Siliconomas faciales / Facial siliconomas

La sustancia de silicona no es estable una vez que se ha inyectado en el cuerpo. Tiende a desplazarse del lugar de la inyección e ingresar a otras áreas del cuerpo. Los granulomas, o masas de tejido infl amatorio, ocurren como resultado de la reacción inmunológica del cuerpo a la silicona. Estos granulomas pueden producir nódulos duros que causan un dolor intenso y alteran la apariencia del área inyectada

Silicone substance is not stable once it has been injected into the body. It tends to migrate from the injection site and enter other areas of the body. Granulomas, or masses of infl ammatory tissue, occur as a result of the body's immune response to the silicone. These granulomas can produce hard nodules that cause severe pain and alter the appearance of the injected area

Interactive Atlas of the Canine Brain, Heart and Kidney Created from Plastinated Samples

SUMMARY: Currently, training in the field of anatomy requires the implementation of learning and knowledge technologies (TAC). Therefore, the objective of this work was to use digital images taken of plastinated canine brains, hearts, and kidneys to create an interactive atlas that facilitates the teaching-learning of the anatomy of these organs. The research was carried out in 3 phases. In the first, canine brains, hearts and kidneys were obtained using the cold-temperature silicone plastination. In the second stage, photographs were taken, the images were edited with Adobe Photoshop and converted to SVG format using Adobe Illustrator. During the last phase, the 2D atlas was created using MongoDB and Node.js for the backend and Vue.js as the framework for the frontend. In addition, it was used three.js to render the 3D models. As a result, the 'Interactive Canine Atlas', ATINCA, was created. The atlas comprises 27 interactive images and 27 in atlas mode view (28 of the brain, 20 of the heart, and 6 of the kidney). Furthermore, the atlas features 3D models of the three organs. The developed atlas constitutes the first digital tool created in Ecuador based on local institutional needs, including a 3D format. Consequently, ATINCA will be integrated into the curricula as a digital material that will facilitate significant autonomous and collaborative learning of canine anatomical knowledge.

Actualmente, la formación en el campo de la anatomía requiere la implementación de tecnologías del aprendizaje y el conocimiento (TAC). Por ello, el objetivo del trabajo fue utilizar imágenes digitales tomadas de cerebros, corazones y riñones caninos plastinados para crear un atlas interactivo que facilite la enseñanza-aprendizaje de la anatomía de estos órganos. La investigación se llevó a cabo en tres fases. En la primera se obtuvieron cerebros, corazones y riñones caninos mediante la técnica de plastinación con silicona al frío. En la segunda etapa se tomaron fotografías, las imágenes se editaron con Adobe Photoshop y se convirtieron a formato SVG con Adobe Illustrator. Durante la última fase, se creó el atlas 2D usando MongoDB y Node.js para el backend y Vue.js como framework para el frontend. Además, se utilizó three.js para renderizar los modelos 3D. Como resultado se creó el Atlas Interactivo del Canino, ATINCA. El atlas cuenta con 27 imágenes interactivas y 27 en vista modo atlas (28 del cerebro, 20 del corazón y 6 del riñón). Además, el atlas presenta modelos 3D de los tres órganos. El atlas desarrollado constituye la primera herramienta digital creada en el Ecuador con base en necesidades institucionales locales y donde se incluye el formato 3D. Con lo cual, ATINCA podrá incorporarse en las mallas curriculares como material digital que facilitará el aprendizaje autónomo y colaborativo significativo de conocimientos anatómicos de los órganos caninos.

Silicone-induced granuloma, hypercalcemia and chronic kidney disease in a transgender patient / Granuloma induzido por silicone, hipercalcemia e doença renal crônica em um paciente transgênero

Background: hypercalcemia mediated by a silicone-induced granulomatous reaction is a condition that, despite being rare, must be remembered since there is an increasing demand for aesthetic procedures among the general population. It is necessary to rule out other causes of hypercalcemia, such as hyperparathyroidism, hypercalcemia of malignancy, infectious and non-infectious granulomatous diseases, as well as the use of drugs. Case presentation: We present a patient with a history of large amounts of silicone implants who was admitted to a hospital presenting hypercalcemia and chronic kidney disease. A skin biopsy revealed a granulomatous foreign body reaction associated with exogenous siliconomatous material. Treatment with corticosteroids was initiated, with partial renal function improvement, with no renal replacement therapy needed. Conclusion: Patients with silicone implants should be carefully monitored for renal function and may be informed to avoid nephrotoxic agents as there is sufficient evidence that this type of aesthetic procedure can trigger hypercalcemia and CKD.

