Compromiso del parénquima pulmonar secundaria a la inyección subcutánea de geles de silicona: reporte de caso

El compromiso del parénquima pulmonar secundario a la inyección subcutánea de geles de silicona es un cuadro de presentación excepcional, que se presenta con mayor frecuencia en mujeres entre los 22 a 55 años. Aunque se han planteado distintas teorías sobre su etiología, esta se desconoce y puede presentar complicaciones locales, sistémicas e incluso tener un desenlace fatal. Son pocos los casos reportados en América del Sur, y en el Perú no existe reporte alguno de esta singular entidad. Se presenta el caso de un paciente varón de 28 años, transexual, previamente sano, quien tras la inyección subcutánea de geles de silicona en la región glútea, en forma ilegal y por una persona que no es profesional de la salud, manifestó, dentro de las primeras 24 horas, un cuadro clínico caracterizado por dificultad respiratoria progresiva y dolor torácico punzante de aproximadamente 7 de 10 en la escala del dolor. Al ingresar a emergencias se evidenció de manera objetiva insuficiencia respiratoria, ya que el paciente presentó una saturación de oxígeno del 72 % a Fio₂: 21 %, asimismo, el compromiso del parénquima pulmonar tanto en la tomografía y radiografía de tórax con signos muy sugerentes de esta patología. Mediante la prueba ARN para SARS-CoV-2 en la muestra respiratoria por RT-PCR en tiempo real se descartó la neumonía secundaria al virus SARS-CoV-2, igualmente se excluyó la patología por inmunosupresión y tromboembolismo pulmonar. Debido a que no existe un tratamiento estandarizado se le brindó las medidas de soporte pertinentes, tales como administración de oxígeno suplementario a bajo flujo por cánula binasal, corticoides sistémicos vía endovenosa, además de antibioticoterapia, y se logró una evolución favorable con resolución del cuadro clínico inicial. Después de 10 días de tratamiento intrahospitalario el paciente fue dado de alta.

Pulmonary parenchymal involvement secondary to the subcutaneous injection of silicone gels is an unusual condition which occurs more frequently in women aged between 22 and 55 years. Although different theories have been put forward about its etiology, it is unknown and the condition may cause local and systemic complications and even have a fatal outcome. Few cases have been reported in South America and there is no report of this unique entity in Peru. We present the case of a previously healthy 28-year-old male transgender patient who, after an illegal subcutaneous injection of silicone gels in the gluteal region given by a non-healthcare professional, showed progressive respiratory distress and stabbing chest pain of approximately 7 out of 10 on the pain scale within the first 24 hours. Upon admission to the emergency room, respiratory failure was objectively evidenced since the patient had an oxygen saturation of 72 % at a FiO₂ of 21 %, as well as pulmonary parenchymal involvement both in the CT scan and chest X-ray with signs highly suggestive of this pathology. Using a SARS-CoV-2 RNA real-time RT-PCR test performed on a respiratory specimen, COVID pneumonia, immunodeficiency disorders and pulmonary embolism were ruled out. Since there is no standard treatment, the patient was given relevant support measures such as the administration of supplemental oxygen at a low flow rate by binasal cannula, intravenous systemic corticosteroids and antibiotic therapy, thus achieving good progress with resolution of the initial clinical presentation. Then, after 10 days of intrahospital treatment, the patient was discharged.

