Effect of using triclosan-impregnated polyglactin suture to prevent infection of saphenectomy wounds in cabg: a prospective, double-blind, randomized clinical trial

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.

Banho pré-operatório em pacientes submetidos à artroplastia do quadril:: ensaio clínico randomizado / Preoperative bath in patients submitted to hip arthroplasty: randomized clinical trial

A infecção de sítio cirúrgico (ISC) é um grande desafio para o paciente, equipe e instituições de saúde. Um fator de risco importante na patogênese das infecções cirúrgicas ortopédicas refere-se à pele do paciente. O banho do paciente com soluções antissépticas, no pré-operatório é recomendado como medida para reduzir o risco de ISC, apesar das controvérsias. O objetivo deste estudo foi avaliar o efeito da intervenção de enfermagem, banho pré-operatório, utilizando as soluções de gluconato de clorexidina a 4%, PVP-I degermante a 10% e sabão sem antisséptico, na prevenção de ISC, em pacientes submetidos à cirurgia eletiva de artroplastia do quadril e estimar a frequência de reações alérgicas causadas pelo uso das soluções. Estudo do tipo ensaio clínico, randomizado, controlado, com mascaramento do pesquisador, paciente e estatístico, utilizando dois grupos de intervenção (clorexidina; PVP-I) e um controle (sabão sem antisséptico). A amostra foi composta por 162 pacientes adultos, submetidos à cirurgia eletiva de artroplastia total do quadril, entre agosto/2015 e outubro/2017, sem infecção no local cirúrgico e alergia às soluções e não portadores nasais de Staphylococcus aureus. A randomização foi realizada por um programa de computador. Utilizados os critérios de descontinuidade de tratamento e a análise por intenção de tratar. Cada grupo foi composto por 54 pacientes. Na consulta de enfermagem os pacientes foram orientados pela enfermeira pesquisadora a tomarem dois banhos: na véspera da cirurgia no domicílio e no dia da cirurgia no hospital. O banho no hospital foi realizado por profissional de enfermagem. Para o banho o paciente recebia um envelope pardo fechado contendo o frasco da solução sorteada, quatro esponjas e um manual que orientava sobre o procedimento. O desfecho primário foi ISC e os pacientes foram monitorados até 90 dias de pós-operatório por meio de telefonemas e nas consultas de egressos ambulatorial. O programa Statistical Package for the Social Sciences (SPSS), versão 19.0, foi utilizado para análise dos dados. O efeito aos tratamentos foi medido comparando os grupos intervenção e controle por meio da incidência de ISC, risco relativo, redução absoluta de risco. As características clínicas/epidemiológicas/cirúrgicas foram similares entre os pacientes nos três grupos. A incidência de ISC em cada grupo foi 5,5% (3/54) [IC95% 1,2-15,4]. A taxa de infecção superficial foi 4,9% e profunda 0,6%. O tempo médio para o surgimento das infecções foi 19 dias (DP ± 7,4). Não houve diferença estatística significativa entre os grupos (p=1,00). Um paciente apresentou reação alérgica com o uso da solução de PVP-I. A taxa de adesão aos dois banhos foi de 99,4% (161/162). Os resultados corroboram recentes revisões sistemáticas que não encontraram diferença nas taxas de infecção cirúrgica quando o banho pré-operatório foi realizado com soluções antissépticas ou sabão. A consulta de enfermagem no pré-operatório pode impactar a taxa de infecção profunda na cirurgia eletiva de artroplastia do quadril. O uso de soluções antissépticas pode ocasionar reações alérgicas na pele do paciente, durante o banho e precisa ser monitorada. É necessário cautela ao recomendar o banho pré-operatório com solução antisséptica como estratégia para reduzir infecção de sítio cirúrgico. A orientação do paciente no pré-operatório de cirurgia eletiva de artroplastia do quadril, quando realizada pelo enfermeiro, pode melhorar a qualidade do cuidado prestado ao paciente cirúrgico. Clinical Trials nº NCTO3001102 (AU)

