Efectos terapéuticos de la crioterapia con nitrógeno líquido en lesiones por fotodaño, en la consulta dermatológica / Therapeutic effects of cryotherapy with liquid nitrogen in lesions by photo damage in dermatologic consultation

RESUMEN La crioterapia es el conjunto de procedimientos que utilizan el frío en la terapéutica médica. Emplea diversos sistemas y tiene como resultado la disminución de la temperatura de la piel; produce una destrucción local de tejido de forma eficaz y controlada. El objetivo de este trabajo fue realizar una actualización para exponer los aspectos esenciales sobre formas de empleos, indicaciones, complicaciones y contraindicaciones. Existen varios métodos de aplicación de la crioterapia, que incluyen las técnicas de congelación de spray o aerosol y con aplicadores, el método criosonda, y el uso de termoacoplador. Está indicada en varias entidades, entre las que se encuentran la queratosis seborreica y actínica, lentigos solares, carcinoma basocelular y espinocelular in situ. Las complicaciones más observadas son vesicoampollas, hiperpigmentación e hipopigmentación, y las contraindicaciones comunes son intolerancia al frío, tumores con bordes no delimitados o con pigmentación muy oscura, en localizaciones cerca de los márgenes de los ojos, párpados, mucosas, alas nasales y el conducto auditivo. El dominio de los métodos de aplicación e indicaciones es indispensable para elegir la conducta adecuada; de esta forma se evitan complicaciones y efectos colaterales (AU).

ABSTRACT Cryotherapy is the whole of procedures that use cold in medical therapy. It uses various systems and results in a decrease in skin temperature, leading to a local destruction of tissue in an effective and controlled way. The objective of this work is to make an update to expose the essential aspects on the ways of use, indications, complications and contraindications. There are several cryotherapy application methods that include spray or spray freezing techniques and applicators, the cryoprobe method, and the thermocoupler use. It is indicated in several entities, and among the most frequent are seborrheic and actinic keratosis, solar lentigo, basal cell and squamous cell carcinomas in situ. The most observed complications are vesical blisters, hyperpigmentation and hypopigmentation, and the most common complications are: cold intolerance, tumors with non-delimited borders or very dark pigmentation, located near the margins of the eyes, on eyelids, mucous membranes, nasal wings, and on the ear canal. The mastery of the signs and application methods are essential to choose the appropriate behavior against the disease: side effects and complications are avoided that way (AU).

Tratamiento con HeberFERON® del carcinoma basocelular en la Atención Primaria de Salud en Cuba / HeberFERON® Treatment of Basal Cell Carcinoma in Primary Healthcare in Cuba

Introducción: El cáncer de piel es el tipo de cáncer más frecuente en el ser humano, el carcinoma basocelular es el más común de todos los cánceres de piel (80-90 por ciento). Excepcionalmente producen metástasis, pero pueden causar significativa morbilidad e involucran a edades más jóvenes, se tratan con éxito mediante cirugía, radioterapia, quimioterapia y crioterapia, generalmente en el nivel secundario de salud, sin embargo, estos tratamientos no siempre son posibles o deseables. El HeberFERON® es una combinación de interferones alfa y gamma humanos recombinantes, que ha mostrado producir efectos sinérgicos en la reducción de la proliferación de varias líneas de células cancerosas, esta formulación ha sido aprobada en Cuba para el tratamiento del carcinoma basocelular. Presentación de casos: Se presentaron tres casos con diagnóstico de carcinoma basocelular, localizados en la cara, tratados con HeberFERON®, en dos casos fue observada la desaparición de la lesión al finalizar la tercera semana de tratamiento. En el tercer caso, una mujer de 84 años de edad, al finalizar el primer ciclo de tratamiento, fue reducido el tamaño de la lesión tratada y desapareció otra lesión adyacente que no recibió directamente tratamiento, la lesión residual, en esta paciente, fue valorada por ultrasonido para determinar su extensión y profundidad, en los tres casos las reacciones adversas fueron leves y transitorias. Conclusiones: El HeberFERON® es una opción efectiva y segura para el tratamiento del carcinoma basocelular en la atención primaria de salud en Cuba(AU)

Introduction: Skin cancer is the commonest type of cancer in humans. Basal cell carcinoma is the commonest of all skin cancers, accounting for 80 percent to 90 percent of all cases. Exceptionally, they metastasize, but can cause significant morbidity and involve younger ages. They are successfully treated by surgery, radiotherapy, chemotherapy and cryotherapy, mostly at the secondary level of health. However, these treatments are not always possible or desirable. HeberFERON® is a combination of recombinant human alpha and gamma interferons, which has been shown to produce synergistic effects in reducing the proliferation of several lines of cancer cells. This formulation has been approved in Cuba for treating basal cell carcinoma. Case presentation: Three cases are presented with a diagnosis of basal cell carcinoma, located on the face, treated with HeberFERON®. In two cases, the lesion was observed to disappear at the end of the third week of treatment. In the third case, an 84-year-old woman, at the end of the first cycle of treatment, the size of the treated lesion was reduced and another adjacent lesion disappeared, which did not receive direct treatment. In this patient, the residual lesion was assessed by ultrasound to determine its extension and depth. In the three cases, the adverse reactions were mild and transitory. Conclusions: HeberFERON® is an effective and safe option for treating basal cell carcinoma in primary health care in Cuba(AU)