Explante de silicone mamário: um estudo longitudinal multicêntrico / Breast silicone explant: a multicenter longitudinal study

Introdução: Após a colocação de implantes mamários de silicone, algumas pacientes apresentam sintomas descritos como doença do implante mamário e buscam a cirurgia de explante. O objetivo deste estudo é analisar o histórico de sintomas e verificar as impressões dos pacientes submetidos ao explante mamário em três momentos distintos: antes de colocar os implantes mamários, enquanto estavam com os implantes e após a cirurgia de explante. Métodos: Essa pesquisa foi delineada como um estudo observacional longitudinal multicêntrico utilizando um questionário on-line de participação voluntária enviado por e-mail. Resultados: Foram analisados 156 pacientes, 84% apresentavam três ou mais sintomas e 66,1% destes obtiveram melhora de sua sintomatologia após o explante (p<0,001). Antes da colocação de silicone, a mediana de autossatisfação corporal era de 7, enquanto estavam com os implantes a mediana tornou-se 9 e após a cirurgia de explante a mediana se manteve em 9 (p<0,001). Grupos de apoio em redes sociais auxiliaram na decisão de fazer o explante em 87,2% das pacientes. Conclusão: Pacientes que têm sintomas após colocarem silicone apresentam melhora com a retirada dos implantes mamários. A autossatisfação corporal aumenta com a colocação de implantes mamários e permanece elevada após a retirada destes. Pacientes que fazem a cirurgia do explante costumam estar arrependidas de terem colocado silicone, muito satisfeitas com a decisão de removêlos e igualmente satisfeitas com o resultado da cirurgia de explante mamário. Grupos de apoio em redes sociais foram importantes na tomada de decisão destas pacientes.

Introduction: Following silicone breast implant placement, some patients present symptoms described as breast implant illness and seek explant surgery. This study aims to analyze the historical symptoms and ascertain breast explant patients' impressions at three different times: before breast implant placement while having the implants, and after the explant surgery. Methods: This survey was designed as a multicenter longitudinal observational study using an online voluntary participation questionnaire sent by e-mail. Results: 156 patients were analyzed, 84% had three or more symptoms, and 66.1% improved their symptoms after the explant (p<0.001). Before the placement of silicone, the median self-body satisfaction was 7, while with the implants, the median became 9, and after the explant surgery, the median remained up to 9 (p<0.001). Support groups on social networks helped in the decision to explant in 87.2% of the patients. Conclusion: Patients presenting symptoms after silicone placement show improvement with breast implant removal. Body self-satisfaction increases with the placement of breast implants and remains increased after their removal. Patients who undergo the explant surgery usually regret having implanted silicone; they are very satisfied with the decision to remove them and equally satisfied with the result of the breast explant surgery. Support groups on social networks were important in the decision-making of these patients.

Passado, presente e futuro utilizando implantes mamários de silicone no Brasil, um relato de 45 anos / Past, present and future using silicone breast implants in Brazil, a 45-year report

O autor conviveu com implantes mamários e relata a história da evolução em seus 45 anos de experiência. Aponta os pontos principais dessa evolução, as coincidências e as complicações no transcorrer do tempo, e propõe ao final acontecimentos possíveis no futuro.

The author lived with breast implants and tells the story of evolution in his 45 years of experience. It points out the main points of this evolution, the coincidences, and complications over time, and proposes possible future events in the end.

Tratamento cirúrgico de ptose mamária com inclusão de prótese de silicone: avaliação de resultados cirúrgicos e satisfação de pacientes / Surgical treatment for breast ptosis with silicone prosthesis: evaluation of surgical results and patient satisfaction

Introdução: A correção da ptose mamária associada à flacidez de pele é corrigida através da mastopexia com inclusão de implante. O objetivo deste trabalho foi avaliar os resultados cirúrgicos e a satisfação de pacientes submetidas à cirurgia de ptose mamária com inclusão de prótese de silicone. Métodos: Foram selecionadas 22 pacientes submetidas à mastopexia com inclusão de implante, no período de fevereiro a setembro de 2016, no Serviço de Cirurgia Plástica do Hospital Heliópolis. Foi realizada entrevista com as pacientes, por meio de aplicação de questionário, com a finalidade de verificar o grau de satisfação e as alterações no cotidiano diário após a cirurgia. A avaliação dos resultados cirúrgicos foi realizada mediante avaliação de três cirurgiões, do qual atribuíram notas a diferentes itens. Resultados: 100% das entrevistadas se sentem satisfeita com a cirurgia e todas relataram a melhora da autoestima delas. Na avaliação das cirurgias realizada com os cirurgiões, cerca de 91% dos resultados estão entre regular e bom. Conclusão: O grau de satisfação das pacientes submetidas à mastopexia com inserção foi excelente e houve impacto favorável na qualidade de vida e bem-estar das pacientes avaliadas, sendo que o resultado pós-cirúrgico se enquadra como regular ou bom.

