Interlaboratory comparison for dichloroacetic acid and trichloroacetic acid determination in drinking water / 公共卫生与预防医学

Objective To improve the detection ability of laboratories, and to identify possible technical defects in the detection of dichloroacetic acid and trichloroacetic acid in drinking water. Methods A number of laboratories were organized to conduct interlaboratory determination of dichloroacetic acid and trichloroacetic acid in drinking water. Prefabricated standard series and intermediate samples were distributed. Data of determination were collected and statistically analyzed to evaluate the detection results. Results The slopes of dichloroacetic acid and trichloroacetic acid working curves were analyzed by Grubbs test. The analysis results showed that there were 1 outlier in the dichloroacetic acid data and 3 outliers in the trichloroacetic acid data, respectively. The determination results of the spiked samples of dichloroacetic acid and trichloroacetic acid were 1.5 and 4 times the actual value, respectively. Conclusion This investigation reveals that there exist some technical problems in the direct determination of dichloroacetic acid and trichloroacetic acid by gas chromatography, such as inappropriate selection of chromatographic conditions and injection port flow control, and incorrect way of spiking internal standards.

Comparative evaluation of therapeutic efficacy and safety of 40% hydrogen peroxide versus 80% of trichloroacetic acid in genital warts

Background: Warts are a common manifestation of infection due to HPV, prevalence more common in developing world. No modality is 100% efficacious in the management of warts. Topical therapy is more preferred method by majority of patients. Trichloroacetic acid (TCA) solution is well established modality in treatment of genital warts. Hydrogen peroxide used in higher concentrations is a good cautery agent. Aim and Objectives: The study was conducted to evaluate and compare the therapeutic efficacy and safety of 40% hydrogen peroxide solution and 80% TCA solution in genital warts. Materials and Methods: Topical 40% hydrogen peroxide and 80% TCA were used in Group A (20 patients) and Group B (20 patients), respectively, for three sittings at 2 weeks interval. Results: About 65% of the patients in TCA and 55% patients in H2O2 group had significant improvement (Grade 4 and Grade 3) (P = 0.311). Descriptive statistical methods and 2-Chi-square relation were used for analyzing data with Statistical Package for the Social Sciences (SPSS) 21 (SPSS Inc., Chicago, IL, USA). Results: About 40% H2O2 and 80% TCA, both are cost-effective and easy to use modalities with 40% H2O2 having better safety profile as compared to 80% TCA. H2O2 group showed decrease in size of lesions 63.33% versus and TCA group 70% (p value 0.311) with 10% of TCA group patients having ulcer formation versus none of the patients having significant adverse effect in H2O2 group. Conclusion: We found both the modalities to be safe and effective. However, we recommend further studies should be carried out to assess the safety and efficacy with bigger sample size and control arms for both the groups topical 40% hydrogen peroxide solution and topical 80% TCA solution.

Determination of dichloroacetic acid and trichloroacetic acid in urine using headspace gas chromatography / 预防医学

Objective@#To develop a headspace gas chromatography ( HS-GC ) assay for simultaneous determination of dichloroacetic acid ( DCA ) and trichloroacetic acid ( TCA ) in urine.@*Methods@#Urine samples (5 mL) were transferred to a 22 mL headspace bottle, added with 0.5 mL 10% sodium acetate solution , immediately sealed, and shaken evenly. The bottle was placed in the HS-GC system, and equilibrated at 90 ℃ for 60 minutes. The mixture was separated with the HP-INNOWAX chromatographic column, and the DCA and TCA concentrations were detected with the hydrogen flame detector.@*Results@#Under the optimal experimental conditions, the correlation coefficient of DCA and TAC was both > 0.999 0 within the range of 10-500.0 μg/L, and the lowest detection limits of DCA and TAC were 2.0 and 3.5 μg/L, with the spike recovery rate of 87.40% to 101.44%, and relative standard deviations of 1.89% to 3.25%. Of the 35 urine samples sampled from occupational populations, DCA and TCA were not detected.@*Conclusions@#The establishment of the HS-GAS assay through addition of sodium acetate and optimization of the headspace conditions, has high recovery and precision, which is effective to meet the requirements for daily determination of DCA and TCA in urine samples.