Oftalmomiasis / Ophthalmomiasis

La oftalmomiasis es una enfermedad poco frecuente, causada por artrópodos; en este caso por la mosca adulta. Presentamos el caso de una paciente femenina, de 44 años de edad, con antecedentes de inmunosupresión severa secundaria a VIH, quien fue atendida en el Servicio de Oftalmología por molestia ocular. Presentaba un aumento de volumen circunscrito en conjuntiva que se extendía sobre la córnea nasal del ojo izquierdo, de aspecto blanco nacarado, deslustrado. Se le realizó exéresis de la lesión y crioterapia. Posteriormente se le aplicó colirio de mitomicina C. A los siete meses la paciente regresó a la consulta con un cuadro de complicación franca y severa de la lesión, con destrucción de los tejidos de la órbita y múltiples cavernas ocupadas por cientos de larvas de moscas(AU)

Ophthalmomiasis is a rare disease, caused by arthropods; in this case by the adult fly. We present the case of a 44-year-old female patient, with a history of severe immunosuppression secondary to HIV, who was treated at the Ophthalmology Service for ocular discomfort. She presented a circumscribed increase in volume in the conjunctiva that extended over the nasal cornea of ​​the left eye, with a pearly white, tarnished appearance. Excision of the lesion and cryotherapy were performed. Subsequently, mitomycin C eye drops were applied. Seven months later, the patient returned to the consultation with a frank and severe complication of the lesion, with destruction of the tissues of the orbit and multiple caverns occupied by hundreds of fly larvae(AU)

Cisto dentígero com transformação ameloblástica / Quiste dentígero con transformación ameloblástica / Dentigerous cyst with ameloblastic transformation

Introdução: O cisto dentígero se origina pela separação do folículo que fica ao redor da coroa de um dente incluso. É o tipo mais comum de cisto odontogênico do desenvolvimento. O seu crescimento é lento, assintomático, e pode atingir grandes dimensões. Objetivo: Relatar um caso clínico cirúrgico de cisto dentígero com transformação ameloblástica, localizado na mandíbula, de paciente, gênero feminino, melanoderma, 14 anos. Caso clínico: Ao exame radiográfico apresentou área radiolúcida unilocular com margem bem definida e esclerótica envolvendo a coroa das unidades 48 e 47. Foi realizada enucleação e curetagem da lesão com exodontia destas unidades sob anestesia local em ambulatório, e aplicada a crioterapia na loja óssea. Encaminhou-se o conteúdo da lesão para exame histopatológico e o diagnóstico de cisto dentígero com transformação ameloblástica foi fechado. Comentários principais: No momento a paciente encontra-se em acompanhamento pós-operatório de 3 anos com neoformação óssea e sem recidivas(AU)

Introducción: El quiste dentígero se origina por la separación del folículo que se queda alrededor de la corona de un diente no erupcionado. Es el tipo más común de quiste odontogénico de desarrollo. Su crecimiento es lento, asintomático y puede alcanzar grandes dimensiones. Objetivo: Reportar un caso quirúrgico de quiste dentígero con transformación ameloblástica. Presentación del caso: Paciente femenina de 14 años, de color de piel negra. La radiografía demostró una radiolucidez unilocular con márgenes bien definidos que envolvían la corona de los dientes 48 y 47. El tratamiento involucró una combinación de enucleación y curetaje de la lesión, exodoncia de los dientes y crioterapia para desvitalizar el hueso circundante. Se realizó el examen histopatológico, luego, se confirmó el diagnóstico de quiste dentígero con transformación ameloblástica. Conclusiones: Al momento de la redacción del reporte la paciente se encontraba en seguimiento posoperatorio de tres años con neoformación ósea y sin recidivas(AU)

Introduction: Dentigerous cysts are caused by the separation of the follicle remaining around the crown of unerupted teeth. They are the most common type of developmental odontogenic cyst. Their growth is slow and asymptomatic, and they may reach large dimensions. Objective: Report a surgical case of dentigerous cyst with ameloblastic transformation. Case presentation: A case is presented of a black female 14-year-old patient. Radiography revealed an area of unilocular radiolucency with well-defined margins enveloping the crowns of teeth 48 and 47. Treatment was a combination of enucleation and curettage of the lesion, exodontia of the teeth and cryotherapy to devitalize the surrounding bone. Eventual histopathological examination confirmed the diagnosis of dentigerous cyst with ameloblastic transformation. Conclusions: At the time when the report was written, the patient had been followed up for three years after surgery, showing bone neoformation and no recurrence of the lesion(AU)