Introduction: The correction of breast ptosis associated with skin flaccidity is done through mastopexy with the inclusion of an implant. This work's objective was to evaluate the surgical results and the satisfaction of patients who underwent breast ptosis surgery with silicone prosthesis placement. Methods: We selected 22 patients who underwent mastopexy with implant placement, from February to September 2016, at the Plastic Surgery Service of Hospital Heliópolis. Interviews were conducted applying to the patients a questionnaire to verify the degree of satisfaction and changes in the daily routine after surgery. The surgical results evaluation was carried out by three surgeons, who attributed scores to different items. Results: 100% of the interviewees feel satisfied with the surgery, and all reported an improvement in their self-esteem. In the evaluation of surgeries performed with surgeons, about 91% of the results are between regular and good. Conclusion: The degree of patient's satisfaction who underwent mastopexy with insertion was excellent. There was a favorable impact on the quality of life and well-being of the patients evaluated, with the post-surgical result being classified as regular or good.

Manejo de cicatrizes com uso de placas e gel de silicone / Management of scars with the use of silicone gel and sheets

A formação de cicatriz é a resposta de cura natural da pele para restabelecer a integridade dérmica após uma lesão. As cicatrizes, além de inestéticas, podem ainda apresentar-se hipertróficas ou queloidianas, tornando o tratamento difícil e, por vezes, insatisfatório. A etnia e a localização da ferida desempenham um papel importante na gênese dos tipos de cicatriz, mas nem sempre podemos prever o resultado final. O uso do silicone tópico tem sido uma opção para o manejo da cicatriz e alvo de diversas publicações ao longo dos anos. Acredita- se que o uso precoce possa prevenir o desenvolvimento de cicatrizes anormais e tratar cicatrizes existentes.

Scar formation is the natural healing response of the skin to reestablish dermal integrity after an injury. Besides being unsightly, the scars can also be hypertrophic or keloids, which makes treatment challenging and many times unsatisfactory. Ethnicity and site of the lesion have an important role in the formation of scar types, but it is not always possible to predict the final result. The use of topical silicone has been an option for scar management and the target of many publications over the years. It is believed that its early use can prevent the development of abnormal scars and treat existing scars.

Effectiveness of TGF-beta 1 neutralizing antibody against the capsule contracture of silicone prosthesis / 中华医学美学美容杂志

Objective To study the effects and mechanism of immediate application of transformation growth factor beta 1 (TGF-β1) neutralizing antibody postoperatively to prevent the fibrous capsule formation in animal model,and to observe the different effects between two concentrations of TGF-β1 neutralizing antibody.Methods Ten ml of smooth round silicone prostheses were implanted subcutaneously in the back of rats.Then 25 μg/0.1 ml or 50 μg/0.1 ml TGF-β1 neutralizing antibody were injected around the implanted prostheses in the experimental group,while the control group was injected with PBS 0.1 ml.On day 7,14 and 28,the thickness of capsule measured;The density of collagen;and the expression of TGF-β1,alpha smooth muscle actin (α-SMA),and fibronectin (FN) was detected.Results After 28 days,the average capsule thickness of the control group was significantly higher in the experimental group,and the difference between the control group and the 25 μg experimental group had statistical significance.TGF-β1 expression and the number of α-SMA positive fibroblasts in control group were significantly higher than that in the experimental group,the difference was statistically significant.In the control group,the expression of FN and collagen density was slightly higher than the two experimental groups,but the differences among the three groups showed no statistical significance at each time point.Conclusions Immediate application of the TGF beta 1 neutralizing antibody in the the implant prosthesis can reduce the thickness of the capsule to some extent.

