[Cutaneous ultrasound and dermal fillers]. / Ecografía cutánea y rellenos dermatológicos.

Requests for fillers or dermatological implants have dramatically increased in dermatology consultations in the last few years, either for the correction of superficial age-related wrinkles and cutaneous creases or to increase the volume of specific areas (cheeks, lips...). Dermatologists are often the first professionals to provide these treatments. Nevertheless, in other situations, the patients have already been treated, and many of them do not know the type of material that has been implanted or may even deny previous treatment, even when evident on clinical examination. In these occasions, cutaneous ultrasound is an effective and reliable tool for the real-time diagnosis of the kind of implant that has been used, its location, and the study of its possible complications.

[Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms]. / Revisión de aneurisma de aorta abdominal: hallazgos en la tomografía computarizada multidetector pre y postratamiento.

The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period.

The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system.

OBJECTIVES: There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion. Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA. METHODS: A retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study. RESULTS: A total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible. To overcome the difficulties we face in clinical practice, a new classification was developed and presented. CONCLUSION: The new proposed classification - Coutinho Classification - aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment.

Percutaneous cementoplasty of periprosthetic aseptic hip loosening.

Progressive population aging and improved healthcare have led to a significant increase in patients with hip arthroplasty (HA). In this patient group, the proportion of those who require a new arthroplasty (prosthetic replacement or secondary revision of the hip), has also increased. For this subgroup of patients in whom surgical prosthetic replacement should be considered but is contraindicated, a new technique has been developed since 2010: percutaneous injection of periprosthetic cement under fluoroscopic or CT control ("femoroplasty; FMP") as an alternative and less invasive treatment compared to surgery to stabilize the HA without replacing it, with excellent results on patients' quality of life. In this brief communication, we describe our positive experience regarding FMP, which we have performed for the first time in Spain on four patients (age range between 74-83 years, 2 female and 2 male patients, 3 right HA and 1 left HA), without post-complications. We highlight both the relative simplicity of this technique, which can be incorporated into radiological intervention even in regional hospitals, and the significant clinical improvement observed in all patients. In conclusion, we hope that our experience can contribute to the increased adoption of this innovative technique within the scientific community.

The "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA) after COVID-19 infection: A case report.

The term "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA) describes a variety of autoimmune conditions triggered by exposure to substances with adjuvant activity. We present the case of a patient with a history of biopolymer infiltration in both glutes, who years later experienced progressive weakness and pain in the lower limbs, myalgias, cramps, and progressive functional impotence following a mild COVID-19 infection. Laboratory test results were not consistent with any autoimmune disease. Physical examination revealed diffuse bilateral subcutaneous nodules. After an extensive etiological study, a gluteal biopsy was performed, which showed findings compatible with sclerosing lipogranuloma. Our patient required treatment with high-dose glucocorticoids and showed significant improvement in symptoms during long-term follow-up. We suggest the role of COVID-19 infection as a possible trigger for ASIA, as it has already been described as a trigger for several other autoimmune diseases.

Is breast ultrasound a good alternative to magnetic resonance imaging for evaluating implant integrity?

OBJECTIVE: To compare the diagnostic performance of breast ultrasound and breast magnetic resonance imaging and to correlate the findings on the two techniques that are suggestive of implant rupture. MATERIAL AND METHODS: We reviewed the images and reports of breast ultrasound and magnetic resonance imaging studies done in our diagnostic and interventional breast imaging unit to evaluate breast implants in 205 patients between January 2015 and December 2017. RESULTS: Ultrasound findings were compatible with implant rupture in 87 (42.4%) patients: intracapsular rupture in 44 (21.5%) and intracapsular and extracapsular rupture in 43 (21.0%). Ultrasound yielded 85.2% sensitivity, 89.7% specificity, 86.2% positive predictive value, and 89.0% negative predictive value. Magnetic resonance imaging findings were compatible with implant rupture in 88 (42.9%) patients: intracapsular rupture in 50 (24.4%) and intracapsular and extracapsular rupture in 38 (18.5%). The correlation between positive findings for the location of the rupture on the two imaging techniques was excellent (0.77; p < 0.0001). CONCLUSION: We found high concordance between the two techniques for the detection of intracapsular and extracapsular implant rupture. These results consolidate the use of ultrasound as the first-line imaging technique to evaluate implant integrity in our population; magnetic resonance imaging can be reserved for cases in which the ultrasound diagnosis of implant integrity is uncertain.

