ABSTRACT
A esclerodermia localizada (morfeia linear) é uma doença rara que causa distrofia e assimetria faciais em mulheres jovens. É relatado o caso de uma paciente de 20 anos que foi tratada com enxertos compostos de gordura. Após a coleta do lipoaspirado de gordura subcutânea profunda, a microgordura e a nanogordura não filtrada foram processadas separadamente para formar enxertos compostos de gordura. Estes foram meticulosamente transplantados em camadas, para reconstruir o subcutaneo da face da paciente. Após um ano, observou-se boa pega de gordura com correção bem-sucedida da assimetria e restabelecimento do equilíbrio facial.
Localized scleroderma (linear morphea) is a rare disease that causes facial dystrophy and asymmetry in young women. We report the case of a 20-year-old female patient who was treated with novel composite fat grafts. After extracting lipoaspirate from deep subcutaneous fat, the microfat and the unfiltered nanofat were processed separately, and amalgamated, obtaining composite fat grafts. These were meticulously transplanted layer by layer to rebuild the subcutaneous tissue of the patient's face. After one year, a good volume of fat retention was observed with successful correction of asymmetry and restoration of facial balance.
ABSTRACT
Introdução: Na última década, o uso do preenchimento com ácido hialurônico para aprimoramento facial aumentou na América Latina. O preenchimento com ácido hialurônico é considerado seguro com baixa incidência de eventos adversos. Como eventos adversos são pouco observados na prática clínica ou têm sido possivelmente sub-relatados são necessárias mais orientações para diagnosticar e tratar eventos adversos relacionados ao ácido hialurônico. Objetivo: Compreender melhor os eventos adversos relacionados ao ácido hialurônico e propor recomendações para o diagnóstico e tratamento. Métodos: Reunião em painel de 25 especialistas médicos multidisciplinares da América Latina foi realizada em São Paulo, Brasil, para discutir o que se conhece sobre eventos adversos relacionados ao ácido hialurônico e fornecer conhecimentos baseados na experiência clínica. Por meio de consenso, foram desenvolvidos recomendações e algoritmos. Resultados: O painel categorizou eventos adversos relacionados ao ácido hialurônico baseado em três momentos de início (imediato, precoce e tardio) e propôs um novo termo para eventos adversos que apresentam edema tardio intermitente persistente ("Etip"). Foram criados algoritmos para diagnóstico e tratamento em cada momento. Conclusões: Novos algoritmos consensuais para diagnósticos e tratamentos associados ao momento de início dos eventos adversos relacionados ao ácido hialurônico orientarão melhores práticas no uso clínico do preenchimento com ácido hialurônico.
Introduction: In the last decade, the use of hyaluronic acid fillers for facial enhancement has increased in Latin America. Hyaluronic acid fillers are considered relatively safe with a low incidence of adverse events. Because adverse events are not seen frequently in clinical practice or have been potentially underreported, there is a need for more guidance on the diagnosis and treatment of Hyaluronic acid-related adverse events. Objecti ve: To provide an enhanced understanding of hyaluronic acid-related adverse events and to propose recommendations for their diagnosis and treatment. Methods: A 25-member multi-disciplinary expert panel meeting of Latin-American physicians was convened in Sao Paulo, Brazil to discuss what is known about hyaluronic acid-related adverse events and to provide insights based on clinical experience. Recommendations and algorithms were developed through a consensus process. Results: The panel categorized hyaluronic acid-related adverse events based on 3 time frames of onset (immediate, early and Late) and proposed a new term for adverse events that display persistent, intermittent, delayed Swelling (PIDS). Algorithms were created for diagnosis and treatment for each time frame. Conc lusions: The new consensus algorithms for time-related diagnosis and treatment of hyaluronic acid-related adverse events will provide guidance for best practices in the clinical use of hyaluronic acid fillers.
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PURPOSE: Ultrarush immunotherapy (ultra-RIT) is more convenient and higher compliant than conventional immunotherapy, but it has rarely used in clinical practice due to severe systemic reactions. This study aimed to determine the safety of ultra-RIT in children and adolescents. METHODS: We investigated 19 patients who received ultra-RIT with the same schedule between January 2011 and May 2016. They were sensitized to house dust mites (HDMs) and/or pollen and had their symptoms associated with positive allergens. Over a 1-day hospitalization period, all patients received ultra-RIT subcutaneously 3 times, increasing at hourly intervals. Systemic reactions were classified according to the World Allergy Organization grade system. RESULTS: Systemic reactions occurred in 14 patients (73.7%). The mean time to adverse reactions after the last injection was 36 minutes, and the majority of systemic reactions were pruritus and urticaria. In addition, the injection of HDM alone or HDM plus pollen caused more than grade 2 systemic reactions in about 50% each of the patients. CONCLUSION: Since ultra-RIT caused a higher incidence of systemic reactions in children and adolescents, it should be carried out cautiously in the hospitalization rather than the office.
