Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor as an Adjuvant Therapy for Patients with Atrophic Acne Scar / 中国医学科学院学报

Objective To study the influence of recombinant bovine basic fibroblast growth factor as an adjuvant therapy on scar alleviation and inflammatory cytokines in patients with atrophic acne scar. Methods The random number table was employed to randomly assign 120 patients with atrophic acne scar into a test group and a control group.Both groups of patients were treated with CO2 lattice laser.After the operation,the control group was routinely smeared with erythromycin ointment and the test group was coated with recombinant bovine basic fibroblast growth factor gel.The clinical efficacy,clinical indicators,scar alleviation,and inflammatory cytokine levels before and after treatment were compared,and adverse reactions were counted. Results The test group had higher total effective rate(P=0.040) and lower total incidence of adverse reactions(P=0.028) than the control group.Compared with the control group,the test group showcased short erythema duration after treatment(P=0.025),early scab forming(P=0.002),and early edema regression(P<0.001).After treatment,the proportion of grade 1 scars graded by Goodman and Baron's acne scar grading system in the test group and control group increased(P=0.001,P=0.027),and the proportion of grade 4 scars decreased(P<0.001,P=0.034).Moreover,the proportion of grade 1 scars in the test group was higher than that in the control group(P=0.031) after treatment,and the proportion of grade 4 scars presented an opposite trend(P=0.031).After treatment,the levels of tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) in both groups declined(all P<0.001),and the test group had lower TNF-α and IL-1β levels than the control group(all P<0.001). Conclusion The recombinant bovine basic fibroblast growth factor gel as an adjuvant therapy of CO2 lattice laser can effectively alleviate the atrophic acne scar,relieve local inflammatory reaction,and has good curative effect and less adverse reactions.

Decline in head circumference growth and associated factors in congenital Zika syndrome / Declínio no crescimento do perímetro cefálico e fatores associados à síndrome congênita associada à infecção pelo vírus Zika / Disminución del crecimiento del perímetro cefálico y factores asociados en el síndrome congénito del Zika

Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child's Health Handbook, parents' reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike's information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.

Pouco se sabe sobre a evolução do perímetro cefálico (PC) em crianças com síndrome congênita associada à infecção pelo vírus Zika (SCZ) em acompanhamentos contínuos. Este estudo buscou avaliar o crescimento do PC em crianças com SCZ nos primeiros três anos de suas vidas e identificar os fatores associados a ele. Os dados do PC ao nascimento e obtidos em consultas neuropediátricas de 74 crianças com SCZ foram coletados no Cartão da Criança, nos laudos paternos e em seus prontuários. Os preditores de escore-z para PC foram investigados utilizando-se diferentes modelos de efeitos mistos. O critério de informação de Akaike foi utilizado para selecionar os modelos usados. O escore-z de PC diminuiu de -2,7 ± 1,6 ao nascimento para -5,5 ± 2,2 aos 3 meses de idade, mas permaneceu relativamente estável desde então. No modelo ajustado selecionado, a presença de atrofia parênquimal cerebral grave e sintomas maternos de infecção no primeiro trimestre de sua gravidez estiveram associados a uma redução mais acentuada no escore-z de PC nos primeiros três anos de vida dos participantes. A diminuição do escore-z de PC em crianças com SCZ nos primeiros 3 meses de sua vida monstra o potencial reduzido de crescimento e desenvolvimento do sistema nervoso central dessas crianças. O prognóstico de crescimento do perímetro cefálico nos primeiros 3 anos de vida é pior quando a infecção materna ocorreu no primeiro trimestre gestacional e em crianças que tiveram atrofia parênquimal grave.

Se conoce poco sobre la evolución del perímetro cefálico (PC) en niños con síndrome de Zika congénito (SZC) en los seguimientos continuos. El objetivo del estudio fue evaluar el crecimiento del PC en niños con SZC en los primeros 3 años de vida e identificar los factores asociados. Se recogieron datos del PC al nacimiento y obtenidos en las consultas de neuropediatría de 74 niños con SZC a partir de la Tarjeta del Niño, los informes de los padres y los registros médicos. Se investigaron los predictores de la puntuación Z del PC mediante diferentes modelos de efectos mixtos; se utilizó el criterio de información de Akaike para la selección del modelo. La puntuación Z del PC disminuyó de -2,7 ± 1,6 al nacer a -5,5 ± 2,2 a los 3 meses de edad, pero a partir de entonces se mantuvo relativamente estable. En el modelo ajustado seleccionado, la presencia de atrofia grave del parénquima cerebral y los síntomas maternos de infección en el primer trimestre del embarazo se asociaron con una reducción más pronunciada de la puntuación Z del PC en los primeros 3 años de vida. La disminución de la puntuación Z del PC en los niños con SZC durante los primeros 3 meses demuestra el menor potencial de crecimiento y desarrollo del sistema nervioso central de estos niños. El pronóstico del crecimiento de la cabeza en los primeros 3 años de vida es peor cuando la infección materna se produjo en el primer trimestre gestacional y en los niños que tenían una atrofia grave del parénquima cerebral.

