Fatores de risco consequentes a complicações no pósoperatório da mastoplastia de aumento primária com implantes de silicone: Estudo retrospectivo / Risk factors resulting from complications in the postoperative period of primary breast augmentation with silicone implants: Retrospective study

Introdução: A mamoplastia de aumento é uma das cirurgias plásticas mais realizadas no mundo. Tendo em vista sua alta aplicabilidade, é fundamental conhecer os fatores de risco relacionados à incidência de complicações pós-operatórias a fim de reduzilas nesse tipo de procedimento. Método: Este estudo é retrospectivo feito por meio da análise dos prontuários de 76 pacientes que realizaram mamoplastia de aumento primária com implantes de silicone durante os meses de janeiro de 2018 a dezembro de 2020. Resultados: Observou-se que a presença de comorbidades aumentou a incidência de complicações pós-operatórias precoces (p<0,001), mas não de complicações pósoperatórias tardias (p=0,8). O maior tempo cirúrgico também aumentou a incidência de complicações pós-operatórias (p=0,005). Conclusão: A presença de comorbidades influencia diretamente na incidência de complicações pós-operatórias da mastoplastia de aumento e por esta razão deve-se realizar uma adequada compensação pré-operatória antes de submeter as pacientes a este procedimento cirúrgico.

Introduction: Breast augmentation is one of the most performed plastic surgeries in the world. Given its high applicability, it is essential to know the risk factors related to the incidence of postoperative complications to reduce them in this type of procedure. Method: This retrospective study analyzed the medical records of 76 patients who underwent primary breast augmentation with silicone implants from January 2018 to December 2020. Results: It was observed that the presence of comorbidities increased the incidence of early postoperative complications (p<0.001) but not of late postoperative complications (p=0.8). Longer surgical time also increased the incidence of postoperative complications (p=0.005). Conclusion: The presence of comorbidities directly influences the incidence of postoperative complications after breast augmentation, and for this reason, adequate preoperative compensation must be carried out before submitting patients to this surgical procedure.

Increase in the volume of the breast implant by passing organic material into it / Aumento do volume do implante mamário por passagem de material orgânico para seu interior

Introduction: The search for an anatomical substitute for the breast, for the purpose of correcting aesthetic problems has a long history of failure until the arrival of silicone. Since the beginning of its use, in the 1960s, many complications have appeared, such as infection, rejection, rupture, in addition to silicone leakage. We did not find in the literature, however, any report on the passage of materials from the human organism to the interior of implants. The objective is to identification by infrared spectrophotometry (FTIR) and clinical analysis, reporting the passage of organic substances into breast implants without any violation of their capsule. Methods: 1500 pairs of breast implants were analyzed, surgically removed from 1998 to 2018. Of which six were included in the study. Results: Three materials were analyzed showing macroscopic changes in their interior, without violating the capsule. A second sample was performed on a similar implant, but without use. The third material was a sample of fatty breast tissue removed from the patient during the surgery. Materials compatible with fat, animal protein and hemoglobin were found inside the implant. Conclusions: The change evidenced in the material inside the two implants indicates the occurrence of the passage of organic materials through an intact capsule.

Introdução: A busca de um substituto anatômico para a mama, para fins de correção de problemas estéticos, tem longa história de insucessos até a chegada do silicone. Desde o início de seu uso, na década de 1960, muitas complicações surgiram, como infecção, rejeição, rotura, além do extravasamento de silicone. Não encontramos na literatura, porém, relato algum sobre a passagem de materiais do organismo humano para o interior de implantes. O objetivo é a identificação por espectrofotometria de infravermelho (FTIR) e análise clínica, relatando a passagem de substâncias orgânicas para o interior de implantes mamários sem que os mesmos apresentem violação qualquer de sua cápsula. Método: Foram analisados 1500 pares de implantes mamários, removidos cirurgicamente no período de 1998 a 2018. Destes, seis foram encaminhados incluídos no estudo. Resultados: Foram analisados três materiais apresentando alterações macroscópicas em seu interior, sem que houvesse violação da cápsula. Uma segunda amostra foi realizada em implante semelhante, porém sem uso. O terceiro material foi uma amostra de tecido gorduroso mamário removido da própria paciente durante o ato cirúrgico. Foram encontrados materiais compatíveis com gordura, proteína animal e hemoglobina no interior do implante. Conclusões: A alteração evidenciada no material do interior dos dois implantes nos indica a ocorrência de passagem de materiais orgânicos através de cápsula intacta.