Papiloma conjuntival / Conjunctival papilloma

RESUMEN El papiloma conjuntival es un tumor de células escamosas adquirido, benigno, que se puede presentar a cualquier edad, pero más frecuentemente en la tercera y cuarta décadas de la vida. Los papilomas están asociados con la infección del virus papiloma humano, usualmente los tipos 6 y 11. Se presenta un paciente quien se encuentra en la cuarta década de la vida, fumador. Acudió al Servicio de Oculoplastia por aumento del volumen conjuntival en el ojo izquierdo. Luego del interrogatorio y de un examen ocular exhaustivo, se realizó el diagnóstico clínico de papiloma conjuntival recurrente. Se propuso exéresis, crioterapia y biopsia de las lesiones conjuntivales. Posterior a la intervención, se confirmó el diagnóstico anatomopatológico y se reajustó el tratamiento tópico ocular con interferón, con lo cual se obtuvieron resultados satisfactorios(AU)

ABSTRACT Conjunctival papilloma is a benign acquired squamous cell tumor occurring at any age, but more commonly in the third and fourth decades of life. Papillomas are associated to human papillomavirus infection, usually of types 6 and 11. A case is presented of a male smoker patient in his fourth decade of life. The patient attended the Oculoplastics Service due to conjunctival volume increase in his left eye. Interrogation and exhaustive ocular examination led to the clinical diagnosis of recurrent conjunctival papilloma. Exeresis, cryotherapy and biopsy of the conjunctival lesions were indicated. The anatomopathological diagnosis was confirmed after the intervention and a readjustment was made of the topical ocular treatment with interferon, with which satisfactory results were obtained(AU)

Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review / Eficacia y seguridad de crioterapia, cono frio o termo-coagulación en comparación con LEEP como terapia para la neoplasia intraepitelial cervical: Revisión sistemática

ABSTRACT OBJECTIVES To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

RESUMEN OBJETIVOS Evaluar la eficacia y seguridad del uso de crioterapia, cono frio o termo-coagulación en comparación con el procedimiento de escisión electroquirúrgica en asa (LEEP) para el manejo de neoplasias intraepiteliales cervicales. MÉTODOS Revisión sistemática de ensayos controlados aleatorizados en mujeres con neoplasia intraepitelial cervical en tratamiento con crioterapia, cono frio, o termo coagulación y LEEP, para estimar su eficacia y seguridad. La búsqueda se realizó en MEDLINE/PUBMED, Registro Cochrane Central de Ensayos Controlados (CENTRAL) y Scopus, hasta setiembre de 2018. RESULTADOS Se identificaron 72 estudios, ocho cumplieron los criterios de inclusión. Cono frio disminuyó el riesgo de enfermedad residual en comparación con LEEP (RR 0,54; IC del 95%, 0,30-0,96, p = 0,04). Crioterapia en comparación con LEEP incrementó el riesgo de recurrencia de enfermedad en un 86,0% (RR 1,86; IC del 95%, 1,16-2,97, p = 0,01) con un tiempo de seguimiento de seis a 24 meses, y de infecciones (RR, 1,17; IC del 95%, 1,08-1,28, p < 0,001); pero redujo el riesgo de sangrado menor en un 51,0% (RR 0,49; IC del 95%, 0,40-0,59, p ≤ 0,001). CONCLUSIONES Cono frio reduce el riesgo de enfermedad residual. Sin embargo, la crioterapia reduce el riesgo de sangrado menor en las 24 horas posteriores al tratamiento e incrementa el riesgo de recurrencia de enfermedad y de infecciones.

Experimental study for evaluation of a low-cost spray cryotherapy system / Estudo experimental para avaliação de um sistema de baixo custo para crioterapia em spray

ABSTRACT Objective To evaluate the feasibility and applicability of a low-cost cryotherapy system. Methods Experimental study with 25kg Landrace pigs submitted to a longitudinal cervico-thoraco-abdominal incision for exposure of the trachea, thorax and abdomen. The tissues were frozen by continuous spray application at different periods of time (5, 10 and 15 seconds). Spray cryotherapy was performed using a fluorinated gas (tetrafluorethane) delivered at - 47°C temperature (DermaFreeze®, Emdutos; ANVISA registration 80409950001; price R$ 394,00). via an adapted, disposable 1.8mm cholangiography catheter (Olympus; price R$ 280,00). The specimens were resected for histopathological analysis. Results Thirty samples were obtained from ten different organs and divided according to spray cryotherapy application time. System activation for 5, 10 or 15 seconds led to consumption of 14g, 27g and 40g of gas respectively (average gas consumption, 2.7g/s using a 1.8mm catheter). The system comprising a spray tube and catheter proved user-friendly and effective, with constant gas dispersion and adequate tissue freezing. In spite of effective freezing, microscopy failed to reveal tissue changes. This may have reflected methodological constraints precluding evaluation at tissue damage peak time (48 hours). Conclusion The low-cost spray cryotherapy system proved feasible and safe.