Introdução: a hipercalcemia mediada por uma reação granulomatosa induzida por silicone é uma condição que, apesar de rara, deve ser lembrada, pois há uma demanda crescente por procedimentos estéticos na população em geral. É necessário descartar outras causas de hipercalcemia, como hiperparatireoidismo, hipercalcemia da malignidade, doenças granulomatosas infecciosas e não infecciosas, bem como o uso de medicamentos. Relato de caso: apresentamos um paciente com histórico implante de grandes quantidades de silicone, que foi admitido em um hospital apresentando hipercalcemia e doença renal crônica (DRC). A biópsia de pele revelou reação granulomatosa tipo corpo estranho associada a material siliconomatoso exógeno. Foi iniciado tratamento com corticosteroides, com melhora parcial da função renal, sem necessidade de terapia renal substitutiva. Conclusão: os pacientes com implantes de silicone devem ser cuidadosamente monitorados quanto à função renal e devem ser informados para evitar agentes nefrotóxicos, pois há evidências suficientes de que esse tipo de procedimento estético pode desencadear hipercalcemia e DRC.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery.@*METHODS@#The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation.@*RESULTS@#All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied.@*CONCLUSION@#Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Laceração de canalículo lacrimal em centro de referência do centro-oeste paulista / Lacrimal canaliculus laceration in a reference center in the Center-West of the state of São Paulo

RESUMO Objetivo: Descrever as características clínico-epidemiológicas, técnicas cirúrgicas e resultado do tratamento das lacerações canaliculares operadas em nosso serviço. Métodos: Estudo retrospectivo, realizado de janeiro de 2012 a junho de 2020, considerando-se as lesões de canalículo lacrimal operadas em um serviço de referência. Dados demográficos, características das lesões, detalhes das cirurgias e resultado do tratamento foram obtidos de prontuários eletrônicos e analisados estatisticamente. Resultados: Foram incluídos 26 portadores de lesões canaliculares, com idade entre 2 e 71 anos, sendo 73,1% homens. A lesão acometia o canalículo superior em 53,9%; 80,8% pacientes procuraram pelo serviço nas primeiras 24 horas, e 46,2% tiveram a cirurgia realizada entre 24 e 72 horas após o traumatismo. Todos os pacientes tiveram intubação mono ou bicanalicular, e o tempo transcorrido entre a cirurgia e a retirada do silicone, variou de zero a 183 dias. Após a cirurgia, 21 pacientes (80,8%; p<0,05) não apresentaram complicações, 2 (7,7%) evoluíram com obstrução canalicular, 2 (7,7%) com granuloma e 1 (3,8%) com ectrópio de ponto lacrimal. Conclusão: As lesões de canalículo encontradas em nossa prática são mais comuns em crianças ou homens jovens, acometem mais o canalículo superior e as nossas condutas levam a sucesso no tratamento na maior parte dos casos. As grandes controvérsias no assunto persistem, como o tipo e o tempo de permanência do tubo de silicone na via lacrimal. Somente estudos com grandes amostras podem consolidar esses conceitos.

ABSTRACT Objective: To describe the clinical and epidemiological characteristics, surgical techniques, and results of the canalicular laceration treatment at our service. Methods: A retrospective study was carried out from January 2012 to June 2020, considering canalicular injuries operated at a reference center. Demographic data, lesion characteristics, surgical details, and treatment outcomes were obtained from electronic medical records and were statistically analyzed. Results: Twenty-six cases of people with canalicular lesions aged between 2 to 71 years old were included, of whom 73.1% were men. The superior canaliculus was affected in 53.9%; 80.8% of patients searched for care within the first 24 hours, and 46.2% had the surgery performed between 24-72 hours after trauma. All patients had mono or bicanalicular intubation and the time elapsed between surgery and silicone removal ranged from 0 to 183 days. After surgery, 21 patients (80.8%, p<0.05) did not present any complications, two (7.7%) evolved with canalicular obstruction, two (7.7%) with granuloma, and one (3.8 %) with lacrimal puncta ectropion. Conclusion: In our practice, canalicular injuries are more common in children or young men, affecting mainly the superior canaliculus, and treatment success using our approach can be achieved in most of the cases. However, great controversies remain on the subject, such as type of intubation and when to remove the silicone tube from the lacrimal pathway. Larger series are required to consolidate controversial concepts.

Use of industrial liquid silicone: a scoping review

Purpose: Illicit cosmetic injections remain highly prevalent and can cause serious complications, including death. We aimed to explore existing literature regarding the use of illicit cosmetic injections globally. Methods: We searched six databases with no language restriction from inception to 2022. We included all articles focused on adult patients of any gender who received any illicit cosmetic injection. Screening and data extraction followed standards from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. Results: After screening 629 abstracts and 193 full texts, 142 citations were included. We identified articles from 28 countries and three multi-country studies. Most were from high-income (75.3%) and upper-middle-income countries (21.8%). Of all patients whose gender identity was described, 49.9% were transgender women, and 40.8% were cisgender women. The anatomic regions most frequently injected were the buttocks (35%) and the breast (13.3%). The most frequently described complications were granuloma (41.5%), dermatological problems (41.5%), infection (35.9%), and pulmonary complications (34.5%). Conclusions: We observed the impact of illicit silicone injections, particularly on cisgender women and transgender individuals. Existing barriers must be addressed, including healthcare prejudice and inadequate knowledge about care for gender minorities. This will require educating at-risk groups and enhancing policies to regulate these procedures.

