Reconstrução da ponta nasal: relatos de casos e revisão histórica / Nasal tip reconstruction: case reports and historical review

As amputações traumáticas da ponta nasal são lesões desfigurantes, que determinam importante rejeição social, impondo ao paciente um sofrimento adicional, além daqueles já causados pela ferida e suas limitações funcionais decorrentes do traumatismo. Tais defeitos representam um desafio para os cirurgiões plásticos, e existem diversas técnicas que poderão ser adotadas para tratar este mesmo tipo de defeito. Neste trabalho são mostrados inicialmente três casos de amputação traumática exclusivamente da ponta nasal com seus respectivos tratamentos, para em seguida apresentar uma revisão histórica e discussão das diversas técnicas utilizadas para reconstrução da ponta nasal, avaliando comparativamente e enfatizando a evolução técnica no armamentário da cirurgia plástica.

Traumatic amputations of the nasal tip are disfiguring injuries, which determine important social rejection, imposing additional suffering on the patient and those already caused by the wound and its functional limitations resulting from the trauma. Such defects represent a challenge for plastic surgeons, and several techniques can be adopted to treat this type of defect. This work shows three cases of traumatic amputation exclusively of the nasal tip with their respective treatments. They present a historical review and discussion of the different techniques used for nasal tip reconstruction, comparatively evaluating and emphasizing the technical evolution in plastic surgery armament.

Resultados radiológicos y funcionales en fracturas de platillo tibial de alta energía / Radiological and functional results in high-energy tibial plate fractures

Resumen: Introducción: Las fracturas de platillo tibial por mecanismos de alta energía son lesiones graves que ocurren sobre una articulación de carga. Son difíciles de abordar, ya que además de afectar la estructura ósea de la pierna suelen tener lesiones de partes blandas asociadas. Objetivo: Evaluar los resultados radiológicos y funcionales de las fracturas de platillo tibial de alta energía con un mínimo seguimiento de un año. Material y métodos: Estudio retrospectivo, observacional y multicéntrico. Análisis de los resultados radiológicos y funcionales en el tratamiento de fracturas de platillo tibial de alta energía tratadas mediante reducción abierta y fijación interna (RAFI) entre 2014 y 2019. Resultados: 54 fracturas tratadas mediante RAFI. Seguimiento un año, 98.1% de consolidación en 13 semanas de promedio, 83.4% sin alteraciones del eje en plano coronal, 74% sin ensanchamiento articular postoperatorio. Escalas funcionales: Lysholm 82.1 puntos promedio y Oxford Knee Score (OKS) 39.5 puntos promedio. Conclusión: El rango de movilidad articular se redujo luego de una fractura de platillos tibiales de alta energía, pero con buenos resultados funcionales. Cuanto menor deseje y menor ensanchamiento radiográfico postoperatorio, se obtienen mejores resultados.

Abstract: Introduction: The tibial plateau fractures due to high-energy mechanisms are serious injuries that occur on a load bearing joint. These are difficult to approach because, also affect the bone structure of the leg, they usually have associated soft tissue injuries. Objective: To evaluate the radiological and functional results of high-energy tibial plateau fractures with a minimum follow-up of one year. Material and methods: Retrospective, observational and multicenter study. Analysis of radiological and functional outcomes in the treatment of high-energy tibial plateau fractures, treated by open reduction and internal fixation (ORIF) between 2014 and 2019. Results: 54 fractures treated by ORIF. Follow-up one year. 98.1% consolidation in 13 weeks on average. 83.4% without alterations of the axis in the coronal plane. 74% without postoperative joint widening. Functional scores: Lysholm 82.1 average points and Oxford Knee Score (OKS) 39.5 average points. Conclusion: The joint range of motion was reduced after a high-energy tibial plateau fracture, but with good functional results. The less off axis and less post-operative radiographic widening, the better results are obtained.

The TNM 8th edition: Validation of the proposal for organ - confined (pT2) prostate cancer

ABSTRACT Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change. Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model. Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery. Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.

Antinociceptive and acute toxicity evaluation of Vernonia condensata Baker leaves extracted with different solvents and their mixtures.