Surgical site infections (SSI) are a major challenge for the patient, staff, and health institutions. An important risk factor in the pathogenesis of orthopedic surgical infections refers to the patient's skin. The patient's bath with antiseptic solutions in the preoperative period is recommended as measure to reduce the risk of SSI, despite controversies. The objective of this study was to evaluate the effect of the nursing intervention, preoperative bath, using 4% chlorhexidine gluconate solutions, 10% PVP-I and non-antiseptic soap in the prevention of SSI in patients submitted to elective hip arthroplasty surgery and the frequency of allergic reactions caused by the use of the solutions. Randomized, controlled clinical trial with masking of the researcher, patient and statistician using two intervention groups (PVP-I, chlorhexidine) and one control (non-antiseptic soap). The sample was consisted of 162 adult patients undergoing elective total hip replacement between August/2015 to October/2017, without infection at the surgical site and allergy solutions and non-nasal carriers of Staphylococcus aureus. The randomization was performed by a computer program. The criteria for treatment discontinuity and intention-to-treat analysis were used. Each group consisted of 54 patients. In nursing consultation patients were instructed by the research nurse to take two baths: the day before the surgery at home and the day of the surgery in the hospital. The bath in the hospital was performed by a nursing professional. For the bath the patient received a closed brown envelope containing the bottle of the solution drawn, four sponges, and a manual that guided about the procedure. The primary outcome was ISC and the patients were monitored up to 90 postoperative days by phone calls and outpatients visits. The Statistical Package for Social Sciences (SPSS), version 19.0, was used for analysis of the data. The effect on treatments was measured by comparing intervention and control group by incidence of ISC, Relative Risk and Absolute Risk Reduction. Clinical/epidemiological/surgical characteristics were similar among the patients of the three groups. The incidence of SSI in each group was 5.5% (3/54) [IC95% 1,2-15,4]. The superficial infection rate was 4.9% and deep 0.6%. The mean time to onset of infection was 19 days (SD ± 7.4). There was no statistically significant difference between the groups (p = 1.00). One patient presented an allergic reaction with the use of the PVP-I solution. The rate of adherence to the two baths was 99.4% (161/162). The results of this study corroborate recent systematic reviews that found no difference in surgical infection rates when the preoperative bath was performed with antiseptic solutions or soap. The preoperative nursing consultation may impact the rate of deep infection in elective hip arthroplasty surgery. The use of antiseptic solutions may cause allergic reactions on the patient's skin during bathing and needs to be monitored. Caution is required when recommending the preoperative bath with antiseptic solution as a strategy to reduce surgical site infection. The orientation of the patient in the preoperative period of elective hip arthroplasty surgeries performed by the nurse can improve the quality of care provided to the surgical patient. Clinical Trials nº. NCTO3001102..(AU)

Clinical trial for evaluation of Ricinus communis and sodium hypochlorite as denture cleanser

Abstract The development of opportunistic infections due to poor denture hygiene conditions justified the search for effective hygiene protocols for controlling denture biofilm. Objective This study evaluated Ricinus communis and sodium hypochlorite solutions in terms of biofilm removal ability, remission of candidiasis, antimicrobial activity, and participant satisfaction. Material and Methods It was conducted a controlled clinical trial, randomized, double-blind, and crossover. Sixty-four denture wearers with (n=24) and without candidiasis (n=40) were instructed to brush (3 times/day) and immerse their dentures (20 min/day) in different storage solutions (S1 / S2: 0.25% / 0.5% sodium hypochlorite; S3: 10% R. communis; S4: Saline).The trial period for each solution was seven days and a washout period of seven days was used before starting the use of another solution. The variables were analyzed at baseline and after each trial period. The biofilm of inner surfaces of maxillary dentures was disclosed, photographed, and total and dyed areas were measured (Image Tool software). The percentage of biofilm was calculated. Remission of candidiasis was assessed by visual scale and score were attributed. Antimicrobial activity was assessed by the DNA-Checkerboard hybridization method. Patient satisfaction was measured using a questionnaire. Results S1 (4.41±7.98%) and S2 (2.93±5.23%) were more effective then S3 (6.95±10.93%) in biofilm remotion(P<0.0001). All solutions were different from the control (11.07±11.99%). S3 was the most effective solution in remission of candidiasis (50%), followed by S1 (46%). Concerning antimicrobial action, S1/S2 were similar and resulted in the lowest microorganism mean count (P=0.04), followed by S3. No significant differences were found with patient's satisfaction. Conclusions 10% R. communis and 0.25% sodium hypochlorite were effective in biofilm removal, causing remission of candidiasis and reducing the formation of microbial colonies in denture surfaces. All solutions were approved by patients.