Experimental protocol for evaluation of biomaterials in an in-vivo silicone implant coverage

Purpose: To describe an experimental surgical model in rats using a dual-plane technique for evaluation of biomaterials in an in-vivo silicone implant coverage. Methods: This study was developed following the ISO 10993-6 standard. In this study, 40 male Wistar rats weighing between 250 and 350 g were used, distributed into two groups: experimental, biomaterial superimposed on the minimammary prosthesis (MP); and control, MP without implantation of the biomaterial, with eight animals at each biological point: 1, 2, 4, 12, and 26 weeks. Thus, at the end of biological points (1, 2, 4, 12, and 26 weeks; n = 8 animals per week), the tissue specimens achieved were fixed in buffered formalin and stained with hematoxylin-eosin. Results: Macroscopically, throughout the study, no postoperative complications were apparent. In the histological analysis, it was possible to observe the evolution of the inflammatory response, tissue repair, and fibrous capsule during the biological points. Conclusions: The experimental model described in this study proved to be suitable for evaluating the biomaterial used in the coverage of breast silicone implants.

Marco legal para la prevención de procedimientos estéticos con sustancias modelantes / Legal framework for preventing aesthetic procedures with modeling substances i:en

En la actualidad, la alogenosis iatrogénica es una condición reconocida en todo el orbe, especialmente en Latinoamérica, donde es evidente la ausencia de control en la administración de sustancias no reguladas con fines estéticos, lo que ha devenido un problema emergente por la magnitud de las complicaciones, ya que algunos productos, como aceites minerales, hidrocarburos, silicona industrial, generan graves consecuencias, tanto locales como sistémicas, en el organismo. Muchos países aún no han regulado la prohibición de esta práctica, aunque cada día son más las campañas para prevenirla; sin embargo, al mismo tiempo aumenta la incidencia de la enfermedad en todo el mundo por el incremento de estos procedimientos estéticos. Al respecto, en Cuba, el creciente número de afectados por esta causa evidencia vulnerabilidad en el cumplimiento de lo establecido hasta la fecha, por lo que se impone instaurar un marco legal de estricto cumplimiento que regule la inyección de sustancias modelantes con fines estéticos.

Currently, iatrogenic allogenosis is a condition recognized throughout the world, especially in Latin America, where the absence of control in the administration of unregulated substances for aesthetic purposes is evident, which has become an emerging problem due to the magnitude of complications, since some products, such as mineral oils, hydrocarbons, industrial silicone, generate serious consequences, both local and systemic, in the body. Many countries have not yet regulated the prohibition of this practice, although every day there are more campaigns to prevent it. However, at the same time the incidence of the disease increases worldwide due to the increase in these aesthetic procedures. In this regard, in Cuba, the growing number of people affected by this cause shows vulnerability in compliance with what has been established to date, that is why it is necessary to establish a legal framework of strict compliance that regulates the injection of modeling substances for aesthetic purposes.

First Experience of Plastination at 4150 Meters Above Sea Level, at the Altitude of La Paz, Bolivia / Primera Experiencia de Plastinación a 4150 Metros sobre el Nivel del Mar, en la Altura de La Paz, Bolivia

SUMMARY: Despite attempts to develop the plastination technique in Bolivia, standardized results have not yet been achieved that could be communicated via scientific publications. There is a great deal of misunderstanding around the technique, confusing it with classic techniques of inclusion in different types of resin, such as polyester and epoxy, but these protocols are not plastination. The aim of this work was to communicate the first standardized room-temperature plastination protocol with silicone in Bolivia, with the unique feature of doing so at the altitude of the city of La Paz, thus constituting the first communication of a plastination technique at 4,150 m.a.s.l. sub sede La Paz, La Paz, Bolivia.

En Bolivia, a pesar de los intentos en el desarrollo de la técnica de Plastinación, aún no se han alcanzado resultados estandarizados que pudieran ser comunicados por medio de publicaciones científicas. Existe una gran confusión al momento de desarrollar la técnica, confundiéndola con técnicas clásicas de inclusión en distintos tipos de reina, como poliéster y epoxy, pero no correspondiendo estos protocolos desarrollados a la técnica de plastinación. En este sentido, el objetivo de esta trabajo consistió en comunicar el primer protocolo estandarizado de plastinación a temperatura ambiente con silicona de Bolivia, con la particularidad de desarrollarlo en la altura de la ciudad de La Paz, constituyéndose, de esta manera, en la primera comunicación de una técnica de plastinación a 4.150 metros sobre el nivel del mar.