Breast-implant-associated anaplastic large-cell lymphoma.

Breast-implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon, recently recognized disease that seems to occur only in relation with implants with textured surfaces. Most cases present with late-onset peri-implant effusion or fluid collections that develop more than 12 months after insertion of the implant. The diagnosis is reached by cytological analysis of fluid samples obtained by ultrasound-guided fine-needle aspiration. These patients usually have a good prognosis after surgical removal of the implant. A small percentage of patients present with a nodule or mass adjacent to the implant that usually develops late. In these cases, the diagnosis is reached by the histological analysis of core-needle biopsy specimens. These patients have a worse prognosis and require a combination of surgery and systemic chemotherapy. The main immunophenotypic characteristics of this lymphoma are intense expression of CD30 and a lack of expression of anaplastic lymphoma kinase (ALK). Here we present a case of BIA-ALCL in a patient with implants with a textured surface that presented with peri-implant effusion and incipient formation of a millimetric nodule and was treated with removal of the implant and bilateral capsulectomy. It is important to point out that the disease requires multidisciplinary management and that the Spanish Agency of Medicines and Medical Devices (AEMPS) should be notified when the diagnosis is confirmed.

Reducción mamaria con implantes: serie de casos, técnica operatoria y resultados a largo plazo.

BACKGROUND: Breast reduction techniques have been considered functional procedures proposed to reduce the volume and elevate the position of the nipple-areola complex. Traditionally these techniques were performed as mostly functional procedures. The main reasons for dissatisfaction after a reduction technique are breasts with a deflated appearance due to alteration of the shape, particularly of the upper pole, and simultaneously, the high frequency in the appearance of pseudoptosis in the medium and long term. All this contributes to the patients' desire for secondary surgeries or refinements. OBJECTIVE: We know that currently the demands and expectations of our patients are increasing, and they specifically request a better aesthetic outcome. METHOD: We present our experience and surgical approach to breast reduction, using a superior base flap in combination with implants. RESULTS: We believe that the results are more stable in the long term and with low complication rates. CONCLUSIONS: According to what has been reported in the literature, our casuistry represents the most extensive to date.

ANTECEDENTES: Las técnicas de reducción mamaria se han considerado procedimientos funcionales propuestos para reducir el volumen y elevar la posición del complejo areola-pezón. Tradicionalmente fueron realizadas como procedimientos mayormente funcionales. Las principales razones de insatisfacción posterior a una técnica de reducción son senos con aspecto desinflado por alteración de la forma, en particular del polo superior, y simultáneamente la elevada frecuencia en la aparición de pseudoptosis a mediano y largo plazo. Todo ello contribuye al deseo por parte de las pacientes de cirugías secundarias o refinamientos. OBJETIVO: Tenemos claro que actualmente las exigencias y las expectativas de nuestras pacientes son cada vez mayores, y por supuesto específicamente radica en un mejor refinamiento estético. MÉTODO: Presentamos nuestra experiencia y enfoque quirúrgico de reducción mamaria utilizando un colgajo de base superior en combinación con implantes. RESULTADOS: Creemos que los resultados son más estables a largo plazo y con bajas tasas de complicaciones. CONCLUSIONES: De acuerdo con lo reportado en la literatura, nuestra casuística representa la más extensa hasta el momento.

