Tissue repair capacity of bioceramic endodontic sealers in rat subcutaneous tissue

Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen.

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno.

Manejo de reações adversas dermatológicas em pacientes submetidos à terapia quimioterápica antineoplásica / Management of dermatological adverse reactions in patients undergoing antineoplastic chemotherapy

Objetivo: o presente estudo tem como objetivo reunir recomendações de cuidados considerando a prevenção e tratamento de lesões de pele induzidas pelo tratamento com quimioterápicos antineoplásicos, de acordo com os estudos e consensos atuais. Metodologia: realizou-se um estudo bibliográfico para levantamento das relações entre os principais fármacos antineoplásicos e suas intercorrências dermatológicas, bem como seus respectivos manejos, para subsidiar a orientação e aconselhamento aos profissionais de saúde que acompanham o paciente oncológico. Resultado: os principais problemas dermatológicos decorrentes do uso de antineoplásicos correspondem às lesões de pele, tais como a descoloração, hiperpigmentação, fotossensibilidade, eritemas, descamação e prurido. Também são recorrentes os efeitos adversos que acometem os pelos e cabelos, resultando em alopecia, e a modificação do crescimento e lesões nas unhas. Tratamentos específicos para cada caso são capazes de amenizar ou reverter os problemas. Conclusão: as reações adversas aos medicamentos envolvendo quimioterapia são frequentes na prática oncológica, e variam em termos de frequência e gravidade, atingindo diversos anexos cutâneos. O adequado manejo destes efeitos melhora a integridade da pele e demais estruturas, proporcionando a esses pacientes a melhoria da autoestima e da qualidade de vida.

Objective: the present study aims to gather care recommendations considering the prevention and treatment of skin lesions induced by treatment with antineoplastic chemotherapy, according to current studies and consensus. Methodology: a bibliographical study was carried out to survey the relationships between the main antineoplastic drugs and their dermatological intercurrences, as well as their respective management, to subsidize the guidance and counselling of health professionals who treat cancer patients. Result: the main dermatological problems arising from the use of antineoplastic agents correspond to skin lesions, such as discoloration, hyperpigmentation, photosensitivity, erythema, scaling and pruritus. Adverse effects that affect hair and body hair are also recurrent, resulting in alopecia, and the modification of growth and lesions on the nails. Specific treatments for each case can alleviate or reverse the problems. Conclusion: adverse drug reactions involving chemotherapy are frequent in oncology practice, and vary in terms of frequency and severity, affecting various skin appendages. Proper management of these effects improves the integrity of the skin and other structures, providing these patients with improved self-esteem and quality of life.

A retrospective study on 53 cases of subcutaneous tissue or subpectoral space implantation for breast reconstruction in breast cancer / 中华内分泌外科杂志

Objective:To investigate the feasibility of the surgical mode of immediate implant-based breast reconstruction (IIBR) with silicone implants under subcutaneous tissue directly after the total mastectomy in breast cancer.Methods:Data of 53 patients who underwent (skin-sparing mastectomy, SSM) or (nipple-areola-complex-sparing mastectomy, NSM) combined with IIBR in Department of Breast Surgery, Maoming People’s Hospital were retrospectively analyzed. Patients were divided into two groups, 31 cases with the silicone implant placed in different anatomical locations of the chest wall, including subcutaneous tissue, and 22 cases with subpectoral space implantation followed NSM or SSM. The two groups were compared in terms of the short-term and long-term complications, as well as the aesthetic outcome. Within 12 months the local recurrence rate was collected to evaluate the treatment safety of the two groups preserving the thickness of subcutaneous adipose after NSM or SSM.Results:There was no nipple-areola-complex (NAC) or skin flap for both groups, and the time of removing the drainage tube had no significant difference ( P>0.05) . There was no significant difference between the two groups in terms of the short-term complications within 6 months (repeated local infection and unknown effusion occurrence) , the long-term complications after 6 months (local skin with wrinkles sign, prosthesis displacement, and grade III-IV capsular contracture ( P>0.05) . However, the subcutaneous tissue implant group were superior ( P<0.05) in cosmetic outcome because of the breast had better symmetry. What’s more, no local tumor recurrence occurred in either group within 12 months. Conclusions:IIBR of subcutaneous tissue implantation (without patches) is an economical, novel, safe, and effective surgical mode for breast reconstruction, and the key to this operation mode depends on quality control of surgical procedures and the thickness of skin flap ≥ 1cm covering silicone implants. However, due to the cases enrolled in this study is not enough and short follow-up time, further clinical studies are still needed.