Conservation of Organs (Heart, Brain and Kidney) of Canine by Cold-Temperature Silicone Plastination in an Animal Anatomy Laboratory in Ecuador / Conservación de Órganos (Corazón, Encéfalo y Riñón) de Canino Mediante la Técnica de Plastinación en Silicona al Frío Realizada en Laboratorio de Anatomía Animal en Ecuador

SUMMARY: For the purposes of teaching anatomy, the use of cadaver preparations is considered the most efficient way of ensuring that students retain knowledge. Nevertheless, in Ecuador the use of animal specimens in universities must comply with the internationally accepted principles of replacement, reduction and refinement (3Rs). Plastination is an alternative technique which allows organs to be conserved in the long term and complies with the 3Rs. The object of the present work was to use cold-temperature silicone plastination with Biodur® products to obtain long-lasting, easy-to-handle canine organs for use as tools for the teaching of animal anatomy. Six canine cadavers were obtained from local animal protection charities. The hearts, brains and kidneys of the cadavers were dissected and fixed with formaldehyde 10 %. They were then dehydrated with acetone at -20 °C. The specimens were impregnated with Biodur® S10:S3 (-20 °C) and finally cured with Biodur® S6. We plastinated six hearts, twelve kidneys, four brains and one encephalic slice of canine. The application of cold-temperature plastination to canine organs followed the parameters established for the conventional protocol, enabling us to obtain organs of brilliant appearance, free of odours, in which the anatomical form was preserved. Thus the technique helped us to comply with the 3Rs, as we obtained easy-to-handle teaching models to replace fresh or formaldehyde-fixed samples for the teaching-learning of the canine anatomy.

En la enseñanza de la Anatomía, el uso de preparaciones cadavéricas se considera el método que permite a los estudiantes retener el conocimiento de una forma más eficiente. No obstante, en Ecuador, el uso de especímenes animales en las universidades se debe realizar bajo el principio internacional de reemplazo, reducción y refinamiento (3Rs). La técnica de plastinación es una técnica alternativa que permite preservar órganos a largo plazo y que se adapta al principio de las 3Rs. El objetivo del trabajo fue utilizar la técnica de plastinación en silicona al frío con productos Biodur® para obtener órganos caninos duraderos y manejables útiles como herramienta para la enseñanza de la anatomía animal. Se obtuvieron seis cadáveres de caninos de fundaciones locales para la protección animal. Se realizaron disecciones de corazones, cerebros y riñones de los cadáveres caninos. Los órganos se fijaron con formalina al 10 %. A continuación, se llevó a cabo la deshidratación con acetona a -20 °C. Los especímenes fueron impregnados con S10:S3 Biodur® (-20 °C) y al final fueron curados con Biodur® S6. Se lograron plastinar seis corazones, doce riñones, cinco encéfalos y un tallo encefálico de canino. La técnica de plastinación al frío utilizada para obtener órganos de canino conservó los parámetros empleados en el protocolo convencional y permitió obtener órganos que presentaron aspecto brillante, ausencia de olores y mantuvieron la forma anatómica. Por lo que, la técnica facilitó cumplir con el principio de las 3Rs al obtenerse modelos didácticos fáciles de manipular que pueden reemplazar muestras frescas o formolizadas en el proceso de enseñanza-aprendizaje de la anatomía del canino.

Embedded 3D printing of porous silicon orbital implants and its surface modification / 南方医科大学学报

OBJECTIVE@#To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants.@*METHODS@#The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats.@*RESULTS@#The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue.@*CONCLUSION@#Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.

Un caso de neumonía organizada tras la ruptura intracapsular de implantes mamarios de silicona / A case of organized pneumonia after intracapsular rupture of silicone breast implants

La neumonía organizada es una entidad poco frecuente, caracterizada por la formación de conglomerados fibroblásticos intraalveolares conocidos como cuerpos de Masson, que puede ser criptogénica o secundaria a una respuesta inmunitaria a diversos estímulos, tales como enfermedades hematológicas, autoinmunitarias, exposición a sustancias químicas, fármacos, tóxicos, etc. Detectada y tratada de forma precoz, suele tener una buena respuesta a la corticoterapia, aunque si se diagnostica de forma tardía, la afectación pulmonar puede ser extensa, y, además, si el estímulo antigénico persiste, la respuesta al tratamiento será incompleta. Presentamos el caso clínico de una paciente de 65 años de edad quien hace 18 meses aproximadamente presentó la rotura intracapsular de sus implantes mamarios, 27 años después de su colocación. Con el mismo tiempo de evolución ha desarrollado progresivamente disnea, tos seca y dolor inframamario, habiendo llegado al diagnóstico de neumonía organizada bilateral difusa, asociada a dicha rotura de implantes.

Organizing pneumonia is a rare entity, characterized by the formation of intraalveolar fibroblastic conglomerates known as Masson bodies, which may be cryptogenic or secondary to an immune response to various stimuli, such as hematological, autoimmune diseases, exposure to chemical substances, drugs, toxics, etc. If it is detected and treated early, it usually has a good response to corticosteroid therapy, although if it is diagnosed late, the lung involvement can be extensive, and furthermore, if the antigenic stimulus persists, the response to treatment will be incomplete. We present the clinical case of a 65-year-old patient who had intracapsular rupture of her breast implants approximately 18 months ago, 27 years after their placement. With the same evolution time, she progressively developed dyspnea, dry cough and under mammary pain, having reached the diagnosis of diffuse bilateral organizing pneumonia, associated with implant rupture.