RESUMO Objetivo Avaliar a exequibilidade e a aplicação de um sistema de baixo custo de crioterapia. Métodos Estudo experimental realizado com um suíno da raça Landrace, 25kg, submetido à cervicotoracolaparotomia longitudinal, com exposição de traqueia, tórax e abdome. Procedemos ao congelamento das estruturas em tempos diferentes (5, 10 e 15 segundos) com jato contínuo. A crioterapia foi realizada com gás fluoretado (tetrafluoretano), na forma de spray em tubo, que atinge a temperatura de -47°C (DermaFreeze®, Emdutos; registro ANVISA 80409950001; preço R$ 394,00). A este tubo, adaptamos um cateter descartável de colangiografia de 1,8mm (Olympus; preço R$ 280,00). As peças foram ressecadas para análise histopatológica. Resultados Foram obtidas 30 amostras em 10 órgãos diferentes, divididos em três intervalos de tempo distintos. Quando o sistema foi acionado por 5 segundos, gastaram-se 14g de gás; por 10 segundos, 27g; e por 15 segundos, 40g; o gasto médio foi de 2,7g/s pelo cateter de 1,8mm. O sistema confeccionado com tubo de gás e cateter proporcionou resultado efetivo, com dispersão adequada e constante do gás, congelamento adequado e de fácil execução. Apesar da técnica evidenciar congelamento efetivo, na microscopia não houve alteração tecidual. Isso ocorreu porque o pico de lesão tecidual por congelamento ocorre após 48 horas, o que não foi possível avaliar por este método proposto. Conclusão O sistema de crioterapia em spray de baixo custo foi exequível e seguro.

The topical treatment of old world cutaneous leishmaniasis with gentian violet along with cryotherapy: a pilot single-blind randomized controlled clinical trial

Abstract INTRODUCTION: The promising non-clinical antileishmanial effects of gentian violet (GV) encouraged us to evaluate the additive effect of GV on cryotherapy. METHODS: For 8 weeks, 59/161 cutaneous leishmaniasis patients/lesions underwent cryotherapy alone (group 1) or cryotherapy accompanied by 1% GV application (group 2). The primary endpoint was clinical response. RESULTS: Ultimately, 54.7% and 45.3% of the significantly cured lesions belonged to groups 1 and 2, respectively, which was not statistically significant. The clinical response was significantly different between the two groups at the end of the fourth week. CONCLUSIONS: Although the clinical response of the two groups was significantly different at the end of the fourth week, application of GV did not increase the efficacy of cryotherapy.

Dellen corneal secundario a carcinoma epidermoide de conjuntiva / Corneal dellen secondary to epidermoid carcinoma of the conjunctiva

El dellen corneal es un área de adelgazamiento corneal localizado como consecuencia de la deshidratación provocada por la falta de humectación relacionada con una zona adyacente de abultamiento conjuntival. Se presenta una paciente femenina de 72 años, blanca, con antecedentes de hipertensión arterial, quien refirió lagrimeo y sensación de cuerpo extraño en el ojo izquierdo, de una semana de evolución. Al examen biomicroscópico se observó tejido fibrovascular en conjuntiva bulbar nasal que infiltraba la córnea, sobreelevado, de superficie lisa, no queratinizada, acompañada de inyección conjuntival y múltiples neovasos. En la córnea periférica y adyacente a esta se observó depresión de base limpia, redondeada, de 6 mm de extensión y profundidad hasta estroma anterior. Teniendo en cuenta las características de la lesión, se planteó como diagnóstico presuntivo dellen corneal secundario a pterigium grado II sintomático. La biopsia informó carcinoma de células escamosas, moderadamente diferenciado, asociado con un extenso infiltrado inflamatorio a predominio de linfocitos(AU)

Corneal dellen is an area of localized corneal thinning as a result of dehydration caused by lack of humectation associated to an adjoining conjunctival bulging. Here is a 72-years old Caucasian woman with a history of hypertension, who presented continuous tearing and feeling of a foreign body in her left eye during a week. The biomicroscopic exam showed fibrovascular tissue in nasal bulb conjunctiva, which infiltrated into the cornea, it was raised of flat surface, unkeratinized, accompanied with conjunctival injection and multiple neovessels. In the peripheral cornea and adjacent to it, there was a clean, rounded depression measuring 6 mm of extension and depth up to the anterior stroma. The presumptive diagnosis was corneal dellen secondary to symptomatic grade II pterygium. The biopsy yielded the presence of squamous cell carcinoma, moderately differentiated, and associated with extensive inflammatory infiltrate with predominance of lymphocytes(AU)

Coats disease associated with vasoproliferative tumor treated with cryotherapy and intravitreal injections of triamcinolone / Doença de Coats associada a tumor vasoproliferativo tratada com crioterapia e injeções intravítreas de triancinolona

Abstract Report of a case of Coats disease associated with retinal vasoproliferative tumor in a young female patient with two peripheral vascularized tumors and lipid exudation involving the macula and peripapillary region with serous retinal detachment areas and pre-papillary fibrous proliferation. The proposed and performed treatment was the intravitreal injection of triamcinolone acetonide to decrease the tumor exudation, followed by photocoagulation of the peripheral areas of telangiectasia without subretinal fluid and cryotherapy of the tumors. Despite that this is a rare and difficult to treat combination, in this case report, success was obtained in receding the tumor masses and reapplying the retina, leading to anatomic and visual stabilization.

Resumo Relato de um caso de Doença de Coats associada a tumor vasoproliferativo de retina em uma paciente jovem com duas tumorações vascularizadas periféricas e exsudação lipídica acometendo mácula e região peripapilar com áreas de descolamento de retina seroso e proliferação fibrosa pré-papilar. O tratamento proposto e realizado foi a injeção intra-vítrea de triancinolona para diminuir a exsudação do tumor, seguida de fotocoagulação periférica das áreas de telangiectasia sem fluido subretiniano e criocoagulação dos tumores. Apesar de se tratar de uma associação rara e de difícil tratamento, neste relato de caso, obteve-se êxito em regredir as massas tumorais e reaplicar a retina, levando à estabilização anatômica e visual.

