients' health and compromise the surgical outcome. OBJECTIVE: To compare the efficacy of autologous fibrin glue/platelet-poor plasma versus suction drainage in preventing surgical complications such as hematoma and seroma following rhytidectomy procedures. METHODS: A prospective, randomized, double-blind, controlled study was conducted to compare the efficacy of the two interventions. Seventy-two patients were selected and divided into two groups of 36 (autologous fibrin glue versus suction drainage). Forty-eight hours after the procedures, all patients underwent ultrasound examination, always by the same radiologist, to measure the volume of exudate under the facial skin flaps. RESULTS: The mean total volume of exudate was 3.21 mL in the suction drainage group and 1.02 mL in the fibrin glue group, with effect size of 68.1% and confidence interval of 55.3 to 77.2 (P < 0.001). CONCLUSIONS: Results significantly favor the use of fibrin glue and show that it was 68.1% more effective than suction drainage in preventing hematoma or seroma in rhytidectomy procedures.

Use of derived adipose stem cells to reduce complications of cutaneous scarring in smokers. An experimental model in rats.

PURPOSE: To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. METHODS: In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. RESULTS: Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. CONCLUSION: The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.

Use of derived adipose stem cells to reduce complications of cutaneous scarring in smokers. An experimental model in rats

Abstract Purpose To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. Methods In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. Results Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. Conclusion The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.

White box: low cost box for laparoscopic training.

BACKGROUND: Laparoscopic surgery is a reality in almost all surgical centers. Although with initial greater technical difficulty for surgeons, the rapid return to activities, less postoperative pain and higher quality aesthetic stimulates surgeons to evolve technically in this area. However, unlike open surgery where learning opportunities are more accessible, the laparoscopic training represents a challenge in surgeon formation. AIM: To present a low cost model for laparoscopic training box. METHODS: This model is based in easily accessible materials; the equipment can be easily found based on chrome mini jet and passes rubber thread and a webcam attached to an aluminum handle. RESULTS: It can be finalized in two days costing R$ 280,00 (US$ 90). CONCLUSION: It is possible to stimulate a larger number of surgeons to have self training in laparoscopy at low cost seeking to improve their surgical skills outside the operating room.

WHITE BOX: LOW COST BOX FOR LAPAROSCOPIC TRAINING / WHITE BOX: CAIXA PARA TREINAMENTO LAPAROSCÓPICO DE BAIXO CUSTO

Background: Laparoscopic surgery is a reality in almost all surgical centers. Although with initial greater technical difficulty for surgeons, the rapid return to activities, less postoperative pain and higher quality aesthetic stimulates surgeons to evolve technically in this area. However, unlike open surgery where learning opportunities are more accessible, the laparoscopic training represents a challenge in surgeon formation.Aim:To present a low cost model for laparoscopic training box. Methods: This model is based in easily accessible materials; the equipment can be easily found based on chrome mini jet and passes rubber thread and a webcam attached to an aluminum handle. Results: It can be finalized in two days costing R$ 280,00 (US$ 90). Conclusion: It is possible to stimulate a larger number of surgeons to have self training in laparoscopy at low cost seeking to improve their surgical skills outside the operating room.

Racional:A cirurgia laparoscópica já é realidade em praticamente todos os centros cirúrgicos. Muito embora haja maior dificuldade técnica, o rápido retorno às atividades, menor dor pós-operatória e maior qualidade estética estimulam os cirurgiões a evoluírem tecnicamente nesta área. Porém, ao contrário das operações abertas onde as oportunidades de aprendizagem são mais acessíveis, o treinamento laparoscópico acaba sendo desafio ao longo da formação de um cirurgião.Objetivo:Apresentar um modelo de caixa de treinamento laparoscópico de baixo custo. Métodos:Foram utilizados materiais de fácil acesso, mini jato cromado, passa fios de borracha e uma webcam acoplada a um cabo de alumínio.Resultados:A white box foi produzida em dois dias com custo de R$ 280,00. Conclusão:É possível estimular o treinamento de maior número de cirurgiões na formação laparoscópica a baixo custo e buscar aperfeiçoamento de suas habilidades cirúrgicas fora do centro cirúrgico.

Perfil clínico e resultados da intervenção coronária percutânea primária em pacientes jovens / Clinical profile and outcomes of prmary percutaneous coronary intervention in young patients

A epidemiologia do infarto agudo do miocárdio com supradesnivelamento do segmento ST(IAMCST) tem se modificado nos últimos anos, com incidência maior em jovens. Nosso objetivo foi comparar o perfil clínico, laboratorial e angiográfico, e os desfechos clínicos em 30 dias de pacientes ≤ 40 anos àqueles > 40 anos submetidos à intervenção coronária percutânea primária (ICPp).Métodos: Estudo de coorte prospectivo com pacientes consecutivos submetidos à ICPp entre 2009 e 2011. Resultados: No período, 1.055 pacientes foram incluídos, sendo identificados 3,3% com ≤ 40 anos. Pacientes jovens eram mais frequentemente negros, tabagistas e com história familiar de doença coronária, e menos frequentemente hipertensos e dislipidêmicos. Nos pacientes ≤ 40 anos, a dosagem de leucócitos e da troponina ultrassensível na admissão foi maior, e a lipoproteína de alta densidade-colesterol, menor.A artéria descendente anterior como vaso culpado e a fração de ejeção do ventrículo esquerdo não foramdiferentes entre os grupos. Apesar de o fluxo TIMI 3 pré ser similar, os jovens mostraram maior prevalênciade blush miocárdico 3 pré-procedimento. O tempo porta-balão foi menor nos pacientes mais jovens (1,0 hora [0,8-1,4 hora] vs. 1,3 hora [0,9-1,7 hora]; p = 0,03). Em 30 dias, os pacientes ≤ 40 anos apresentaram mortalidade de 0% vs. 8,8% nos pacientes > 40 anos (p = 0,07). Conclusões: Pacientes ≤ 40 anos com IAMCST e submetidos à ICPp apresentam diferenças nos perfis clínico,angiográfico e do procedimento quando comparados àqueles > 40 anos. Nesta análise, representativa da prática médica atual, a mortalidade em 30 dias desses pacientes foi muito baixa...

The epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoingprimary percutaneous coronary intervention (pPCI). Methods: Prospective cohort study of consecutive patients undergoing pPCI between 2009 and 2011. Results: A total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic.In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07). Conclusions: Patients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low...