Reconstrução de terço distal do nariz: série de casos e revisão de literatura / Reconstruction of the distal third of the nose: case series and literature review

Introdução: O nariz apresenta grande importância estética e funcional, com alta incidência de lesões malignas. Existem várias técnicas de reconstrução do terço distal do nariz, não havendo uma indicação universal; irá depender das características da lesão. As opções cirúrgicas variam entre enxerto de pele, retalhos locais, regionais e microcirúrgicos. O objetivo é apresentar uma série de casos de reconstrução de terço distal do nariz com diferentes técnicas cirúrgicas, discutindo as peculiaridades e os resultados obtidos. Método: Trata-se de estudo retrospectivo realizado no Hospital do Servidor Público Estadual de São Paulo (HSPE), avaliando uma série de oito pacientes com diagnóstico de câncer de pele não melanoma localizados em terço distal de nariz e que foram submetidos a reconstrução pela equipe de Cirurgia Plástica. Resultados: Foram obtidos resultados satisfatórios para todos os pacientes submetidos a reconstrução distal do nariz, tendo sido utilizadas técnicas de enxerto de pele total (n=1) e retalhos locais (n=7), tais como o retalho bilobado, nasogeniano, dorsal do nariz, frontal paramediano, e transposição nasolabial. Conclusão: A reconstrução de defeitos do terço distal do nariz é desafiadora e com grande variabilidade técnica. Deve-se realizar avaliação criteriosa do paciente e da lesão, avaliar riscos e benefícios e compartilhar a decisão com o paciente.

Introduction: The nose has great aesthetic and functional importance, with a high incidence of malignant lesions. There are several techniques for reconstructing the distal third of the nose, but there is no universal indication; will depend on the characteristics of the injury. Surgical options vary between skin grafts and local, regional, and microsurgical flaps. The objective is to present a series of cases of reconstruction of the distal third of the nose using different surgical techniques, discussing the peculiarities and the results obtained. Method: This is a retrospective study carried out at the Hospital do Servidor Público Estadual de São Paulo (HSPE), evaluating a series of eight patients diagnosed with non-melanoma skin cancer located in the distal third of the nose and who underwent reconstruction by the team of Plastic Surgery. Results: Satisfactory results were obtained for all patients undergoing distal nose reconstruction, using total skin graft techniques (n=1) and local flaps (n=7), such as the bilobed, nasolabial, and dorsal nose flap. nose, paramedian frontal, and nasolabial transposition. Conclusion: Reconstruction of defects in the distal third of the nose is challenging and involves great technical variability. A careful assessment of the patient and the injury must be carried out, risks and benefits assessed and the decision shared with the patient.

Retalho em hélice para reconstrução de sequelas em membros inferiores / Propeller flap for reconstruction of sequelae in lower limbs

Introdução: O retalho em hélice, ou propeller flap, é um tipo de retalho local baseado em vasos perfurantes. Apresenta diversas vantagens, como a reconstrução de tecidos semelhantes ao original, menor morbidade da área doadora, manutenção dos principais vasos da região e a possibilidade de amplo arco de rotação (até 180º). Entretanto, está sujeito a complicações, sendo a mais preocupante a necrose parcial ou total do retalho. Métodos: Estudo retrospectivo de uma série de três casos de sequelas de trauma em membros inferiores tratados com retalho em hélice. Resultados: Retalhos em hélice reduzem o tempo cirúrgico, dias de internação e custos. Todavia, não são isentos de complicações, encontra-se a ocorrência de necrose parcial de 10,5 a 11% e total de 1 a 5%. Outras complicações descritas são epidermólise (3,5%) e congestão venosa transitória (3%). Nos casos descritos, evoluíram sem complicações. Classicamente, os defeitos de membro inferior, principalmente no terço distal, têm indicação de reconstrução com retalhos microcirúrgicos. Conclusão: Os retalhos propeller podem ser uma alternativa nestes casos, principalmente em defeitos pequenos e moderados. Ainda não existem trabalhos comparando diretamente estas duas técnicas, mas algumas informações importantes já estão disponíveis, como a semelhança entre os percentuais de necrose total entre as técnicas.

