Composite Sling: A Strategy for Enhancing Inferolateral Support in Mastopexy with Implant.

Augmentation mastopexy has attracted the attention of numerous authors seeking to improve surgical outcomes and ensure breast implant stability. The utilization of the dual plane technique with a lateral sling, pioneered by Ono and Karner, has demonstrated effectiveness in providing long-term implant support. However, challenges arise in cases of anatomical variations, such as a short pectoralis major (PM) muscle or chest, necessitating alternative approaches like the composite sling. This study presents a technique designed to elongate and broaden the lateral sling to enhance implant support. The composite sling incorporates components from the abdominal part of the PM muscle, the aponeurotic/muscular part of the external oblique muscle, and the cranial part of the rectus abdominis. Procedures were performed on 29 patients using the composite sling technique from July 2022 to October 2023. The follow-up period ranged from 6 to 18 months (average of 11.89 months). The lateral sling approach was successfully extended to cases with a short PM muscle or chest, previously managed using the dual plane technique without inferolateral support. No increase in complications or implant displacements was observed compared with the original lateral sling approach. However, four reoperations addressed issues such as dog ears, scarring, and minor asymmetries. Consistent results were observed throughout the follow-up period, particularly in maintaining upper pole fullness and preventing lower pole ptosis. The composite sling approach provides a viable solution for cases where the original sling technique is impractical. Its implementation could broaden surgical options and optimize results, particularly in cases of unfavorable anatomy.

Sleep disorders among undergraduate students in Southern Brazil.

PURPOSE: Sleep disorders are very common in the young, being a result of the typical lifestyle lived by young people or a sleep disease that requires assistance and treatment. Furthermore, according to previous findings, sleep alterations can favor the development of depressive mood disorder. This survey aimed to assess the prevalence and characteristics of sleep disorders in a young population sample and their association with depressive symptoms. METHODS: With a cross-sectional study design, self-administered questionnaires were applied to 1,180 undergraduate students. The Mini-Sleep Questionnaire (MSQ) and the Beck Depression Inventory were used to evaluate sleep disturbances and depressive symptoms, respectively. Bivariate and multivariate analyses were conducted, with the main findings being the presence of disrupted sleep (MSQ > 24), with an alpha error of 5%. The median point of the MSQ was 26 (P25-P75, 21-32 points). RESULTS: Sleep alterations were found in 59.6%. The prevalence of depression was 9.3% (n = 110), mild depression being identified in 5.9% (n = 62), moderate in 3.4% (n = 40), and severe in 0.7% (n = 8) of the students. In logistic regression, female gender (OR, 1.48; CI 95%, 1.09-2.01; P = 0.012) and being depressed (OR, 4.42; CI 95%, 2.30-8.50; P < 0.001) were independent factors for disrupted sleep. CONCLUSIONS: Sleep alterations are prevalent complaints among young people, being present in nearly 60% of the students. Female gender and being depressed are independent factors for having some form of sleep disorder.

Increased prevalence of low back pain among physiotherapy students compared to medical students.

Some studies have demonstrated that physiotherapists have a high prevalence of low back pain (LBP). The association between physiotherapy students, who are potentially exposed to the same LBP occupational risks as graduates, and LBP has never been demonstrated. The objective of the study is to evaluate the association between undergraduate physiotherapy study and LBP. The study design includes a cross-sectional study. A questionnaire-based study was carried out with physiotherapy and medical students. LBP was measured as lifetime, 1-year and point prevalence. Bivariate and multivariate analyses were performed to find the factors associated with LBP. Bivariate analyses were also performed to assess differences between LBP characteristics in the two courses. 77.9% of the students had LBP at some point in their lives, 66.8% in the last year and 14.4% of them reported they were suffering from LBP at the moment of answering the questionnaire. Physiotherapy students reported a higher prevalence of LBP when compared with the medical students in all measures. In the logistic regression model, physiotherapy students (A-OR 2.51; 95% CI 1.35-4.67; p = 0.003), and being exposed to the undergraduate study for more than four semesters (A-OR 2.55; 95% CI 1.43-4.55; p = 0.001) were independently associated with LBP. There were no differences between the courses concerning pain intensity and disability. As it was a cross-sectional study, we were not able to observe accurately if there is an increasing incidence of LBP during the course. Also, we did not intend to identify which activities in the course were associated with the development of LBP. This study clearly demonstrated an association between undergraduate physiotherapy study and LBP. The length of course exposure is also associated with LBP.

Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel.

BACKGROUND: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). OBJECTIVES: To evaluate QoL in patients with primary cutaneous SCC. METHODS: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. RESULTS: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. CONCLUSION: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.

Breast reconstruction after mastectomy for breast cancer: comparative analysis of early and delayed reconstruction.

BACKGROUND: Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. METHODS: This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. RESULTS: Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. CONCLUSIONS: The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.

Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel

Abstract: Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). Objectives: To evaluate QoL in patients with primary cutaneous SCC. Methods: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. Results: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. Conclusion: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.

How can we teach them about neurotrauma prevention? Prospective and randomized "Pense Bem-Caxias do Sul" study with multiple interventions in preteens and adolescents.

UNLABELLED: OBJECT.: A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. METHODS: In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices "always or sometimes" and negative as "never" using safety devices. RESULTS: The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. CONCLUSIONS: Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111-1121-0192 (National System of Ethics and Research in Brazil).

Miotomia glabelar fechada: uma nova abordagem cirúrgica para tratar rugas sem cicatrizes / Closed glabellar myotomy: a new surgical approach to treat wrinkles without scarring

Introdução: A hiperatividade da musculatura glabelar e as consequentes rugas são queixas frequentes na cirurgia plástica. O tratamento consiste em impedimento dos músculos relacionados. Propomos uma abordagem fechada para o tratamento da musculatura glabelar. Métodos: 78 pacientes foram operados entre abril de 2012 e agosto de 2015. A miotomia é realizada guiada pela marcação e tem início utilizando fio de poliglactina 0 ou fio de aço, passando várias vezes através das linhas marcadas, entrando pelo supercílio e utilizando o plano justaperiostal, retornando através do mesmo orifício da agulha em direção ao orifício de entrada, agora usando o plano subcutâneo. Resultados: Foram obtidos bons resultados em todos os casos com impedimento da atividade da musculatura glabelar durante o período avaliado (pelo menos 1 ano), com melhora das rugas e hiperatividade. As complicações observadas foram parestesia temporária na região frontal central (35 casos) e recidiva parcial (4 casos). Não foi observado nenhum caso de recorrência completa. As opções de tratamento cirúrgico de longo prazo para rugas glabelar são miotomia, neurotomia parcial ou miectomia. A miotomia glabelar fechada evita algumas possíveis complicações associadas a essas opções, diminui o tempo cirúrgico utilizando instrumentos cirúrgicos convencionais, permite a correção de assimetria, com menos edema, menos equimoses e evita cicatrizes. Conclusão: A miotomia glabelar fechada parece ser uma boa alternativa às outras opções cirúrgicas tradicionais, porque evita cicatrizes, permite correção de assimetria e apresenta bons resultados a longo prazo.

Introduction: Hyperactivity of the glabellar musculature and resulting wrinkles are frequent complaints in the field of plastic surgery. Treatment consists of blocking the involved muscles. We propose a closed approach for the treatment of glabellar musculature. Methods: Seventy-eight patients underwent operation between April 2012 and August 2015. Myotomy includes the use of markings and polyglactin 0 wire or steel wire, passing through the marked lines several times, entering the eyebrow and using the juxtaperiostal plane, returning through the same orifice of the needle toward the entry hole, and using the subcutaneous plane. Results: Good results were obtained in all cases by preventing glabellar muscle activity during the period evaluated (at least 1 year), with improvement in wrinkles and muscle hyperactivity. The complications observed included temporary paresthesia in the frontal region (35 cases) and partial recurrence (4 cases). There was no case of total recurrence. The options for long-term surgical treatment of glabellar wrinkles are myotomy, partial neurotomy, or myectomy. Closed glabellar myotomy prevents some possible complications associated with these options, reduces the surgical time, requires the use of conventional surgical instruments, eliminates scarring, and causes asymmetric correction, less edema, and fewer bruises. Conclusion: Closed glabellar myotomy seems to be a good alternative compared to other traditional surgical options, because it eliminates scarring, allows correction of asymmetry, and presents good long-term results.

Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento / Pectus excavatum and breast asymmetry: correction with breast augmentation

Introdução: O pectus excavatum é definido com uma depressão aproximando o esterno e as cartilagens costais à coluna vertebral. Existem diversas teorias em relação à etiologia; a mais aceita consiste no crescimento exagerado das cartilagens costais, causando um deslocamento posterior do esterno e consequente depressão. Dentre as formas de tratamento, encontra-se a correção das assimetrias mamárias utilizando próteses mamárias de silicone em pacientes sem sintomas cardiopulmonares, apenas com queixa estética. Métodos: Foram revisados os registros em prontuários e registros fotográficos de oito casos de pacientes femininas com diagnóstico de pectus excavatum operadas em um hospital privado na região Sul do Brasil, que procuravam o serviço com queixas estéticas locais, e não apresentavam queixas cardiorrespiratórias. Resultados: Seis casos foram submetidos somente à inclusão de prótese mamária. Uma paciente havia colocado prótese havia 15 anos, sendo essa substituída por novo implante, no mesmo plano. Outra paciente já havia realizado cirurgia de correção de pectus descrito por Nuss, 10 anos antes, vindo a consulta com queixa de hipomastia e assimetria. O tipo anestésico preferido foi a anestesia geral, em cinco dos casos. O plano de inclusão de prótese na quase totalidade dos casos foi o subglandular. Somente uma paciente apresentou complicação (seroma). Conclusões: Evidenciamos, na nossa amostra, que a inclusão de prótese mamária em pacientes com pectus excavatum é capaz de trazer resultados estético harmônicos, atenuando e/ou mascarando o defeito torácico, com resultados estéticos satisfatórios para os pacientes.

Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients.

Rinofima: opção cirúrgica como tratamento / Rhinophyma: a surgical treatment option

Introdução: Rinofima é uma inflamação crônica dos tecidos do nariz, caracterizada por hipertrofia e hiperplasia progressivas das glândulas sebáceas e do tecido conjuntivo. Determina um aspecto de elefantíase nasal, secundária à congestão dos vasos da derme. Sua etiologia está associada, na maioria dos casos, ao uso abusivo de álcool. É considerada por alguns autores como sendo um estágio avançado de acne rosácea. O artigo tem como objetivo relatar um caso de rinofima, tratado cirurgicamente no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal de Santa Catarina com decorticação e eletrocoagulação. Método: Foi realizado revisão de prontuário e registro fotográfico de um caso de rinofima. Resultados: Paciente foi submetido a tratamento cirúrgico com evolução favorável. Conclusão: Existem diversos tratamentos para rinofima, sendo que a decorticação e a eletrocoagulação constituem uma excelente opção terapêutica.

Introduction: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. Methods: A review of medical and photographic records of a case of rhinophyma was conducted. Results: The patient was underwent surgical treatment with favorable outcomes. Conclusion: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option.

Retalho mediofrontal para reconstrução nasal / The median-frontal flap for nasal reconstruction

Introdução: O retalho mediofrontal foi descrito 600 anos antes de Cristo para a reconstrução nasal, mas é ainda muito utilizado na reconstrução das lesões nasais tumorais. Objetivo: Relatar a experiência de um serviço universitário de cirurgia plástica no uso desse retalho. Métodos: Foi realizado o estudo restrospectivo descritivo de uma série de 35 casos operados em período de dez anos e seis meses. Resultados: A idade média dos pacientes foi de 68,6 anos com predomínio do gênero masculino. O retalho mediofrontal foi utilizado para reconstrução após ressecção de tumores, sendo o carcinoma basocelular o mais frequente. Conclusões: O retalho mediofrontal representa a escolha ideal reconstrutiva para muitos pacientes com bom resultado estético e funcional.