Efficacy of two mouthwashes with cetylpyridinium chloride: a controlled randomized clinical trial

Abstract This study aimed to evaluate the anti-plaque and anti-gingivitis effects of two mouthwashes containing cetylpyridinium chloride (CPC), in comparison to negative control mouthwash. One hundred and twenty subjects were randomly assigned to study groups: test (0.075% CPC and 0.28% zinc lactate), positive control (0.07% CPC) and negative control mouthwash without CPC. All volunteers were examined by a calibrated examiner for the Quigley-Hein Plaque Index (Turesky modification) and Löe-Silness Gingival Index (GI). Gingival severity was also measured by the percentage of sites with positive gingival bleeding. During six weeks, oral hygiene consisted of brushing twice daily with a toothbrush and toothpaste and rising with their assigned mouthwash. Plaque and gingival parameters were assessed at baseline, after four and six weeks of product use. Statistical analyses were performed separately for plaque and gingival indices, by ANOVA, paired t-test and ANCOVA (α < 0.05). After 4 and 6 weeks, all mouthwashes groups presented statistically significant reductions in plaque and gingival parameters as compared to baseline. In comparison to the positive control, the test group presented additional reductions in dental plaque of 19.8% and 16.8%, after 4 and 6 weeks, respectively. For GI, the additional reductions in the test group were 9.7% and 14.3%, at 4 and 6 weeks, respectively. The test group showed additional reduction of 35.3% and 54.5% in the gingival severity, at week 4 and 6, respectively. It is concluded that the mouthwash containing CPC and zinc lactate presents significant anti-plaque and anti-gingivitis effects as compared to positive and negative control mouthwashes.

Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit

Abstract Aims The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU). Methods This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0–2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data. Results In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR = 2.60, 95% CI: 1.04–6.49, p = 0.0279). The mean ± SD MCPIS was calculated as 3.91 ± 1.35 in the HP group and 4.65 ± 1.55 in the NS group, a difference statistically significant (p = 0.042). There were no significant differences in the risk factors for VAP between the two groups. Conclusion HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP.

Hematological change parameters in patients with pressure ulcer at long-term care hospital / Alterações dos parâmetros hematológicos em pacientes portadores de úlcera por pressão em um hospital de longa permanência

Objective To assess factors associated with the development of pressure ulcers, and to compare the effectiveness of pharmacological treatments. Methods The factors associated with the development of pressure ulcers were compared in lesion-carrying patients (n=14) and non-carriers (n=16). Lesion-carrying patients were treated with 1% silver sulfadiazine or 0.6IU/g collagenase and were observed for 8 weeks. The data collected was analyzed with p<0.05 being statistically relevant. Results The prevalence of pressure ulcers was about 6%. The comparison of carrier and non-carrier groups of pressure ulcers revealed no statistically significant difference in its occurrence with respect to age, sex, skin color, mobility, or the use of diapers. However, levels of hemoglobin, hematocrit, and red blood cells were found to be statistically different between groups, being lower in lesion-carrying patients. There was no significant difference found in lesion area between patients treated with collagenase or silver sulfadiazine, although both groups showed an overall reduction in lesion area through the treatment course. Conclusion Hematologic parameters showed a statistically significant difference between the two groups. Regarding the treatment of ulcers, there was no difference in the area of the lesion found between the groups treated with collagenase and silver sulfadiazine. .