Oral Use of Phenytoin to Reduce Calcification in Bovine Pericardium and Porcine Aortic Leaflets Implants in Rats

Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). Conclusion: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.

Photosensitizers and exposure times to light showed tissue compatibility in isogenic mice / Fotossensibilizadores e tempo de exposição a luz em relação a compatibilidade de tecidos em ratos isogênicos

Objective: The aim of this study was to evaluate the subcutaneous tissue response after different protocols to photodynamic therapy (PDT). In Phase 1, were tested the diode laser (used for 1min) associated to the photosensitizer phenothiazine chloride solution (PCS) in different concentrations. In Phase 2 ­ the diode laser and LED were tested associated to two different photosensitizers, PCS and Curcumin, in different exposure times of light application. Material and Methods: After 7, 21 and 63-days the animals were euthanized and the subcutaneous tissue processed to histological analysis. Qualitative and semi-quantitative descriptions of the inflammatory process and immunohistochemical technique were performed. The obtained data were analyzed by Kruskal-Wallis and Dunn's post-test (α= 0.5). Results: On Phase 1, the tissue response was very similar among the groups. For the inflammatory infiltrate, PCS with concentration of 10mg/mL exhibited the most intense reaction (p > 0.05). On Phase 2, at 7-days period, the analyzed parameters presented small magnitude and after 21 and 63-days, all the parameters demonstrated tissue compatibility. Conclusion: Both photosensitizers presented proper tissue compatibility regardless the different concentrations used on Phase 1 and different durations of light exposure on Phase 2 (AU)

Objetivo: Este estudo avaliou a resposta do tecido subcutâneo após terapia fotodinâmica, utilizando na Fase 1 - laser diodo por 1min e solução fotossensibilizadora de cloreto de fenotiazina (CF) em diferentes concentrações e Fase 2 - laser diodo e LED e dois fotossensibilizadores, CF e Curcumina, em diferentes tempos de exposição da aplicação de luz. Material e Métodos: Após 7, 21 e 63 dias, foram realizadas descrições qualitativas e semiquantitativas do processo inflamatório e técnica de imunoistoquímica. Os dados foram analisados pelo pós-teste de Kruskal-Wallis e Dunn (α = 0,5). Resultados: Na Fase 1, a resposta do tecido foi muito semelhante. O infiltrado inflamatório, na concentração de 10 mg / mL, exibiu reação mais intensa (p > 0,05). Na Fase 2, aos 7 dias, os parâmetros analisados apresentaram pequena magnitude. Aos 21 e 63 dias, todos os parâmetros demonstraram compatibilidade com o tecido. Conclusão: Ambos os fotossensibilizadores apresentaram compatibilidade de tecido adequada, independentemente das diferentes concentrações utilizadas na Fase 1 e diferentes durações de exposição à luz na Fase 2 (AU)

Evaluation of botulinum toxin A injections for the treatment of glabellar lines by using high-frequency ultrasound / 中华皮肤科杂志

Objective To investigate changes in thickness of the skin and muscular layer during the treatment with botulinum toxin A injections in patients with glabellar lines.Methods Twenty-six subjects with moderate to severe glabellar lines were enrolled into this study,who received botulinum toxin A injections in Peking Union Medical College Hospital from August 2017 to February 2018.Before the injections,4 and 16 weeks after the injections,thickness of the dermis at the injection site was measured by using 50 MHz high-frequency ultrasound,and full thickness of the skin and thickness of the muscular layer were measured with 20 MHz high-frequency ultrasound.Repeated measures analysis of variance,paired ttest and Bonferroni method were used to compare the pretreatment and posttreatment tissue thicknesses measured by using high-frequency ultrasound.Results Before the injections,the thickness of the dermis,full thickness of the skin,thickness of the muscular layer were 2.01 ± 0.48,4.32 ± 0.73 and 4.51 ± 0.67 mm respectively.No significant difference was observed among the pretreatment,4-and 16-week posttreatment thickness of the dermis (F =1.94,P =0.199),while there were significant differences among the pretreatment,4-and 16-week posttreatment full thickness of the skin and thickness of the muscular layer (F =6.28,24.19,P =0.020,＜ 0.001 respectively).Four weeks after the injections,the full thickness of the skin significantly increased (4.88 ± 0.93 mm,t =3.72,P =0.004),while the thickness of the muscular layer significantly decreased (3.82 ± 0.79 mm,t =4.65,P =0.001)compared with the pretreatment thicknesses.Sixteen weeks after the injections,the full thickness of the skin (4.61 ± 0.73 mm) and thickness of the muscular layer (4.38 ± 0.90 mm) did not significantly differ from those before and 4 weeks after the injections (all P ＞ 0.016 7).Conclusions Botulinum toxin A injections can change the thickness of the subcutaneous tissue and muscular layer.High-frequency ultrasound can be applied to the evaluation of efficacy and to follow-up after the treatment of glabellar lines with botulinum toxin A injections.