Evaluation of the learning curve and initial outcomes with a short cervicometaphyseal fixation stem: A case series. / Evaluación de la curva de aprendizaje y resultados iniciales con un vástago corto de fijación cervicometafisaria: Una serie de casos.

INTRODUCTION: Total hip arthroplasty in young patients has evolved in recent decades, and the use of short stems in young adult patients has been gaining popularity. The restitution of the biomechanics of the hip is a primary requirement to determine the future success of total hip replacement, and even more so in young adults who present the particularity of having a high functional demand and a long life expectancy. OBJECTIVE: The aim of this prospective study was to evaluate the learning curve and initial clinical-radiological outcomes of the Alteon Neck Preserving Stem™ (ANPS) (Exactech, Gainesville, FL, USA) with a minimum of 2 years follow up. MATERIAL AND METHODS: We conducted a multicenter prospective study that analyzed 90 consecutive total hip replacements during 2014. We performed a clinical-radiological analysis measuring Harris Hip Score (HHS), subjective Rodes and Maudsley satisfaction evaluation, radiolucencies, components position, limb length discrepancy, heterotopic ossification, medical and surgical complications and learning curve. RESULTS: During the first 30 cases, the intraoperative complication rate was 16%, while in the next 60 cases no intraoperative complications were reported. Thigh pain was reported in 3 cases (3.3%), being 2 moderates, and 1 severe. In 2 cases subsidences of 3 mm were detected in the first scheduled X-ray, both related to intraoperative fractures with no progression after 3 months. Mean HHS improved from 42.9 points (range 37-54 points) preoperatively to 93.2 on average (range, 87-96) at the end of the follow up (p < 0.01). Subjective evaluation was excellent in 75 (83.3%) cases and good in 15 patients (16.6%). CONCLUSIONS: This short stem has good clinical radiological results in a short and medium term follow-up and in the hands of surgeons specializing in arthroplasty the learning curve is estimated to be less than 30 surgeries.

Is breast ultrasound a good alternative to magnetic resonance imaging for evaluating implant integrity? / ¿Es la ecografía mamaria una buena alternativa a la resonancia magnética en la evaluación de la integridad protésica?

OBJECTIVE: To compare the diagnostic performance of breast ultrasound and breast magnetic resonance imaging and to correlate the findings on the two techniques that are suggestive of implant rupture. MATERIAL AND METHODS: We reviewed the images and reports of breast ultrasound and magnetic resonance imaging studies done in our diagnostic and interventional breast imaging unit to evaluate breast implants in 205 patients between January 2015 and December 2017. RESULTS: Ultrasound findings were compatible with implant rupture in 87 (42.4%) patients: intracapsular rupture in 44 (21.5%) and intracapsular and extracapsular rupture in 43 (21.0%). Ultrasound yielded 85.2% sensitivity, 89.7% specificity, 86.2% positive predictive value, and 89.0% negative predictive value. Magnetic resonance imaging findings were compatible with implant rupture in 88 (42.9%) patients: intracapsular rupture in 50 (24.4%) and intracapsular and extracapsular rupture in 38 (18.5%). The correlation between positive findings for the location of the rupture on the two imaging techniques was excellent (0.77; p<0.0001). CONCLUSION: We found high concordance between the two techniques for the detection of intracapsular and extracapsular implant rupture. These results consolidate the use of ultrasound as the first-line imaging technique to evaluate implant integrity in our population; magnetic resonance imaging can be reserved for cases in which the ultrasound diagnosis of implant integrity is uncertain.

Breast-implant-associated anaplastic large-cell lymphoma. / Linfoma anaplásico de células grandes asociado a implantes mamarios.