Immediate Breast Reconstruction Using Silicone Implants in Previously Augmented Patients

BACKGROUND: Augmentation mammoplasty is rapidly becoming one of the most frequently performed cosmetic surgeries. Consequently, the number of breast cancer patients with a history of breast augmentation surgery will increase. The purpose of this study is to report our experience of breast reconstruction in augmented women and discuss their treatment characteristics. METHODS: From March 2010 to August 2015, 7 patients who had previously undergone breast augmentation were treated at our institution. Epidemiologic data as well as data regarding body mass index, types of mastectomy, and complication were recorded and analyzed. RESULTS: The mean age was 43.4 years, the average follow-up period was 21 months, and the mean body mass index (BMI) was 19.3 kg/m2, the average weight of the mastectomy specimen was 150 g. Implant-based immediate breast reconstruction after skin-sparing mastectomy was performed in seven patients and in four of these patients, acellular dermal matrix (ADM) was used. One patient had a capsular contracture of Baker grade II. One patient had seroma. CONCLUSIONS: Previously augmented patients tend to have a slender abdomen and back. Moreover, Asians have a smaller body frame and lower muscle and fat percentage than westerners, making it more suitable for implant-based reconstruction than autologous tissue. It can be recommended as a surgical method as our patients were highly satisfied with the cosmetic outcomes.

Regulation of Transforming Growth Factor beta1, Platelet-Derived Growth Factor, and Basic Fibroblast Growth Factor by Silicone Gel Sheeting in Early-Stage Scarring

BACKGROUND: Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. METHODS: Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-beta1, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. RESULTS: In both the epidermis and the dermis, the expression of TGF-beta1 (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). CONCLUSIONS: The levels of TGF-beta1, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.

Foreign Body Granulomas after the Use of Dermal Fillers: Pathophysiology, Clinical Appearance, Histologic Features, and Treatment

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

The Clinical Implications of Poly Implant Prothese Breast Implants: An Overview

Mammary implants marketed by Poly Implant Prothese (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Prothese", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

Immediate breast construction with silicone prosthesis after nipple-areola complex sparing mastectomy / 中国组织工程研究

BACKGROUND:As Chinese women have the smaler breast capacity, the traditional breast conserving operation may lead to the poor breast shape, moreover, breast reconstruction with latissimus dorsi myocutaneous flap and transverse rectus abdominis myocutaneous flap is very difficult and has trauma and more complications. Therefore, the immediate breast construction with implants after nipple-areola complex sparing mastectomy is a good choice. OBJECTIVE: To investigate the feasibility of immediate breast construction using silicone prosthesis after nipple-areola complex sparing mastectomy. METHODS:The immediate breast reconstruction after nipple-areola complex sparing mastectomy was performed in 33 female patients with breast cancer (20 cases in the left side and 13 cases in the right side), aged 30-48 years. The effects of reconstructed breast were evaluated according to objective and subjective criteria during the folow-up. RESULTS AND CONCLUSION:Of the 33 cases, 2 cases had nipple-areola complex ischemic necrosis postoperatively and were cured quickly; 1 case had intra-operative blood loss > 800 mL and recovered wel after fluid and blood transfusion. The aesthetic outcome was wel in 31 cases and the satisfactory rate was 94% during 10-51 months of folow-up period. No recurrence and metastasis were found in al cases. The operation method of immediate breast reconstruction with implants after nipple-areola complex sparing mastectomy is maneuverable and has excelent aesthetic effects with no severe complications.