Inverse klippel-trenaunay syndrome / Síndrome de klippel-trenaunay inverso

ABSTRACT Objective: To report a rare case of inverse Kipplel-Trenaunay. Case description: A 16-year-old girl with a grayish-depressed plaque on her left thigh. Angioresonance showed a vascular malformation affecting the skin and subcutaneous tissue. Comments: Inverse Klippel-Trenaunay is a Klippel-Trenaunay syndrome variation in which there are capillary and venous malformations associated to hypotrophy or shortening of the affected limb. Modifications on the limb's length or width result from alterations in bones, muscles, or subcutaneous tissues. It has few described cases. Further clinical and molecular studies must be performed for a proper understanding.

RESUMO Objetivo: Relatar um caso raro de Klippel-Trenaunay inverso. Descrição do caso: Menina de 16 anos com placa deprimida acinzentada na coxa esquerda, evidenciando-se, por meio de angioressonância, uma malformação vascular, acometendo a pele e tecidos subcutâneos. Comentários: Klippel-Trenaunay inverso é uma variante da síndrome de Klippel-Trenaunay em que há malformação capilar e venosa associada à hipotrofia ou encurtamento do membro afetado. Pode envolver acometimento ósseo, muscular ou subcutâneo, modificando o comprimento ou a circunferência do membro. Há poucos casos descritos, e mais estudos clínicos e moleculares precisam ser realizados para seu correto entendimento.

Fascitis necrosante genital posterior a parto instrumentado: reporte de un caso / Genital necrotizing fasciitis after operative vaginal delivery: A case report

Resumen ANTECEDENTES: La fascitis necrosante es una infección rara del tejido subcutáneo y la fascia que rápidamente puede complicarse y poner en riesgo la vida; por esto siempre debe tenerse en mente la posibilidad de este diagnóstico. OBJETIVO: Describir un caso raro de fascitis necrosante genital aparecida luego de un parto instrumentado. CASO CLÍNICO: Paciente primigesta, de 30 años, con antecedente de infección vaginal por Ureaplasma. El parto instrumentado tuvo lugar a las 39 semanas; se reparó la episiotomía medio-lateral derecha, sin complicaciones, y se dio de alta del hospital a las 48 horas. Al quinto día de puerperio acudió a Urgencias por dolor perineal intenso y fiebre. Durante la auscultación se encontró un hematoma perineal y glúteo derecho, con eritema alrededor, indurado y con crepitación vaginal, con secreción hematopurulenta fétida. Reportes de laboratorio: leucocitosis y anemia. Los cultivos de la herida reportaron infección polimicrobiana. El ultrasonido pélvico evidenció dos colecciones debidamente delimitadas en planos dérmicos y musculares. Se indicó tratamiento con antibióticos de amplio espectro, lavado quirúrgico y desbridamiento quirúrgico diario durante 5 días. Después, se inició la terapia de cierre asistido por vacío (VAC) durante 7 días hasta lograr la granulación. Se continuó con lavados quirúrgicos durante 5 días más. El día 18 posparto se cerró la herida sin complicaciones. A la sexta semana de seguimiento la herida había cicatrizado, sin dolor, ni incontinencia fecal o urinaria: solo hipoestesia de la cicatriz, pero con evolución satisfactoria. CONCLUSIÓN: Lo ideal es establecer el diagnóstico lo más temprano posible para disminuir la morbilidad y mortalidad, ofrecer inmediatamente atención multidisciplanaria que permita conseguir los mejores desenlaces quirúrgicos e incrementar la supervivencia.