Oxidative Damage to BV2 Cells by Trichloroacetic Acid: Protective Role of Boron via the p53 Pathway / 生物医学与环境科学（英文）

This study aimed to investigate the neurotoxicity induced by trichloroacetic acid (TCA) and the possible protective mechanisms of boron (B). Mouse BV2 cells were treated with TCA (0, 0.39, 0.78, 1.56, 3.12, 6.25, or 12.5 mmol/L) and B (0, 7.8, 15.6, 31.25, 62.5, 125, 500, or 1,000 mmol/L) for 3 h and 24 h, respectively. Then, reactive oxygen species, and supernatant proinflammatory cytokine and protein levels were analyzed after 24 h of combined exposure. Beyond the dose-dependent decrease in the cellular viability, it clearly increased after B supplementation ( P < 0.05). Moreover, B decreased oxidative damage, and significantly down-regulated IL-6 levels and up-regulated TNF-β production ( P < 0.05). B also decreased apoptosis via the p53 pathway. The present findings indicated that TCA may induce oxidative damage, whereas B mitigates these adverse effects by decreasing cell apoptosis.

Criocirurgia com nitrogênio líquido versus ácido tricloroacético no tratamento de verruga peniana por papilomavírus humano (HPV): um ensaio clínico randomizado / Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial

Introdução: verrugas anogenitais são a infecção sexualmente transmissível prevalente (0,5%) entre atendimentos dermatológicos. Dentre as estratégias de tratamento, destacam-se a crioterapia com nitrogênio líquido (NL) e causoterapia com ácido tricloroacético (ATA). Objetivo: avaliar a eficácia do NL versus ATA no tratamento de verrugas penianas em pacientes de instituição pública brasileira. Métodos: ensaio clínico aberto, paralelo e randomizado. Em cada visita, as verrugas foram contadas e submetidas à crioterapia (10s) ou à causoterapia (ATA 80%), após randomização. A principal variável dependente foi a contagem de lesões antes e após quatro semanas de tratamento. Foram analisados: eliminação completa, idade, imunossupressão, tabagismo, topografia e escolaridade. Resultados: foram avaliados 142 tratamentos em 52 participantes. Houve predominância de adultos jovens, menor escolaridade, e a principal topografia afetada foi a haste. A redução percentual média por sessão foi 48% para o NL e 26% para o ATA (p=0,11). Clearance completo foi atingido por 42 (81%) participantes, sendo que 39 (75%; IC95%: 64-85%) atingiram o clearance em até três sessões. A idade associou-se à pior taxa de resposta terapêutica (ß=-0,09; p<0,01). Conclusões: NL e ATA mostraram-se eficazes na terapêutica das verrugas penianas, sem diferença entre os tratamentos. A idade foi associada à pior resposta terapêutica.

Background: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. Objective: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. Methods: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. Results: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01). Conclusions: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response

Uso de ácido tricloroacético para fechamento de lesão por alargadores em lóbulos de orelhas / Use of trichloroacetic acid for closure of lesion by extensors in lobules of ears

Introdução: O uso de alargadores de lóbulos de orelhas provoca um defeito circular cujo fechamento se torna um desafio para o cirurgião plástico. Existem múltiplas técnicas com mobilização de retalhos locais na tentativa de promover o fechamento e devolver o formato natural do lóbulo. Nossa proposta é apresentar o ácido tricloroacético (ATA) como alternativa para a correção dessas lesões. Métodos: Foram selecionados um total de 5 pacientes com lesões por alargadores nos lóbulos das orelhas e utilizado ATA 90% para o fechamento dos defeitos. Resultados: Após a aplicação do produto, observouse uma hiperemia ao redor da área onde foi aplicado o ácido nos primeiros dias, a área de frosting foi substituída por uma crosta, que foi se soltando com o passar dos dias, concomitante a redução do diâmetro da lesão com fechamento progressivo do defeito. Conclusão: Apesar de mais estudos serem necessários, a utilização de ATA 90% se mostrou uma opção simples e eficaz para o fechamento de lóbulos de orelhas alargados.