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Clinical results of collagenase treatment for dupuytren's disease: a case series study with 2-years follow-up / Resultados clínicos do tratamento com colagenase para a doença de dupuytren: um estudo de série de casos com 2 anos de acompanhamento

ABSTRACT Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series.

RESUMO Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos.

450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection in the treatment of bladder neck contracture: a case report / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.

Free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury / 中华显微外科杂志

Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.

Avaliação dos dados contidos nas requisições do exame anatomopatológico da mama na cirurgia de troca ou explante de implantes mamários de silicone: análise de 251 casos / Evaluation of the data contained in the requests for the anatomopathological examination of the breast in the surgery of exchange or explantation of silicone breast implants: analysis of 251 cases

Introdução: A descrição do linfoma anaplásico de células T e o recente aumento das cirurgias de explante resultou na elevação do número de exames anatomopatológicos nas cirurgias de retirada de implantes mamários de silicone. O objetivo desta pesquisa é analisar a qualidade e quantidade de dados contidos na requisição do exame histopatológico. Métodos: Foram estudados 251 casos. Os seguintes dados foram analisados: sexo, idade, localização anatômica e espacial, lateralidade, história clínica, sinais e sintomas, quimioterapia e radioterapia prévia, hipótese diagnóstica, cirurgias prévias, tipo e marca do implante, exames de imagem prévios e número e características dos espécimes enviados. Resultados: A idade média foi de 43 anos. A lateralidade não foi mencionada em 16 (0,84%). A localização anatômica foi citada em 15 casos. O tipo de cirurgia foi mencionado por 40 (15,94%). O número de contêineres variou de 1 a 5, com mediana de 2. A cápsula foi enviada em 242 casos, em 161 de forma isolada, tecido mamário em conjunto com cápsula em 27, tecido mamário e cápsula em contêineres diferentes em 54 casos. A história clínica foi incluída em 19,12%, sinais e sintomas em 13,94%, em que a contratura foi o único termo inserido em 64. Em 27 requisições foi citado linfoma. Em 15 pacientes a presença de seroma foi referida e destes nove foram enviados. O tipo e marca do implante não foi citado. Conclusão: Os dados são escassos. Recomenda-se a criação de protocolos na retirada da cápsula e tecido adjacente, incluindo a orientação anatômica e espacial.

Introduction: The description of the Anaplastic Large Cell Lymphoma and the explantation surgery resulted in an increase of histopathological exams in breast implant removing surgery. Methods: 251 pathology requests were studied. The following data from the medical requests were analyzed: gender, age, type of surgery, number of specimens containers sent, laterality, anatomical and spatial location, clinical history, signs and symptoms, previous radiotherapy, previous chemotherapy, diagnostic hypothesis, previous surgeries, and reference to previous breast exams. Results: The mean age was 43 years old. Laterality was not mentioned in 16 requests. The surgery performed was mentioned in 15.94% requests. The number of containers varies from 1 to 5, with a median of 2. The containers include capsules in 242 cases, 161 as isolated capsule, 27 mammary tissue, and capsule in the same specimen, 54 mammary tissues sent in a separate container, anatomical and spatial location was mentioned in 6.33% cases. The detailed clinical data was included in 19.12%, signs and symptoms 13.94%, contracture as the only item mention in 64 of them. In 27 requests, lymphoma evaluation was requested. 15 included seroma and from nine of those, liquid was sent with a request for immunohistochemical and cytology analysis. None of the requests had any data on implant type or brand. Conclusion: The amount of information contained in the medical request forms is minimal. The authors recommend the need for a protocol to standardize the surgical removal of the capsule and the adjacent mammary tissue. Surgical specimens should be spatially oriented.

Explante de prótese mamária de silicone: reconstrução da mama pela técnica dos retalhos cruzados / Silicone breast prosthesis explant: breast reconstruction using the crossed flap technique

Introdução: Em 1963 Cronin e Gerow introduziram o uso do implante de silicone e seu uso aumentou exponencialmente. Contudo, complicações relacionadas aos implantes surgiram ao longo do tempo. O conjunto de situações adversas ao uso dos implantes de silicone, alimentado pelo crescimento das mídias sociais, culminou em um aumento da retirada definitiva do implante. Muitos casos de explante têm o pedículo inferior comprometido pela lesão dos vasos perfurantes e a técnica dos retalhos cruzados é uma alternativa para a reconstrução das mamas explantadas. Métodos: Foram realizados explantes de silicone com reconstrução imediata da mama sem o uso de um novo implante, motivados por indicação médica ou por desejo próprio do paciente. A técnica dos retalhos cruzados foi utilizada em todos os casos. Ela se vale do cruzamento de retalhos parenquimatosos de pedículo superior, um medial e outro lateral, conforme descrito por Sperli. Resultados: Foram operados 10 casos de 2004 a 2021. O tempo de uso das próteses variou de 3 a 19 anos e a principal motivação para o explante foi contratura capsular. Nenhum caso de necrose foi observado. Conclusões: A técnica dos retalhos cruzados é uma alternativa útil e segura para as cirurgias de reconstrução da mama após explante definitivo.