Uso de injertos capsulares autólogos periprotésicos en mamoplastías estéticas / Used of peri prosthetics autologous capsular graft in aesthetic mammoplasty

INTRODUCCIÓN Y OBJETIVO: presentamos nuestra experiencia con el uso de injertos de capsulas autólogas peri protésicas en pacientes que evolucionaron con ptósis mamaria importante, que tenían implantes siliconados envejecidos implantados en plano subglandular y que además presentaban contractura capsular unilateral Baker III o IV y donde fue necesario cambiar de plano de implantación a sub muscular prolongando la cobertura protésica de musculo pectoral con capsulas autólogas a manera de injer-to simple para cubrir totalmente al implante siliconado, obtenidas de la mama sana contra lateral tipo I a II de Baker, seguido de la mamoplastia de elevación. El objetivo del trabajo es utilizar y reaprovechar tejidos autólogos sanos a cero costos. MATERIAL Y MÉTODO: registramos 12 pacientes operadas, de quienes se obtuvo un segmento de capsulas peri protési-cas autólogas resecadas en bloque de la mama sana contra lateral incluyendo el implante en su interior a través de disección digital simple o con electrobisturí, de prótesis implantadas en plano sub glandular. No se reglo el tamaño de la capsula en únicos moldes, sino se utilizó el tamaño requerido para la cobertura del implante, las cuales fueron injertadas uniendo el segmento medial y el distal del músculo pectoral, cubriendo y protegiendo el nuevo implante que fue implantado en plano submuscular. Posteriormente se ejecutó la mamoplastia de elevación. RESULTADOS: de las 12 pacientes, 1 evoluciono con shock anafiláctico por automedicación de una quinolona fluorada y presento edema generalizado, seroma moderado al 5to día de post operación lo que generó una revisión quirúrgica de urgencia, observando necrosis del injerto capsular motivo por el que fueron movidas. Y una paciente presento un aumento significativo y proyección del polo inferior mayor de la mama en relación con su homóloga seguramente porque se injerto un segmento mayor tamaño de capsula y no quedo a tensión suficiente en esa región, pero no se presentó ninguna reacción local inflamatoria excepto una forma asimétrica de esa mama. El resto es decir las otras 10 pacientes evolucionaron satisfactoriamente. CONCLUSIÓN: el uso de capsulas peri protésicas autólogas, son una alternativa técnica para tener en cuenta en mamoplastias de elevación cuando se opta por cambio de plano de implantación de las prótesis, cuando no se cuentan con matrices acelulares de alto costo, siendo un tejido con alta probabilidad de integración a cero costos y cuando es necesario cubrir al implante.

INTRODUCTION AND OBJECTIVE: we present our experience of using periprosthetic autologous capsule grafts in patients who evolved with significant breast ptosis, had aged silicone implants placed in the sub glandular plane, had unilateral capsular contracture Baker III or IV and had the need to change the plane of implantation to sub muscle plane to prolong the prosthetic coverage with autologous grafted capsules obtained from the healthy contralateral breast Baker type I to II, followed by lifting mammoplasty. The objective of this project is to use and take advantage of healthy autologous tissues at no cost. MATERIALS AND METHODS: we registered 12 operated patients from whom we resected, from the healthy contralateral breast, segments of autologous periprosthetic capsules, including the implant inside through simple digital dissection or with an electro scalpel of the prostheses located in the sub-glandular plane. The size of the capsule was not regulated in single mold, instead the required size to cover the implant was used and was grafted joining the medial and distal segment of the pectoral muscle, wrapping and protecting the new implant located at the submuscular plane. Subsequently, mammoplasty elevation was performed. RESULTS: of the 12 patients, 1 evolved, on the 5th day of surgery, with an anaphylactic shock due to self medication with a fluorinated quinolone tablet presenting a generalized edema, intense seroma, leading to an emergency surgical review and observing necrosis on the capsular graft, which had to be removed. Another patient presented a significant increase and projection of the lower pole of the breast in relation to its counterpart, surely because a larger segment of the capsule was grafted and was not tensioned enough in that region. No local inflammatory reaction was observed except for an asymmetric shape of that breast. The ten remaining patients evolved satisfactorily. CONCLUSIONS: the use of autologous periprosthetic capsules is an alternative technique to be considered for mammoplasty elevation when deciding to change the prostheses implantation plane, since it is a tissue with a high probability of integration at no cost, especially when high cost acellular matrices are not available and when it is necessary to cover the new implant.