Abstract BACKGROUND: Necrotizing fasciitis is a rare infection of the subcutaneous tissue and the fascia that is rapidly progressive and deadly, requiring early and aggressive surgical debridement to decrease mortality. The objective of this study was to describe a rare case of genital necrotizing fasciitis after operative vaginal delivery. CLINICAL CASE: A 30 years old primiparous woman with a history of vaginal infection by Ureaplasma. Instrumented delivery was attended at 39 weeks, repairing right mid-lateral episiotomy without complications and discharge after 48 hours. On the fifth day of the puerperium she went to the emergency department for severe perineal pain and fever, finding perineal hematoma and right gluteus with erythema around, indurated and with vaginal crepitation with fetid hemato-purulent secretion. The laboratories reported leukocytosis and anemia, wound cultures showed polymicrobial infection and pelvic ultrasound diagnosed 2 well-defined collections in dermal and muscular planes. Management was initiated with broad-spectrum antibiotics plus washing and daily surgical debridement for 5 days. Subsequently, it was placed with VAC therapy for 7 days until granulation was achieved; and then, surgical washes were continued for 5 more days. On the 18th day, the wound was closed without complications. In her sixth week of follow-up she has a scarred wound, without pain or fecal or urinary incontinence; only refers to hypoesthesia of the scar, but with satisfactory evolution. CONCLUSION: The ideal is to establish the diagnosis as early as possible to decrease morbidity and mortality, immediately offer multidisciplinary care that allows the best surgical outcomes to be achieved, and increases survival.

A study on adverse drug reactions in hospitalized pediatric patients in a Tertiary Care Hospital

Pediatric populations are the most vulnerable group with regard to rational drug prescribing since many new drugs aremarketed without any proper pharmacovigilance study, thereby increasing the risk of toxicity. The study was aimedto determine the adverse drug reaction (ADR) pattern in the pediatric population over a period of 6 months. A total of200 patients were enrolled in the study, 15 patients were suspected with ADRs and were confirmed by the physiciansattending the pediatric department. Out of 15 cases, eight were male patients (53.33%) and seven were female patients.46.66% of ADRs were affected in the skin and subcutaneous tissue, followed by the gastrointestinal system (40%).Most common group of showing ADRs were found to be antibiotics (66.65%), followed by anticonvulsants (19.99%).Type B reactions were the most commonly observed ADRs, of which subtype 1 was of the common type. 73.33% ofthe events were in the probable category, 20% of the events were in the possible category, and 6.66% events were inthe definite category and also most of the ADRs were of mild varieties (60%), followed by moderate (40%). 73.33% ofADRs were cured and 26.66% were getting better with further therapeutical management. The study indicated the needfor a rigid ADR monitoring among pediatric patients to ensure the safety of drug therapy. Various pharmacovigilanceawareness programs should be conducted to increase the spontaneous reporting of ADRs.

Ectopic pleomorphic adenoma on subcutaneous plane of the cheek

Pleomorphic adenoma is the most common benign tumor of the salivary gland. Pleomorphic adenoma occurs most commonly in the parotid gland but it may involve other salivary gland such as submandible or lingual. We report an ectopic pleomorphic adenoma in the subcutaneous layer of the face. A woman presented with a mass of the nasolabial fold. After excision of the mass, it was revealed as an pleomorphic adenoma pathologically. An ectopic pleomorphic adenoma which was located in the subcutaneous layer of the face is very rare in medical literature.

Erythema Nodosum Masking Kawasaki Disease with an Initial Manifestation of Skin Lesions

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.

Subcutaneous Sparganosis on Abdomen Mimicking Multiple Lipomas

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.

Rare adverse reactions to microfocused ultrasound for facial skin tightening / 中华皮肤科杂志

Microfocused ultrasound (MFU) , as a new approach for facial skin tightening and lifting, has been widely applied in recent years. Its action mechanism is that heat can be transmitted to the deep dermis and superficial musculoaponeurotic system through precise and depth-consistent microcoagulation zones, leading to the contraction and remodeling of skin collagen without damage to the epidermis. MFU has high safety with few serious adverse reactions. However, there are still doubts whether it can lead to subcutaneous scar formation, the risk of lipolysis, or nerve, vessel and eye injuries, etc. Appropriate use and selection of patients can minimize the occurrence of these rare adverse reactions as much as possible.