Introduction: In 1963 Cronin and Gerow introduced the use of the silicone implant and its use increased exponentially. However, complications related to implants emerged over time. The set of adverse situations to the use of silicone implants fueled by the growth of social media culminated in an increase in the permanent removal of the implant. Many cases of explants have the inferior pedicle compromised by injury to the perforating vessels, and the crossed flap technique is an alternative for the reconstruction of explanted breasts. Methods: Silicone explants were performed with immediate breast reconstruction without the use of a new implant, motivated by medical indication or the patients own desire. The crossed flap technique was used in all cases. It uses the crossing of parenchymal patches of the superior pedicle, one medial and one lateral, as described by Sperli. Results: 10 cases were operated from 2004 to 2021. The time of use of the prostheses ranged from 3 to 19 years and the main motivation for the explant was capsular contracture. No cases of necrosis were observed. Conclusions: The crossed flap technique is a useful and safe alternative for breast reconstruction surgeries after definitive explantation.

Plano intramuscular para mamoplastia de aumento com implante de silicone / Intramuscular plane for breast augmentation with a silicone implant

Introdução: O aumento mamário é um procedimento estético frequente na cirurgia plástica, o plano ideal ainda não foi encontrado. Cada loja tem sua indicação, suas vantagens e desvantagens. A técnica da loja intramuscular foi inicialmente descrita para uso em cirurgias de aumento dos glúteos com implantes de silicone, e mais tarde sua segurança foi reforçada com a utilização do método XYZ. O estudo tem a finalidade de apresentar a utilização da técnica intramuscular na mamoplastia de aumento com implante de silicone. Métodos: Este estudo descreve em detalhes a técnica da loja intramuscular na mamoplastia de aumento com implante de silicone, utilizada em 50 pacientes do sexo feminino. Resultados: A técnica intramuscular propicia uma boa definição de contorno estético nos quadrantes mediais das mamas. Tivemos um caso de seroma no pós-operatório, causado por erro técnico na separação dos fascículos. Conclusão: A técnica é segura e apresenta baixa incidência de complicações.

Introduction: Breast augmentation is a frequent aesthetic procedure in plastic surgery; the ideal plane has not yet been found. Each pocket has its indication, its advantages, and disadvantages. The intramuscular pocket technique was initially described for use in buttock augmentation surgeries with silicone implants, and later its safety was reinforced with the use of the XYZ method. This study aims to present the use of the intramuscular technique in breast augmentation with a silicone implant. Methods: This study describes the intramuscular pocket technique in breast augmentation with a silicone implant used in 50 female patients. Results: The intramuscular technique provides a good definition of aesthetic contour in the medial quadrants of the breasts. We had a case of seroma in the postoperative period caused by a technical error in separating the fascicles. Conclusion: The technique is safe and has a low incidence of complications.

Review of articulated elbow orthotics for joint stiffness rehabilitation / Revisão de órteses articuladas de cotovelo para reabilitação de rigidez articular

ABSTRACT Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

RESUMO A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Spinopelvic mobility in patients with hip osteoarthritis and total hip arthroplasty indication / Mobilidade espinopélvica nos pacientes com artrose do quadril e indicação de artroplastia total

ABSTRACT Introduction: Reduction of spinopelvic mobility is associated with an increased dislocation of total hip arthroplasty (THA). Objective: To assess 1) spinopelvic mobility in patients with primary hip osteoarthritis and THA indication and 2) the influence of hip flexion contracture on spinopelvic mobility. Methods: Thirty adult patients with primary hip osteoarthritis and THA indication were evaluated using radiographic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar flexibility, and spinopelvic mobility). Results: Spinopelvic mobility ranged from 6.90 a 54.50° (mean 32.79 ± 11.42) and the group of patients with hip flexion contracture had higher mobility. Spinopelvic mobility was correlated with pelvic tilt as well as with lumbar flexibility. Conclusion: Around 13.4% of patients had spinopelvic mobility under 20° , indicating reduced spinopelvic mobility and risk of THA dislocation. Level of Evidence III, Retrospective Comparative Study.