Breast-implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon, recently recognized disease that seems to occur only in relation with implants with textured surfaces. Most cases present with late-onset peri-implant effusion or fluid collections that develop more than 12 months after insertion of the implant. The diagnosis is reached by cytological analysis of fluid samples obtained by ultrasound-guided fine-needle aspiration. These patients usually have a good prognosis after surgical removal of the implant. A small percentage of patients present with a nodule or mass adjacent to the implant that usually develops late. In these cases, the diagnosis is reached by the histological analysis of core-needle biopsy specimens. These patients have a worse prognosis and require a combination of surgery and systemic chemotherapy. The main immunophenotypic characteristics of this lymphoma are intense expression of CD30 and a lack of expression of anaplastic lymphoma kinase (ALK). Here we present a case of BIA-ALCL in a patient with implants with a textured surface that presented with peri-implant effusion and incipient formation of a millimetric nodule and was treated with removal of the implant and bilateral capsulectomy. It is important to point out that the disease requires multidisciplinary management and that the Spanish Agency of Medicines and Medical Devices (AEMPS) should be notified when the diagnosis is confirmed.

Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. / Papel del cirujano ortopédico y traumatólogo en la impresión 3D: aplicaciones actuales y aspectos legales para una medicina personalizada.

3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of orthopaedic surgery and traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering. This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.

Percutaneous pulmonary valve implant: Two Colombian case reports.

Los pacientes con cardiopatías congénitas que afectan la continuidad del ventrículo derecho con la arteria pulmonar deben someterse con frecuencia a intervenciones debido a la limitada vida útil de los conductos quirúrgicos, lo que lleva al desarrollo de disfunción ventricular derecha por cambios en la geometría ventricular y predisposición a arritmias letales, con el consiguiente riesgo de reintervenciones. El implante valvular percutáneo pulmonar es una nueva alternativa terapéutica, menos invasiva en comparación con la quirúrgica, para pacientes seleccionados. Se realiza una revisión de las publicaciones médicas actuales disponibles y se describe la experiencia inicial del implante valvular pulmonar percutáneo en un centro colombiano de alta complejidad para el tratamiento de enfermedades cardiovasculares, en dos pacientes con disfunción del homoinjerto aórtico en posición pulmonar con doble lesión valvular, en los cuales el implante valvular pulmonar percutáneo fue una conducta exitosa. Se eligió a pacientes con cardiopatías congénitas, conductos quirúrgicos disfuncionales con estenosis o insuficiencia pulmonar significativa, y disfunción y dilatación ventricular derechas. Se empleó la técnica regular para el implante de la válvula pulmonar Melody, sin documentarse complicaciones durante el procedimiento ni al año de seguimiento. El implante percutáneo de la válvula pulmonar es un gran avance en el tratamiento de pacientes con cardiopatías congénitas, con resultados favorables a corto y mediano plazos, lo cual hace posible la restauración de la función ventricular con riesgo mínimo, frente al reemplazo quirúrgico en pacientes seleccionados.Patients with congenital heart disease that involves reconstruction of the right ventricular outflow tract must frequently undergo interventions derived from the limited useful life of the surgical canals, which leads to the development of right ventricular dysfunction due to changes in the ventricular geometry and predisposition to lethal arrhythmias, with the consequent risk of reinterventions. The percutaneous pulmonary valvular implant is a new therapeutic alternative, less invasive, compared to surgery, for selected patients. A review of the available literature is made and the initial experience of percutaneous pulmonary valve implantation in a Colombian center of high complexity for the treatment of cardiovascular diseases is described, in two patients with aortic homograft dysfunction in a pulmonary position with double valvular lesion, in which the percutaneous pulmonary valve implant was a successful strategy. Patients with congenital heart disease were chosen, with dysfunctional surgical conduits with stenosis or significant pulmonary insufficiency, with dysfunction and right ventricular dilatation. The standard technique for the implantation of the Melody pulmonary valve was used, without complications during the procedure or one year of follow-up. Percutaneous implantation of the pulmonary valve is a great advance in the management of patients with congenital heart diseases, with favorable results in the short and medium term, allowing the restoration of ventricular function with minimal risk, compared to surgical replacement in selected patients.

