Ataque isquémico transitorio por embolia aérea iatrogénica secundaria a inyecciones intracavernosas en procedimiento urológico / Transient ischemic attack due to iatrogenic air embolism secondary to intracavernous injections during an urologic procedure

RESUMEN Se presenta un caso de ataque isquémico transitorio con sintomatología compatible con lesión de la circulación cerebral posterior, secundario a embolia aérea iatrogénica. Se describe la evolución clínica y las consideraciones más relevantes de la atención y el diagnóstico del ataque cerebrovascular de la circulación posterior. En cuanto a la embolia gaseosa, se describen los métodos diagnósticos, las intervenciones clínicas y las opciones de tratamiento disponibles.

SUMMARY Here ia a case of transient ischemic attack with symptoms compatible with injury to the posterior cerebral circulation, secondary to iatrogenic air embolism. Clinical evolution and the most relevant aspects for the care and diagnosis of cerebrovascular stroke of the posterior circulation are described. Regarding air embolism, the diagnostic methods, clinical interventions, and available treatment options are described.

Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations

Abstract Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or "roots" that may be missed if an excised tumor is serially cross-sectioned in a "bread-loaf" fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs's initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.

Desprendimiento seroso de retina agudo inducido por cirugía en posición prono / Acute serous detachment of retina after surgery in prone position

Resumen La posición en decúbito prono es utilizada en cirugía para acceder a diferentes estructuras anatómicas del paciente. Esta posición puede asociarse a pérdida visual postoperatoria en el 0,05 a 1 % de las complicaciones reportadas. El desprendimiento seroso de retina es la separación de la retina neurosensorial del epitelio pigmentario de la retina por acumulación de líquido, sin daño estructural, como resultado de cambios en la permeabilidad y perfusión de la coroides. Se presenta el caso de una mujer con indicación de extracción de prótesis glútea bilateral mediante cirugía en decúbito prono. Se identificó un desplazamiento del cojín posicionado en la cara y la cabecera no correspondía con la estructura ósea de la paciente. En sala de recuperación la paciente refirió pérdida visual en ojo izquierdo, por lo cual fue evaluada inmediatamente por Oftalmología encontrando una presión intraocular bilateral normal; un examen de fondo de ojo izquierdo evidenció múltiples áreas de desprendimiento de la retina. La tomografía con coherencia óptica confirmó la presencia de fluido subretiniano. Fue tratada con nepafenaco y prednisolona tópicas y evaluada a las 72 horas y a la semana, con resolución total del cuadro y agudeza visual corregida de 20/20. No existen reportes en la literatura de desprendimiento seroso de retina posterior a cirugía en prono. Al evaluar el caso se asumió que la incorrecta posición del cojín y el tamaño inadecuado de la cabecera fueron factores que podrían haber contribuido a estasis venoso del flujo coroideo aumentando súbitamente la presión hidrostática en la coroides, lo que provocó el desprendimiento seroso de retina.

Abstract Prone position is used in surgery to access different anatomical structures of the patient. This position can be associated with postoperative visual loss in 0.05 to 1 % of complications. Serous retinal detachment is the separation of the neurosensory retina from the retinal pigment epithelium by fluid accumulation without structural damage. This is the result of changes in the permeability and perfusion of the choroid. This is the case of a woman with an indication for removal of a bilateral gluteal prosthesis by surgery in the prone position. A displacement of the cushion positioned on the face was identified and the headboard did not correspond to the bone structure of the patient. In the recovery room, the patient reported visual loss in the left eye, which was immediately evaluated by Ophthalmology, finding a normal bilateral intraocular pressure. The left eye fundus examination revealed multiple areas of retinal detachment. Optical coherence tomography confirmed the presence of subretinal fluid. She was treated with topical nepafenac and prednisolone, and evaluated at 72 hours and a week, with total resolution of the condition and corrected visual acuity of 20/20. There are no reports in the literature of serous retinal detachment after prone surgery. When evaluating the case, it was assumed that the incorrect position of the cushion and the inadequate size of the bedside are factors that could have contributed to venous stasis of the choroidal flow, suddenly increasing the hydrostatic pressure in the choroid that caused the serous retinal detachment.