Photocatalytic activity, water absorption capacity, and thermal stability of white cement-based mortars with polysiloxane silicone and different doses of titanium dioxide nanoparticles / Actividad fotocatalítica, absorción de agua y estabilidad térmica de morteros a base de cemento blanco con silicona de polisiloxano y diferentes dosis de nanopartículas de dióxido de titanio

White cement-based mortars in urban areas are usually discolored and altered their esthetic properties due to air pollutants. The addition of nanoparticles in these mortars can provide photocatalytic properties that can decompose pollution agents. Likewise, other hydrophobic agents have been individually studied to improve outdoor building constructions. Therefore, this study presented the photocatalytic and hydrophobic effect of adding nano-TiO2and silicone hydrophobic powder (DOWSILTM) in a white cement matrix. The nano-TiO2 were characterized by X-Ray Diffraction (XRD); afterwards, the mortar was mixed with additions of nano-TiO2 (0.0, 0.5, 1.0, 3.0%) and DOWSILTM (0.0, 0.5%). The mortar's photocatalytic performance was evaluated using a modification of the standard Italian test Ente Nazionale Italiano di Unificazione 11259:2016 based on Rhodamine B (RhB) degradation on the sample exposed to UV irradiation. Therefore, mortar samples were subjected to UV irradiation to degrade the organic dye rhodamine B, monitoring their color variation using a C I E L* a* b* spectrophotometer. Moreover, the water permeability and the contact angle were evaluated. This research demonstrates that the white cement-based mortar samples added with nano-TiO2/DOWSILTM possess photocatalytic activity. The samples with the addition of 1.0%/0.5% and 3.0%/0.5% nano-TiO2/DOWSILTM showed a higher RhB degradation for R4 and R26. Therefore, these two materials can be employed in these proportions to improve the quality of the white cement-based mortars in urban constructions.

Los morteros a base de cemento blanco generalmente se decoloran y alteran sus propiedades estéticas debido a los contaminantes del aire en las áreas urbanas. Nanopartículas añadidas a estos morteros pueden proporcionar propiedades fotocatalíticas que descomponen estos contaminantes. Asimismo, otros agentes hidrofóbicos se han estu-diado individualmente para mejorar las construcciones a la intemperie. Por lo tanto, se presenta el efecto fotocatalítico e hidrofóbico al incorporar nano-TiO2 y silicona hidrofóbica de polisiloxano (DOWSILTM) en una matriz de cemento blanco. El nano-TiO2 se caracterizó por medio de Difracción de Rayos X (DRX); luego, el mortero se mezcló con adiciones de nano-TiO2 (0.0, 0.5, 1.0, 3.0%) y DOWSILTM (0.0, 0.5%). Los morteros se sometieron a irradiación UV, para degradar el colorante orgánico rodamina B, monitoreando su variación de color usando un espectrofotómetro C I E L* a* b*. La eficiencia fotocatalítica del mortero se evaluó utilizando una modificación de la norma italiana Ente Nazionale Italiano di Unificazione 11259:2016 basada en la degradación de la rodamina B (RhB) en el mortero expuesto a la radiación UV. Además, se evaluó la permeabilidad al agua y el ángulo de contacto. Esta investigación demostró que el mortero de cemento con nano-TiO2/ DOWSILTM posee actividad fotocatalítica. Las muestras con 1.0%/0.5% y 3.0%/0.5% nano-TiO2/DOWSILTM mostraron una mayor eficiencia de degradación de RhB para R4 y R26. Por lo tanto, estos materiales tienen potencial para mejorar la calidad de los morteros en construcciones urbanas.

Silicone plastination of nasus and lingua in large ruminants with and without use of formaldehyde / Plastinación de silicona de nasus y lengua en rumiantes mayores con y sin el uso de formaldehido

SUMMARY: Plastination is an anatomical preparate preparation technique characterized by the replacement of tissue fluids with a reactive polymer. Although more challenging and economically costly than many anatomical methods, this method is desirable because of the fact that specimens created in this method are highly similar to the natural appearance of the intended objects, and they are durable and harmless end products for human health. Our main goal was to completely leave out formaldehyde and similar carcinogenic chemicals used in a method like plastination and to allow production of formaldehyde-free plastinates to be used in anatomy training and examinations in our country. To that end, we compared nose and tongue of 10 large ruminants by subjecting them to plastination, 5 of them with formaldehyde and 5 of them without formaldehyde, and aimed to leave formaldehyde out by taking into account the difference between them. Silicone plastination is the most commonly-used and best-known technique among the plastination techniques because specimens created using this technique look aesthetically impressive. Silicone plastination consists mainly of 5 phases. First of all, we obtained the anatomical situs we wanted and made specimens ready by dissecting some of them after fixation and some of them without fixation. Then, after the implementation of a dehydration phase in acetone baths at -25 °C, a forced impregnation phase was implemented by using a mixture of S10-S3 chemical under negative pressure. In the final phase, the curing and hardening phase, the plastination process was completed by giving the specimens their final shape with the use of the S6 solution. As a result, no significant difference was observed between silicone plastination with and without formaldehyde.