Introduction: The use of ear lobe extenders causes a circular defect whose closure becomes a challenge for the plastic surgeon. There are multiple techniques with mobilization of local flaps in an attempt to close and return to the natural shape of the lobe. We propose to present trichloroacetic acid (TCA) as an alternative for the correction of these lesions. Methods: A total of five patients with lesions by ear skin eyelets were selected, and 90% TCA was used to close the defects. Results: After applying the product, in the first days, there was a hyperemia around the area where the acid was applied. The frosting area was replaced by a crust, which loosened over the days, concomitantly reducing the diameter of the lesion with progressive closure of the defect. Conclusion: Although more studies are needed, the use of 90% TCA proved to be a simple and practical option for the closure of enlarged ear lobes.

Chemical Regeneration of Wound Defects: Relevance to the Canine Palatal Mucosa and Cell Cycle Up-Regulation in Human Gingival Fibroblasts

BACKGROUND: Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model.METHODS: The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21 h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration.RESULTS: While the 0.5–1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9 h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healingCONCLUSION: TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.

Screening of allergens of trichloroethylene-induced occupational medicamentosa-like dermatitis / 中国职业医学

OBJECTIVE: To screen the allergens of trichloroethylene-induced occupational medicamentosa-like dermatitis( OMDT) by patch test,and explore methods for OMDT auxiliary diagnosis and trichloroethylene( TCE) allergic population screening. METHODS: A total of 20 subjects diagnosed with OMDT were selected as case group,and 22 nonOMDT healthy workers exposed to TCE≥12 weeks were selected as control group. Different concentrations of TCE and its main metabolites such as chloral hydrate( CH),trichloroethanol( TCOH) and trichloroacetic acid( TCA) were used as allergens in a skin patch test in workers of these two groups. Another 20 new workers exposed to TCE < 12 weeks without OMDT were tested as validation group. They were tested with a patch test at a mass fraction of 15. 00% CH and follow-up observations were performed until 12 weeks of TCE exposure. RESULTS: The patch test of TCE,CH,TCOH and TCA were negative in the control group. In the case group,the patch test positive rate for 50. 00% TCE was 10. 00%,the patch tests were negative in 25. 00%,10. 00% and 5. 00% TCE. The CH patch test positive rate was 100. 00% with the CH mass concentrations of 15. 00%,10. 00% and 5. 00%. The TCOH patch test positive rates were 90. 00%,75. 00% and50. 00%,with the corresponding concentration of 5. 00%,0. 50% and 0. 05%. The TCA patch test positive rates were50. 00% and 0. 00% with the TCA concentrations of 5. 00% and 0. 50% respectively. When the mass concentration was5. 00%,the patch test positive rates in case group from high to low were CH,TCOH,TCA and TCE( P < 0. 01). And the patch test positive rates of CH and TCOH showed no statistical significant difference( P > 0. 05). The patch test positive rate of TCOH increased with increase of TCOH mass concentrations( P < 0. 01). The patch test positive rates for 5. 00%TCA was higher than that of 0. 50% TCA( P < 0. 01). The patch test positive rate in 0. 50% TCOH was higher than that of 0. 50% TCA( P < 0. 01). In the validation group,the patch test of 15. 00% CH was negative,and there was no OMDT case found during the follow-up 12 weeks of TCE exposure. CONCLUSION: The metabolites CH and TCOH of TCE may be the main allergens of OMDT after exposure to TCE. The CH and TCOH patch test can be an auxiliary diagnosis method for OMDT. The CH patch test could be used as a method for screening population allergic to TCE.