Anaesthetic management of intracranial hypertension and pregnancy. A case report. / Manejo anestésico de hipertensión intracraneal y embarazo. Informe de un caso.

Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices. The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear. We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time. This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus.

Clinical Profile and Results Obtained in Patients Treated by Auditory Brainstem Implants. / Perfil clínico y resultados obtenidos en los pacientes tratados mediante implante auditivo del tronco del encéfalo.

INTRODUCTION: Cochlear implants have been able to treat some types of hearing loss, but those related to cochlear nerve impairment made it necessary to find new ways to manage these deficits; leading to auditory brainstem implants (ABI). AIM: Our objective is to present the clinical profile of patients treated through an ABI and the results obtained from 1997 to 2017. MATERIAL AND METHODS: On the one hand, patients with statoacoustic nerve tumours (VIIIcranial nerve) were selected, and on the other hand, patients withoutVIII tumours with congenital malformations of the inner ear. Before and after the placement of the ABI, hearing was assessed through tonal audiometry, from which the PTA (Pure Tone Average) and the CAP (Categories of Auditory Performance) scale were obtained. RESULTS: A total of 20 patients undergoing ABI surgery were included. Eight were of tumour cause (40%) and 12 non-tumour (60%). In 15 subjects (75%) a suboccipital approach was performed and in 5 (25%) translabyrinthine. The mean of active electrodes before the implantation of Cochlear® (Nucleus ABI24) was 13/21 (61.90%) versus 8.5/12 (70.83%) of the Med-el® (ABI Med-el). An improvement in the mean PTA of 118.49dB was found against 46.55dB at 2years. On the CAP scale, values of1 were obtained in the preimplantation and of 2.57 (1-5) in the 2-year revision. CONCLUSION: The ABI is a safe option, and with good hearing results when the indication is made correctly.

Uncommon complications of breast prostheses. / Complicaciones infrecuentes de las prótesis de mama.

Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions.

Thermal analysis of the muscle-bone interface in test samples after the use of therapeutic ultrasound / Análise térmica da interface músculo-osso em corpos de prova após utilização de ultrassom terapêutico

Abstract Introduction Ultrasound used in diathermic therapies aims to achieve temperatures between 40 and 45 °C, since temperatures above 45 °C are known to cause tissue necrosis and burns. Many studies have been conducted to investigate the effect of therapeutic ultrasound in the presence of metallic implants, using phantoms (test samples) and in vivo and ex vivo animal models. In most of these studies, the ultrasound probe is fixed in one area, while in clinical practice, it is recommended that it be moved to avoid possible local overheating. Objective To analyze the thermal field at the muscle-bone interface in phantoms in the presence or absence of metallic implants after the application of therapeutic ultrasound. Methods Phantoms composed of layers simulating fat and muscle, and a layer of beef rib bone, with and without a titanium metallic implant, were prepared. The experiment involved different intensities (1.0, 1.5, and 2.0 W/cm2) and exposure times (5 and 10 minutes), common in clinics, with linear scanning of the probe. Results The experiments indicated that the muscle/implant interface heated less than the muscle/bone interface, especially at intensities of 1.5 and 2.0 W/cm2, after 5 and 10 minutes of treatment. Conclusion The results suggest the possibility of using therapeutic ultrasound in patients with metallic implants, encouraging future research to develop evidence-based protocols and safe recommendations in physiotherapy.