Objetivo Avaliar os fatores associados ao desenvolvimento da úlcera por pressão e comparar a efetividade de tratamentos farmacológicos. Métodos Os fatores associados ao desenvolvimento de úlcera por pressão foram comparados entre pacientes portadores (n=14) e não portadores (n=16) da lesão. Os pacientes com a ferida foram tratados com sulfadiazina de prata 1% ou colagenase 0,6UI/g, sendo acompanhados durante 8 semanas. Os dados coletados foram analisados considerando-se estatisticamente significativo se p<0,05. Resultados A prevalência de úlcera por pressão foi de cerca de 6%. A comparação entre os grupos de portadores e não portadores de úlcera por pressão não revelou diferença estatística significativa entre ocorrência desta segundo idade, sexo, cor da pele, mobilidade e uso de fralda. Por outro lado, os valores de hemoglobina, hematócrito e hemácias foram estatisticamente diferentes entre os grupos, sendo menor naqueles pacientes portadores da lesão. Não houve diferença significativa na área da lesão entre aqueles pacientes tratados com colagenase ou sulfadiazina de prata, embora ambos os tratamentos tenham evidenciado uma redução média da área da lesão. Conclusão Os parâmetros hematológicos apresentaram diferença estatística entre os dois grupos avaliados, ao contrário das demais variáveis analisadas. Em relação ao tratamento das úlceras, não houve diferença na área da lesão na comparação entre a colagenase e a sulfadiazina. .

Comparative efficacy of two daily use mouthrinses: randomized clinical trial using an experimental gingivitis model

Two antimicrobial agents, a fixed combination of essential oils (EOs) and 0.07 percent cetylpyridinium chloride (CPC) are found in commercially available mouthrinses, Listerine® Antiseptic and Crest® Pro HealthTM, respectively. Both mouthrinses have been shown to control dental plaque and gingivitis in short and longer term studies. The aim of this study was to determine the comparative effectiveness of these two mouthrinses using a 2-week experimental gingivitis model. Qualified subjects were randomly assigned to one of three mouthrinse groups: a fixed combination of EOs, 0.07 percent CPC, or negative control (C) rinse. Following baseline clinical assessments and a dental prophylaxis, subjects began a two-week period in which they rinsed twice daily with their assigned rinse and abstained from any mechanical oral hygiene procedures or other oral care products. Subjects were reassessed at the end of the two-week period. One hundred and forty-seven subjects were randomized and 142 completed this study. After two weeks use, the EOs rinse was superior (p < 0.011) to the CPC rinse in inhibiting the development of gingivitis, plaque, and bleeding, with 9.4 percent and 6.6 percent reductions compared to CPC for gingivitis and plaque, respectively. Both rinses were superior to the negative control rinse (p < 0.001). This study demonstrates that the essential oil-containing mouthrinse has superior antiplaque/antigingivitis effectiveness compared to the 0.07 percent CPC-containing mouthrinse without mechanical oral hygiene influence.

Análise microbiológica comparativa da ação de diferentes agentes descontaminantes sobre superfícies de titânio / Microbiological comparison of different decontaminant agents on rough and smooth titanium surfaces: microbiological analysis