Mastopexia secundária com troca de prótese: técnica em "D" espelhado / Secondary mastopexy with exchange of prosthesis: mirror "D" technique

Introdução: A inclusão de implante mamário combinada com pexia é uma cirurgia desafiadora, não somente pela ausência de procedimento padrão, mas por se mostrar uma cirurgia com elevado potencial de complicações, entre elas, alto índice de revisões pós-cirúrgicas. Neste trabalho é descrita a utilização da técnica em "D" espelhado originalmente usada para mastopexia primária e inclusão de implantes de silicone em mamas hipoplásicas associadas à ptose moderada a grave, agora se estendendo o uso para o tratamento de recidiva de ptoses com deslocamento das próteses com ou sem contratura capsular e/ou cicatrizes inestéticas. Método: O procedimento descrito, realizado em 90 pacientes, faz uso de marcação própria que determina ressecção em bloco de pele e parênquima subjacente para simetrização, retalho de pedículo medial, troca dos implantes originais para próteses de silicone texturizada, perfil alto, redonda, volumes iguais bilateralmente, posicionadas em plano submuscular, resultando em uma cicatriz final vertical. Resultados: Pelos dados obtidos não foi necessária revisão cirúrgica em nenhum dos casos. Não houve ocorrência de infecção pós-cirúrgica ou necrose da placa areolopapilar, bem como da cicatriz. A ressecção média do parênquima foi de 80g. Oitenta e nove pacientes (98,8%) foram submetidas à ressecção de diferentes tamanhos. O volume médio das próteses incluídas foi de 300ml. O comprimento da cicatriz vertical se mostrou estável em média de 6,5cm após 2 anos. Os resultados foram considerados satisfatórios pela avaliação feita pelos pacientes. Conclusão: A mastopexia secundária mostrou-se uma cirurgia de maior complexidade devido à atrofia severa dos tecidos, resultado da cirurgia prévia. Seus benefícios incluem maior simetrização, cicatrizes mais finas com diminuição da tensão da placa areolopapilar, resultados duradouros e alto grau de satisfação das pacientes.

Introduction: Breast implantation combined with mastopexy is challenging, not only because a standard procedure is lacking, but also because of the high potential for complications, including a high rate of post-surgical revision. Originally intended for primary mastopexy and inclusion of silicone implants in hypoplastic breasts with moderate to severe ptosis, the use of the mirror "D" technique is now extended to treatment of ptosis recurrence with displacement of prostheses, with or without capsular contracture and/or unsightly scars. Method: The procedure described was performed in 90 patients, using specific marking to determine block resection of skin and underlying parenchyma for symmetrization. The procedure included use of a medial pedicle flap and exchange of original implants for textured, high-profile, round silicone prostheses with equal volumes bilaterally and positioned in the submuscular plane, resulting in a final vertical scar. Results: No surgical revision was required in any of the cases. There was no occurrence of postoperative infection or necrosis of the nipple-areola complex or scar. The average parenchyma resection was 80 g. Eighty-nine patients (98.8%) were submitted to resection of different volumes. The average prosthesis volume was 300 mL. The length of the vertical scar was stable with an average of 6.5 cm after 2 years. The results were considered satisfactory according to patient assessment. Conclusion: Secondary mastopexy is a more complex surgery due to severe atrophy of the tissue as a result of previous surgery. Its benefits include improved symmetrization, thinner scars and reduction in tension on the nipple-areola complex, long-lasting results, and a high degree of patient satisfaction.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients / Prevalência de achados gástricos endoscópicos e histopatológicos em pacientes obesos

CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9%) patients. In three patients (2.4%) the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8%) had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53%) and 16.7% of gastric atrophy and/or intestinal metaplasia.