RESUMEN: La plastinación es una técnica de preparados anatómicos caracterizada por la sustitución de fluidos tisulares por un polímero reactivo. A pesar de ser económicamente más costoso que muchas métodos anatómicos, este técnica es deseable debido a que las muestras creadas son muy similares a la apariencia natural de los objetos previstos y son productos finales duraderos e inofensivos para la salud humana. Nuestro objetivo principal fue dejar completamente de lado el formaldehído y las sustancias químicas cancerígenas similares utilizadas en un método como la plastinación y permitir la producción de plastinados libres de formaldehído para su uso en la formación y los exámenes de anatomía en nuestro país. Con ese fin, comparamos la nariz y la lengua de 10 rumiantes mayores sometiéndolos a plastinación, 5 de ellos con formaldehído y 5 de ellos sin formaldehído, y buscamos eliminar el formaldehído considerando la diferencia entre ellos. La plastinación con silicona es la técnica más utilizada y más conocida entre las técnicas de plastinación porque los especímenes creados con ella se ven estéticamente impresionantes. La plastinación con silicona consta principalmente de 5 fases. En primer lugar, obtuvimos el situs anatómico que queríamos y preparamos los especímenes diseccionando algunos de ellos después de la fijación y otros sin fijación. Luego, de la implementación de una fase de deshidratación en baños de acetona a -25 °C, se implementó una fase de impregnación forzada utilizando una mezcla del químico S10-S3 a presión negativa. En la fase final, la fase de curado y endurecimiento, se completó el proceso de plastinación dando a los especímenes su forma definitiva con el uso de la solución S6. Como resultado, no se observaron diferencias significativas entre la plastinación con silicona con y sin formaldehído.

Migration of liquid silicone, an emerging contraindication of neuraxial anesthesia / Migración de silicona líquida, una contraindicación emergente de la anestesia neuroaxial

Abstract The illegal use of liquid silicone products or biopolymers in gluteal augmentation procedures is giving rise to multiple complications, with a significant negative health impact, both in the short and long-term. The migration of polymers to the sacral and lumbar region represents a major limitation to conducting neuraxial anesthesia procedures. This silicon migration is unpredictable through the superficial tissue as is widely described in the literature. Caudal, spinal and epidural anesthesia may cross the silicone in the fascia and contaminate the neural axis with substances that are highly capable of causing inflammation, edema and tissue necrosis. In order to improve the safety of neuraxial anesthetic procedures and avoid the potential risk of dissemination and contamination of the neural axis, this complication must be ruled out, or be considered an emerging contraindication for these anesthetic procedures.

Resumen La aplicación ilegal de productos como silicona líquida o biopolímeros en procedimientos de aumento de glúteos está generando múltiples complicaciones con gran impacto negativo para la salud tanto a corto como a largo plazo. La migración de polímeros a la región sacra y lumbar representa una importante limitación para la realización de procedimientos de anestesia neuroaxial. Esta migración de silicona es impredecible a través del tejido superficial, la cual está ampliamente descrita en la literatura. Los procedimientos anestésicos caudal, espinal y epidural podrían atravesar los silicomas en la fascia del tejido y contaminar el neuroeje con sustancias con alta capacidad de generar inflamación, edema y necrosis de tejidos. Con el fin de aumentar la seguridad de los procedimientos anestésicos neuroaxiales y evitar el riesgo potencial de dispersión y contaminación del neuroeje, es necesario descartar esta complicación o considerar una contraindicación emergente en estos procedimientos anestésicos.

Desarrollo de técnicas microquirúrgicas usando tinción vascular con y sin silicona en placenta humana con modelos craneales 3D / Development of microsurgical techniques using vascular staining with and without silicone in human placenta with 3D cranial models

En las ultimas décadas, ha habido un cambio en la formación en las especialidades quirúrgicas, lo cual ha llevado a plantearse la necesidad de adquisición de habilidades por fuera del quirófano por medio de la simulación. El objetivo de este trabajo es demostrar que el uso de placentas humanas con modelo craneal tridimensional (3D), es un método de alta fidelidad y retroalimentación para el desarrollo de técnicas microquirúrgicas. Se realizó un estudio de evaluación técnica en el Laboratorio de Microcirugía Dr. Evandro de Oliveira del Hospital de la Beneficiencia de Portugal de São Paulo, utilizando 15 placentas con técnicas de coloración y preservación vascular con silicona para moldes; realizando ejercicio de anastomosis vasculares, ejercicios de disección parenquimatosa placentaria que remedan la disección aracnoidea y del valle silviano, además de simulación de resección de tumores. Cualitativamente la placenta humana es un método con alta fidelidad y retroalimentación, además, es de acceso universal para la adquisición de habilidades microquirúrgicas, que asociada a un modelo craneal 3D permite el perfeccionamiento de craneotomías, coordinación visomotriz, propiocepción y relación de profundidad que se requieren para abordajes neuroquirúrgicos.

In the last decades, there has been a change in training in surgical specialties, which has led to the need to acquire skills outside the operating room through simulation. The aim of this work is to demonstrate that the use of human placentas with a three-dimensional (3D) cranial model is a high fidelity and feedback method for the development of microsurgical techniques. A technical evaluation study was carried out in the Dr. Evandro de Oliveira Microsurgery Laboratory of the Hospital de la Beneficiencia de Portugal in São Paulo, using 15 placentas with coloration techniques and vascular preservation with silicone for molds; performing vascular anastomosis, placental parenchymal dissection exercises that mimic arachnoid and sylvian fissure dissection, in addition to simulating tumor resection. Qualitatively, the human placenta is a method with high fidelity and feedback, and it is also universally accessible for the acquisition of microsurgical skills, which, associated with a 3D cranial model, allows the refinement of the craniotomies, visomotor coordination, proprioception, and depth relationship required for neurosurgical approaches.