Introduction: The use of a median-frontal flap for nasal reconstruction was first described in 600 B.C., and it is still widely used for the reconstruction of nasal tumoral lesions. Objective: To report the experience of a medical school's plastic surgery service in the use of this flap type. Methods: A retrospective descriptive study was carried out with a series of 35 cases surgically treated from January 2005 to June 2015. Results: The patients' mean age was 68.6 (± 10.8) years, with a predominance of the male gender (68.6%). The median-frontal flap was used for reconstruction after resection of tumors, with basal cell carcinoma being the most frequent. Conclusions: The median-frontal flap is the ideal reconstructive choice for many patients, with good aesthetic and functional outcomes.

[Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn]. / Fatores perinatais associados a recém-nascidos de termo com pH<7.1 na artéria umbilical e índice de Apgar <7.0 no 5º minuto.

PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7.0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

Impact of an injury prevention program on teenagers' knowledge and attitudes: results of the Pense Bem-Caxias do Sul Project.

OBJECT: Trauma is the leading cause of mortality and morbidity in children, young people, and working-age adults. Because of the high incidence of intentional and unintentional injuries in young people, it is necessary to implement injury-prevention programs and measure the efficacy of these initiatives. The authors evaluated the effectiveness of an injury-prevention program in high school students in a city in southern Brazil. METHODS: In a randomized controlled study, 1049 high school students were divided into a control group and intervention group. The study was conducted in the following 3 stages: a questionnaire was applied 1 week before the educational intervention (P0), shortly after the intervention (P1), and 5 months later (P3). In the control group, a questionnaire based on the Pense Bem Project was applied at the 3 time stages, without any intervention between the stages. RESULTS: The postintervention analysis evidenced a slight change in knowledge about unintentional spinal cord and brain injuries. Regarding attitudes, the only significant improvement after the intervention lecture was in the use of helmets, which remained high 5 months later. A substantial number of students only partially agreed with using safety behaviors. The only significant postintervention change was the major agreement to check swimming pool depth before entering the water (P0 89% and P1 97.8%, p < 0.001; P2 92.8%, p = 0.005). CONCLUSIONS: An educational intervention based on a single lecture improved students' knowledge of traumatic brain and spinal cord injuries, but this type of intervention did not modify most attitudes toward injury prevention. Clinical trial registration no.: U1111-1121-0192.

Reconstrução parcial de nariz baseada em retalho nasogeniano após ressecção de carcinoma espinocelular envolvendo septo nasal, columela e lábio superior / Partial reconstruction of a nose based on a nasolabial flap after the resection of a squamous cell carcinoma involving the nasal septum, columella, and upper lip

INTRODUÇÃO: Reconstruções de defeitos complexos na face constituem um desafio para os cirurgiões. Após ressecção da lesão, o reparo nasal é difícil, já que possui uma variedade de tecidos e área local doadora reduzida para reconstrução. Já as lesões de lábio possuem como principal dificuldade a restauração da função, priorizando a integridade da estrutura esfincteriana, a continência oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrução dessas áreas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrução nasal e de lábio superior em dois tempos cirúrgicos, utilizando retalho nasogeniano, após defeito complexo causado por ressecção de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do gênero feminino, 56 anos, apresentou CEC de progressão avançada em região nasal da columela, terço anterior do septo e parte do lábio superior. A paciente foi submetida à reconstrução com retalho nasogeniano e, em segundo momento cirúrgico, ao enxerto de cartilagem costal para reconstrução de columela. Apresenta evolução com boa integração e viabilidade dos enxertos e retalhos. O resultado estético foi satisfatório. CONCLUSÃO: A utilização de retalho nasogeniano como opção terapêutica para a reconstrução parcial de nariz e de lábio superior apresentou desfechos funcionais/estéticos favoráveis. Além disso, a segmentação do procedimento cirúrgico traz segurança na utilização dos retalhos locais, principalmente em indivíduos de difícil cicatrização.

INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing.