Cold water immersion and inflammatory response after resistance exercises / Imersão em água fria e resposta inflamatória após exercícios resistidos / Inmersión en agua fría en respuesta inflamatoria posterior a ejercicios resistidos

INTRODUCTION: High-intensity resistance exercises (RE) cause an inflammatory response that reduces functionality. OBJECTIVE: To evaluate the effects of Cold Water Immersion (CWI) on leukocytosis, oxidative stress parameters, inflammatory markers and delayed onset muscle soreness (DOMS) resulting from a RE session in untrained volunteers. METHODS: Thirteen volunteers (aged 26 ± 5 years) who do not engage in RE were randomized and underwent Control RE and RE with CWI sessions. Exercise sessions (leg extension machine, squats and leg presses) consisted of four sets of 10 maximum repetitions (one-week interval between the assessment and the sessions). CWI consisted of immersion in water (15°C) to the umbilicus for 10 minutes immediately after the exercise session. Complete blood count, CRP, creatine kinase (CK) and lipoperoxidation (LPO) were assessed previously (baseline) and immediately, 30 minutes and 2 hours after RE. DOMS was assessed 24 hours after the sessions. RESULTS: RE induced progressive leukocytosis (P<0.001). CRP was elevated 2 hours after exercise (P=0.008) only in the Control RE session. CK increased 30 minutes and 2 hours after exercise (P<0.001) in the Control session, whereas in the CWI session the increase was observed after 2 hours (P<0.001). LPO increased only in the Control session after 2 hours (P=0.025). CWI reduced DOMS by 57% (P<0.001). CONCLUSION: CWI slows the inflammatory response and reduces DOMS in untrained individuals undergoing RE. Level of Evidence I; Randomized Clinical Trial.

INTRODUÇÃO: Os exercícios resistidos (ER) de alta intensidade provocam resposta inflamatória que reduz a funcionalidade. OBJETIVO: Avaliar os efeitos da imersão em água fria (IAF) sobre leucocitose, parâmetros de estresse oxidativo, marcadores inflamatórios e dor muscular de início tardio (DMIT), resultantes de uma sessão ER em voluntários destreinados. MÉTODOS: Treze voluntários (26 ± 5 anos de idade) não praticantes de ER foram randomizados e submetidos a sessões de ER Controle (ERC) e ER com IAF (ER+IAF). As sessões de exercícios (cadeira extensora, agachamento e leg press) consistiram em quatro séries de 10 repetições máximas (intervalo de uma semana entre a avaliação e as sessões). A IAF consistiu em imersão em água (15 °C), no nível da região umbilical, durante 10 minutos, imediatamente após a sessão de exercícios. Hemograma completo, PCR, creatina quinase (CK) e lipoperoxidação (LPO) foram avaliados previamente (basal) e imediatamente, aos 30 minutos e 2 horas após os ER. A DMIT foi avaliada 24 horas após as sessões. RESULTADOS: Os ER induziram leucocitose progressiva (P < 0,001). A PCR foi elevada 2 horas após os exercícios (P = 0,008), apenas na sessão de ER Controle. A CK aumentou 30 minutos e 2 horas após os exercícios (P < 0,001) na sessão Controle, enquanto na sessão IAF o aumento foi observado após 2 horas (P < 0,001). A LPO aumentou somente na ERC depois de 2 horas (P = 0,025). A IAF reduziu em 57% a DMIT (P < 0,001). CONCLUSÃO: A IAF retarda a resposta inflamatória e reduz a DMIT em indivíduos destreinados submetidos a ER. Nível de Evidência I; Ensaio Clínico Randomizado.

INTRODUCCIÓN: Los ejercicios resistidos (ER) realizados en alta intensidad provocan una respuesta inflamatoria que reduce la funcionalidad. OBJETIVO: Evaluar los efectos de la inmersión en agua fría (IAF) sobre la leucocitosis, estrés oxidativo, marcadores inflamatorios y en el dolor muscular de inicio tardío (DMIT) resultantes de una sesión de ER en voluntarios no entrenados. MÉTODOS: Trece voluntarios (26 ± 5 años de edad) no practicantes de ER fueron aleatoriamente sometidos a sesiones de Control ER y ER con IAF. Las sesiones de ejercicios (silla extensora, sentadillas y leg press) consistieron en cuatro series de 10 repeticiones máximas (intervalo de una semana entre la evaluación y las sesiones). La IAF consistió en inmersión en agua (15°C) a nivel de la cicatriz umbilical, durante 10 minutos posteriores a la sesión de ejercicios. Se realizó un análisis completo de hemograma, PCR, creatina quinasa (CK) y lipoperoxidación (LPO), los cuales se evaluaron previa (basal), e inmediatamente después de 30 minutos y 2 horas después de los ER. La DMIT fue evaluada 24 horas después de las sesiones. RESULTADOS: Los ER indujeron a una progresiva leucocitosis (P<0,001). La PCR se elevó 2 horas luego de los ejercicios (P=0,008) apenas en la sesión de Control ER. La CK aumentó después de 30 minutos y 2 horas después de los ejercicios (P<0,001) en la sesión Control, mientras que en la sesión IAF el aumento se observó después de 2 horas (P<0,001). La LPO sólo aumentó en la sesión de Control en 2 horas (P=0,025). La IAF redujo en 57% el DMIT (P<0,001). CONCLUSIÓN: La IAF retarda la respuesta inflamatoria y reduce la DMIT en individuos no entrenados sometidos a ER. Nivel de Evidencia I, Ensayo Clínico Randomizado.