The Combination Therapy of Chemocauterization and Electrocauterization on Fourth Branchial Cleft Cyst

BACKGROUND AND OBJECTIVES: Fourth branchial cleft cyst is a rare congenital anomaly which cause a recurrent cervical abscess. Complete excision of fourth branchial cleft cyst is difficult because of a complicated fistula tract. In addition to attempting chemocauterization with trichloroacetic acid (TCA) to avoid surgical complications, authors performed an electrocauterization to close internal opening of pyriform sinus. MATERIALS AND METHODS: We reviewed ten patients of fourth branchial cleft cyst underwent TCA chemocauterization and electrocauterization simultaneously. Clinical characteristics including patient informations, medical records, treatment results were analyzed retrospectively. RESULTS: Interval time until diagnosed with fourth branchial cleft cyst was variable from several days to decades. Five patients had a history of incision and drainage. Mean follow up period was 36.1 months and all patients were treated with no recurrence. CONCLUSION: TCA chemocauterization with electrocauterization can be a effective choice to reduce recurrence rate and ensure safety of patients of fourth branchial cleft cyst.

Efectividad de la terapia con ácido tricloroacético en el tratamiento de lesiones en la hiperplasia epitelial focal / Effectiveness of trichoroloacetic acid in treatment of focal epithelial hiperplasia lesions

Propósito: El propósito del estudio fue evaluar la efectividad de la terapia con el ácido tricloroacético en el tratamiento de las lesiones orales producidas en la hiperplasia epitelial focal. Material y métodos: Se incluyeron 11 pacientes que presentaron características clínicas e histopatológicas de hiperplasia epitelial focal y que aceptaron participar en el estudio, se aplicó muestreo por conveniencia, en pacientes que asistieron a consulta de la clínica odontológica de la Corporación Universitaria Rafael Núñez y la Universidad de Cartagena, se les realizó biopsia excisional en una de las lesiones para establecer diagnóstico anatomopatológico, posteriormente se aplicó ácido tricloroacético al 80% sobre las lesiones cada quince días hasta que desaparecieron. Resultados: De un total de 11 pacientes pediátricos el 63.64% fueron de género femenino, promedio de edad fue nueve años, los sitios de mayor afección en cavidad bucal fueron mucosa labial superior e inferior representando un 100%, en el estudio anatomopatológico se describió la presencia de acantosis epitelial, papilomatosis y coilocitosis en todos los casos, el mayor número de aplicaciones con el ácido fue tres y cuatro veces con un 27%, el promedio de desaparición de las lesiones fue de 61.3 días, no se ha presentado recidiva en el 100% de los casos. Conclusión: La aplicación del ácido tricloroacético en la hiperplasia epitelial focal es una técnica efectiva, consiguiendo la resolución de las lesiones en forma rápida, poco traumática, sin generar ansiedad y temor en los pacientes.

Objective: The aim of the present study was to assess effectiveness of trichloroacetic acid therapy in the treatment of oral lesions produced in focal epithelial hyperplasia cases. Material and methods: In the present study 11 patients were included. Patients exhibited clinical and histopathological characteristics of focal hyperplasia and were willing to participate in the study. Convenience sampling was executed in patients attending clinical consultation at the Dental Clinic of the Rafael Nuñez University Corporation and the University of Cartagena. Patients underwent excision biopsy in one of the lesions so as to establish anatomical-pathological diagnosis. Subsequently, 80% trichloroacetic acid was applied every two weeks on the lesions, until lesions disappeared. Results: Out of 11 pediatric patients 63.64% were female, average age nine years. Locations of greater involvement in the mouth were upper and lower labial mucosa (representing 100%). Anatomical-pathological study revealed in all cases presence of epithelial acanthosis, papillomatosis and koilocytiosis. The greatest number of acid applications was three and four episodes with 27%, average time for lesion disappearance was 61.3 days. No relapse was observed in 100% of cases. Conclusion: Trichloroacetic acid application in focal epithelial hyperplasia cases is an effective technique which achieves rapid, atraumatic stress-free lesion resolution which did not generate fear in involved patients.