RESUMO Introdução: A redução da mobilidade espinopélvica tem sido associada com o risco de luxação da prótese total do quadril. Objetivos: Avaliar a mobilidade espinopélvica nos pacientes com artrose primária da articulação do quadril e com indicação de artroplastia total do quadril (ATQ), e a influência da contratura em flexão do quadril sobre a mobilidade espinopélvica. Métodos: Trinta pacientes adultos com artrose primária do quadril e indicação de ATQ foram avaliados por meio de parâmetros radiográficos (incidência pélvica, versão pélvica, inclinação do sacro, mobilidade da coluna lombar e mobilidade espinopélvica). Resultados: A mobilidade espinopélvica variou de 6,90 a 54,50 graus (média 32,79 ± 11,42), e foi estatisticamente maior no grupo de pacientes com contratura em flexão do quadril. Foi observado correlação entre a mobilidade espinopélvica e a versão pélvica e flexibilidade da coluna lombar. Conclusão: A mobilidade espinopélvica abaixo de 20 graus, que caracteriza a redução da mobilidade espinopélvica e risco aumentado de luxação ou impacto dos componentes da prótese total foi observada em 13,4% dos pacientes. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Graft versus host disease-related eosinophilic fasciitis: cohort description and literature review

Abstract Background: Chronic graft versus host disease (cGVHD) simulating eosinophilic fasciitis (EF) is an underdiagnosed and challenging complication due to the lack of knowledge about its pathogenesis, refractoriness to traditional immunosuppressive agents and their negative impact on the physical function and quality of life. The aim of this study is to describe the clinical-biological characteristics and response to treatment of a case series and to provide a comprehensive literature review on cGVHD related EF involvement. Methods: Prospective observational study to describe the clinical and diagnostic evaluation characteristics of patients with EF-like follow-up as part of our multidisciplinary cGVHD consultations. In addition, the literature on joint and/or fascial musculoskeletal manifestations due to cGVHD was comprehensively reviewed. Results: 118 patients were evaluated in multidisciplinary cGVHD consultations, 39 of whom (33%) developed fasciitis. Notably, 11 patients had isolated joint contractures without sclerotic skin. After a median of three lines of treatment, the vast majority of patients achieved some degree of response. 94 potentially eligible articles were identified by the search strategy, with 17 of them, the majority isolated case reports, making the final selection. The validated staging scales used for the assessment were the Joint and Fascial Score and the Photographic Range of Motion. Conclusion: Fascial/articular involvement needs to be recognized and evaluated early. To our knowledge, our cohort is the second largest series to have been reported. Literature addressing fascial/joints complications related to cGVHD is scarce. The search for new biomarkers, the use of advanced imaging techniques and multidisciplinary approach may help improve the prognosis of patients with cGVHD.

The polymorphism of metalloproteinases 1 and 13 and posttraumatic elbow stiffness / O polimorfismo das metaloproteinases 1 e 13 e a rigidez articular pós-traumática do cotovelo

ABSTRACT Introduction To evaluate the relationship between the genetic polymorphism of matrix metalloproteinases 1 and 13 and posttraumatic elbow stiffness, as well as the association of other risk factors with this condition. Materials and methods We evaluated 20 patients with posttraumatic elbow stiffness and 12 controls with traumatic elbow disorders without contracture. Deoxyribonucleic acid (DNA) was obtained from buccal mucosa epithelial cells of the volunteers. The MMP-1 and MMP-13 genotypes were determined using PCR-restriction fragment length polymorphism assays. Results We did not find any significant differences in the frequency of genotypes and alleles between the test and control groups for the polymorphism of metalloproteinases 1 and 13. We observed that genotypes 1G/2G and 2G/2G of MMP-1 were present in 65% (13/20) of patients with articular stiffness and 50% (6/12) of controls (p = 0.599). Genotypes A/A and A/G of MMP-13 were obtained in 95% (19/20) of patients and 91.6% (11/12) of controls (p = 0.491). Among the prognostic factors for elbow stiffness, only immobilization time correlated positively. The mean immobilization time for cases and controls were 16 ± 10 days and 7 ± 7 days, respectively (p = 0.017). Conclusion The genetic polymorphism of MMP-1 at position -1607 and MMP-13 at position -77 was not associated with post-traumatic elbow stiffness. Level of Evidence III; Prognosis Study; Case-Control Study.