Resumo Introdução O ultrassom utilizado em terapias diatérmicas visa atingir temperaturas entre 40 e 45 °C, sabendo-se que temperaturas acima de 45 °C podem causar necrose tecidual e queimaduras. Muitas pesquisas têm sido realizadas para estudar o efeito do ultrassom terapêutico na presença de implantes metálicos, utilizando phantoms (corpos de prova) e animais in vivo e ex vivo. Na maioria dessas pesquisas, o cabeçote ultrassônico está fixo em uma área, enquanto que na prática clínica recomenda-se que ele seja movimentado para evitar eventuais sobreaquecimentos locais. Objetivo Analisar o campo térmico na interface músculo-osso em phantoms na presença ou ausência de implantes metálicos após a aplicação do ultrassom terapêutico. Métodos Foram elaborados phantoms compostos de camadas simuladoras de gordura e músculo e de uma camada de osso de costela bovina, sendo esta com e sem implante metálico de titânio. O experimento envolveu diferentes intensidades (1.0, 1.5 e 2.0 W/cm2) e tempos de exposição (5 e 10 minutos) comuns em clínica, com varredura linear do cabeçote. Resultados Os experimentos indicaram que a interface músculo/implante aqueceu menos do que a interface músculo/osso, especialmente nas intensidades de 1.5 e 2.0 W/cm2, após 5 e 10 minutos de tratamento. Conclusão Os resultados obtidos apontam para a possibilidade de utilização do ultrassom terapêutico em pacientes com implantes metálicos, incentivando pesquisas futuras para desenvolver protocolos baseados em evidências e recomendações seguras na fisioterapia.

Tratamento da periimplantite por meio da descontaminação do implante: um relato de caso / Treatment of peri-implantitis through implant decontamination: a case report

Os implantes dentários osseointegrados representam uma parte da reabilitação oral, sendo uma alternativa cada vez mais utilizada na Odontologia a fim de substituir dentes perdidos. À semelhança das doenças periodontais, o fator etiológico das doenças periimplantares é o acúmulo de biofilme ao redor dos implantes dentários. Esta patologia também é classificada de acordo com os tecidos acometidos por ela, em mucosite e periimplantite. Para um correto tratamento e sucesso na terapia periimplantar, o diagnóstico deve ser baseado na sua etiologia e, seu tratamento segue variando de acordo com cada caso e estágio da doença. O presente trabalho tem como objetivo relatar o tratamento de um caso de periimplantite por meio da descontaminação da superfície do implante através de uma cirurgia de acesso. Paciente leucoderma, com 56 anos, sexo feminino, procurou atendimento no curso de graduação em Odontologia do centro Universitário da Serra Gaúcha ­ FSG, com queixa de sangramento/supuração, dor e edema na região dos dentes 15 e 16, reabilitados com implantes, e exposição de componentes protéticos. A paciente foi diagnosticada com periimplantite. O plano de tratamento proposto foi de promover a descontaminação da superfície do implante por meio de acesso cirúrgico. Com base no caso clínico apresentado, foi possível concluir que a técnica de tratamento utilizada foi eficaz para a resolução da periimplantite, no período de acompanhamento do estudo (90 dias), demonstrando melhora nos parâmetros clínicos e radiográficos(AU)

Osseointegrated dental implants represent a part of oral rehabilitation, being an increasingly used alternative in Dentistry in order to replace lost teeth. Similar to periodontal diseases, the etiological factor of peri-implant diseases is the accumulation of biofilm around dental implants. This pathology is also classified according to the tissues affected by it, in mucositis and peri-implantitis. For a correct treatment and success in peri-implant therapy, the diagnosis must be based on its etiology, and its treatment continues to vary according to each case and stage of the disease. The present work aims to report the treatment of a case of peri-implantitis through the decontamination of the implant surface through an access surgery. Caucasian female patient, 56 years old, sought care at the graduation course in Dentistry at Centro Universitário da Serra Gaúcha ­ FSG, complaining of bleeding/suppuration, pain and edema in the region of teeth 15 and 16, rehabilitated with implants, and exposure of prosthetic components. The patient was diagnosed with peri-implantitis. The proposed treatment plan was to promote decontamination of the implant surface through surgical access. Based on the presented clinical case, it was possible to conclude that the treatment technique used was effective for the resolution of periimplantitis, in the follow-up period of the study (90 days), demonstrating improvement in clinical and radiographic parameters(AU)