Caracterización de lesiones dermatológicas por ecografía / Characterization of Dermatological Lesions by Ultrasound

Introducción: En la actualidad, el uso de transductores de alta resolución ha permitido avances muy importantes en la caracterización de lesiones dermatológicas, brindando información anatómica como tamaño, profundidad, patrón de vascularización, depósitos de calcio, contenido sólido o quístico e, incluso, elementos como cabello. Objetivo: Revisar las características ecográficas de lesiones cutáneas de diferentes etiologías, como infecciosas, tumorales y traumáticas. Metodología: Se utilizaron las imágenes ecográficas correspondientes a pacientes de consulta externa vistos en nuestra institución. Conclusión: Se concluye que la ecografía es una herramienta muy útil que aporta información adicional al clínico para el manejo de múltiples lesiones dermatológicas.

Introduction: At the present day the use of high resolution transducers have allowed significant progress in characterizing skin lesions, providing anatomical information such as size, depth, vascularization, calcium deposits, cyst or solid contents and even hair. Objective: the objective of this article is to review the ultrasound characteristics of skin lesions, like: infections, tumors, and traumas. Methodology: for its methodology, we use ultrasound images of outpatients seen at our institution. Conclusion: we conclude that ultrasound is a useful tool that provides additional clinical information for the management of multiple skin lesions.

Form-Stable Highly Cohesive gel Breast Implants

Highly cohesive, form-stable cohesive gel implants were introduced in 1993. This resulted in a paradigm shift in breast augmentation surgery. With the introduction of shaped textured implants, surgeon started to think in terms of shape and dimensions rather than volume and cup size. Basically most aspects of such breast augmentations are different. The way of selecting implants is different. Patient preoperative markings, surgical techniques, postoperative recommendations and results also differ. These are not mere new types of implant, but they represent a new concept in breast augmentation surgery. Surgeons who believe that form stable implants behave in the same way as non-form stable implants will tend to plan, select implants and perform surgery in traditional ways. Unfortunately, they are bound to encounter significantly more complications and problems. These implants are recently available in Korea since 2012 and will provide patients and surgeons with the ability of enhanced outcome and results if used properly; however there needs to be a transition from round cohesive gel implant thought process to a more comprehensive approach for the typical Korean plastic surgeon.

Primary Breast Augmentation with Anatomical Form-stable Implant

The Natrelle(TM) 410 (Allergan Inc., Irvine, CA, USA) shaped, form-stable silicone gel implant was introduced in Europe in 1993. Its "form stability" relates to increased cohesiveness or stiffness of the gel filler, allowing the implant to maintain its shape in the upright position. The anatomical form-stable implant is helpful for reducing ripples and provides more natural looking due to less upper pole fullness, so it has some benefits for the thin patients. And it provides more expansion to the lower pole, it has also benefits for the ptotic breasts or constricted breasts. I have experienced 69 cases with anatomical form-stable implants (52 Polytech Replicon(R) (POLYTECH Health & Aesthetics, Dieburg, Germany) implants, 85 Natrelle(TM) 410 implants) from February to December of 2012. The most common used implants are MF295 g of Natrelle(TM) 410 and high profile 315 g of Polytech Replicon(R). I did reoperations for 2 breasts of 2 patients. One was due to hematoma and the other was due to displacement. Both cases are my early experiences of shaped implants. There is no other complication yet. I need longer follow-up period for the appropriate evaluation. In my early experiences, the results of anatomical form-stable implants seem to make less fullness of upper pole, less ripples, more tightness, and similar recovery periods in contrast with the results of round textured implants.