Utilidad de la crio-tecnología para uso diagnóstico y terapéutico en neumología intervencionista: crio-biopsia pulmonar transbronquial y crioterapia / Transbronchial cryobiopsies and cryotherapy in lung diseases

Bronchoscopy cryoprobes are used for palliative treatment of endobronchial obstructions caused by tumors and removal of granulation tissue or foreign bodies. Currently this technology is also used for diagnosis of diffuse interstitial lung disease (ILD). The multidisciplinary team that establishes the clinical, radiological and histopathological correlation in ILD, decides about performing a surgical lung biopsy when the characteristics of the interstitial disease are not similar to Idiopathic Pulmonary Fibrosis (IPF). Although surgical lung biopsy is the gold standard for diagnosis, treatment, and prognosis, transbronchial cryo-biopsy has a high diagnostic yield, low morbidity and mortality rate, low rate of complications and lower cost. It is the diagnostic method of choice in ILD when it is available. Technological improvements with greater freezing power and tensile strength of the cryo probes, allow their use in cryotherapy and cryo-recanalization for occlusive airway tumors.

Lobomycosis: a therapeutic challenge

Abstract: Lobomycosis or lacaziosis is a chronic granulomatous fungal infection caused by Lacazia loboi. Most cases are restricted to tropical regions. Transmission is believed to occur through traumatic inoculation in the skin, mainly in exposed areas. It is characterized by keloid-like nodules. There are only a few hundred cases reported. The differential diagnoses include many skin conditions, and treatment is difficult. The reported case, initially diagnosed as keloid, proved to be refractory to surgical treatment alone. It was subsequently approached with extensive surgery, cryotherapy every three months and a combination of itraconazole and clofazimine for two years. No signs of clinical and histopathological activity were detected during follow-up.

Cryotherapy: biochemical alterations involved in reduction of damage induced by exhaustive exercise

When exercises are done in intense or exhaustive modes, several acute biochemical mechanisms are triggered. The use of cryotherapy as cold-water immersion is largely used to accelerate the process of muscular recovery based on its anti-inflammatory and analgesic properties. The present study aimed to study the biochemical effects of cold-water immersion treatment in mice submitted to exercise-induced exhaustion. Swiss albino mice were divided into 4 treatment groups: control, cold-water immersion (CWI), swimming exhaustive protocol (SEP), and SEP+CWI. Treatment groups were subdivided into times of analysis: 0, 1, 3, and 5 days. Exhaustion groups were submitted to one SEP session, and the CWI groups submitted to one immersion session (12 min at 12°C) every 24 h. Reactive species production, inflammatory, cell viability, and antioxidant status were assessed. The SEP+CWI group showed a decrease in inflammatory damage biomarkers, and reactive species production, and presented increased cell viability compared to the SEP group. Furthermore, CWI increased acetylcholinesterase activity in the first two sessions. The present study showed that CWI was an effective treatment after exercise-induced muscle damage. It enhanced anti-inflammatory response, decreased reactive species production, increased cell viability, and promoted redox balance, which could decrease the time for the recovery process.

Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy / Análise do tecido muscular de ratos Wistar submetidos ao modelo de compressão do nervo isquiático e à crioterapia

ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.

RESUMO Objetivo: Avaliar os efeitos da compressão nervosa do isquiático direito e da crioterapia no tecido muscular. Métodos: Foram utilizados 42 ratos Wistar machos, subdivididos nos Grupos Controle, Lesão 3, Lesão 8 e Lesão 15, submetidos a compressão nervosa e eutanasiados, respectivamente, no 3°, 8° e 15° dias pós-operatório; Lesão Crioterapia 3, tratado com crioterapia, por imersão durante 20 minutos, por 1 dia, e eutanasiados no 3° dia pós-operatório; e Lesão Crioterapia 8 e Lesão Crioterapia 15, tratados durante 6 dias e eutanasiados no 8° e 15° dias pós-operatório. A avaliação funcional foi realizada pela força de preensão do membro pélvico direito. Os músculos tibiais anteriores direitos foram avaliados quanto a massa, menor diâmetro e área de secção transversa. Em Lesão Crioterapia 8 e Lesão Crioterapia 15, foi dosada a hidroxiprolina nos sóleos direitos. Resultados: Na preensão, houve diferença significativa nos Grupos Lesão quando comparados ao Grupo Controle (p<0,05). No menor diâmetro, o Grupo Controle foi maior que Lesão 8 (p=0,0094), Lesão 15 (p = 0,002) e Lesão Crioterapia 15 (p<0,001). Na comparação entre os grupos com eutanásia no mesmo pós-operatório, houve diferença significativa (p=0,0363) no 8° pós-operatório, sendo Lesão Crioterapia maior que Lesão. Na área das fibras, o Grupo Controle também foi maior que Lesão 8 (p=0,0018), Lesão 15 (p<0,001) e Lesão Crioterapia 15 (p<0,001). Na hidroxiprolina, não houve diferença significativa entre os grupos. Conclusão: A lesão nervosa resultou na diminuição da força e em trofismo muscular, e a crioterapia retardou a hipotrofia, porém este efeito não se manteve após o tratamento cessar.