Radiographic Analysis of Intra-articular Fractures of the Calcaneus in patients undergoing Minimally Invasive Surgical Treatment in a Tertiary Hospital / Análise radiográfica de fraturas intra-articulares de calcâneo em pacientes submetidos a tratamento cirúrgico minimamente invasivo em hospital terciário

Abstract Objective This paper aims to evaluate patients with articular calcaneal fractures treated with a minimally invasive surgical technique between January 2015 and August 2016, with emphasis on radiographic results. Methods Retrospective study of 49 patients with 64 displaced calcaneal fractures treated with open reduction by minimal lateral access to the subtalar joint and minimal fixation. Pre- and postoperative radiographic studies were performed to measure the angles of Böhler and Gissane. Results The average angle of Böhler before surgery was 2.5º, increasing to an average value of 25.3º after the minimally invasive surgical treatment. The average angle of Gissane before surgery was 136.3º, decreasing to an average value of 114.3º after the procedure. Conclusion The minimally invasive surgical technique improves the radiographic parameters of intra-articular calcaneal fractures, with appropriate anatomical restoration of anatomical shape.

Resumo Objetivo Avaliar pacientes com fraturas intra-articulares de calcâneo tratados entre janeiro de 2015 e agosto de 2016 com técnica cirúrgica minimamente invasiva, com ênfase no resultado radiológico. Métodos Estudo retrospectivo de 49 pacientes com 64 fraturas intra-articulares de calcâneo, submetidos a tratamento cirúrgico minimamente invasivo. As lesões foram tratadas com redução aberta por acesso mínimo lateral à articulação subtalar e fixação mínima. Foi realizado estudo radiográfico no pré- e no pós-operatório para aferição dos ângulos de Böhler e de Gissane. Resultados O ângulo de Böhler médio dos casos antes da cirurgia foi de 2,5º, apresentando aumento da média dos ângulos para 25,3º após o tratamento cirúrgico minimamente invasivo. O ângulo de Gissane médio dos casos antes da cirurgia foi de 136,3º, apresentando diminuição da média dos ângulos para 114,3º na análise após a cirurgia. Conclusão A técnica cirúrgica minimamente invasiva permite melhora dos parâmetros radiográficos (ângulos de Böhler e Gissane) nas fraturas intra-articulares de calcâneo, com sua adequada recuperação da forma anatômica.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Diagnosis and treatment of mucocele in a pediatric patient: case report / Diagnóstico e tratamento de mucocele em paciente pediátrico: relato de caso

ABSTRACT Mucocele is a benign lesion, originating from disorders of minor salivary glands containing mucus. These lesions are found in children and young adults and usually occur due to local trauma. Clinically, it presents as a circumscribed, asymptomatic, soft and bluish or normocromic blister. The treatment of choice is surgical removal, when the lesion does not rupture naturally. This study aims to report a clinical case of mucocele in a pediatric patient removed through total surgical excision. A 7-year-old patient accompanied by mother sought care at the Dentistry Clinic of the "Tiradentes" University Center (UNIT / AL), with a main complaint of asymptomatic blister in the lower lip for about 15 days. In the anamnesis, the habit of biting in the region was reported. At clinical examination, a blister with clear limits of approximately 10 mm in diameter was observed in the lower lip mucosa, with slightly firm/fibrous consistency, which gave rise to doubts about the possible diagnosis, since it presented characteristics similar to that of a mucocele, although consistency at palpation indicates possible fibroma. Surgical excision of the lesion was performed; the material collected was fixed in 10% formalin and sent to histopathological examination that confirmed the diagnosis of mucocele. The patient was kept on follow-up, and there was no recurrence of the lesion. Surgical excision demonstrated an effective and prognostic therapeutic course, allowing accurate diagnosis through the histopathological evaluation of the lesion.

RESUMO Mucocele é uma lesão benigna, proveniente de desordens de glândulas salivares menores, que contém muco em seu interior. Essas lesões são encontradas em crianças e adultos jovens e ocorrem, geralmente, devido a um traumatismo local. Clinicamente apresenta-se como uma bolha circunscrita, assintomática, de consistência mole e cor azulada ou normocrômica. O tratamento de escolha é a remoção cirúrgica, quando a lesão não rompe naturalmente. Objetivo: Este trabalho tem como objetivo relatar um caso clínico de mucocele em paciente pediátrico removido por meio de excisão cirúrgica total. Relato de caso: Paciente acompanhado da mãe, 7 anos, procurou atendimento na Clínica de Odontologia do Centro Universitário Tiradentes (UNIT/AL), com queixa principal de aparecimento de bolha no lábio inferior, assintomática, cerca de 15 dias, na anamnese foi relatado o hábito de mordedura na região. Ao exame clínico foi observada uma bolha, com limites nítidos, de aproximadamente 10 mm de diâmetro, na mucosa do lábio inferior, de consistência levemente firme/fibrosa o que gerou dúvidas sobre o possível diagnóstico, pois apresentava características semelhantes à de uma mucocele apesar da consistência a palpação indicar um possível fibroma. Foi realizado a excisão cirúrgica da lesão, o material colhido foi fixado em formol a 10% e encaminhado para exame histopatológico que confirmou o diagnóstico de mucocele. O paciente foi mantido em acompanhamento, não havendo recorrência da lesão. Conclusão: A excisão cirúrgica demonstrou-se uma conduta terapêutica eficaz e com bom prognóstico, possibilitando um diagnóstico preciso através da avaliação histopatológica da lesão.