Extract of Vernonia condensata (Asteraceae = Compositae) leaves has different uses in Brazilian folk medicine, which includes analgesic and antiinflamatory agent. The aim of this study was to apply a modified simplex-centroid mixture design to evaluate the best extractor system for the antinociceptive activity, evaluated by writhing test. Different solvents (acetone, dichloromethane, ethanol and ethyl acetate) as well as their binary, ternary and quaternary mixtures were used. For comparison, aqueous extract was also evaluated. LD50 was estimated and qualitative phytochemical screening, conducted. The extracts with antinociceptive activity were: aqueous, acetone, dicloromethane (DCM), ethanol (ETOH), acetone-DCM, acetone-ETOH, acetone-ethyl acetate, ETOH-ethyl acetate, acetone-DCM-ethyl acetate, acetone-ETOH-ethyl acetate and DCM-ETOH-ethyl acetate. The higher margin of safety (LD50/ED50) was for acetone > acetone-ETOH-ethyl acetate > aqueous > ETOH = acetone-ETOH > DCM > acetone-ethyl acetate > DCM-ETOH-ethyl acetate > acetone-DCM > acetone-DCM-ethyl acetate. Phytochemical screening showed that all the extracts contained alkaloids, phenolic compounds, flavonoids, tannins and saponins. In conclusion, the extractor system influences both the pharmacological activity and acute toxicity of leaves from V. condensata. Acetone and the ternary mixture, acetone-ETOH-ethyl acetate extracts showed higher margin of safety than aqueous extract.

Disfunção erétil / Erectile dysfunction

A disfunção erétil ou "incapacidade de obter e manter ereção peniana" é condição antiga na história da humanidade. No entanto, ainda é uma entidade muito frequente nos consultórios médicos que merece atenção, abordagem e tratamento específico.Apesar do grande avanço da medicina, a história clínica e exame físico são partes fundamentais no diagnóstico e conduta desses pacientes. Durante anamnese detalhada, as causas etiológicas podem ser facilmente identificadas e direcionar a forma de tratamento mais adequada.Nos últimos anos vários novos métodos terapêuticos foram desenvolvidos e outros, utilizados no passado, foram aperfeiçoados. Dentre esses, os principais são: os inibidores da 5-fosfodiesterase (5FDE), avaliação psicológica, injeções intracavernosas e próteses penianas.Com certeza, a medicação via oral utilizada sob demanda mudou a história da disfunção erétil e se tornou o tratamento mais utilizado e efetivo para esse grupo de pacientes. Por esse motivo, especialistas no assunto se referem à história da disfunção erétil como "era pré e pós-inibidores da 5FDE".

Sentinel lymph node biopsy in penile cancer: a comparative study using modified inguinal dissection

INTRODUCTION: In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. MATERIALS AND METHODS: In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. RESULTS: The mean age of the study sample was 57.7 years (44 - 81 years) and the sentinel lymph node presented 0 percent false negative 66 percent sensitivity, and 79.3 percent specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. CONCLUSION: Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.

Biomonitoring of Pb and Cd in two impacted watersheds in Southeast Brazil, using the freshwater mussel Anodontites trapesialis (Lamarck, 1819) (Bivalvia: Mycetopodidae) as a biological monitor

Studies were carried out to investigate the contamination of Piracicaba and Mogi-Guaçu River basins (Säo Paulo State, Southeastern, Brazil) for heavy metals (Cd and Pb), using the limnic bivalve Anodontites trapesialis as a biological monitor. The results showed that the concentrations of Pb were higher than the control group in both basins, showing the bioavailability of this non-essential element in the basins. The concentrations were higher in the Mogi-Guaçu than in the Piracicaba basin, and in the slightly contaminated sites in both basins. There was no correlation between the degree of human impact and Cd and Pb concentrations, it was not possible to infer about concentrations of these heavy metals in the bivalves based only in a broad evaluation of human impact

Biological monitoring of organochlorine pesticides using Anodontites trapesialis (Lam, 1819), (Bivalvia: Mycetopodidae) in a lotic environment-urban sewage

The contribution of domestic and industrial waste to the discharge of organochlorine compounds into the Pardo river, the major body of water in the northeast region of the state of São Paulo, was studied through the biological monitoring of the limnal bivalve anodontites trapesialis. The method used was gas-phase chromatography using a CG 35370 chromatograph. The results showed the abscense of organochlorine pesticide waste from the urban sewage of the city of Ribeirão Preto.

Biological monitoring of organochlorides using the limnic bisalves anodontites trapesialis: (Lam., 1819)

The mussel Anodontites trapesialis (Lam, 1819) was used as an indicator of organochloride pollutans in the Canoas River, located in the municpality of Mococa (21-25'08"S and 47W), State of Säo Paulo, Brazil. Biological monitoring was performed for one year at the site of an orange grove on the left bank of the river. Forty-five animals were placed in aluminum enclosures on the river bottom at this site and 4 animals were sacrificed for pesticide analysis at 3-month intevals, each corrsponding to one season of the year. Pesticides were extracted by the method of Bedford et al., (1968), modified, and the analyses were performed bay gas phase chromatography equipped with an elelctron capture detector. The aninals were found to have been exposed to DDT. Lindane and Heptachlor. Variation in Aldrin and Dieldrin levels was not significant enough to permit inferences. Endrin was not detected in any of the analyses