Os implantes de titânio estabeleceram-se, ao longo do tempo, como uma opção de tratamento com grande índice de sucesso. Entretanto, falhas são passíveis de ocorrer, devido à exposição de suas superfícies ao meio bucal, imediatamente ou até muito tempo passado de sua implantação. Estas superfícies de titânio podem se infectar por bactérias e seus produtos, de forma semelhante à que ocorre na superfície de raízes dentais. Tais contaminantes intensificam a resposta inflamatória, além de alterar a estrutura superficial do implante podendo dar origem às doenças peri-implantares, como a mucosite peri-implantar e a peri-implantite. Para o tratamento destas doenças, diversos métodos de descontaminação de superfícies de implantes têm sido propostos, incluindo o uso substâncias anti-sépticas, jatos abrasivos, ácidos, antibióticos e lasers. O objetivo foi avaliar comparativamente a capacidade de descontaminação do peróxido de hidrogênio a 1,5 % (H2O2), do gluconato de clorexidina a 0,12% (CLX) e do soro fisiológico (SF) já que, até o momento, nenhuma metodologia está estabelecida como padrão ouro para a limpeza superficial. Placa bacteriana foi colhida de sítios de doença periodontal crônica para contaminação de discos de titânio de superfícies lisas e rugosas. Posteriormente, os discos foram submersos em 10 mL das substâncias estudadas por 1 minuto, friccionados com swab e enxaguados em solução fisiológica. Discos controle (C) foram somente enxaguados em soro fisiológico. Desta forma resultaram os seguintes grupos de estudo, constituídos de 5 discos de cada tipo de superfície lisa (L) e rugosa (R): H2O2 R , CLXR, SFR, CR, H2O2L, CLXL , SFL e CL. A avaliação do potencial descontaminante das substâncias foi realizada através da quantificação do crescimento bacteriano pela contagem das unidades formadoras de colônia (UFCs) após semeadura em Agar-brucella e incubação em jarra de CO2 a 37oC por 24 horas. Os resultados após descontaminação foram comparados através da...

Actually, the titanium implants are a successful option of treatment in Dentistry. However, failures are possible to occur due to surface exposition to oral environment immediately or lately after its implantation. The titanium implants surfaces can be infected by bacteria and its products similarly to dental roots surfaces. The contaminants turn the inflammatory response tissues more intensive and them alter the surface structure of the implant and cause periimplant diseases like mucositis and peri-implantitis. Several methods of treatment for those diseases have been proposed in the literature, including antiseptics rinses, abrasives air powder, acids, antibiotics and lasers. The aim of this work was to comparatively evaluate the potential for decontamination of the hydrogen peroxide at 1,5% (H2O2), the 0,12% chlorhexidine gluconate (CLX) and the saline solution (SF) as cleaning methods, once until this moment there is not a gold standard method established for this purpose. Bacterial plaque harvested from sites of chronic periodontal disease was used to contaminate smooth and rough surfaces of titanium. Subsequently, decontamination procedures were realized by submerging the discs in 10 ml of the studied substances for 1 minute, cleaned by rubbing with swab and washed on saline solution. Control discs (C) were only washed in saline solution. The following test groups composed by 5 discs of each surface, smooth (L) and rough (R):, were then originated: H2O2 R , CLXR, SFR, CR, H2O2L, CLXL , SFL and CL. The decontaminant potential of studied substances was realized by counting the colony forming units after seeding in Agar-brucella, under anaerobiosis condition for 24 hours under 37oC. The data analysis was made by Variance Analysis (ANOVA) at 5% of significance level. The results lead to the following conclusions: the chronic periodontal biofilm adhesion was possible on smooth and rough titanium surfaces; the surface characteristic had no significant...

Removal of oral lichen planus by CO2 laser

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

O objetivo deste relato de caso é apresentar a remoção cirúrgica com o laser de CO2 de um líquen plano diagnosticado histologicamente. O líquen plano da cavidade oral é uma doença muco-cutânea crônica de etiologia desconhecida. Tratamentos diferentes têm sido usados para sua resolução. Uma paciente do sexo feminino de 46 anos de idade foi encaminhada para a Clinica de Laser da Faculdade de Odontologia da Universidade Federal da Bahia para a remoção de uma lesão na boca caracterizada pela presença de manchas brancas que estava causando dor e ardimento não havia respondido a tratamento com triamcinolone e corticoides durante 3 meses. O laser de CO2 foi utilizado para remover a lesão e o diagnóstico histopatológico conclusivo foi o de líquen plano de cavidade oral. A paciente foi acompanhada durante 1 ano sem sinal de recorrência da lesão. O uso do laser de CO2 foi considerado útil e efetivo no tratamento do líquen plano.