Factores de riesgo asociados a traumatismo al nacimiento / Risk factors associated with birth trauma

ANTECEDENTES: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. OBJETIVO: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. MÉTODO: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo <0,10 en los análisis bivariado fueron insertas en la regresión logística. Se utilizó el modelo de entrada por bloques (block entry) para selección del modelo final de la regresión. RESULTADOS: En el período citado nacieron 2.137 infantes, 26 de ellos (1,2%) sufrieron trauma al nacimiento. La fractura de clavícula fue la lesión más frecuente (n=14; 53,8%), seguida del cefalohematoma (n=5; 19,2%). Las variables gasométricas no presentaron diferencia estadística. En la regresión logística, las únicas variables independientes asociadas a traumatismo al nacimiento fueron parto vaginal (OR-A: 11,08; IC95%: 2,45-49,98; p=0,002) y perímetro torácico >33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). CONCLUSIÓN: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm.

BACKGROUND: Obstetrics injuries can be defined as fetal lesions suffered by the fetus during labor or expulsion. OBJECTIVE: Identify risk factors for fetal birth trauma. METHOD: Case-control study conducted from July 2004 to December 2005. We analyzed maternal and fetal variables using software SPSS 19.0. The variables showing a significance level <0.10 in the bivariate analysis were included in the logistic regression analysis. We used the block entry model for selection of the final regression model. RESULTS: During these period, we identified 2137 births and 26 (1.2%) were related to fetal birth injury. Clavicle fracture was the most frequent injury (n = 14; 53.8%), followed by cephalohematoma (n = 5; 19.2%). Umbilical cord blood gas analysis did not show statistical significance. In the regression analysis of the variables that had significance level <0.10, the only independent variables associated with fetal birth injury were vaginal delivery (OR-A: 11.08; 95%CI: 2.45-49.98; p=0.002) and thorax circumference > 33 cm (OR-A: 3.36; 95%CI: 1.35-9.73; p=0.010). CONCLUSION: The risk factors for fetal birth injury were vaginal delivery and chest circumference equal to or larger than 33 cm. Other variables were not associated with the outcome in discussion.

Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto / Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn

OBJETIVO: Avaliar os fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min<7,0. MÉTODOS: Estudo retrospectivo com delineamento caso-controle, realizado após revisão dos prontuários de todos os nascimentos ocorridos entre setembro/1998 e março/2008, no Hospital Geral de Caxias do Sul. Foi considerado fator de inclusão os recém-nascidos de termo que apresentaram índice de Apgar no 5º min <7,0 e pH de artéria umbilical <7,1. Na análise univariada foi utilizado o teste t de Student e Mann-Whitney para as variáveis contínuas, o teste do c² para as variáveis dicotômicas e estimativa de risco pelo odds ratio (OR). Foi utilizado um valor de p<0,05 como estatisticamente significativo. RESULTADOS: De um total de 15.495 nascimentos consecutivos observaram-se 25 neonatos (0,16%) de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min <7,0. Apresentaram associação significativa com o evento acidótico a apresentação pélvica (OR=12,9; p<0,005), parto cesáreo (OR=3,5; p<0,01) e cardiotocografia intraparto alterada (OR=7,8; p<0,02). Dentre as características fetais, associaram-se o déficit de base (-15,0 versus -4,5; p<0,0001), necessidade de internação em unidade de terapia intensiva neonatal (OR=79,7; p<0,0001) e necessidade de reanimação (OR=12,2; p<0,0001). CONCLUSÃO: Baixo índice de Apgar no 5º min de vida associado a pH<7,1 na artéria umbilical pode predizer desfechos neonatais desfavoráveis.

PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral / Instrumentos de evaluación clínica y funcional en cirugía de la columna vertebral / Instruments of clinical and functional evaluation in spine surgery

Alguns dos indivíduos submetidos à cirurgia de coluna vertebral terão desfechos pós-operatório desfavoráveis, independente do êxito técnico. Esse insucesso gera aumento da morbidade e dos custos socioeconômicos. Sabe-se que fatores psicossociais interferem na impressão do sujeito. Com o propósito de identificá-los, tem-se estimulado a busca de preditores prognósticos por meio de instrumentos de triagem. Porém, a eleição do mais adequado pode ser difícil, já que existe um grande número de questionários. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfação, dor, depressão, distúrbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicações e limitações dos instrumentos de avaliação do paciente com doença na coluna vertebral.