Role of Anatomical Implant in Augmentation of Glandular Ptotic Breast

Breast augmentation of ptotic micromastia is relatively difficult procedure than simple augmentation. Surgeon must make into account many variables, ptosis degree, chest wall size, shape, asymmetry, nipple and inframammary fold level, soft tissue characteristic etc. One-stage mastopexy augmentation procedure has higher patient acceptance because this limits the number of sick days and the need for hospital care, and it is also less expensive. Because of two procedures that has opposite effect to soft tissue be done in the same time, there can be high incidence of unfavorable outcomes and complications. Some well known doctors recommend that 2-step procedure of mastopexy folllowed by augmentation can be much better option. It can make more predictable result and it is also safe in soft tissue problem and vascularity. In one stage augmentation mastopexy, high and extrahigh projection implants have often been promoted for augmenting glandular ptotic breast, emphasizing the role of implant projection to the sagging parenchyma and skin of lower pole of breast anteriorly to "lift" the breast and "correct" the ptosis. High and extra high profile implants may contribute projection, but they are not the best choice for correction of glandular ptosis. It has several negatives, additional parenchymal atrophy, lower pole skin stretch and thinning and visible and palpable rippling. All of these tissue consequences are irreversible and uncorrectable. Optimal implant design for augmentation of glandular ptotic breast is full height, moderate profile, shaped, textured, form stable implant.

Mastopexia crescente com implantes de silicone: um estudo longitudinal prospectivo / Crescent mastopexy with silicone implants: a longitudinal prospective study", "_e": "n

INTRODUÇÃO: Mastopexia periareolar crescente com aumento mamário é uma técnica bem descrita para correção de ptoses mamárias classificadas com graus I e II de Regnault. O objetivo deste estudo é discutir os resultados obtidos utilizando essa técnica, com posicionamento do centro de implantes redondos abaixo do mamilo. MÉTODO: Ptoses de grau I foram corrigidas, em pacientes selecionadas, utilizando uma combinação de mastopexia crescente periareolar com aumento mamário utilizando implantes de gel de silicone redondos de perfil alto. As pacientes responderam a um questionário, classificando os resultados obtidos com a mamoplastia como pobres, satisfatórios ou bons. RESULTADOS: Foram estudadas 128 pacientes, que receberam implantes de silicone com volume médio de 308 ml. Foram observadas taxas de reoperação e de complicação de 9,4% e 8,6%, respectivamente. Oitenta e uma (63,3%) pacientes responderam ao questionário, das quais 58% consideraram o resultado bom, 35,8% satisfatório e 6,2% pobre. CONCLUSÕES: Este estudo demonstrou que essa combinação de técnicas proporciona bons resultados, com baixo índice de complicações.

BACKGROUND: The combination of crescent periareolar mastopexy with breast augmentation is a well-described technique for the cosmetic improvement of breast ptosis classified as grades I and II, according to the Regnault grade scale. The aim of this study is to discuss the results obtained by the authors using a combination technique where the center of the round implants was positioned below the nipple projection. METHODS: Grade I ptosis was corrected in certain patients by a combination of crescent periareolar mastopexy with breast augmentation using round-shaped, high-profile silicone gel implants. Each patient completed a questionnaire and rated the results obtained as poor, satisfactory, or good. RESULTS: Were studied 128 patients who received silicone implants (average volume, 308 mL). The observed reoperations and complications rates were 9.4% and 8.6%, respectively. Eighty-one (63.3%) patients responded to the questionnaire, and 58% considered the result good, 35.8% considered it satisfactory, and 6.2% considered it poor. CONCLUSIONS: This study showed that this combination of techniques yields good results and low complication rates.

Braquioplastia de aumento: cirurgia para rejuvenescimento dos braços / Augmentation brachioplasty: surgery for improving the appearance of the arms

INTRODUÇÃO: Os implantes de silicone são utilizados em diversas regiões do corpo. Em mulheres, a flacidez da musculatura do tríceps constitui um dos grandes incômodos; por outro lado, em homens, a hipertrofia da região do bíceps e tríceps é sinal de masculinidade e beleza. O objetivo deste trabalho é descrever uma técnica relativamente simples e reprodutível para aumento da circunferência do braço ou para correção de flacidez de grau leve a moderado com fins estéticos, com uso de implantes de silicone gel e elastômero. MÉTODO: Foram selecionados e operados 32 pacientes, com a introdução de no mínimo 2 implantes e no máximo 4 implantes por braço. RESULTADOS: Houve melhora significativa da estética dos braços dos pacientes estudados, com índice de satisfação superior a 90%. A melhora foi sentida na avaliação estática e em movimento do braço, grande queixa da maioria de pacientes do sexo feminino. CONCLUSÕES: A técnica cirúrgica apresentada para braquioplastia de aumento é segura e reprodutível, sendo mais uma opção no arsenal terapêutico do cirurgião plástico em sua busca por resultados melhores, com incisões menores.