RESUMO Introdução Avaliar a relação entre o polimorfismo genético das metaloproteinases 1 e 13 da matriz e a rigidez pós-traumática do cotovelo, assim como a associação de outros fatores de risco com essa condição. Material e método Foram avaliados 20 pacientes com rigidez pós-traumática do cotovelo e 12 controles com distúrbios traumáticos do cotovelo sem contratura. O ácido desoxirribonucleico (DNA) de voluntários foi obtido a partir de células epiteliais da mucosa bucal. Os genótipos MMP-1 e MMP-13 foram determinados usando ensaios de polimorfismo de comprimento de fragmento de restrição de PCR. Resultados Não encontramos diferença significativa na frequência de genótipos e alelos entre os grupos teste e controle para o polimorfismo das metaloproteinases 1 e 13. Observamos que os genótipos 1G/2G e 2G/2G de MMP-1 estavam presentes em 65% (13/20) dos pacientes com rigidez articular e 50% (6/12) dos controles (p = 0,599). Os genótipos A/A e A/G da MMP-13 foram obtidos em 95% (19/20) dos pacientes e 91,6% (11/12) dos controles (p = 0,491). Dentre os fatores prognósticos para rigidez de cotovelo, apenas o tempo de imobilização se correlacionou positivamente. O tempo médio de imobilização para casos e controles foi de 16 ± 10 dias e 7 ± 7 dias, respectivamente (p = 0,017). Conclusões O polimorfismo genético de MMP-1 na posição -1607 e MMP-13 na posição -77 não foi associado à rigidez pós-traumática do cotovelo. Nível de Evidência III; Estudos Prognósticos; Estudo de Caso-Controle.

Epidemiological aspects of dupuytren's disease in brazil / Aspectos epidemiológicos da doença de dupuytren no brasil

ABSTRACT Objectives: The purpose of this study is to describe associated factors and epidemiological aspects of Dupuytren's Disease in patients followed up in a Brazilian tertiary public hospital, at the Hand Surgery service. Methods: A cross-sectional study was performed from 2014 to 2019. Data collected included: age, gender, ancestry, associated comorbidity presence, phenobarbital, tobacco, and alcohol use, family history of Dupuytren's Disease and associated fibrotic diseases. Then, the patients underwent a clinical examination to identify and characterize the involvement of the fingers. The patients were also assessed in regard to whether they presented Dupuytren's Disease severity factors. Results: 140 patients were included, 70.7% men and 29.3% women. Only 42.3% reported being of European ancestry; 20% had first-degree relatives with the disease; 59.3% presented comorbidities, including hypertension, diabetes, chronic heart disease, dyslipidemia, epilepsy, and HIV infection; 15.8% had Ledderhose disease, 7.1% had Peyronie's disease. 31% were smokers, 16.6% were alcoholic, and 37.1% were phenobarbital users; 40% presented with a severe form of DD. Conclusion: The population studied was composed of Brazilians, most of whom did not report European ancestry; still, they presented several characteristics similar to those described in literature worldwide. Level of Evidence II; Prognostic Studies; Investigating the effect of a patient characteristic on the outcome of a disease .

RESUMO Obejtivo: Descrever fatores associados e aspectos epidemiológicos da Doença de Dupuytren em uma população de pacientes acompanhados em serviço de Cirurgia de Mão de hospital público terciário brasileiro. Métodos: Realizou-se um estudo transversal entre os anos de 2014 e 2019. Coletamos dados como idade, gênero, ascendência, comorbidades associadas, doenças fibróticas associadas, uso de fenobarbital, uso de tabaco e álcool e histórico familiar de Doença de Dupuytren. Em seguida, realizamos exame clínico, caracterizando o acometimento dos dedos da mão. Também foi avaliado se os pacientes da amostra apresentavam fatores de gravidade da Doença de Dupuytren. Resultados: 140 pacientes foram incluídos, 70,7% eram homens e 29,3% mulheres. Apenas 42,3% dos pacientes relataram ascendência europeia; 20% apresentaram parentes de primeiro grau com a doença; 59,3% apresentaram comorbidades, incluindo hipertensão, diabetes, cardiopatia crônica, dislipidemia e infecção por HIV; 15,8% tinham doença de Ledderhose e 7,1% tinham doença de Peyronie. 31% eram fumantes, 16,6% declararam alcoolismo, 37,1% faziam uso de fenobarbital e 40% apresentaram a forma grave da DD. Conclusão: A população estudada foi composta por brasileiros que apesar de, em sua maioria, não relatarem ascendência europeia, apresentaram diversas características semelhantes às descritas na literatura mundial. Nível de Evidência II; Estudos Prognósticos; Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Is Elevated Hba1c Level Associated with Achilles Tendon Contracture Development in Diabetic Foot Patients?