Rare adverse reactions to microfocused ultrasound for facial skin tightening / 中华皮肤科杂志

Microfocused ultrasound (MFU),as a new approach for facial skin tightening and lifting,has been widely applied in recent years.Its action mechanism is that heat can be transmitted to the deep dermis and superficial musculoaponeurotic system through precise and depth-consistent microcoagulation zones,leading to the contraction and remodeling of skin collagen without damage to the epidermis.MFU has high safety with few serious adverse reactions.However,there are still doubts whether it can lead to subcutaneous scar formation,the risk of lipolysis,or nerve,vessel and eye injuries,etc.Appropriate use and selection of patients can minimize the occurrence of these rare adverse reactions as much as possible.

Panniculitides of particular interest to the rheumatologist

Abstract The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

Quiste hidatídico subcutáneo: reporte de dos casos en Huancayo, Perú / Subcutaneous hydatidic cyst: report of two cases in Huancayo, Peru

RESUMEN La hidatidosis es una infección zoonótica que puede invadir múltiples órganos en el ser humano. Sin embargo, el tejido subcutáneo es el órgano menos afectado por esta enfermedad, cuando esto ocurre se aprecia escasa sintomatología, lo que ocasiona periodos prolongados de enfermedad asociado a diagnóstico tardío y a una pobre respuesta a la terapia antiparasitaria. La sierra central del Perú es la zona con mayor prevalencia, presumiblemente por las inadecuadas medidas de saneamiento ambiental, la falta de educación y las casi inexistentes medidas de control de la enfermedad. Con el objetivo de discutir los problemas relacionados a la localización subcutánea y su probable fisiopatología, reportamos dos casos de hidatidosis subcutánea que se presentaron con lesiones tumorales de evolución prolongada y que no afectaron al hígado ni a los pulmones y que finalmente fueron tratados mediante extirpación quirúrgica debido a la falta de respuesta al tratamiento con albendazol.

ABSTRACT Hydatidosis is a zoonotic infection that can invade many organs in the human being. Nevertheless, the subcutaneous tissue is the less affected organ by this disease. When this disease appears, little symptomatology is observed, which causes prolonged periods of disease associated to delayed diagnosis and a poor answer to the antiparasitic therapy. The central mountain range of Peru is the geographical zone with the greatest prevalence, presumably due to the inadequate measures of environmental sanitation, the lack of education and the almost non-existent control measures of the disease. With the aim to discuss the problems related to the subcutaneous location and its probable physiopathology, this study reports two cases of subcutaneous hydatidosis that appeared with tumor lesions with a prolonged evolution and that did not affect the liver or the lungs and which were finally treated by means of surgical removal due to the lack of response to treatment with albendazol.

Bilateral periorbital necrotizing fasciitis: case report / Fasciite necrosante periorbital bilateral: relato de caso

ABSTRACT Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.

RESUMO Fasciite necrosante é uma infecção grave do tecido subcutâneo, caracterizada pela necrose da fáscia superficial e da pele sobrejacente. Traumas prévios e cormobidades geralmente estão associados à fasciite necrosante. Fasciite necrosante periorbital é rara. Perda visual e defeitos em tecidos moles são as morbidades mais comuns. Diagnóstico precoce, tratamento clínico rápido e intervenção cirúrgica oportuna levam a um melhor prognóstico. Reportamos um caso incomum de fasciite necrosante periorbital bilateral sem eventos desencadeantes. Uma paciente de 50 anos apresentou edema e eritema na pálpebra superior direita, que progrediu em 24 horas para ambas pálpebras bilateralmente. Ela era previamente hígida. A paciente foi submetida a debridamento cirúrgico do tecido necrótico, no mesmo dia. A paciente foi submetida a outras duas cirurgias, o que melhorou o fechamento palpebral e a aparência. Apesar da gravidade da doença, antibioticoterapia e cirurgias oportunas foram cruciais para o desfecho bem sucedido deste caso.