In vivo efficacy of alkaline peroxide tablets and mouthwashes on Candida albicans in patients with denture stomatitis

OBJECTIVE: Effective cleaning of dentures is important for the maintenance of good oral hygiene for denture stomatitis patients. The in vivo efficacy of three different brands of alkaline peroxide tablets (Polident, Efferdent, and Fittydent) and two mouthwashes (CloSYS II and Corsodyl) to eliminate Candida albicans on dentures was evaluated in this in vivo study. MATERIAL AND METHODS: Ninety denture wearers with clinical evidence of denture stomatitis were randomly divided into 5 test groups and 1 control group. Each group was further divided into three subgroups in which the dentures were subjected to 15-, 30-, and 60-min disinfection procedures. The dentures of each test group were treated with one of the cleaners, while those of the control group were treated with distilled water. Swab samples from the palatal surfaces (2 cm x 2 cm template delimited area) of the upper dentures were obtained before and after 15, 30, and 60 min periods of cleaner use and examined mycologically. RESULTS: The reduction in the number of colony-forming units (CFU) of C. albicans before, and after 15, 30, and 60 min of use of CloSYS II and Corsodyl was significantly greater than that of the control group (p<0.05). Moreover, there was no statistically significant difference (p>0.05) among Polident, Efferdent and the control group in any of the treatment periods. Dentures treated with Fittydent appeared to have a significantly greater reduction in the number of Candida spp. only after 60 min of treatment. CONCLUSIONS: The results of this study showed that the use of mouthwashes significantly reduced the number of microorganisms on dentures.

Fototerapia (LEDs 660/890nm) no tratamento de úlceras de perna em pacientes diabéticos: estudo de caso / Phototherapy (LEDs 660/890nm) in the treatment of leg ulcers in diabetic patients: case study

Avaliou-se a fototerapia na cicatrização de úlceras de perna (UP) mistas em dois pacientes diabéticos (tipo 2), hipertensos. O aparelho apresentava sonda 1 (S1) (1 LED de 660nm, 5mW) aplicado em 3 UP e sonda 2 (S2) (32 LEDs de 890nm e 4 LEDs de 660nm, 500mW) em 6 UP. Após antissepsia,úlceras foram tratadas com sondas a 3J/cm2, 30seg, 2x/semana seguido pelo curativo diário com sulfadiazina de prata a 1 por cento por 12 semanas. Pela análise com software Image J®, as UP com S2 tiveram índices de cicatrização médios de 0,6; 0,7 e 0,9 enquanto S1 foi de 0,2; 0,4 e 0,6 no 30º, 60º e 90º dias, respectivamente. A fototerapia acelerou a cicatrização das úlceras de perna em pacientes diabéticos.

This study evaluated the use of phototherapy in the healing of mixed leg ulcers in two diabetic patients (type 2) with arterial hypertension. The device had probe 1 (one 660nm LED, 5mW) applied in 3 ulcers and probe 2 (32 890nm LEDs associated with 4 660nm LEDs, 500mW) in 6 ulcers. After asepsis, ulcers were treated with probes to 3 J/cm2, 30sec per point, twice a week, followed by topical daily dressing with 1 percent silver sulphadiazine during 12 weeks. The following analyses of ulcers with software Image J showed that probe 2 presented mean healing rates of 0.6; 0.7 and 0.9, whereas probe 1 had 0.2;0.4 and 0.6 at 30, 60 and 90 days, espectively. Phototherapy accelerated wound healing of leg ulcers in diabetic patients.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Infecçäo no local de saída e túnel subcutâneo de cateteres tipo HickmanR em pacientes de transplante de medula óssea alogênico, relacionada aos anti-sépticos a base de polivinilpirrolidona - ido e glatamato de clorohexidina / Exit-site and tunnel HickmannR catheters infection in allogenic bone marrow transplant patients, according to the use of povidone-iodine or chlorhexidine gluconate antiseptics