Some individuals submitted to spine surgery will have unfavorable postoperative outcomes, regardless of the success of the technical procedure. This failure leads to an increase in morbidity and socioeconomic costs. Also, it is known that psychosocial factors influence the subject's impression. In order to identify these factors, the search for prognostic predictors through screening instruments has been stimulated. However, selecting the most appropriate one may be difficult, as a large number of questionnaires already exist. The aspects addressed by these questionnaires include: functional incapacity, quality of life, satisfaction, pain, depression, mood swings and functional activity. This work reviews the special characteristics, indications and limitations of the instruments used to evaluate patients with spine disease.

Algunos individuos, sometidos a la cirugía de columna vertebral, tendrán resultados posoperatorios desfavorables, independientemente del éxito técnico. Esta falla causa aumento de la morbilidad y de los costos socioeconómicos. Se sabe que factores psicosociales interfieren en las impresiones del sujeto. Con la finalidad de identificarlos, se ha estimulado la búsqueda de predictores pronosticadores mediante instrumentos de selección. Sin embargo, elegir el más adecuado puede ser difícil, ya que existe un gran número de cuestionarios. Entre los aspectos abarcados por estos, podemos citar: incapacidad funcional, calidad de vida, satisfacción, dolor, depresión, disturbios del humor y actividad funcional. El trabajo tiene el objetivo de revisar las particularidades, indicaciones y limitaciones de los instrumentos de evaluación del paciente con enfermedad en la columna vertebral.

Características clínicas de pacientes obstétricas admitidas em uma Unidade de Tratamento Intensivo Terciária: revisão de dez anos / Clinical features and results of obstetric patients admitted to a Tertiary Intensive Care Unit: ten-year review

Introdução: Taxas significativas de morbimortalidade materna ainda podem ser observadas no período gestacional. Um indicador importante de morbidade materna é a necessidade de transferência de paciente obstétrica para a Unidade de Terapia Intensiva. O objetivo do estudo foi avaliar os desfechos maternos e perinatais relacionados a pacientes obstétricas admitidas em unidade de cuidados intensivos. Mé-todos: Estudo observacional e consecutivo das pacientes obstétricas admitidas na Unidade de Tratamento Intensivo do Hospital Geral da Universidade de Caxias do Sul, de Março/1998 a Dezembro/2008. Foram analisadas variáveis maternas, obstétricas e neonatais. As variáveis contínuas foram apresentadas sob a forma de porcentagens e as categóricas, sob a forma de proporções. Foi realizado o cálculo de intervalo de confiança com nível de significância (alfa) de 5%. Resultados: no Hospital Geral, no período citado, ocorreram 17.071 nascimentos e 2.758 internações em Unidade de Tratamento Intensivo, sendo que dessas, 87 (3,2%) estiveram relacionadas a complicações da gravidez ou abortos. O principal motivo de internação hospitalar foram as síndromes hipertensivas (70,1%); de óbito, a coagulação intravascular disseminada e o choque séptico. A média da idade materna foi 26,8±7,8; 45 (51,7%) eram nulíparas; 21 (27,6%) apresentaram algum tipo de complicação intraparto. A taxa de mortalidade materna foi de 8,1% (n=7) e a de mortalidade perinatal foi de 22,4% (n=17). Conclusões: Oitenta e sete pacientes obstétricas necessitaram de tratamento intensivo. Fundamentalmente, eram pacientes nulíparas, hipertensas, com pouca escolaridade e assistência pré-natal inadequada. Sete (8,1%) pacientes morreram durante a estada hospitalar.