@#Introduction: Chronic hyperglycemia can increase extracellular matrix (ECM) accumulation that leads to tendon fibrosis and subsequent contracture. Considering the reversibility of fibrosis, it is important to identify factors that are associated with it. The purpose of this study was to determine whether elevated HbA1c levels are associated with the development of Achilles tendon contracture in diabetes mellitus patients. Materials and methods: We reviewed 206 patients with diabetic foot problems between January 2015-December 2019. Demographic data, the presence of Achilles tendon contracture, and laboratory results were documented and statistically analysed between patients with contracture and without contracture. Results: Patients’ mean age was 58.46 ± 6.67 years old. Contracture was found in 84 out of 206 patients (40.78%) patients, with female predominance (45/84 patients; 53%). While contracture was found significantly associated with sex difference (0.035) and age groups (p=0.006), there was no meaningful association with HbA1c level groups (p=0.324). Conclusion: Findings do not support the use of HbA1c level as a sole determinant of Achilles tendon contracture. Seemingly, there are other confounding factors affecting the Achilles tendon contracture development in diabetes mellitus patients. It should be emphasised that albeit the association between chronic hyperglycemia and contracture development, the low HbA1c should not be overlooked as having no risk of Achilles tendon contracture and vice versa.

Juvenile hyaline fibromatosis: a case report and literatures review / 口腔疾病防治

Objective@#To investigate the clinicopathological characteristics, imaging manifestations, genetic manifestations, diagnosis and treatment of juvenile hyaline fibromatosis.@*Methods @# A case of juvenile hyaline fibromatosis was reported, and the patient's clinical manifestations, imaging examinations, histopathological examinations, genetic changes and treatment were summarized and analyzed.@*Results @#Juvenile hyaloid fibromatosis is more common in infants and children. This patient had typical clinical and pathological manifestations, including posterior occipital masses, skin and subcutaneous nodules, gum hyperplasia, joint contractures, and joint osteolytic lesions. The histopathological lesions were characterized by the proliferation of spindle cells in the tissue accompanied by a large amount of amorphous transparent matrix. Genetic testing was performed to confirm an ANTXR2 gene mutation, consistent with the known genetic changes of juvenile hyaline fibromatosis. The 6-month follow-up of the patient showed that there was no obvious recurrence after resection of the gum and facial mass. In addition to surgery, the treatment of this disease requires multidisciplinary symptomatic treatment combined with rehabilitation and supportive treatment to achieve a better prognostic effect.@*Conclusion@# Juvenile hyaline fibromatosis is a rare nonneoplastic autosomal recessive genetic disease. Mutations in the ANTXR2 gene lead to disorders of collagen synthesis and metabolism in the tissues and further cause subcutaneous nodules, gingival hyperplasia, joint contractures and bone dissolution.

Circumflex scapular perforator propeller flap for reconstruction of axillary scar contractures / 中华显微外科杂志

Objective:To estimate the preliminary result of circumflex scapular perforator propeller flap in reconstruction of axillary scar contractures.Methods:From January 2016 to June 2021, circumflex scapular perforator propeller flaps were used in 7 cases for reconstruction of soft tissue defect after axillary scar contractures. Patients were 5 males and 2 females. Age ranged from 23 to 38 years old, mean age of 27.7 years old. According to Kurtzman and Stern classification of axillary scar contractures, there were 1 case with type 1a, 1 with type 1b, 2 with type 2, and 3 with type 3. The preoperative range of motion of the shoulder joint were 40°-85°, with an average of 63.7°. All the patients were underwent scar release and circumflex scapular perforator propeller flap transfer. All flaps were transferred as the manner of perforator propeller flap. All the donor sites were closed directly. The defects after releasing ranged from 5.0 cm×7.0 cm to 11.0 cm×9.0 cm, and the flaps ranged from 16.0 cm×7.0 cm to 24.0 cm×9.0 cm. Flap survival, complications of donor site and recipient site were recorded after surgery. The range of motion of the shoulder joint, donor and recipient sites were reviewed in outpatient clinic.Results:All flaps survived uneventfully after surgery, besides 1 case complicated with distal venous congestion. The follow-up time ranged from 6 to 23 months, with an average of 12 months. The texture and contour of the flaps were good in all. At last follow-up, the range of motion of the shoulder joints were 90°-120°, with an average of 107°. Mild scar hyperplasia occurred in 2 cases.Conclusion:The circumflex scapular perforator propeller flap is an effective protocol in reconstruction of axillary scar contractures.