Effect of proximal-distal brachial plexus block on short-term operation in a department of hand surgery / 中华麻醉学杂志

Objective To evaluate the effect of proximal-distal brachial plexus block for short-term operation in a department of hand surgery.Methods One hundred patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,weighing 45-90 kg,undergoing palm and finger surgery,were divided into 2 groups (n =50 each) using a random number table method:proximaldistal brachial plexus block group (group A) and proximal brachial plexus block group (group B).In group A,1％ lidocaine 20 ml was given using the subclavian coracoid approach,and 0.35％ ropivacaine was given for ulnar nerve,radial nerve and median nerve of forearm (5 ml for each nerve root).In group B,0.35％ ropivacaine 20 ml was given through the subclavian coracoid approach.Sufentanil 0.1 μg/kg was intravenously infused at 5 min before nerve block,and dexmedetomidine was intravenously infused over 10 min in a loading dose of 0.8 μg/kg followed by a continuous infusion of 0.4 pμg · kg-1 · h-1 until the end of operation at the same time.The blocking effect was assessed by pin-prick test at 15 min after administering local anesthetics,and the operation was started after the blocking effect was satisfactory.Muscle strength of upper arm was measured at 2,3,4,6,8,10 and 12 h after administering local anesthetics (T1-7),the recovery of muscle strength (≥ grade 3) was recorded,and visual analogue scale scores were recorded at the same time.When visual analogue scale score ≥4,tramadol 100 mg was intramuscularly injected,and the requirement for tramadol was recorded.The occurrence of adverse events (local anesthetic intoxication,pneumothorax,anaphylaxis,nerve injury,nausea and vomiting,etc.) was recorded,and the tourniquet reaction was recorded.Results Compared with group B,the muscle strength recovery rate was significantly increased at T2-6 (P＜0.05),and no significant change was found in the requirement for tramadol in group A (P＞0.05).Tramadol was used at T6 in group B and at T7 in group A.Conclusion Proximal-distal brachial plexus block can be safely and effectively used for short-term operation in a department of hand surgery and is beneficial to the rapid recovery of muscle strength after operation.

Nova classificação para hipertrofia dos pequenos lábios vaginais e correlação com as técnicas cirúrgicas indicadas / New classification of hypertrophy of the labia minora and correlation with indicated surgical techniques

Introdução: Primeira colocada entre as mais procuradas cirurgias plásticas genitais, a ninfoplastia ou labioplastia visa a correção da hipertrofia dos pequenos lábios vaginais e prepúcio, retirando seu excesso, sem interferir na sua função de proteção da vagina e auxílio na lubrificação genital. Diversos tipos de classificações foram propostos para facilitar a compreensão do grau de hipertrofia dos pequenos lábios vaginais e ajudar na escolha da técnica da labioplastia. Após analisar várias classificações, o autor propõe uma nova classificação, no intuito de facilitar a compreensão da hipertrofia das ninfas, capuz do clitóris e prepúcio e ajudar na escolha da técnica apropriada para labioplastia. Métodos: Foi feita uma busca na literatura médica PubMed/Medline com os termos hipertrofia lábios vaginais, labioplastia, labiaplasty, labioplasty, lábia minora hipertrophy, labial protrusion. Foram analisadas todas as classificações descritas nos trabalhos encontrados. Resultados: Uma nova classificação foi proposta. A hipertrofia dos pequenos lábios vaginais foi classificada em 4 graus: Grau 0 (≤ 1 cm), Grau 1 (> 1 cm e ≤ 3 cm), Grau 2 (> 3 cm e ≤ 5 cm) e Grau 3 (> 5 cm). Conclusões: A nova classificação, além de facilitar a compreensão do tamanho e extensão da hipertrofia das ninfas, também auxilia na escolha da técnica a ser escolhida para a labioplastia.