Infecçöes relacionadas a cateteres venosos centrais tipo Hickman R säo freqüentes, podendo constituir-se em um importante obstáculo para sua manutençäo. A padronizaçäo de rotinas de manipulaçäo e o treinamento da equipe de enfermagem säo importantes para evitar este tipo de complicaçäo. Como contribuiçäo ao aumento de conhecimentos sobre o tema, foi realizado neste estudo comparativo, retrospectivo, com abordagem quantitativa junto aos pacientes do ambulatório de transplante de medula óssea da Fundaçäo Pró-Sangue/Hemocentro de Säo Paulo cujos objetivos se constituíram em estudar a incidência de infecçäo de saída e túnel subcutâneo de cateteres tipo Hickman R e comparar a eficácia dos anti-sépticos polivinilpirrolidona-iodo aquoso a 10 porcento (PVPI) e gluconato de clorohexidina alcoólica a 0,5 porcento (CHX). Foram elegíveis para o estudo os pacientes portadores de um primeiro cateter em acompanhamento ambulatorial, em programa de transplante de medula óssea alogênico. No período de janeiro de 1996 a junho de 1998, 51 pacientes fizeram parte do grupo experimental, sendo utilizada CHX como anti-séptico, no local de saída do cateter na pele. Os resultados foram comparados com um grupo de controle histórico, fazendo parte deste, 52 pacientes nas mesmas condiçöes e com o mesmo tipo de cateter, no período de janeiro de 1993 a junho de 1995, onde foi utilizado o PVPI como anti-séptico. As variáveis moderadoras consideradas no estudo foram: idade, sexo, tipo de doença, tipo de condicionamento, presença de DECH aguda, presença de DECH crônica e uso de antimicrobianos. Nos dois grupos os curativos foram realizados diariamente com anti-séptico (PVPI ou CHX), gazes estéreis e fitas derentes tipo micropore R, sendo colhidas culturas para bactéria e fungo na presença de qualquer tipo de secreçäo observada. Todos os cateteres que apresentaram infecçäo de túnel foram removidos por indicaçäo médica. Como resultado, constatou-se que 38 pacientes (73,0 porcento) do grupo do PVPI apresentaram infecçäo, sendo 54 episódios de infecçäo de saída e 11 de túnel subcutâneo. No grupo da CHX apenas um paciente (1,9 porcento) apresentou infecçäo, sendo um episódio de túnel subcutâneo. O agente etiológico mais isolado no grupo do PVPI foi o Staphylococcus epidermis (49,2 porcento dos episódios infecciosos), seguido pelo Staphylococcus aureus (19,0 porcento). No grupo da CHX o único agente infeccioso foi a Xantomonas malthophilia. No grupo do PVPI, 42 cateteres...

Importancia de los cursos de actualización organizados por departamento de docencia del Hospital Baca Ortíz. 1993 / Importance of the advanced training courseses organized by department of teaching of the Hospital Baca Ortíz. 1993

El Hospital Baca Ortíz es una institución de salud dependiente del Ministerio de Salud Pública cuya filosofía en dar atención médica integral y gratuita, a la población infantíl de todos los estratos sociales, esta casa asistencial brinda atención en diferentes especialidades a los pacientes con variadas patologías...

Antibioticoterapia local en prostatisis bacteriana crónica: informe preliminar / Local antibioticoteraphy in chronic bacterial prostatitis: preliminary report

Se realizó un estudio prospectivo de noviembre de 1990 a octubre de 1991, en el que se incluyeron 24 pacientes con prostatitis bacteriana crónica como afección única y no complicada, que fueron atendidos la primera vez en la consulta externa. Se encontraron antecedentes clínicos mayores de seis meses de evolución que se corroboraron por medio de cultivos de orina y secreción prostárica con la técnica de Stamey . Se trataron con cefazolina y gentamicina intraprostática por vía transuretral y en forma ambulatoria. La edad de los pacientes fluctuó entre 18 y 45 años. El agente patógeno más frecuente fue Staphylococcus aureus coagulasa positivo, sensible a cefazolina. Se comunican los datos encontrados en la anamnesis. Se obtuvo éxito de curación en 79.1 porciento y fueron necesarias de dos a cuatro aplicaciones, con un promedio de tratamiento de cuatro meses.