Establishment and Clinical Application of the Analytical Method for Plasma L-citrulline and L-arginine Concentration / 现代检验医学杂志

Objective To establish a method for simultaneously measuring L-citrulline and L-arginine concentration in plasma using reversed-phase high performance liquid chromatography (RP-HPLC)with ultraviolet detection,and the novel method is applied to the patients with digestive system tumor.Methods Plasma samples were deproteinized by trichloroacetic acid with heating method.Phenylisothiocyanate (PITC)was used as derivatization reagent and a gradient elution was adopted. The feasibility verification of method was carried out by detecting plasma L-citrulline and L-arginine acid concentration in 21 cases of advanced digestive tract malignant tumor patients,21 cases of non malignant tumor patients and 39 cases of healthy people.Results The linearity for L-citrulline and L-arginine ranged from 0 to at least 1 000 μmol/L.r=0.999 95 for both. The lower limits of quantification for L-citrulline and L-arginine were 0.240 μmol/L and 0.448 μmol/L respectively.The in-traday and interday coefficients of variation (CVs)were less than 3.4% and 7.2%,respectively.The average recovery rate was from 95.2% to 104.1%.The ratio of plasma L-citrulline/L-arginine in patients with digestive cancar was significantly higher than that in the healthy control group,t-test,P =0.009.The sensitivity and specificity of plasma L-citrulline/L-argi-nine ratio in the malignant tumor of digestive system were 81% and 71.4% respectively.Conclusion This method can pro-vide a reliable and efficient method for the clinical determination of the L-citrulline and L-arginine concentration in plasma. The ratio of plasma citrulline/arginine increased obviously in patients with digestive cancer,suggesting that this ratio is a more sensitive index than single concentration of L-citrulline or L-arginine when evaluating patients with digestive tumor.

Evaluation of different protein extraction methods for banana (Musa spp.) root proteome analysis by two-dimensional electrophoresis.

Four protocols viz., the trichloroacetic acid-acetone (TCA), phenol-ammonium acetate (PAA), phenol/SDS-ammonium acetate (PSA) and trisbase-acetone (TBA) were evaluated with modifications for protein extraction from banana (Grand Naine) roots, considered as recalcitrant tissues for proteomic analysis. The two-dimensional electrophoresis (2-DE) separated proteins were compared based on protein yield, number of resolved proteins, sum of spot quantity, average spot intensity and proteins resolved in 4-7 pI range. The PAA protocol yielded more proteins (0.89 mg/g of tissues) and protein spots (584) in 2-DE gel than TCA and other protocols. Also, the PAA protocol was superior in terms of sum of total spot quantity and average spot intensity than TCA and other protocols, suggesting phenol as extractant and ammonium acetate as precipitant of proteins were the most suitable for banana rooteomics analysis by 2-DE. In addition, 1:3 ratios of root tissue to extraction buffer and overnight protein precipitation were most efficient to obtain maximum protein yield.

Efficacy of Trichloroacetic Acid in Patients with Toenail Onychomycosis: Pilot Study with 14 Patients / 대한의진균학회지

BACKGROUND: Various methods have been employed for treatment of onychomycosis. These methods can be categorized as topical, oral, or device-related. Among them, oral therapies have been regarded as the gold standard for treatment. However, the efficacy of oral therapies on onychomycosis remains limited and safety may be an issue, leaving many patients in need of alternative treatments. As an alternative treatment for onychomycosis, topical therapies are under investigation with great interest. OBJECTIVE: We conducted an investigation on the efficacy of trichloroacetic acid (TCA) as a new therapeutic option in treatment of onychomycosis. METHODS: Fourteen patients with onychomycosis in both great toenails, which was confirmed by fungal examination, were enrolled. About 0.1 ml of 100% TCA solution was applied on one great toenail of the patients eight times at an interval of one week. The other great toenail of the patients was treated with vehicle. RESULTS: At the end of the treatment period, clinical improvement of TCA-treated great toenails with onychomycosis was observed in eleven out of 14 patients. By contrast, no clinical improvement was observed in vehicle-treated great toenails with onychomycosis. Irritant contact dermatitis of the periungual nail folds occurred in 29% as an adverse effect. CONCLUSIONS: Topical solution of TCA may become a new therapeutic option for treatment of patients with onychomycosis who desire alternatives to oral antifungal agents.

