Tratamiento periorbitario con ácido hialurónico / Periorbital treatment with hyaluronic acid

Hoy, gran cantidad de pacientes solicitan un cambio en la zona palpebral ya que se ven con aspecto de cansados. Muchas veces presentan bolsas y piel redundante, pero no quieren someterse a una cirugía, que en muchos casos es el tratamiento de elección. Pueden ofrecerse como alternativa los rellenos con ácido hialurónico. Como problemas estéticos en la zona, se pueden encontrar: • Surco nasoyugal o de las lágrimas (tear trough) • Surco palpebromalar • Bolsas palpebrales • Bolsas malares • Flaccidez cutánea Sólo en algunas situaciones puede aplicarse relleno a nivel submuscular solamente y es cuando los pacientes presentan piel tensa con un surco nasoyugal o palpebromalar marcados. Si hay bolsas, piel redundante y atrófica deberá aplicarse, además, relleno en el plano subcutáneo, lo que generará una transición mucho más suave entre el párpado y la mejilla. Si bien hacemos una clara distinción entre la aplicación subcutánea y submuscular, no debemos olvidar que en el medio está el orbicular de los párpados y frecuentemente la aplicación se hace en el espesor del músculo mismo. Si bien puede haber complicaciones como los cordones o las pápulas, que se deben a defectos en la técnica, no suele haber reacciones inflamatorias ni graves ni crónicas, como pueden generar la silicona, el metacrilato, la poliacrilamida u otros productos aunque estén correctamente aplicados(Existen multiples reportes de complicaciones con acidos hialuronicos, algunas graves como cegueras, si existe bibliografia seria y confiable sobre "la tecnica correcta" para evitar las complicaciones aportarla como referencia). Los moretones son habituales, el edema y en menor medida el dolor son otras posibles complicaciones

Today, many patients are requesting a change in the eyelid area because they feel that look tired. Often, they have bags and redundant skin, but don't want to do a surgery, which in many cases is the treatment of choice. It can be offered as an alternative fillers with Hyaluronic acid. As aesthetic problems in the area, we can find: • Nasojugal groove or tear trough • Palpebromalar groove • Palpebral bags • Malar bags • Cutaneous flaccidity In some situations, it can be apply to submuscular filling level, only when patients present tense skin with the nasojugal or palpebromalar groove marked. If there are bags, redundant and atrophic skin, should also be applied in the subcutaneous area, generating a much smoother transition between the eyelid and the cheek. While we make a clear distinction between subcutaneous and submuscular application, we must not forget that in the middle is the orbicularis, and frequently the application is made in the thickness of the muscle itself. Hyaluronic acid is a very noble substance, unless it is misapplied, generally there are no problems with the product. While there may be complications such as cords or papules, which are flaws in technique, there is usually no inflammatory reactions or serious or chronic as can generate silicone, methacrylate, polyacrylamide or other products, even if they are properly applied. Bruises are common, edema, and in second level the pain, as other possible complications.

Copaiba oil effect under different pathways in mice subjected to sepsis

PURPOSE: To evaluate the effects of copaiba oil administered by different routes on survival of mices subjected to cecal ligation and puncture. METHODS: Thirty two mice were distributed into four study groups (N=8): Sham group: normal standard animals; Control group: submitted a cecal ligation and puncture (CLP); Gavage group: submitted a CLP, and treat with copaiba oil by gavage; and Subcutaneous group: submitted a CLP, and treat with copaiba oil by subcutaneous injection. After the death of the histological analysis were performed. The Kaplan-Meier curves of surviving time were realized. RESULTS: All animals that received copaiba, regardless of the route used, survived longer when compared to the control group (p<0.0001), whereas the survival time ranged from 20 hours for the control group up to 32 hours for the animals of gavage group and 52 for subcutaneous group. The animals that received gavage copaiba lived about and about 20 hours unless the subcutaneous group (p=0.0042). There was no statistical difference when compared the intensity of inflammatory response (p>0.05) CONCLUSION: Prophylactic subcutaneous administration of copaiba in mice subjected to severe sepsis by cecal ligation and puncture, resulted in a survival time higher than non-use or use of this oil by gavage. .