Displasia de alto grado en esófago de Barrett: ¿ablación, mucosectomía o cirugía? / High-grade dysplasia in Barrett's oesophagus: ablation, mucosectomy or surgery?

Barrett's esophagus has a risk of developing esophageal adenocarcinoma and it increases when dysplasia is present. For this reason, its diagnosis requires endoscopic surveillance or eradication if dysplasia or cancer appears. In the past, high-grade dysplasia and intramucosal esophageal adenocarcinoma were routinely treated with esophagectomy, but with considerable morbidity and mortality. This has led to the development of new alternatives as less invasive endoscopic treatments for both dysplastic lesion and total eradication of the remaining metaplastic mucosa. The most commonly used treatment options include cryotherapy, radiofrequency ablation, endoscopic resection (mucosal resection or endoscopic submucosal dissection) or a combination of these (multimodal endoscopic eradication). For patients with low-grade dysplasia still some international guides suggest keeping endoscopic follow up; however, considering the good results of endoscopic ablation and new evidence about the course of this disease, this concept has changed towards the therapeutic approach. For Barrett´s esophagus without any complication, endoscopic therapy is not recommended, but endoscopic surveillance. In this article we will review the endoscopic therapeutic alternatives to Barrett's esophagus, its scientific basis and how they have evolved in recent times.

El Esófago de Barrett es una lesión adquirida que tiene riesgo de desarrollar adenocarcinoma esofágico. Su presencia obliga, por lo tanto, a la vigilancia endoscópica y erradicación cuando aparece displasia sobre este epitelio, pues aumenta la probabilidad de progresar a cáncer. Antes de la aparición de la terapia endoscópica estos casos con displasia de alto grado y adenocarcinoma esofágico independiente de su estadío, eran sometidos a una esofagectomía. Sin embargo, esta intervención se asocia a una morbimortalidad importante. De esta manera, los avances en la cirugía endoscópica también han sido traspasados al manejo del Esófago de Barrett con displasia o cáncer intramucoso, que incluyen en estos casos la erradicación del epitelio columnar en su totalidad. Las alternativas terapéuticas más utilizadas son la crioterapia, ablación por radiofrecuencia, resección endoscópica (mucosectomía o disección submucosa endoscópica) o una combinación de éstas (erradicación endoscópica multimodal). Para pacientes portadores de Barrett con displasia de bajo grado, la recomendación de la mayoría de las guías internacionales sigue siendo la vigilancia endoscópica. Sin embargo, dado los buenos resultados de la ablación endoscópica y nuevas evidencias respecto al curso de esta patología, este concepto ha ido cambiando hacia tomar una conducta terapéutica. En caso de ausencia de displasia no se recomienda la terapia endoscópica de regla sino la vigilancia endoscópica. En el presente artículo revisaremos las alternativas terapéuticas endoscópicas frente al esófago de Barrett, su sustento científico y cómo han evolucionado en el último tiempo.

Fractura por avulsión de la tuberosidad anterior de la tibia en adolescentes / Fracture-avulsion de la tubérosité tibiale antérieure chez l'adolescent / Avulsion fracture of the anterior tuberosity of the tibia in adolescents

Las fracturas por avulsión de la tuberosidad anterior de la tibia ocurren generalmente en adolescentes atletas. Estas lesiones son más frecuentes en el sexo masculino y su incidencia puede cifrarse entre el 0,4 por ciento al 2,7 porciento del total de las lesiones epifisarias. Presentamos un adolescente masculino de 15 años de edad, que durante la práctica de voleibol sufrió fractura por avulsión de la tuberosidad anterior de la tibia tipo II A de Odgen. Se le realizó reducción abierta y fijación interna e inmovilización. No presentó complicaciones. Hacemos una revisión de esta entidad por ser poco frecuente(AU)

Avulsion fractures of the anterior tuberosity of the tibia generally occur in adolescent athletes. These lesions are more frequent in males and their incidence can range 0.4 percent to 2.7 percent of the total epiphyseal lesions. We present a 15-year-old male adolescent, who during the volleyball practice suffered an avulsion fracture of the anterior tuberosity tibia Odgen type II A. He underwent open reduction and internal fixation and immobilization. He had no complications. A review of this entity is conducted since it is rare(AU)