Introduction: The propeller flap is a type of local flap based on perforating vessels. It has several advantages, such as the reconstruction of tissues similar to the original, less morbidity of the donor area, maintenance of the main vessels of the region and the possibility of a wide rotation arc (up to 180º). However, it is subject to complications, the most worrisome being partial or total necrosis of the flap. Methods: A retrospective study of a series of three cases of lower limb trauma sequelae treated with helix flaps. Results: Helical flaps reduce surgical time, hospitalization days, and costs. However, they are not free of complications, with partial necrosis occurring in 10.5 to 11% and total necrosis in 1 to 5%. Other complications described are epidermolysis (3.5%) and transient venous congestion (3%). In the cases described, they evolved without complications. Classically, lower limb defects, especially in the distal third, are indicated for reconstruction with microsurgical flaps. Conclusion: Propeller flaps may be an alternative in these cases, especially in small and moderate defects. There are still no studies directly comparing these two techniques, but some valuable information is already available, such as the similarity between the percentages of total necrosis between the techniques.

Transposição da veia cefálica para reconstrução microcirúrgica de cabeça e pescoço: estudo anatômico em cadáveres / Cephalic vein transposition for head and neck microsurgical reconstruction: anatomical study in cadavers

Introdução: A transposição de veia cefálica é uma alternativa interessante como veia doadora na reconstrução oncológica de cabeça e pescoço em pacientes com história de radioterapia cervical. O objetivo do trabalho é avaliar as características anatômicas da veia cefálica em cadáveres. Métodos: Foram dissecadas seis veias cefálicas de três cadáveres. As veias foram seccionadas na parte medial do braço e transpostas até o pescoço por cima das clavículas. Resultados: As veias apresentaram média de comprimento de 18,75±1,84cm e número de tributárias com variação de 7-9. O diâmetro coincidiu em ambas as veias de cada cadáver. O parâmetro anatômico usado para identificálas (sulco deltopeitoral) se mostrou confiável, possibilitando uma dissecação previsível. Conclusão: A veia cefálica tem características constantes e fácil localização, sendo uma opção relevante ao arsenal terapêutico do cirurgião plástico reconstrutor.

Introduction: Cephalic vein transposition is an interesting alternative as a donor vein in head and neck cancer reconstruction in patients with a cervical radiotherapy history. This work aims to evaluate the cephalic vein anatomical characteristics in cadavers. Methods: Six cephalic veins from three cadavers were dissected. The veins were sectioned in the medial part of the arm and transposed to the neck over the clavicles. Results: The veins had an average length of 18.75 ± 1.84 cm and several tributaries with a variation of 7-9. The diameter coincided in both veins of each corpse. The anatomical parameter used to identify them (deltopectoral groove) proved reliable, allowing predictable dissection. Conclusion: The cephalic vein has constant characteristics and is easy to locate, being an option relevant to the reconstructive plastic surgeon's therapeutic arsenal.

Acute colonic pseudo-obstruction after cesarean section: a retrospective analysis of 11 cases / 中华围产医学杂志

Objective To summary the risk factors,clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS).Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018.Another 55 patients without ACPO after CS,performed within two weeks' difference from the case group,were randomly selected as the control group.Clinical data of all subjects were analyzed retrospectively.Potential clinical risk factors were statistically analyzed.T test,Chi-square test and logistic regression analysis were used for statistical analysis.Results In the case group,the abdominal distension presented on 2 d (n=1),3 d (n=7),4 d (n=2) and 17 d (n=1) respectively after CS,and all cases experienced abdominal pain and nausea.Vomiting was reported in some cases.Plain abdominal X-ray images revealed pneumocolon with colon pouch.The maximum diameter of cecum was 6 to 12 cm.Air-liquid levels were observed in two patients.All patients underwent fasting,gastrointestinal decompression,intravenous fluid infusion,correction of electrolyte imbalance,hypertonic saline enema and prophylactic antibiotic treatment.The disease condition lasted two to six days in these patients.Conservative treatment was successful in eight patients and failed in the other three who later went for operations.The maximum cecal diameters in the three patients who underwent surgery were all ≥ 9 cm,among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction.In this case,the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases.One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment.One patient suffered a relapse after having been treated conservatively for five days,and then underwent surgeries of resection of ileocecum,distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation.Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38,95％CI:1.12-1.71,P=0.003) and postoperative body temperature ＞38 ℃ (OR=6.47,95％CI:1.06-39.61,P=0.044) were the risk factors for ACPO after CS.Conclusions Elevated leukocyte count and body temperature ＞38 ℃ were two high-risk factors for ACPO after CS.ACPO is characterized by acute onset,and the first choice is conservative management.Active surgical treatment would be required if conservative treatment fails,especially when the maximum diameter of the cecum is ≥ 9 cm,which may increase the incidence of intestinal necrosis or perforation.