BACKGROUND: Silicone implants are used in several regions of the body. In women, sagging of the triceps muscle is a major concern. Meanwhile, men consider biceps and triceps hypertrophy to be a symbol of masculinity and beauty. Here, we describe a relatively simple and reproducible procedure used for esthetic purposes to increase arm circumference or correct mild to moderately sagging skin using gel silicone implants and elastomer. METHODS: Thirty-two patients were selected and operated on. Two to four implants per arm were introduced. RESULTS: The esthetics of the arms improved significantly in the studied patients, with a satisfaction rate exceeding 90%. The procedure improved static evaluation and arm movement, which were the major complaints of majority of the female patients. CONCLUSIONS: The surgical technique presented for augmentation brachioplasty is safe and reproducible, and should be considered by plastic surgeons in an attempt to achieve better results with smaller incisions.

Comparison of Scarclinic-thin(TM) and Scarclinic(TM) in Terms of Scar Improvement: A pilot study

Silicone gel sheets are widely used to treat keloids and hypertrophic scars. Scarclinic(TM) is a type of silicone gel sheet developed in Korea, and has been shown to improve the appearance of scars. However, Scarclinic(TM) has demerits that include weak adhesiveness, a color that differs from skin, and too great a thickness. Scarclinic-thin(TM) was recently developed with these disadvantages in mind. The purpose of this pilot study was to compare the effects of Scarclinic-thin(TM) and Scarclinic(TM) on scar appearance and wearer's comfort. From April 2010 to May 2010, Scarclinic-thin(TM) and Scarclinic(TM) were applied to treat a single scar in each of 8 patients. One half of each scar was treated with Scarclinic-thin(TM) and the other with Scarclinic(TM). After 3 months, scar quality and wearer's comfort were evaluated using the Vancouver Scar Scale(VSS) and an objective self-assessment scale (OSAS). Mean Vancouver Scar Scale scores for Scarclinic(TM) and Scarclinic-thin(TM) at 3 months were 3.4+/-1.3 and 3.3+/-2.0, respectively, and mean objective self-assessment scale scores were 21.7+/-4.5 and 22.3+/-2.9, respectively. No statistically significant difference was observed between Scarclinic(TM) and Scarclinic-thin(TM) in terms of Vancouver Scar Scale or objective self-assessment scale scores(p=0.83 and 0.70, respectively). Scarclinic-thin(TM) and Scarclinic(TM) are similar in terms of their scar improving effects and wearer's comfort.

Effect of the emodin thermosensitive hydrogel on coilagenase in gingival crevicular fluid of patients with chronic periodontitis / 中国基层医药

Objective To observe the effect of the emodin thermosensitive hydrogel on collagenase in gingival crevicular fluid of patients with chronic periodontitis and to evaluate the clinical efficacy.Methods Forty patients with chronic periodontitis were selected.For each patient after scaring and root planning,the one teeth on one side in a person was assigned at the test group and treated with the emodin thermosensitive hydrogel in the pocket once a week for four weeks.The teeth on the other side were assigned as the control group,just with the primary periodontal treatment.The PLI、SBI、PD、AL、MD and content of collagenase in gingival crevicular fluid were examined at baseline,before administration and after administration four weeks.The COL-II level in GCF was detected using ELISA method.Results There were no significant differences in PLI、SBI、PD、AL、MD and content of collagenase in gingival crevicular fluid before the treatment(P ＞ 0.05).While there are some evidences that periodontal indexes dropped down and the type Ⅱ collagenase level in gingival crevicular fluid also declined after using the emodin thermosensitive hydrogel than the control group(t =3.46,4.02,4.18,3.03,2.79,4.29,all P ＜ 0.05).Conclusion Ultrasonic scaling using the emodin thermosensitive hydrogelas was more effective in reducing the type Ⅱ collagenase level in gingival crevicular fluid.And improving clinical parameters associated with periodontal health in patients with chronic periodontitis.