A Comparative Study of the Efficacy and Safety of 100% TCA CROSS and Phenol CROSS for Atrophic Acne Scarring / 대한피부과학회지

BACKGROUND: Atrophic acne scars have been treated using various modalities. The CROSS (Chemical Reconstruction of Skin Scars) technique using 100% TCA has the advantage of reconstructing acne scars by focusing on dermal thickening and collagen production. However, the phenol CROSS technique is not widely used for acne scarring. OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness and safety of 100% TCA CROSS and phenol CROSS in the treatment of facial atrophic acne scars. METHODS: Twenty-four participants were randomly and equally divided into 2 groups: group 1 received 2 sessions (8 weeks apart) of 100% TCA CROSS, while group 2 received 2 sessions (8 weeks apart) of phenol CROSS. The severity of atrophic acne scarring and treatment efficacies were evaluated by standardized photography, patient satisfaction, physician global assessment, and the ECCA grading scale. Side effects were assessed at the 8- and 20-week visits. RESULTS: At the 0-, 8-, and 20-week visits, both groups showed an acceptable improvement in patient satisfaction and physician global assessment. ECCA grading scale scores improved by a mean of 22.2% (p<0.05) in group 1 and 19.1% (p<0.05) in group 2. The between-group difference in the degree of ECCA score improvement was not statistically significant (p=0.392). Complications such as pain, crust, postcrust erythema, postcrust dryness, and postinflammatory hyperpigmentation were observed in both treatment groups. However, no severe side effects occurred in either group. CONCLUSION: Both 100% TCA CROSS and phenol CROSS are effective treatment modalities for atrophic acne scarring without significant side effects.

Tratamento de cistos conjuntivais em cavidade anoftálmica com injeção intralesional de ácido tricloroacético (ATA) a 25% / Treatment of conjunctival cysts in anophthalmic socket with intralesional injection of trichloroacetic acid (ATA) 25%

Cistos conjuntivais em cavidades anoftálmicas podem ter implicações funcionais e estéticas negativas para os pacientes. Dentre as opções terapêuticas disponíveis, o uso do ácido tricloroacético é relativamente recente. Os casos relatados apresentaram boa evolução após 30 dias do tratamento, sendo bem tolerado pelos pacientes e possibilitando maior preservação de tecido conjuntival...

Conjunctival cysts in anophthalmic socket may have functional and aesthetic implications for the patients.Among the available treatment options, the use of trichloroacetic acid is relatively recent. Our reported cases showed a good outcome after 30 days of treatment, that was well tolerated by patients, with greater conjunctival tissue preservation...

Instilación intrauterina de ácido tricloroacético como tratamiento de la hemorragia uterina anormal / Intrauterine trichloroacetic acid instillation as treatment of abnormal uterine bleeding

Objetivo: Demostrar la eficacia de la instilación intrauterina de ácido tricloroacético como método de ablación endometrial para el tratamiento de la hemorragia uterina. Métodos: Se realizó un estudio prospectivo, analítico, comparativo, en 60 pacientes que acudieron a la consulta del Servicio de Ginecología del Hospital Universitario de Caracas entre mayo 2008 y agosto 2009, en quienes se empleó ácido tricloroacético al 95 %, como método de ablación endometrial. Se seleccionaron dos grupos al azar, uno sujeto a la colocación previa de analógos de GnRh y otro control, sin este. Resultados: A los 3 meses del tratamiento, el grupo que recibió acetato de leuprolide presentó eumenorrea en 62,5 % e hipomenorrea en 37,5 %. Ninguna de las pacientes de este grupo presentó hipermenorrea, ni amenorrea. El grupo que no recibió análogos presentó eumenorrea en 50 % de los casos, hipomenorrea en 32,1 % e hipermenorrea en 17,9 %. La tasa de éxito y satisfacción de la paciente, fue de 100 % para el grupo con análogos y de 82,1 % para el control. Estos cambios resultaron estadísticamente significativos (P < 0,05). Conclusión: La instilación intrauterina de ácido tricloroacético es eficaz en el tratamiento de la hemorragia uterina, obteniendo mejores resultados al preparar el endometrio con acetato de leuprolide.