Analysis on related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma / 中华疾病控制杂志

Objective To investigate the related factors of lymph node metastasis and ovary involvement in endometrioid adenocarcinoma. Methods The clinicopathological data of endometrioid adenocarcinoma patients who underwent surgical treatment at the first affiliated hospital of university of science and technology of China from January 2011 to January 2018 were analyzed retrospectively. A total of 189 endometrioid adenocarcinoma were retrieved in the study. Results In the univariate analysis, D-dimer, preoperative plasma fibrinogen and CA125 levels could be elevated in endometrioid adenocarcinoma patients with ovary involvement (all P<0.05). Endometroid adenocarcinoma patients with lymph node metastasis had lower body mass index (BMI) (t=2.133, P=0.040), preoperative plasma fibrinogen, D-dimer, CA125 levels and BMI were higher in patients with lymph node metastasis (all P<0.05). In Logistic regression analysis, D-dimer levels(OR=1.448, 95% CI:1.105-1.898) and preoperative plasma fibrinogen(OR=1.925, 95% CI:1.018-3.640) were elevated in endometrioid adenocarcinoma patients with ovary involvement; Multiparity was the protective factor(OR=0.498, 95% CI: 0.253-0.982) for endometrioid adenocarcinoma patients with lymph node metastasis, but elevated preoperative plasma fibrinogen (OR=2.191, 95% CI: 1.085-4.422) was the risk factor among the patients. Conclusion Increased preoperative plasma fibrinogen or D-dimer levels could be predictors of lymph node metastasis or ovary involvement in endometrioid adenocarcinoma.

Study on Medication Regularity of Famous TCM Doctors for Diabetes Based on Improved Apriori Algorithm / 中国中医药信息杂志

Objective To analyze the medication regularity of TCM famous doctors for diabetes by using improved Apriori algorithm to obtain more efficient data mining methods. Methods This article put forward Apriori vertical data storage, and improved ADPM obtained by difference set method was used to conduct data mining to find out the medication regularity in Guo Jia Ji Ming Lao Zhong Yi Tang Niao Bing Yan An Liang Fang. Results After screening, 402 prescriptions were included, involving 24 kinds of high-frequency medicine, 15 high-frequency medical combinations, and 18 highly-dependent medical combinations, which were mainly tonifying deficiency medicine, clearing heat medicine, blood-activating and stasis-resolving medicine, and damp-draining diuretic medicine. Conclusion ADPM algorithm can be applied in the analysis on medication regularity and find out high-frequency medicine, medical combinations and medical dependent relation, with high efficiency.

Influência das complicações pós-operatórias no insucesso da reconstrução de mama imediata com implante de silicone / Influence of postoperative complications on the failure of immediate breast reconstruction with silicone implants

Introdução: A reconstrução da mama imediata pós-mastectomia, com implante de silicone é um método simples, porém, pode evoluir com complicações e remoção do implante. O objetivo do estudo foi analisar as complicações pós-operatórias e buscar relação entre estas e a remoção do implante. Método: No período de 4 anos, foram estudados retrospectivamente 323 casos de reconstrução de mama imediata com implante de silicone após mastectomia total realizados no Institut Gustave-Roussy, França. Resultados: A complicação mais frequente foi a linfocele (34,9%), seguida da necrose cutânea com 22,9%, da infecção com 19,3% e do hematoma, com 13,3% dos casos. A remoção do implante foi mais frequente quando ocorreu algum tipo de complicação cirúrgica e maior quando ocorreu mais de um tipo de complicação. A complicação mais frequente nos casos de remoção do implante foi a infecção (75,0%). O expansor foi o implante que mais teve relação com remoção do implante. O uso de implantes de volume acima de 300 ml teve significativamente mais risco de remoção do implante. Conclusões: 1) A presença de complicação pós-operatória foi fator de risco para a remoção do implante. 2) O risco de remoção foi maior na presença de mais de um tipo de complicação 3) A infecção foi o principal tipo de complicação que se relacionou com a remoção 4) O expansor apresentou maior risco de complicações e de remoção do implante. 5) A utilização de implantes de volume maior do que 300 ml apresentou maior risco de remoção.