Análise da lipoenxertia estruturada na redefinição do contorno facial / Analysis of structured fat grafting for redefining facial contours

INTRODUÇÃO: A enxertia de gordura como preenchimento no rejuvenescimento e melhoria do contorno facial vem sendo usada por alguns autores e demonstra um potencial excelente como método de escolha para essa finalidade, uma vez que tem como premissa o princípio básico de corrigir as deformidades com o tecido mais semelhante possível. O objetivo deste trabalho foi avaliar clinicamente a eficiência da enxertia de gordura estruturada na redefinição do contorno facial. MÉTODO: Foi realizada análise retrospectiva de 39 pacientes submetidos a lipoenxertia estruturada para a redefinição do contorno facial, entre 2002 e 2012. A seleção de pacientes incluiu correção de deformidades, assimetrias, harmonização do contorno e aumento da projeção óssea, mas excluiu o rejuvenescimento per se. A avaliação do resultado clínico foi realizada pelo paciente e pelo cirurgião, com auxílio de documentação fotográfica pré e pós-operatória. O resultado clínico foi classificado pelo paciente e cirurgião, empregando escala que variava de 1 a 3: (1) o objetivo não foi alcançado de forma alguma; (2) o objetivo foi alcançado parcialmente; ou (3) o objetivo foi alcançado totalmente. Foi realizado, também, levantamento de prontuários para obtenção dos seguintes dados: idade, alteração ponderal, volume enxertado por área, número de sessões de enxertia realizadas, história de tabagismo e complicações. RESULTADOS: As médias das avaliações do cirurgião e paciente foram, respectivamente, 2,6 ± 0,6 e 2,7 ± 0,5, havendo correlação estatisticamente significante (P < 0,0001). Não foi encontrada relação significativa entre as avaliações e idade, alteração ponderal, volume de enxertia ou tabagismo, com uma única exceção. CONCLUSÕES: A lipoenxertia estruturada demonstrou ser eficiente adjuvante na redefinição do contorno facial e sua eficiência não foi prejudicada por idade, alteração ponderal ou tabagismo. O volume a ser enxertado deve ser adequado às necessidades específicas de cada área.

INTRODUCTION: Fat grafting as a filling method for the rejuvenation and enhancement of facial contours was demonstrated by some authors to be an excellent alternative method for redefining facial contours, based on the premise that the donor tissue used in the correction of the deformities has similar characteristics as the recipient tissue. The objective of the present study was to clinically evaluate the efficiency of structured fat grafting when redefining facial contours. METHODS: A retrospective evaluation was performed in 39 patients who underwent structured fat grafting to redefine their facial contours between 2002 and 2012. The patients selected included those who underwent corrections of deformities, asymmetrical features, contour smoothing, and increased bone projection. Patients who underwent facial contour rejuvenation were excluded. The clinical outcome assessment was performed by the patient and surgeon, with the aid of preoperative and postoperative photographic documentation. The clinical outcome was rated by the patient and surgeon, using a scale ranging from 1 to 3, defined as follows: 1, the objective has not been achieved in any way; 2, the objective was partially achieved; or 3, the objective was fully achieved. In addition, a survey was conducted using the patients' medical charts to obtain the following data: age, weight change, volume grafted by area, number of grafting sessions performed, history of smoking, and complications. RESULTS: The mean surgeon and patient assessment scores were 2.6 ± 0.6 and 2.7 ± 0.5, respectively, with a statistically significant correlation (P < 0.0001). No significant relationship was found between the assessments and age, weight change, graft volume, or smoking habit, with the exception of the cheekbone area. CONCLUSIONS: Structured fat grafting proved to be an efficient adjuvant technique for redefining facial contours, and its efficiency was not affected by age, weight change, or smoking habit. However, the fat volume to be grafted should be adequate for the specific needs of each area.

Engraftment of human adipose derived stem cells delivered in a hyaluronic acid preparation in mice / Implante de células tronco do tecido adiposo humano numa preparação de ácido hialurônico em camundongos

PURPOSE: To evaluate the implant of human adipose derived stem cells (ADSC) delivered in hyaluronic acid gel (HA), injected in the subcutaneous of athymic mice. METHODS: Control implants -HA plus culture media was injected in the subcutaneous of the left sub scapular area of 12 athymic mice. ADSC implants: HA plus ADSC suspended in culture media was injected in the subcutaneous, at the contra lateral area, of the same animals. With eight weeks, animals were sacrificed and the recovered implants were processed for extraction of genomic DNA, and histological study by hematoxilin-eosin staining and immunufluorescence using anti human vimentin and anti von Willebrand factor antibodies. RESULTS: Controls: Not visualized at the injection site. An amorphous substance was observed in hematoxilin-eosin stained sections. Human vimentin and anti von Willebrand factor were not detected. No human DNA was detected. ADSC implants - A plug was visible at the site of injection. Fusiform cells were observed in sections stained by hematoxilin- eosin and both human vimentin and anti von Willebrand factor were detected by immunofluorescence. The presence of human DNA was confirmed. CONCLUSION: The delivery of human adipose derived stem cells in preparations of hyaluronic acid assured cells engraftment at the site of injection.

