Desbridamiento enzimático con Nexobrid® en el paciente quemado: exposición de manejo terapéutico a propósito de un caso / Desbridamento enzimático com Nexobrid® no paciente queimado: exposição do manejo terapêutico e relato de caso / Enzymatic debridement in the burn patient with Nexobrid®: exposition of therapeutic management and case report

Objetivo: Exponer el manejo terapéutico del desbridante enzimático Nexobrid® a través de un caso representativo. Reporte del caso: Se expone el caso de un paciente varón de 43 años que sufre quemaduras circulares de segundo grado profundo en ambas manos por flash eléctrico y llama, que fue tratado mediante desbridamiento enzimático con Nexobrid®, sin llegar a precisar de la realización de injertos cutáneos. Se alcanzó la epitelización completa de las lesiones 28 días tras la quemadura, sin realizarse injertos cutáneos, y logrando una buena calidad cicatricial, sin aparición de limitaciones funcionales. Consideraciones finales: El desbridamiento enzimático con Nexobrid® es un nuevo recurso terapéutico que permite realizar un desbridamiento completo y específico del tejido quemado, sin precisar de la logística de un quirófano. Pese a los buenos resultados reportados en la literatura reciente, los beneficios del uso del desbridante enzimático Nexobrid®, todavía han de ser respaldados por mayor cantidad de estudios con un adecuado nivel de evidencia.

Objetivo: Expor o manejo terapêutico do agente de debridamento enzimático Nexobrid® em um caso representativo. Relato de caso: Relatamos o caso de um homem de 43 anos com queimaduras profundas de segundo grau em ambas as mãos causadas por flash elétrico e chama, que foi tratada por desbridamento enzimático com Nexobrid®, sem a necessidade de enxerto de pele. Epitelização completa foi obtida 28 dias após a queimadura, sem a necessidade de realizar enxertos na pele, conseguindo uma boa qualidade da cicatriz, sem qualquer limitação funcional após 102 dias de seguimento. Considerações finais: O desbridamento enzimático com Nexobrid® é um novo recurso terapêutico que permite um desbridamento completo e específico de tecidos queimados, sem requerer a logística de uma cirurgia. Apesar dos bons resultados relatados na literatura recente, os benefícios deste tratamento devem ser respaldados por uma ampla gama de estudos com níveis adequados de evidência.

Objective: To expose the therapeutic management of the enzymatic debriding agent Nexobrid® through a representative case. Case report: We expose the case of a 43 year-old male suffering from circular deep second degree burns in both hands caused by electric flash and flame, who was treated through enzymatical debridement with Nexobrid®, without the need of skin grafting. Complete epithelialization was achieved 28 days after the burn, without the need to perform skin grafting, achieving good scar quality, without any functional limitation after 102 days follow-up. Final considerations: Enzymatical debridement with Nexobrid® is a new therapeutic resource which allows for a complete and specific debridement of burned tissues, without requiring the logistics of a surgery. Despite the good results reported in recent literature, the benefits of this treatment must be supported by a wider range of studies with adequate levels of evidence.

TeleCondutas: lesão por pressão / TeleGuides: pressure injury

A Lesão por Pressão (LP) é um dano localizado na pele e/ou tecidos moles subjacentes, geralmente sobre uma proeminência óssea, relacionada ao uso de dispositivo médico ou a outro artefato. É um problema de saúde frequente no atendimento da Atenção Primária à Saúde (APS), especialmente identificado em visitas domiciliares na avaliação de pacientes acamados, podendo levar a repercussões graves como infecção bacteriana disseminada e osteomielite. Esta guia apresenta informação que orienta a conduta para casos de lesão por pressão no contexto da Atenção Primária à Saúde, incluindo: etiologia, classificação, características da lesão conforme estágio, tipos de tecido, avaliação e tratamento da infecção, check-list, cuidados com a ferida, escolha da cobertura, irrigação da lesão, desbridamento, controle do odor, medidas preventivas.

Effects of various irrigation/aspiration protocols on cleaning of flattened root canals

This study aimed to evaluate, by means of scanning electron microscopy (SEM), the cleaning of flattened root canals, varying irrigation/aspiration protocols during biomechanical preparation. Thirdy human mandibular incisors were distributed into three groups (n = 10) according to the aspiration/irrigation protocols: conventional, conventional + brush, and apical negative pressure irrigation. Irrigation procedure was performed with 5 mL of 1% NaOCl at each change of instrument; final irrigation was conducted with 17% EDTA for 5 min. After biomechanical preparation, the roots were sectioned and prepared for SEM analysis. The images obtained were evaluated under 35× and 1,000× magnification by three calibrated examiners, following a double-blind design. All data were analyzed using Kruskal–Wallis and Dunn’s post hoctests (α = 0.05). Canals wherein the conventional method and apical negative pressure irrigation were employed revealed less debris, statistically different from the conventional + brush group (p < 0.05). Regarding the presence of smears, apical negative pressure irrigation was more effective in cleaning, showing lowest scores (p < 0.05), compared with the other tested protocols. Comparing each root canal third revealed that the apical portion was difficult to clean as all the tested protocols showed similar high scores (p > 0.05), both for the presence of debris and smear layer. In conclusion, although none of the studied irrigation/aspiration protocols have completely cleaned flattened root canals, apical negative pressure irrigation was more effective in smear layer removal, whereas the conventional + brush protocol was the least effective in removing the debris and smear layer.