Introduction: Immediate breast reconstruction with silicone implants following mastectomy is a simple method, but can develop complications culminating in implant removal. The aim of this study was to analyze postoperative complications and evaluate their correlation with implant removal. Method: In a period of 4 years, 323 cases of immediate breast reconstruction with silicone implants following total mastectomy were retrospectively studied in the Institut Gustave-Roussy, France. Results: The most frequent complication was lymphocele (34.9%), followed by cutaneous necrosis (22.9%), infection (19.3%), and hematoma (13.3%). Implant removal was more frequent when a surgical complication occurred, and even more frequent when there was more than one type of complication. The most frequent complication leading to implant removal was infection (75.0%). The expander was the implant that had the highest correlation with implant removal. The use of implants with a volume greater than 300 ml was associated with a significantly higher risk of implant removal. Conclusions: 1) The presence of postoperative complications was a risk factor for implant removal. 2) The risk of removal was higher when more than one complication was present. 3) Infection was the main type of complication associated with implant removal. 4) The expander presented a higher risk of complications and implant removal. 5) The use of implants with a volume greater than 300 ml had a greater risk of need for removal.

Expression of LC3B in cervical squamous carcinoma and its relationship with Ki-67 expression / 临床与实验病理学杂志

Purpose To investigate the expression of autophagy-related protein LC3B in cervical squamous carcinoma and its relation-ship with Ki-67 expression. Methods To detect the expression of LC3B in 16 cases of normal cervical tissues and 126 cases of squa-mous cell carcinoma by immunohistochemical staining. In addition, Ki-67 protein was also detected in 126 cases of squamous cell car-cinoma in the same assay. The relationship between LC3B expression and Ki-67 in cervical squamous cell cancer was statistical analy-sis. Results Expression level of LC3B were significantly lower in cervical squamous carcinoma than normal squamous epithelial cells (P<0. 05), and the expression of LC3B was negatively correlated with Ki-67(rs = -0. 248, P<0. 05). Conclusion It appears that decreased levels of autophagy which indicated by low expression of LC3B may promote cancer cell proliferation in the early stages of cervical squamous cell carcinoma, which provides a clinical referential evidence for further explore the mechanism of autophagy in cer-vical cancer development.

Complicações pós-operatórias em reconstrução da mama imediata com implante de silicone / Post operative complications in immediate breast reconstruction with prosthesis

A reconstrução da mama imediata pós mastectomia, com implante de silicone, é um método simples. Pode, porém, ser acompanhada de efeitos adversos e morbidade pósoperatória. Foram estudados retrospectivamente 323 casos de reconstrução de mama imediata com implante de silicone, após mastectomia total, com ou sem linfadenectomia axilar, realizados no Institut Gustave-Roussy - Villejuif - França, no período entre janeiro de 1990 a janeiro de 1992. O objetivo do estudo foi analisar as complicações pós-operatórias e buscar relação entre as complicações pós-operatórias e a remoção do implante. Os métodos estatísticos utilizados foram o teste do Qui-quadrado, e o teste exato de Fisher quando ocorreram as restrições de Cochran. A complicação pós-operatória mais freqüente foi a linfocele, encontrada em 34,9 por cento das cirurgias, seguido da necrose cutânea com 22,9 por cento , da infecção com 19,3 por cento e do hematoma com 13,3 por cento dos casos. A remoção do implante foi mais freqüente, com significância estatística, quando ocorreu algum tipo de complicação cirúrgica (X2 = 48,428 *), e quando ocorreu mais de um tipo de complicação (p < O,OOOO I *). A complicação pós-operatória mais freqüente nos casos de remoção do implante foi a infecção (75,0 por cento ), com associação significante entre a presença de infecção e a remoção do implante (p < O,OOOO I *). O expansor foi o tipo de implante que mais teve relação com complicações pósoperatórias (p = O,002 por cento *) e remoção do implante (p = O,0164 *). O uso de implantes de volume acima de 300 ml apresentaram significativamente mais risco de remoção do implante que os implantes de volume até 300 MI (X2 = 4,287 *)