CONTEXT: A prevalência de obesidade tem aumentado significativamente nos últimos anos. Bypass gástrico em Y-de-Roux, uma das técnicas cirúrgicas realizadas no tratamento da obesidade, envolve exclusão de parte do estômago. Atrofia, metaplasia intestinal e câncer gástrico têm sido associados com infecção pelo Helicobacter pylori. OBJETIVOS: Avaliar a prevalência de achados endoscópicos e alterações histopatológicas em pacientes obesos mórbidos em relação à presença de células inflamatórias, atividade inflamatória, hiperplasia linfóide, infecção pelo H. pylori, atrofia e metaplasia intestinal na mucosa gástrica. MÉTODOS: Achados na endoscopia digestiva alta e histopatologia gástrica foram analisados em 126 pacientes obesos na avaliação pré-operatória de cirurgia bariátrica. RESULTADOS: Anormalidades endoscópicas do trato digestivo superior foram diagnosticadas em 73/126 pacientes, com três pacientes (2,4%) apresentando úlcera gástrica e um paciente (0,8%) com úlcera duodenal. A histopatologia das biopsias gástricas dos obesos estudados revelou 65,1% de processo inflamatório na mucosa, atividade inflamatória em 50,0%; infecção pelo H. pylori em 53,2%, hiperplasia linfóide em 50,0%, atrofia e/ou metaplasia intestinal em 16,7%. CONCLUSÕES: No presente estudo, através de endoscopia digestiva alta e histopatologia de biopsias gástricas, foram detectados 57,9% de pacientes com anormalidades endoscópicas, prevalência de infecção pelo H. pylori em 53% e atrofia e/ou metaplasia intestinal em 16,7%.

Sudden death in a child with epilepsy: potential cerebellar mechanisms? / Morte súbita em uma criança com epilepsia: potenciais mecanismos cerebelares?

Epilepsy is the most common neurological disorder in humans. People with epilepsy are more likely to die prematurely than those without epilepsy, with the most common epilepsy-related category of death being sudden unexpected death in epilepsy (SUDEP). The central mechanisms underlying the fatal process remain unclear, but cardiac and respiratory mechanisms appear to be involved. Recently, cerebellar, thalamic, basal ganglia and limbic brain structures have been shown to be implicated in respiratory and cardiac rate regulation. We discuss here the potential mechanisms underlying the fatal process, with a description of cerebellar actions likely failing in that SUDEP process.

Epilepsia é uma das doenças neurológicas mais comuns em seres humanos. Pessoas com epilepsia têm maior chance de morrer prematuramente do que pessoas sem epilepsia, sendo a principal causa de óbito a morte súbita em epilepsia (SUDEP). Os mecanismos centrais envolvidos neste processo fatal não são claros, mas mecanismos cardíacos e respiratórios parecem estar envolvidos. Recentemente, regiões cerebrais como o cerebelo, núcleos talâmicos, gânglios basais e estruturas límbicas foram relacionadas com a variação das frequências cardíaca e respiratória. Aqui, discutiremos potenciais mecanismos envolvidos na SUDEP, com uma descrição do possível papel do cerebelo na sua ocorrência.

Idiopathic chronic subdural hematoma, MCA infarct and cortical atrophy with status epilepticus in infants.

Spontaneous chronic subdural hematomas in infants are extremely rare. A very limited number of cases are known and reported in literature. The clinical presentation can be myriad varying from asymptomatic cases to gross neurological deficits. We report the cases of 2 infants who presented to us with repeated episodes of generalized tonic clonic seizures since birth. No etiology could be established for either of them. Subsequent imaging revealed chronic subdural hematoma, MCA infarct and cortical atrophy in both the cases. Both the cases improved following evacuation of the chronic subdural hematoma. One of the infants had secondary craniosynostosis for which additional coronal suturectomy had to be done. The management of such cases and a brief review of literature are discussed.

Cerebral hemiatrophy: an associated finding in an epileptic child

Cerebral hemiatrophy is a rarely occurring condition of different etiologies that can be regarded as the final stage of a number of different disease processes. It is characterized by a marked asymmetry of the cerebral hemispheres. A 12 year old girl with history of epilepsy since infancy and psychomotor delay presented in status epilepticus, developed marked cerebral edema, bilateral uncal herniation and bilateral infarcts of the posterior cerebral artery territories. Autopsy findings revealed left cerebral hemiatrophy as an incidental findings. The clinicopathologic features and classification of this entity are discussed.