Subject(s)
Adolescent , Child , Humans , Allergens , Appointments and Schedules , Hospitalization , Hypersensitivity , Immunotherapy , Incidence , Injections, Subcutaneous , Pediatrics , Pollen , Pruritus , Pyroglyphidae , UrticariaABSTRACT
Objective To investigate the effect of two different injection durations and four local pressing durations on the incidence of subcutaneous hemorrhage after low molecular weight heparin, and find a optimum injection duration and pressing time to reduce the incidence of subcutaneous hemorrhage associated with subcutaneous low molecular weight heparin. Methods 80 patients, who were deep venous thrombosis (DVT), pulmonary embolism (PE), and undergone inferior vena cava filter (IVCF) after the operation and received low molecular weight heparin (LWMH) for eight times were selected. The injection time and pressing duration after the injection were randomized into 30 s and 2 min, 30 s and 6 min, 30 s and 10 min, 30s and 14 min, 10s and 2 min, 10s and 6 min, 10 s and 10 min, 10 s and 14 min respectively. The incidence of subcutaneous hemorrhage were measured after 12 h. Single and multiple factor logistic regression analysis were used to analyze the data. Results The injection time and pressing duration after the injection were randomized into 30 s and 2 min, 30 s and 6 min, 30 s and 10 min, 30 s and 14 min, 10 s and 2 min, 10 s and 6 min, 10 s and 10 min, 10 s and 14 min respectively. The results of the incidence rate of subcutaneous hemorrhage were 46.25% (37/80), 22.50% (18/80), 23.75% (19/80), 25.00% (20/80), 71.25% (57/80), 43.75% (35/80), 50.00% (40/80), 50.00% (40/80) respectively. By the single factor test, the results showed that pressing duration and injection duration are associated with the incidence of subcutaneous hemorrhage after low molecular weight heparin. With regard to the incidence of subcutaneous hemorrhage, there was significantly difference between 2 min group and the other 3 groups (P0.05). By multiple factors logistic regression analysis, it was revealed that pressing duration and injection duration were significant factors (P|b'(pres ing duration)|=|-1.0729|). Compared with inject 10 s, there was a significantly lower incidence of bruising in inject 30 s. There was a significantly lower incidence of bruising in the longer pressing duration (b|b'(pres ing duration)|). Compared with inject 10 s, there was a significantly lower incidence of bruising in inject 30 s (b<0). there was significantly difference between 2min group and the other 3 groups (P<0.01), while other adjacent groups had no significant differences. Compared with others, there was a significantly high incidence of bruising in pressing 2min and the pressing duration for at least 6 min. Conclusions It is suggested that inject 30 s with pressing for 6 min can effectively reduce the incidence of subcutaneous hemorrhage resulted from subcutaneous injection of LMWH.
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PURPOSE: The aim of this study is to investigate the anesthetic effect on a modified subcutaneous single-injection digital block in accordance with the location of the finger. METHODS: We recruited volunteers from the workshop training course. We injected less than 5 mL of 2% lidocaine at the volar side, between the 3rd metacarpal and proximal phalangeal joint, until the swelling in the dorsal side of the finger increased. At 10 minutes post the modified subcutaneous single-injection digital block, we recorded the pain score (0-10) using 11-point numeric rating pain scale (NRPS) according to the location of the finger (volar proximal phalanx, VPP; volar middle phalanx, VMP; volar distal phalanx, VDP; dorsal distal phalanx, DDP; dorsal middle phalanx, DMP; dorsal proximal phalanx, DPP) via a pinprick test. We analyzed and compared the NRPS on the location of the finger by the Friedman test with a Pairwise comparison. RESULTS: Fifty-eight volunteers of healthy adult were enrolled in this study. The pain scales on DPP and DMP were 7.00 (4.00-8.00) and 2.00 (1.00-4.00), respectively. The pain scales on DDP, VDP, VMP and VDP were 0.00 (0.00-2.00), 0.00 (0.00-0.00), 0.00 (0.00-1.00) and 0.00 (0.00-1.00), respectively. The pain scales on DPP and DMP were significantly different among DDP, VPP, VMP and VPP (p0.999; VDP vs. VMP, p>0.999; VMP vs. VPP, >0.999). CONCLUSION: A modified subcutaneous single-injection digital block should be considered useful in regional anesthesia at the volar side of the finger and the dorsal side of the distal phalanx.
Subject(s)
Adult , Humans , Anesthesia, Conduction , Anesthesia, Local , Anesthetics , Education , Finger Injuries , Fingers , Injections, Subcutaneous , Joints , Lidocaine , Nerve Block , Pain Measurement , Volunteers , Weights and MeasuresABSTRACT
PURPOSE: The purpose of this study was to identify effects of abdominal skin massage and warming therapy on the pain and anxiety to breast cancer patients who underwent hormone injections. METHODS: The subjects for the study were 60 breast cancer patients who underwent hormone injections (20 in the control group, 20 in the abdominal skin massage group, and 20 in the warming therapy group). Abdominal skin massage was conducted following KSMA's (Korea science massage association) advice and warming therapy was executed at 48 ℃ for 20 minutes. The results were checked using subjective and objective measurement tools. RESULTS: After abdominal skin massage and warming therapy, subjective (Visual Analogue Scale, VAS) and objective (facial expression and vocal change) pain scores were significantly decreased (p<.001) Also, Anxiety state was significantly decreased compared to the control group (p =.043). CONCLUSION: The results of this study indicate that abdominal skin massage and warming therapy were highly effective in alleviating pain and anxiety in patients who underwent hormone injections.