Incisão transareolopapilar para mamoplastia de aumento: experiência dos últimos 10 anos do Instituto Ivo Pitanguy / Transareolopapilar incision for breast augmentation: 10-year experience at the Ivo Pitanguy Institute

INTRODUÇÃO: Várias vias de acesso foram criadas para a inclusão de implantes na cirurgia de aumento das mamas. Em 1966, Pitanguy descreveu a via de acesso transareolopapilar. O objetivo do presente estudo é avaliar as mamoplastias de aumento realizadas no Instituto Ivo Pitanguy (Rio de Janeiro, RJ, Brasil), nas quais se utilizou a incisão transareolopapilar, nos últimos 10 anos. MÉTODO: Realizado estudo retrospectivo, analisando-se os seguintes parâmetros: tamanho dos implantes, indicação da incisão transareolopapilar e complicações pós-operatórias, como alterações cicatriciais. RESULTADOS: Foram incluídas no estudo 53 pacientes, com média de idade de 33,54 anos e tempo médio de seguimento de 11,6 meses. A maioria (60,4 por cento) dos implantes possuía menos de 200 ml. Doze pacientes foram submetidas a reintervenções pelas seguintes razões: nódulo mamário (1 caso), infecção (1 caso), contratura capsular (1 caso), e insatisfação com a forma das mamas (4 casos), com o volume (4 casos) e com a cicatriz unilateral (1 caso). Dezesseis (30,2 por cento) pacientes desenvolveram alguma complicação menor no pós-operatório e 13 (24,5 por cento) apresentaram alguma alteração cicatricial no pós-operatório: hipocromia (18,9 por cento), hipertrofia unilateral (1,9 por cento), retração cicatricial unilateral (1,9 por cento), e aréola bífida (1,9 por cento). Vinte (37,7 por cento) pacientes realizaram seguimento pós-operatório superior a um ano e relataram satisfação com a cicatriz. CONCLUSÕES: A incisão transareolopapilar permite a inclusão de implantes de tamanho pequeno a moderado, com baixo índice de complicações pós-operatórias e cicatriciais, desde que seguida a correta técnica cirúrgica.

BACKGROUND: There are numerous access routes for inserting implants during breast augmentation surgery. In 1966, Pitanguy described the transareolopapilar route. The aim of this study was to assess the use of transareolopapilar incision during breast augmentation surgery at the Ivo Pitanguy Institute (Rio de Janeiro, RJ, Brazil), over the past 10 years. METHODS: Retrospective analyses of the size of the implants used, indications for transareolopapilar incision, postoperative complications, and postoperative scarring were performed. RESULTS: Fifty-three patients with a mean age of 33.54 years were included, and the mean follow-up period was 11.6 months. Most (60.4 percent) of the implants were <200 ml. Twelve patients required a second operation due to a breast lump (1 case); infection (1 case); capsular contracture (1 case); and dissatisfaction with breast shape (4 cases), volume (4 cases), and unilateral scarring (1 case). Sixteen (30.2 percent) patients developed some form of minor postoperative complication; 13 (24.5 percent) had one or more scarring issues, including hypochromia (18.9 percent), hypertrophy (1.9 percent), scar retraction (1.9 percent), and areola bifida (1.9 percent). Twenty (37.7 percent) patients underwent postoperative follow-up for more than one year and were satisfied with the postoperative scar. CONCLUSIONS: The transareolopapilar incision facilitates the insertion of small-to-moderate size implants with a low rate of postoperative complications and a low incidence of scarring, provided the correct surgical technique is used.