Involuntary hand levitation associated with parietal damage: another alien hand syndrome

The alien hand syndrome (AHS) usually consists of an autonomous motor activity perceived as an involuntary and purposeful movement, with a feeling of foreignness of the involved limb, commonly associated with a failure to recognise ownership of the limb in the absence of visual clues. It has been described in association to lesions of the frontal lobes and corpus callosum. However, parietal damage can promote an involuntary, but purposeless, hand levitation, which, sometimes, resembles AHS. In the present study, four patients (cortico-basal ganglionic degeneration -- n=2; Alzheimer's disease -- n=1 and parietal stroke -- n=1) who developed alien hand motor behaviour and whose CT, MRI and/or SPECT have disclosed a major contralateral parietal damage or dysfunction are described. These results reinforce the idea that parietal lobe lesions may also play a role in some patients with purposeless involuntary limb levitation, which is different from the classic forms of AHS

Congenital destructive hemispheric lesions and epilepsy: clinical features and relevance of associated hippocampal atrophy

We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70 percent of group 1 patients and 77.7 percent of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment

Unilateral mesial temporal atrophy after a systemic insult as a possible etiology of refractory temporal lobe epilepsy: case report

Mesial temporal sclerosis is the main pathological substrate present in refractory temporal lobe epilepsy and its presence is often related to the occurrence of febrile seizures in infancy. These is an on-going discussion on the nature of mesial temporal sclerosis as it related to epilepsy: cause or consequence. A previously normal child developed hyperosmolar coma after abdominal surgery at the age of 6. Three months afterwards he developed simple and complex partial seizures with an increasing frequency and refractory to multiple mono- and polytherapic drug regimens. He was evaluated for surgery at the age of 13. Ictal and interictal recordings showed left temporal lobe abnormalities. Early CT scaning suggested left temporal atrophy. MRI showed mesial temporal sclerosis. Neuropsichological testing showed verbal memory deficits and he passed a left carotid artery amytal injection. He was submitted to a cortico-amygdalo-hippocampectomy and has been seizure-free since then. The clinical data obtained from this patient suggest that at least in this case mesial temporal sclerosis would be related to the cause of epilepsy and not resultant from repeated seizure activity.

Peso del encéfalo normal del venezolano adulto según sexo y edad / Normal brain weight in venezuelan adults related to sex and age

Se revisa el peso de los encéfalos de sujetos con edades comprendidas entre 19 y 100 años, obtenidos de 3967 necropsias suscesivas realizadas durante un período de diez años en el Hospital General del Sur de Maracaibo. El análisis del peso de 1104 cerebros adultos normales arroja un promedio de 1215 g para sujetos sel sexo masculino y de 1122 g para el sexo femenino. Se obseva que el peso encefálico disminuye a medida que se incrementa la edad de los sujetos, disminución que es más acentuada después de los 65 años en los hombres y de 75 años en las mujeres

Agenesia de vesícula biliar / Gallblader agenasia

Se presentan dos casos de anomalia congénita de agenesia de vesícula biliar, cuyos resultados fueron intraoperatorios, el primer caso con patología biliar de coledocolitiasis y el segundo caso, paciente femenina sin patología ostensible. Es imprescindible realizar una colangiografía en el acto quirúrgico para descartar vesícula intrahepática u otra anomalía de las vías biliares.

Lúpus eritematoso sistêmico: atrofia cerebral e manifestaçöes neuropsiquiátricas / Systemic lupus erythematosus: cerebral atrophy and neuropsychiatric manifestations

Os autores relatam o caso de uma paciente de 17 anos de idade, sexo feminino, com poliartrite, febre, insuficiência cardíaca, alteraçäo do comportamento e hipertonia plástica. O diagnóstico de LES foi confirmado laboratorialmente somente através de anticorpos anti-Sm e anti-Ro. Foi realizada tomografia computadorizada cerebral (TCC), que revelou acentuaçäo dos sulcos cerebrais e calcificaçöes periventriculares. A introduçäo de prednisona reverteu o quadro neurpsiquiátrico e uma nova TCC, realizada quatro meses após a primeira, näo demonstrou a referida acentuaçäo dos sulcos cerebrais, mantendo-se apenas as calcificaçöes

Essential iris atrophy

A 54-year-old woman developed unilateral essential iris atrophy. The condition progressed extremely slowly for several years without developing any complications. Eventually, glaucoma developed that failed to respond to medical therapy after three years, and a filtering procedure became necessary. The other eye remained normal