Introduction: Significant rates of maternal morbidity and mortality still occur during pregnancy. An important indicator of maternal morbidity is the need for transfer of obstetric patients to the Intensive Care Unit. The aim of the study was to evaluate maternal and perinatal outcomes related to obstetric patients admitted to intensive care units. Methods: An observational study of consecutive patients admitted to the obstetric intensive care unit of the General Hospital of the University of Caxias do Sul, from March/1998 to December/2008. Maternal, obstetric and neonatal variables were analyzed. Continuous variables were presented as percentages, and categorical variables as proportions. Confidence interval with significance level (alpha) at 5% was calculated. Results: In the general Hospital, in the mentioned period, there were 17,071 births and 2,758 admissions to the Intensive Care Unit, and of these, 87 (3.2%) were related to complications of pregnancy or abortion. The main reason for hospital admission were hypertensive disorders (70.1%); for death, disseminated intravascular coagulation and septic shock. The mean maternal age was 26.8 ± 7.8; 45 (51.7%) were nulliparous; and 21 (27.6%) had some type of intrapartum complication. The maternal mortality rate was 8.1% (n = 7) and the perinatal mortality rate was 22.4% (n = 17). Conclusions: Eighty-seven obstetric patients required intensive care. Fundamentally, they were nulliparous, hypertensive, with poor education and inadequate prenatal care. Seven (8.1%) patients died during their hospital stay.

Fatores de risco para tocotraumatismo materno / Risk factors to maternal birth injury

Os tocotraumatismos maternos acometem com mais frequência partes moles da genitália materna e, por isso, estão relacionados a substancial morbidade, como nos casos de rupturas perineais, vaginais e cervicais. A mortalidade é representada principalmente pela ruptura uterina. O objetivo deste estudo foi identificar os fatores de risco relacionados ao tocotraumatismo materno. Métodos: Estudo caso-controle, realizado em uma enfermaria de puerpério, no período de julho/2004 a dezembro/2005. Foram avaliadas variáveis maternas e fetais. As variáveis categóricas foram apresentadas como proporções, as com distribuição normal como média e desvio padrão, e as sem distribuição normal como mediana e intervalo interquartil. Para verificação das variáveis associadas ao tocotraumatismo materno, foram conduzidas análises bivariadas, com o teste qui-quadrado. Resultados: Dentre 2.137 puérperas, foram identificados 37 casos (1,7%) de tocotraumatismo. As lesões de primeiro e segundo graus foram as mais prevalentes (n=29; 78,4%). Foi observado um caso de ruptura uterina. As variáveis: a) segundo período de trabalho de parto inferior a 30 minutos, b) peso fetal entre 3.000g e 3.499 g, c) comprimento fetal entre 46 cm e 50 cm e d) perímetro torácico ≥33 cm estiveram associadas ao tocotraumatismo materno na análise bivariada, mas não tiveram significância quando da regressão logística. Conclusão: As lesões de primeiro e segundo graus foram as mais prevalentes (n=29). Parto vaginal, multiparidade e perímetro cefálico ≥33 cm foram identificados como fatores de risco independentes para lesão materna.

Maternal birth injuries affect most often the soft parts of the maternal genitalia and therefore are related to substantial morbidity, such as in cases of perineal, vaginal and cervical ruptures. Mortality is mainly represented by uterine rupture. The aim of this study was to identify risk factors related to maternal birth trauma. Methods: A case-control study conducted in a postpartum ward from Jul 2004 to Dec 2005. Maternal and fetal variables were evaluated. Categorical variables were shown as proportions, those with normal distribution as mean and standard deviation, and those without normal distribution as median and interquartile range. In order to check the variables associated with maternal birth trauma, bivariate analysis was conducted with the chi-square test. Results: Of 2,137 women, 37 cases (1.7%) of maternal birth trauma were identified. Lesions of first and second degrees were the most prevalent (n = 29, 78.4%). One case of uterine rupture was found. Variables (a) second period of labor less than 30 minutes, (b) fetal weight between 3,000 g and 3,499 g, (c) fetal length between 50 cm and 46 cm) and (d) chest girth ≥ 33 cm were associated with maternal birth trauma in the bivariate analysis, but had no significance in the logistic regression. Conclusion: First and second degrees lesions were the most prevalent (n = 29). Vaginal delivery, multiparity and head circumference ≥ 33 cm were identified as independent risk factors for maternal injury.