Les fractures-avulsion de la tubérosité tibiale antérieure se produisent généralement chez de jeunes athlètes. Ces lésions touchent souvent les garçons, et leur incidence peut aller de 0,4 pourcent à 2,7 pourcent de la totalité des lésions épiphysaires. Le cas d'un garçon âgé de 15 ans, ayant souffert une fracture-avulsion de la tubérosité tibiale antérieure type IIA selon la classification d'Odgen au cours de sa pratique de volleyball, est présenté. Il a subi alors une réduction ouverte et fixation interne, ainsi qu'une immobilisation. Il n'a pas eu de complication. Due à sa rareté, une révision de cette affection est réalisée(AU)

Morphometric and fractal analysis of injured skeletal muscle tissue subjected to a combination of treatments; cryotherapy and therapeutic ultrasound / Análisis de la morfometría y de la dimensión fractal en la lesión del tejido muscular esquelético expuesto en la combinación de los tratamientos de crioterapia y ultrasonido

The aim of this study was to analyze the effects of an association of cryotherapy and therapeutic ultrasound on the treatment of muscle injured by impact. Fifty-five Wistar rats were divided into five groups (n = 11), Acute Injury (AI), Injury (I), Cryotherapy (CR), Therapeutic Ultrasound (TU) and Association of Cryotherapy and Therapeutic Ultrasound (CRTU). The CR and CRTU groups received applications of Cryotherapy three times (immediately, 24 and 48 h after injury) of 20 minutes duration. The TU and CRTU groups received applications of Therapeutic Ultrasound for seven days, for five minutes, in pulsed mode, 0.5 w/cm intensity, frequency 1 MHz. Body mass and gastrocnemius mass were analyzed. In addition to histological slides stained with hematoxylin and eosin used for morphometric analysis, picrosirius dye was used for quantification of collagen by Fractal Dimension (FD). The results of the intra-group analysis showed lower body mass and gastrocnemius in the CRTU group in relation to the AI (p = 0.001), I (p = 0.001), CR (p = 0.001) and TU groups (p = 0.001), and lower values of FD to quantify collagen in the CRTU group in relation to the AI (p = 0.007) and CR groups (p = 0.014). In summary, the present study showed that the association of Cryotherapy with Therapeutic Ultrasound promoted better results in the aspects analyzed compared to application of the therapies in isolation.

El objetivo del estudio fue evaluar los efectos de la asociación de las técnicas de crioterapia y ultrasonido terapéutico en el tratamiento de la lesión muscular por impacto. Fueron utilizadas 55 ratas Wistar, expuestas a lesión y separadas en grupos (n = 11): Lesión aguda (LA), Lesión (L), Crioterapia (CR), Ultrasonido Terapéutico (UT) y Crioterapia + Ultrasonido Terapéutico (CRUT). Los grupos CR y CRUT recibieron la aplicación, durante 20 minutos, en tres momentos (inmediatamente, 24 y 48 horas, después de la lesión). Los grupos UT y CRUT, recibieron UT por siete días, con una duración de cinco minutos, en modo pulsado, con una intensidad de 0,5 W/cm2 y frecuencia de 1 MHz. Fueran medidos el peso corporal y el peso de los músculos gastrocnemios y se realizaron cortes histológicos del músculo gastrocnemio, los cuales fueron teñidos con hematoxilina-eosina (HE) para el análisis morfométrico y con picrosirius para el análisis del colágeno por dimensión fractal (DF). Los resultados de los análisis intragrupo demostraron una menor disminución de la masa coporal y muscular en el grupo CRUT. Además, fue observado un valor inferior en la morfometría en el grupo CRUT en comparación a los grupos LA (p = 0,001), L (p = 0,001), CR (p = 0,001) y UT (p = 0,001), y un menor valor de la DF con respecto al colágeno en el grupo CRUT en comparación a los grupos LA (p = 0,007) y CR (p = 0,014). En síntesis, el presente estudio demostró que el protocolo de asociación de las técnicas de CR y UT causaron mayores respuestas benéficas en los aspectos analizados en comparación a los protocolos con los tratamientos aplicados de forma aislada.

Técnicas de crioterapia para el tratamiento de la neoplasia intraepitelial en el instituto hondureño de seguridad social durante el período de enero 2011 a junio del 2012 / Cryotherapy techniques for the treatment of intraepithelial neoplasia in the honduran institute of social security during the period January 2011 to June 2012

Ojetivo: Describir las técnicas de crioterapia de simple y doble congelación, determinar la eficacia complicaciones del tratamiento en las mujeres que asisten a la consulta externa. Métodos: estudio descriptivo transversal, seleccionando 120 mujeres a conveniencia que asistieron a la consulta externa del Instituto Hondureño de Seguridad Social con diagnóstico de neoplasia intraepitelial de bajo grado. Resultados: de las 120 pacientes tratadas con crioterapia, 25 pacientes persistieron con NIC 7 de ellas tratadas con doble congelación y 16 con una sola congelación. 4 pacientes presentaron complicaciones las cuales fueron tratadas con la técnica doble...

Objective: Describe cryotherapy techniques and double freezing, determine the efficacy of treatment complications in women attending outpatient. Methods: cross-sectional study, 120 women choosing to convenience attending the outpatient Social Security Institute diagnosed with low-grade intraepithelial neoplasica. Results: Of the 120 patients treated with cryotherapy, 25 patients persisted with CIN 7 were treated with double freeze and 16 with a single freeze. 4 patients had complications which were treated with the technique with double freeze...