OBJETIVO: Avaliar o implante de células tronco do tecido adiposo humano (CTTAH) em gel de ácido hialurônico (AH), injetados no tecido subcutâneo de camundongos atímicos. MÉTODOS: Implantes controle - HA com meio de cultura foram injetados no tecido subcutâneo da região infraescapular esquerda de 12 camundongos atímicos. Implantes de CTTAH: HA com CTTAH suspensas em meio de cultura foi injetado no subcutâneo da região contra lateral, dos mesmos animais. Com oito semanas, os animais foram sacrificados e os implantes recuperados foram processados para extração de DNA genômico, estudo histológico por coloração por hematoxilina eosina e imnuoflurescência utilizando anticorpos anti vimentina humana e anti fator de von Willebrand. RESULTADOS: Controles - implantes não visualizados no local da injeção. Uma substância amorfa foi observada nos cortes corados por hematoxilina eosina. Vimentina humana e fator anti von Willebrand não foram identificados. DNA humano não foi detectado. Implantes de CTTAH - Uma massa era visível no local da injeção. Células fusiformes foram observadas nos corte corados com hematoxilina eosina. Tanto vimentina humana quanto fator de von Willebrand foram identificados pela imunofluorescência. A presença de DNA humano foi confirmada. CONCLUSÃO: O implante de células tronco do tecido adiposo humano em veículo de ácido hialurônico gel assegurou a manutenção das células no local do implante.

Via subcutânea: segunda opção em cuidados paliativos / Subcutaneous route: second option in palliative care

A via subcutânea é indicada como via de segunda opção para a administração de fármacos de forma contínua ou intermitente nos pacientes em cuidados paliativos que não podem utilizar a via oral. No entanto, há controvérsias e pouca aderência ao seu uso. A dissecção venosa e/ou punção de subclávia ainda são procedimentos frequentes nos pacientes com doença avançada, vivenciando a fase final da vida. A via subcutânea é um método consensualmente reconhecido como seguro internacionalmente, não produzindo nenhuma complicação grave quando comparado ao intravenoso e, tecnicamente, a aplicação do cateter subcutâneo é mais fácil. No Brasil, os relatos científicos da administração de fármacos por via subcutânea são incipientes e, na prática clínica, ainda pouco utilizada. Uma discussão sobre essa técnica é premente no meio hospitalar. O objetivo deste estudo é realizar uma revisão teórica sobre o uso da via subcutânea na prática clínica com pacientes em cuidados paliativos. A busca foi realizada nas bases de dados no período de 1998 a 2010, nos meses de setembro e outubro de 2011. A análise do material encontrado apontou que é uma técnica de fácil aplicabilidade e manutenção em ambiente hospitalar ou domiciliar; melhora a autonomia e a qualidade de vida do paciente, sendo esse o objetivo primordial em cuidados paliativos.

Subcutaneous route is the second option for continuous or intermittent administration of medication to patients in need of palliative care who cannot receive oral medication. However, there is controversy over the use of the subcutaneous route and, thus, poor adherence to it. Vein dissection and/or subclavian puncture are frequent procedures in patients with advanced diseases during their terminal phase of life. Subcutaneous route is considered to be a safe method that does not cause severe complications when compared with the intravenous route. In addition, the technique used for subcutaneous catheter placement is much simpler. In Brazil, there are few reports on the administration of medication using the subcutaneous route, and this technique is seldom used in clinical practice. Therefore, there is urgent need for discussing the use of this technique in hospitals. The objective of this review of the literature was to investigate the use of the subcutaneous route in palliative care. We searched the databases in September and October of 2011. The studies included in our search were published between 1998 and 2010. The analysis of the articles selected suggests that the subcutaneous route is easy to use and maintain in both hospital and home environments. This technique improves the patients’ autonomy and quality of life, which is the main goal of palliative care.

Aspectos toxicológico, clínico-patológico e ultraestrutural das intoxicações iatrogênica e experimental por vitamina D em coelhos / Toxicological, clinic-pathological and ultrastructural aspects of iatrogenic and experimental poisoning by vitamin D in rabbits

São descritos aspectos toxicológicos, clínico-patológicos e ultraestruturais de coelhos intoxicados iatrogênica e experimentalmente por vitamina D por via subcutânea. Clinicamente, os animais evidenciaram sinais de insuficiência cardiovascular como ascite e edema pulmonar, hiporexia, anorexia, diarréia mucosa, emagrecimento e apatia. As clássicas alterações de mineralização e, por vezes, osseificação, do sistema cardiovascular, bem como as alterações de rins, pulmões, estômago, entre outros órgãos, foram reproduzidas com administrações subcutâneas de solução oleosa de colecalciferol (vitamina D3 não-ativada).