Objective: To demonstrate the efficiency of intrauterine instillation of trichloroacetic acid as a method of endometrial ablation for the treatment of uterine hemorrhage. Methods: This was a prospective, analytical and comparative study performed in 60 patients who came to consultation at the Servicio de Ginecologia del Hospital Universitario de Caracas between May, 2008 and August, 2009, in whom 95 % trichloroacetic acid was used as method of endometrial ablation. Two groups were selected at random, one subject to the previous administration of gonadotropin-releasing hormone analogue and another control, without this one. Results: To 3 months of treatment, the group that received leuprolide acetate presented eumenorrhea rates of 62.5 % and hypomenorrhea of 37.5 %. None of the patients of this group presented menorrhagia, not amenorrhea. The group that did not receive analogous presented eumenorrhea in 50 % of the cases, hypomenorrhea in 32.1 % and menorrhagia in 17.9 %. The rate of success and satisfaction of the patient was 100 % for the group with analogous and 82.1 % for the control group. These results turned out to be statistically significant (P <0.05). Conclusion: Intrauterine instillation of trichloroacetic acid is effective in the treatment of uterine hemorrhage, obtaining better results when leuprolide acetate is used previous the procedure.

Pyriform Sinus Fistula: A Single Center Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pyriform sinus fistula with 3rd and 4th branchial cleft anomaly is an extremely rare congenital condition that is not very well understood owing to its rarity. The aim of the study was to review our experience with pyriform sinus fistulae to better understand them. SUBJECTS AND METHOD: Of 163 patients with branchial anomaly treated at our institute between 1999 and 2011, medical records of 15 patients with pyriform sinus fistula were retrospectively reviewed. RESULTS: Overall, 9.2% had pyriform sinus fistulae and this proportion was higher than that of patients with 1st branchial anomaly. The mean age at the time of initial symptom presentation was 11.9 years. However, five patients (33.3%) were not diagnosed at that time because pyriform sinus fistula was not suspected. Computed tomography (CT) was the most sensitive diagnostic tool in patients suspected to have pyriform sinus fistulae; the sensitivity of CT was 86.7%, whereas that for esophagography was only 20%. Conservative surgical treatment involving cauterization of the opening of the fistula tract was performed in nine patients and showed favorable results with 22.2% of recurrence rate during a mean follow-up period of 23.1 months. In 67.7% of the patients, the causative organisms were bacteria inhabiting human mouth, suggesting that infection source for pyriform sinus fistula may be food contents and discharge of upper aerodigestive tract. CONCLUSION: The incidence of pyriform sinus fistula may be higher than expected. Therefore, the possibility of pyriform sinus fistulae coexisting should be considered while treating young patients with perithyroidal infection.

Granuloma piogênico exuberante bilateral: tratamento cirúrgico / Exuberant bilateral pyogenic granuloma: surgical treatment

Granuloma piogênico é uma proliferação vascular comum, que pode ser encontrada na pele e mucosa. Clinicamente se apresenta como lesão nodular, friável, eritematosa e com história de crescimento rápido. O granuloma piogênico ungueal está, geralmente, relacionado à onicocriptose e trauma, sendo muito doloroso nesta localização. Há várias opções de tratamento, incluindo excisão cirúrgica, crioterapia, eletrocauterização, curetagem, lasers, aplicação de ácido tricloroacético, imiquimode e microembolização. Relatamos um caso de granuloma piogênico bilateral nos háluces, de crescimento exuberante, levando a oclusão da placa ungueal. Foi realizado exérese cirúrgica da lesão com bom resultado estético.

Pyogenic granuloma is a common vascular proliferation that can be found on skin and mucous membranes. Its clinical presentation is that of a nodular, friable and erythematous lesion, with fast growth history. The nail bed pyogenic granuloma is generally related to onychocryptosis and trauma, being very painful in that site. There are several treatment options, including surgical excision, cryotherapy, electrocautery, curettage, lasers, application of trichloroacetic acid, imiquimod and microembolization. The present study reports a case of bilateral pyogenic granuloma in the halluces with exuberant growth, leading to the occlusion of the nail plate. The surgical excision of the lesion was performed with good cosmetic results.