Efficacy and safety of bladder neck resection combined with local steroid injection in the treatment of bladder neck contracture after TURP / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of bladder neck resection combined with multipoint injection of triamcinolone acetonide in the treatment of bladder neck contractures (BNC) after transurethral resection prostate (TURP).Methods:The data of 25 patients with BNC after TUPR who underwent transurethral surgery in West China Hospital of Sichuan University from July 2019 to November 2021 were retrospectively analyzed, and the patients were divided into 2 groups according to the treatment method. There were 15 cases in the steroid injection group, with an average age of (67.5±8.8) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time after TURP was (21.9±29.1) months, the preoperative International Prostate Symptom Score (IPSS) was (30.0±3.5) points, quality of life (QOL) score was (5.7±0.5) points. There were 10 cases in the non-steroid injection group, with an average age of (65.2±10.5) years, 1 case of diabetes, and 2 cases of hypertension. And the average postoperative time of TURP was (29.3±33.5) months, and the preoperative IPSS was (30.4±2.6) points, QOL score was (5.8±0.4) points. There was no significant difference between the two groups ( P>0.05). In the steroid injection group, bladder neck resection combined with multipoint injection of triamcinolone acetonide was performed. The patients were in the lithotomy position, and a scope was placed through the urethra into the distal end of the narrow urethra under direct vision for observation, and a supersmooth guide wire was placed. The narrow section is then incised at 6 o'clock. After replacing the resectoscope, the urethral stricture scar was excised until the normal tissue of the bladder neck was exposed. Hemostasis by electrocoagulation resulted in no active bleeding from the urethra after resection. After the bladder injection needle was inserted, 80 mg (12 ml) of triamcinolone acetonide injection was injected in 6 equally spaced needles at the direction of the bladder neck from 3 to 9 o'clock. A supersmooth guide wire was placed, and a three-channel silicone urinary catheter was indwelled along the guide wire. The non-steroid injection group underwent simple bladder neck resection. Re-examination of urethroscopy at 3 and 6 months after operation showed that the patient had obvious dysuria and the microscopic examination showed that the recurrence of bladder neck stenosis was defined as the recurrence of stenosis. The efficacy, complications, and recurrence-free survival rates of the two groups were compared. Predictors of postoperative BNC recurrence were analyzed. Results:The operations in both groups were successfully completed. The operation time of the steroid injection group and the non-steroid injection group were (36.0±17.8) min and (48.5±57.9) min respectively ( P=0.438), and the intraoperative blood loss was (1.9±3.0) ml and (12.0±31.1) ml ( P=0.221)respectively. The length of hospital stay was (5.8±1.2) d and (4.4±2.5) d, respectively ( P=0.070). There was 1 case of transient hematuria and 1 case of epididymitis in the steroid injection group, and 1 case of transient hematuria and 1 case of transient dysuria in the non-steroid injection group ( P>0.05), all of which were relieved after symptomatic treatment. The IPSS of steroid injection group and non-steroid injection group were (11.0±5.6) points and (12.4±3.9) points at 3 months after operation, and (10.1±4.9) points and (14.7±7.7) points at 6 months after operation, respectively. QOL at 3 months after operation was (1.7±1.2) points and (2.1±1.5) points, respectively, and at 6 months after operation, it was (1.5±1.3) points and (3.0±2.0) points, respectively. There was statistical significance ( P<0.05). There were 1 case and 2 cases of recurrence in the steroid injection group and non-steroid injection group at 3 months after operation ( P=0.543), and 1 case and 5 cases at 6 months after operation ( P=0.023). The difference in survival curve between the two groups was statistically significant ( P=0.013). Combined steroid therapy ( OR=14.000, 95% CI1.299-150.889, P=0.030), time after scar resection ( OR=1.138, 95% CI1.017-1.273, P=0.025), postoperative IPSS( OR=1.302, 95% CI1.018-1.666, P=0.036), postoperative QOL score ( OR=4.280, 95% CI1.523-12.030, P=0.006) were the predictors of stenosis recurrence 6 months after surgery. Conclusion:Bladder neck scar resection combined with steroid injection could be safe and effective in the treatment of BNC after TURP, and local steroid injection may help reduce the recurrence rate of postoperative stenosis.