Toxicological, clinic-pathological and ultrastructural aspects of iatrogenic and experimental subcutaneous poisoning in rabbits by vitamin D are described. Clinically the animals showed signs of cardiovascular insufficiency, as ascite and lung edema, hyporexia, anorexia, mucous diarrhoea, loss of weight and apathy. The classical alterations of minera-lization and, occasionally, ossification of the cardiovascular system, as well the lesions of kidneys, lungs, stomach, among other organs, were reproduced by the subcutaneous administration of an oily solution of cholecalciferol (non-activated vitamin D3).

Comparison of traditional two injections dorsal digital block with volar block

To compare the traditional two injections dorsal digital block with volar block in terms of effectiveness of anaesthesia and pain of initial pinprick. Study Design: Quasi-experimental. Place and Duration of Study: AVH and casualty operation theatres, Mayo Hospital, KEMU, Lahore, from January to June 2007. Thirty patients requiring surgical procedure distal to proximal phalanx crease on two fingers of same or one finger of both hands were included. Cases with allergy to lignocaine, previous vascular insufficiency, previous digital replantation or peripheral neuropathy were excluded. One finger of every patient received two injection dorsal block whereas the other finger received single subcutaneous injection in the midline of the phalanx with lignocaine and epinephrine [volar block]. Patient looked away during the performance of block and wrote the severity of initial pinprick on a visual analogue scale. Effectiveness of anaesthesia was made measurable by the absence of pain during the surgical procedure. Total duration of the anaesthesia and any undesirable numbness of adjacent finger were noted. The t-test was used to compare the means and p-value less than 0.05 was considered significant. The mean pain scale score were 4.27+0.87 and 5.27+1.05 for volar and dorsal techniques respectively [p < 0.05]. Volar blocks were 100% effective whereas in dorsal blocks success rate was 80% [p < 0.05]. Single subcutaneous injection in the midline of phalanx with lignocaine and epinephrine [volar block] was significantly less painful to administer, is effective and safe technique to achieve digital anaesthesia, compared to the dorsal technique

Study of insulin injection technique amongst the nursing staff

To assess the knowledge and technique of insulin injection amongst the nursing staff. A total of 272 nurses working in three different hospitals [one private and two public] of Lahore, Pakistan were assessed regarding timing with meals, knowledge of site of insulin injection, tissue of injection, and technique of injection. Observations were recorded in Proforma and results were analyzed. Out of these 272 nurses only 40 knew all the steps regarding the insulin injection technique. The fact that insulin should be injected 30 minutes before meal was known to 57.4% and 66.2% had the idea of injecting insulin in subcutaneous tissue. Sixty-four percent knew about injecting insulin in upper arm, 75% knew about upper thigh as site of injection and 89.7% of the nurses knew that this has to be given in the abdomen. Technique of pinching skin was right in 64% nurses, 56.6% knew that cleaning the skin with spirit is not required. While assessing the technique of injection 72.8% of the nurses gave it correctly at an angle of 900. Nurses an integral part of health care providing team are not themselves properly trained to administer insulin injection in a developing country like Pakistan. Therefore for better health care provision their training has to be improved generally in all the fields and especially in the field of diabetes mellitus. The authorities responsible for their training should realize these facts and take effective measures

effect of subcutaneous R-Hu EPO in patients with malignancy and anemia secondary to chemotherapy

Cancer patients receiving cisplatinum containing chemotherapy often develop anemia; although the cause is multifactorial, erythropoietin deficiency appears to play an important role. This study included six patients with epithelial ovarian, seminomatous germ cell malignancies, colonic adenocarcinoma and nasopharyngeal squamous cell carcinoma treated with cisplatinum containing chemotherapy and manifesting anemia, [Hb <10 g/dl] not responding to full iron and multivitamin therapy received subcutaneous r-Hu EPO in a dose of 150 mu/kg/day, three times weekly for eight weeks. Three out of six patients achieved completed response [Hb >10 g/dl], two-six patients achieved good response [an increase in Hb level >1 g/dl with Hb <10 g/dl] and one-six patients achieved moderate response [an increase in Hb level <1 g/dl]. The improvement in Hb level was accompanied by a decrease in blood transfusion requirements. There was also improvement of quality of life [assessed by linear scale analogue] among five-six patients. The drug is well tolerated with no severe toxic effects. Mild transient local itching and erthyema were seen among two-four patients

Clinical toxicology subcutaneous injection of metallic mercury report of 4 cases

Four cases of subcutaneous injection of metallic mercury were reported and compared with those recorded by others. Subcutaneous injection always causes local inflammatory reaction and granuloma formation. Systematic mercury absorption is the rule as it is proved by high mercury levels in blood and urine. Nevertheless, this absorption is usually too small to be responsible for toxic manifestations. Surgical excision of all accessible contaminated subcutaneous areas should be performed. When residual mercury is roentgenographically detectable, regular monitoring of CNS, renal function and urinary and /or flood mercury levels are necessary