Relationship of the skin and subcutaneous tissue thickness in the tensiomyography response: a novel ultrasound observational study

SUMMARY BACKGROUND: The aim of the study was to describe and correlate the skin, subcutaneous tissue, and superficial fascia thickness assessed by ultrasonography (US) with the lumbar erector spinae muscles contractile properties evaluated by tensiomyography (TMG). METHODS: A cross-sectional descriptive study with 50 healthy participants was performed. The point of maximum lordosis in the lumbar region of the right erector spinae was evaluated by US and TMG. First, the skin, subcutaneous tissue, and superficial fascia thicknesses (cm) were assessed by US. Second, the five contractile TMG parameters were analyzed from the right erector spinae muscles belly displacement-time curves: maximal radial displacement (Dm), contraction time (Tc), sustain time (Ts), delay time (Td), and half-relaxation time (Tr). Finally, correlation analyses using Pearson (r for parametric data) and Spearman (rs for non-parametric data) coefficients were performed. RESULTS: A strong negative correlation was shown between Dm and subcutaneous tissue thickness (rs=-0.668; P<.001). Furthermore, moderate negative correlations were observed between Dm and skin thickness (r=-0.329; P=0.020) as well as Tr and subcutaneous tissue thickness (rs=-0.369; P=0.008). The rest of the parameters did not show statistically significant correlations (P >.05). CONCLUSION: Therefore, the lumbar erector spinae contractile properties during TMG assessments, especially Dm and Tr, may be widely correlated by the skin and subcutaneous tissue thickness.

RESUMO CONTEXTO: O estudo foi elaborado para descrever e correlacionar a pele, o tecido subcutâneo e a espessura da fascia superficial avaliados pelo ultrassom (EUA) com as propriedades contráteis do músculo eretor da coluna lombar avaliadas por tensiomiografia (TMG). MÉTODOS: Foi realizado um estudo descritivo transversal com 50 participantes saudáveis. O ponto de lordose máxima na região lombar da coluna ereta direita foi avaliado pelos EUA e TMG. Primeiro, a pele, o tecido subcutâneo e as espessuras da fáscia superficial (cm) foram avaliadas pelos EUA. Em segundo lugar, os cinco parâmetros TMG contráteis foram analisados a partir das curvas de deslocamento-tempo da barriga do músculo eretor da espinha direita: deslocamento radial máximo (Dm), tempo de contração (Tc), tempo de sustentação (Ts), tempo de atraso (Td) e meio tempo de relaxamento (Tr). Finalmente, foram realizadas análises de correlação usando os coeficientes Pearson (r para dados paramétricos) e Spearman (rs para dados não paramétricos). RESULTADOS: Uma correlação forte negativa foi mostrada entre Dm e espessura subcutânea do tecido (rs = −0,668; P < 0,001). Além disso, foram observadas correlações moderadas negativas entre Dm e espessura da pele (r = −0,329; P = 0,020), bem como a espessura subcutânea do tecido (rs = −0,369; P = 0,008). O restante dos parâmetros não mostrou correlações estatisticamente significativas (P > 0,05). CONCLUSÃO: Portanto, as propriedades contráteis do eretor da espinha lombar durante as avaliações TMG, especialmente Dm e Tr, podem ser amplamente correlacionadas com a pele e a espessura subcutânea do tecido.

Human Sparganosis in Korea

BACKGROUND: Sparganosis is a larval cestodiasis caused by the plerocercoid of Spirometra spp. Since the first description of human sparganosis in 1924, several hundred cases have been reported in Korea. However, systematic approaches for literature surveys of Korean sparganosis have seldom appeared. METHODS: We searched publicly available databases such as PubMed, Research Information Sharing Service, and Korea Medical Citation Index with relevant Medical Subject Headings. RESULTS: At least 438 Korean sparganosis cases have been described from 1924 to 2015. Preoperative diagnosis has been significantly increased since the 1980s due to popularization of serological and imaging diagnostics. Cases were largely detected from fifth decades in general, but cerebral sparganosis was detected in relatively young age groups (third and fourth decades). Sparganosis was prevalent in men (75.9%). Consumption of frog/snake and drinking unfiltered water were found in 63.4% and 16.9% of patients, respectively. Most frequently affected sites were subcutaneous tissues (49.9%), followed by the central nervous system (36.2%). Involvements of visceral organs (7.6%), ocular regions (3.6%), and muscles (2.7%) were noticed. In women, breast sparganosis constituted a large proportion (34.2%). Sparganosis associated with immunocompromised patients has recently been reported. CONCLUSION: Sparganosis has been continuously reported in Korea during the past 90 years, although its incidence has decreased during the last 20 years. The disease is mostly characterized by subcutaneous nodule, but infection of the worm in vital organs often results in serious illness. Continuous awareness is warranted to monitor sparganosis occurrence and associated clinical consequences.

Thin elevation: A technique for achieving thin perforator flaps

Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.