Artrogripose Múltipla Congênita: Relato de dois casos / Arthrogryposis Multiplex Congenita: Report of two cases

RESUMO: A Artrogripose Múltipla Congênita (AMC) é uma síndrome rara, que representa um grupo de condições congênitas caracterizado por contraturas articulares em duas ou mais articulações, não progressivas, geralmente simétricas, de etiologia desconhecida e que pode estar associada a outras malformações, como viscerais e neurológicas. Apresenta-mos dois casos isolados com achados característicos de AMC, atendidos em ambulatório de pediatria de alto risco de uma cidade do Oeste do Paraná. Caso 1: lactente, sexo feminino, 14 dias de vida, com redução dos movimentos fetais referidos pela mãe, apresentando malformações envolvendo somente os membros, visualizadas logo após o nasci-mento. Caso 2: lactente, sexo masculino, quatro meses de vida, com diagnóstico de hipocinesia fetal ao ultrassom obstétrico de 23 semanas, ao nascimento apresenta contraturas dos membros e disfunção do sistema nervoso cen-tral. O diagnóstico da artrogripose é complexo e essencialmente clínico, sendo necessária uma anamnese meticulosa, contemplando uma avaliação da gestação, via de parto, história familiar e um exame físico minucioso, classificando quais os tipos de contraturas, membros envolvidos, presença de musculatura alterada e de alterações neurológicas, a fim de diferenciar a AMC das outras síndromes que também cursam com contraturas articulares. O seguimento e tratamento dos lactentes com artrogripose devem ocorrer em acompanhamento multidisciplinar devido às variadas manifestações que a doença pode apresentar e à característica de recidiva ao longo dos anos. (AU)

ABSTRACTArthrogryposis Multiple Congenita (AMC) is a rare syndrome that represents a group of congenital conditions character-ized by joint contractures in two or more joints, non-progressive, usually symmetrical, of unknown etiology and which may be associated with other malformations, such as visceral and neurological. We present two isolated cases with characteristic features of AMC, seen in a high-risk pediatrics outpatient clinic in a city in western Paraná. Case 1: infant, female, 14 days old, with reduced fetal movements reported by the mother, presenting malformations involving only the limbs, seen immediately after birth. Case 2: infant, male, four months old, diagnosed with fetal hypokinesia on 23-week obstetric ultrasound, at birth, presents limb contractures and central nervous system dysfunction. The diagnosis of ar-throgryposis is complex and essentially clinical, requiring a meticulous anamnesis, including an assessment of pregnan-cy, delivery, family history and a thorough physical examination, classifying what types of contractures, involved limbs, presence of altered musculature and neurological changes to differentiate AMC from other syndromes that also have joint contractures. The aftercare and treatment of infants with arthrogryposis must occur in multidisciplinary follow-up due to the varied manifestations that the disease may present and the characteristic of recurrence over the years. (AU)

Intraoperative Assessment of Endogenous Microbiota in the Breast / Avaliação intraoperatória da microbiota endógena da mama

Abstract Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter. Results: Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively. Conclusion: The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.

Resumo Objetivo: A cirurgia de mama é considerada uma cirurgia limpa; entretanto, as taxas de infecção variam entre 3 e 15%. O objetivo deste estudo foi investigar no intraoperatório a presença de microbiota autóctone na mama. Métodos: Pedaços de tecido mamário coletados de 49 pacientes submetidas à cirurgia eletiva da mama (reconstrutiva, diagnóstica ou oncológica) foram cultivados. Os pedaços de tecido mamário tinham aproximadamente 1 cm de diâmetro e foram removidos da área retroareolar e dos quadrantes medial e lateral. Cada pedaço de tecido foi incubado em caldo BHI (brain heart infusion) por 7 dias a 37 ° C, e nos casos em que o meio ficou turvo devido ao crescimento de microrganismos, as amostras foram colocadas em placas de Petri para cultivo e isolamento de cepas e para identificação de espécies usando um contador automatizado. Resultados: O crescimento do microrganismo foi observado nas amostras de 10 das 49 pacientes (20,4%) e em 11 dos 218 pedaços de tecido (5%). As espécies detectadas foram Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis e Aeromonas salmonicida. Nenhum paciente com amostras positivas apresentou infecção clínica no pós-operatório. Conclusão: A presença dessas bactérias no tecido mamário em aproximadamente 20% das pacientes desta série sugere que a cirurgia mamária deve ser considerada uma fonte potencial de contaminação que pode ter implicações nas reações adversas aos implantes mamários e deve ser estudada em um futuro próximo por suas implicações oncológicas na etiologia do linfoma de células grandes associado ao implante de mama.