Protocolo unificado de plastinación con silicona en frío y a temperatura ambiente / Unified plastination protocol with silicone at cold and room temperature

RESUMEN: En la actualidad, la técnica de plastinación es considerada una de las más novedosas formas de conservación cuerpos completos, secciones y órganos, tanto humanos como animales, para su uso en docencia de pre y postgrado, como así también investigación morfológica. En este sentido, para desarrollar las diversas técnicas de plastinación se requiere de equipamiento específico y formación especializada de académicos, que tengan la capacidad de llevar adelante la diversidad de protocolos que existen, según el material anatómico que se desee preservar. En el año 2015, desde el Laboratorio de Plastinación y Técnicas Anatómicas de la Universidad de La Frontera, se propuso por primera una nueva técnica de plastinación a temperatura ambiente, que permitió obtener preparaciones plastinadas de igual calidad que las técnicas clásicas de plastinación. En la actualidad, desde nuestro laboratorio, se propone un nuevo protocolo de plastinación con silicona que unifica las técnicas que se desarrollan en frío como así también a temperatura ambiente para la conservación de cuerpos humanos y animales completos, secciones anatómicas, regiones corporales, y órganos aislados.

SUMMARY: At present, plastination technique is considered one of the newest forms of conservation of whole bodies, sections and organs, both human and animal, for use in undergraduate and graduate teaching, as well as morphological research. In this sense, to develop the various plastination techniques requires specific equipment and specialized training of academics, who have the ability to carry out the diversity of protocols that exist, according to the anatomical material that is to be preserved. In 2015, from the Laboratory of Plastination and Anatomical Techniques of Universidad de La Frotera, a new plastination technique was proposed for the first time at room temperature, which allowed obtaining plastinated preparations of the same quality as the classic plastination techniques. At present, from our laboratory, a new protocol for plastination with silicone is proposed that unifies the techniques that are developed in cold as well as at room temperature for the conservation of complete human and animal bodies, such as as well as anatomical sections, body regions, and isolated organs.

Mastite puerperal complicada em paciente com implante de silicone: Um relato de caso / Puerperal mastitis complicated in patient with silicone implantation: A case report

A mastite é uma patologia relativamente frequente na mulher que amamenta. Surge maioritariamente nas primeiras seis semanas após o parto (prevalência entre 75-95% antes do bebé completar os três meses de vida), podendo, contudo, ocorrer ao longo de todo o período da amamentação. Apresenta-se clinicamente com mastalgia, eritema e edema mamário, linfonodomegalia axilar, febre, calafrios, mal-estar e prostração. Entretanto, o quadro clínico completo pode não estar presente em todos os casos. A técnica incorreta de amamentação provoca as microlesões mamáriasque são fatores associados à mastite, inicialmente, e esta quando não recebe tratamento adequado pode evoluirpara os abscessos mamários, que são caracterizados clinicamente por nodulação palpável ou não, flutuante, parcialmente circunscrita, geralmente no quadrante superior lateral da mama afetada. O microrganismo mais envolvido é o Staphylococcus aureus. O diagnóstico diferencial envolve principalmente outras causas não infecciosas de mastite, por exemplo a granulomatosa com reação a corpo estranho (piercing, implantes de silicone) e também malignidade. A ultrassonografia é um método bastante útil na investigação inicial daqueles quadros com suspeita de desenvolvimento de tal complicação e possibilita de maneira segura o tratamento minimamente invasivo e a obtenção de amostra para analise laboratorial. Isto permite a escolha de antibioticoterapia direcionada para os microorganismos causadores.

Mastitis is a relatively common condition in breastfeeding women. It appears mostly in the first six weeks after delivery (prevalence between 75-95% before the baby is three months old), however, it can occur throughout the entire period of breastfeeding. It may present clinically with mastalgia, erythema and breast edema, axillary lymph node enlargement, fever, chills, malaise and prostration. However, the complete clinical picture may not be present in all cases. The incorrect breastfeeding technique causes breast microlesions which are factors associated with mastitis, initially, and when it does not receive adequate treatment it can evolve for breast abscesses, which are characterized clinically by palpable or not, floating, partially circumscribed nodulation, usually in the upper lateral quadrant of the affected breast. The most involved microorganism is Staphylococcus aureus. The differential diagnosis mainly involves other non-infectious causes of mastitis, for example granulomatous with a foreign body reaction (piercing, silicone implants) and also malignancy. Ultrasonography is a very useful method in the initial investigation of those conditions suspected of developing such a complication, and it safely allows minimally invasive treatment and obtaining a sample for laboratory analysis. This allows the choice of antibiotic therapy directed at the causative microorganisms.

Experimental comparative study of arterial implants made of silicone reinforced with polyester fabric and expanded polytetrafluoroethylene (PTFE) in rabbits aorta / Estudo experimental comparativo de implantes arteriais em silicone com reforço de poliéster e politetrafluoretileno expandido (PTFE) em aorta de coelhos

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.

RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.