Hiperplasia epitelial focal: tratamiento conservador con ácido tricloroacético / Focal epithelial hyperplasia: conservative treatment with trichloroacetic acid

La hiperplasia epitelial focal conocida también como enfermedad de Heck es una patología benignaque se caracteriza por la presencia de múltiples pápulas en la mucosa de la cavidad bucal, producidapor el virus del papiloma humano afectando principalmente niños y adolescentes. Se reportacaso clínico de paciente femenina de 7 años de edad, remitida por odontopediatría al servicio deestomatología y cirugía oral, por presentar múltiples pápulas en mucosa bucal, de tamaño variable,asintomáticas y de 8 meses de evolución, se realizó biopsia excisional en una de las lesiones yel estudio anatomopatológico reportó hiperplasia epitelial sin atipias; como terapéutica se aplicóácido tricloroacético al 80%, observándose resolución de las lesiones con seis topicaciones.

Focal Epithelial Hyperplasia also known as Heck's disease is a benign pathology characterized bythe presence of multiple papules in the mucosa of the oral cavity, produced by the human papillomavirus affecting mainly children and adolescents. A clinical case of a 7 year old female patient wasreported who was referred by Pediatric Dentistry to the Stomatology and Oral surgery Service dueto the presence of multiple papules in the oral mucosa which were variable in size, asymptomatic and had a history of 8 months; an excisional biopsy was performed in one of the lesions and theanatomic pathological study reported epithelial hyperplasia without atypia. Trichloroacetic acid at 80%was applied as treatment and resolution of the lesions was observed with six topical applications.

Cauterização química das conchas nasais inferiores com ácido tricloroacético / Chemical cautery of the inferior turbinates with trichloroacetic acid

INTRODUÇÃO: Obstrução nasal crônica secundária a hipertrofia das conchas nasais inferiores é um sintoma comum, de importante morbidade em nosso meio. Várias técnicas cirúrgicas são descritas para os casos refratários aos tratamentos clínicos, porém, há controversas sobre qual delas é a mais efetiva e sujeita a menos complicações. OBJETIVO: Avaliar a eficácia, a segurança e exequibilidade do uso do ácido tricloroacético ambulatorial para o tratamento da hipertrofia dos cornetos inferiores. MÉTODO: Trabalho prospectivo com 29 pacientes que foram submetidos à técnica ambulatorial de infiltração de ácido tricloroacético a 30 por cento submucosa dos cornetos inferiores, sob anestesia tópica. Foram avaliados os sintomas de rinorreia e obstrução nasal utilizando escala visual e analógica (EVA 010) pré cauterização e um ano pós procedimento. RESULTADOS: Diminuição significativa da obstrução nasal e da rinorreia um ano pós procedimento. As complicações foram sinéquias leves em dois pacientes e sangramentos, de pequena monta, em quatro casos com resolução espontânea. CONCLUSÃO: O método proposto apresentou ótimos resultados quanto à obstrução nasal e rinorreia, pode ser realizado em ambiente ambulatorial, e vem nos mostrando ser de baixa complicação.

INTRODUCTION: Chronic secondary nasal obstruction, the hypertrophy of the inferior turbinates is a common symptom of great morbidity in our society. Several surgical techniques are described to cases refractory to medical treatments, however, there are controversy about which one of them is more effective and less subject to complications. OBJECTIVE: Evaluate the efficacy, security and practicability of using ambulatory trichloroacetic acid to treat the hypertrophy of the inferior turbinates. METHOD: Prospective study with 29 patients submitted to the ambulatory technique of 30 percent trichloroacetic acid infiltration in the inferior turbinate's submucosa, under topic anesthesia. The symptoms of rhinorrhea and nasal obstruction were evaluated using the analogical and visual scale (AVS 010) pre-cautery and one year post-procedure. RESULTS: Significant nasal obstruction and rhinorrhea reduction one year post-procedure. The complications were light synechia in two patients and small bleedings in four spontaneous resolution cases. CONCLUSION: The proposed method showed excellent results concerning nasal obstruction and rhinorrhea, can be conducted in ambulatory environment, and has proved to be a low-complication method.