Introduction: Nymphoplasty or labioplasty is the most common genital plastic surgery. The objective of labioplasty is to correct hypertrophy of the labia minora and clitoral prepuce, removing excess tissue without affecting their function of protecting the vagina and aiding in genital lubrication. Several types of classifications have been proposed to facilitate the understanding of the degree of hypertrophy of the labia minora and assist in selecting the most suitable procedure in labioplasty. After analyzing several classifications, the author proposes a new classification to facilitate the understanding of hypertrophy of the labia minora, clitoral hood, and vaginal prepuce and help select the best labioplasty procedure. Methods: A literature search was conducted in PubMed/Medline using the following terms: hipertrofia lábios vaginais, labioplastia, labiaplasty, labioplasty, labia minora hypertrophy, and labial protrusion. All the classifications described in the identified studies were analyzed. Results: A new classification has been proposed. Hypertrophy of the labia minora was classified in four grades: grade 0 (≤ 1 cm), grade 1 (> 1 cm and ≤ 3 cm), grade 2 (> 3 cm and ≤ 5 cm), and grade 3 (> 5 cm). Conclusions: The new classification improves the understanding of the size and extent of hypertrophy of the labia minora and helps select the best procedure in labioplasty.

Clinical effects of pretarsal fullness reconstruction of the lower eyelid using autologous dermis or acellular dermis / 中华医学美学美容杂志

Objective To investigate the new metheds of recreating pretarsal fullness of the lower eyelid using autologous dermis or acellullar dermis.Methods Between September 2010 and November 2013,total 16 patients underwent the procedures of recreating of pretarsal fullness of the lower eyelid using dermis materials.A stab skin incision of approximately 4-5 mm was made at the lateral canthus and inner canthus along the subciliary crease of the lower eyelid respectively,and then the skin was undermined to create a subcutaneous tunnel between two stab incisions.The dermis roll was introduced into the undermined subcutaneous plane of the lower eyelid.The end of dermis was sutured to orbicularis oculi muscle to maintain the appropriate tension.Results 11 cases of them used autologous dermis,5 of used acellullar dermis.The patients were followed up for 3-24 months.Lower-eyelid pretarsal fullness regained abvious and natural appearance,and the patients were highly satisfied.Complications included slight sclera show,partial absorption of dermis material and slight irregular apperence.One case of dermis infection occured and dermis roll had to be removed.Conclusions Autologous dermis or acellullar dermis grafting are simple,efficient techniques for recreating of pretarsal fullness of the lower eyelid.

Surgical treatment of type I neuritis in a teenage boy with borderline tuberculoid leprosy

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

A randomized-controlled, double-blind comparison of the postoperative analgesic efficacy of caudal bupivacaine and levobupivacaine in minor pediatric surgery / 대한마취과학회지

BACKGROUND: We compared the postoperative analgesic efficacy of caudal levobupivacaine with bupivacaine in pediatric subumbilical surgery. METHODS: Sixty American Society of Anesthesiologists I-II patients scheduled for elective minor surgery (1.5-7 years old) were randomly divided into three groups to receive caudal injections of study drugs at 0.5 ml/kg. All patients received 0.1 mg/kg oral midazolam 30 min before surgery. Group B received 0.125% bupivacaine, group L received 0.125% levobupivacaine, and group LF received 0.125% levobupivacaine + 0.5 microg/kg fentanyl. Blood pressure, heart rate and sedation (using a four-scale sedation score) were monitored perioperatively. During the postoperative period, an anesthesiologist blinded to the study groups used the Children's and Infants' Postoperative Pain Scale to monitor patients' pain and degree of sedation. The time before the first rescue analgesic was recorded as well as any side effects over the next 24 h. RESULTS: The four-scale sedation and postoperative pain scale scores in all groups were identical. Blood pressure and heart rate measured at 15 min postoperatively were lower, and time to first rescue analgesic was longer, in Group LF compared to the others. CONCLUSIONS: Caudal 0.5 ml/kg of 0.125% bupivacaine and levobupivacaine are equally effective for postoperative analgesia after subumbilical surgeries in pediatric patients. Addition of fentanyl may lower the required amount of local anesthetics.

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…

An experience of increased pain in patient with postherpetic neuralgia who had skin excision: A case report

Surgical excision or undermining of the affected skin in patients with postherpetic neuralgia (PHN) has been introduced as an optional treatment when other treatment failed to reduce the pain. Such peripheral operation is rarely performed due to its limited effects and invasiveness. There were few reports about long-term outcome regarding surgical excision of PHN skin. We had experienced a case of PHN patient, who underwent surgical excision 10 years ago and suffered with returned pain and severe allodynia. The pain subsided markedly after a treatment with intercostal nerve block and topical lidocaine patch.