Supraglotoplastía asistida con microdebridador en pacientes con síndrome de Pierre Robin y laringomalacia severa / Assisted endoscopic microdebrider supraglottoplasty in patients with Pierre Robin syndrome and severe laryngomalacia

Se presenta el caso de una paciente recién nacida de término portadora de un síndrome de Pierre Robin asociada a laringomalacia severa que requirió resolución quirúrgica para estabilización de su vía aérea superior Se presenta la experiencia clínica en el uso de microdebridador para realización de supraglotoplastía como una novedosa alternativa en el tratamiento quirúrgico de este tipo de pacientes y se realiza revisión de la literatura respecto de esta técnica.

Pierre Robin syndrome is a triad formed by micrognathia, and cleft palate glossoptosis. His association with laryngomalacia is not set however determining the coexistence of these two diseases and their severity is of utmost importance as they condition the prognosis of a patient with Pierre Robin syndrome. Currently one of the surgical techniques used in patients with severe laryngomalacia, is assisted endoscopic microdebrider supraglottoplasty. In the ENT unit of the Hospital Luis Calvo Mackenna, this procedure is being implemented in order to give our patients a safe and effective treatment option for their pathology.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

OBJECTIVES: The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). MATERIAL AND METHODS: 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLI TM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. RESULTS: The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. CONCLUSION: Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

Uso de microdebridador para el tratamiento del edema de Reinke / Use of microdebrider for Reinke's edema treatment

El edema de Reinke, corresponde al aumento de volumen y de consistencia del compartimento subepitelial, por lo cual la voz se hace de menor frecuencia y más áspera. El tratamiento de elección para esta patología consiste en la reducción quirúrgica de la matriz gelatinosa que se ubica bajo el epitelio. Se presenta aquí la técnica de reducción de esta matriz con microdebridador, lo cual permite dejar sin lesiones el epitelio cordal y lograr una cicatrización apropiada de la mucosa.

Reinke's edema is characterized by the swelling and increased consistency of the subepitelial compartment, which results in lower-than-normal pitch and hoarseness. Surgical reduction of the gelatinous matrix underlying the epithelium by means of a microdebrider is the choice treatment for this pathology, allowing for adequate healing of the mucosa, without damaging the vocal chord epithelium.

Functional Endoscopic Sinus Surgery (FESS).

Functional Endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up the sinus air cells and the sinus ostia with an endoscope. The use of FESS as a sinus surgical method has now become widely accepted and the term functional is meant to distinguish this type of endoscopic surgery from the nonendoscopic more conventional sinus procedure. Functional Endoscopic sninus surgery is being done regularly at TU Teaching Hospital from 2003. Total number of cases done from March 2003 till December 2005 were 94. Maximum number of FESS was done for nasal polyps, which was carried out in 80 patients, out of which, FESS for ethmoidal polyp was done in 47 patients and for antrochoanal polyps in 33 patients. Other conditions where FESS was carried out were chronic maxillary sinusitis in 8 patients, fungal sinusitis in 5 patients, and endoscopic medial maxillectomy for inverted papilloma in 1 patient.

Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

An in-vitro SEM comparative study of debridement ability of K-Files and Canal Master.

The aim of this study was to compare in vitro the debridement ability of Canal Master and K-Files using scanning electron microscope. One hundred and twelve freshly extracted human upper central incisor teeth were divided into two groups of 56 each. One group was instrumented using Canal Master and another group was instrumented using K-Files. The teeth were sectioned longitudinally and examined under the SEM. Scanning electron micrographs were qualitatively and statistically analysed for the degree of cleanliness with regard to the presence of debris, smeared layer and patency of dentinal tubules in the apical third of each root canal. In order to determine whether there is a difference between the two instrumentation techniques, a chi-square test of equal proportions was used. This test gave a chi-square value of 24.19 (P < .001). Both the instrumentation techniques were ineffective in completely debriding the canals. However, the results showed that the Canal Master produced cleaner showing lesser debris than that produced by K-Files.

Desbridamiento percutáneo de la espóndilo-disquitis piógena con el nucleotomo / Percutaneous debridement of the pyogenic spondilo-discitis by nucleotome

Se estudiaron 22 pacientes con espóndilo-disquitis piógena de la columna lumbar, siendo 15 hombres y siete mujeres con edad promedio de 54 años. En sólo 2/3 se encontró el foco de infección con predominio de: Salmonella, Brucella y cocos Gram positivos. El nivel más afectado fue L3-L4 y clínicamente todos tuvieron una lumbociatalgia con irradiación a algún dermatoma y los estudios radiológicos mostraron un proceso óseo destructivo en las plataformas vertebrales con reacción esclerosa, espículas óseas, compresión neurológica por el absceso e inestabilidad segmentaria. Tradicionalmente existen dos tipos de tratamiento: el conservador, con antibióticos y reposo en cama hasta por nueve meses y el quirúrgico, con un riesgo alto de morbimortalidad. Nosotros proponemos otra alternativa viable de tratamiento, con el uso de menos nucleotomo, para el desbridamiento percutáneo del absceso por ser invasivo y proporcionar muestra para estudio bacteriológico e histopatológico. Con el desbridamiento percutaneo del absceso, se descomprimen las estructuras neurológicas y la lumbociatalgia remitió en uno a cinco días con recuperación neurológica progresiva de uno a cuatro semanas en el 95 por ciento de los casos. Al drenar el absceso se observó una pronta reparación del defecto óseo y una función intersomática espontánea de cuatro a cinco meses de los 22 casos, estabilizándose la columna

Tratamiento del mal de Pott con déficit neurológico / Treatment of Pott's disease with neurologic damagae

Treinta pacientes con mal de Pott cérvico-torácico, torácico-lumbar o lumbar y con déficit neutológico fueron tratados con drenaje del absceso, descompresión, vertebrectomía, colocación de injerto por vía anterior y por vía posterior con resección del arco posterior, artrodesis e instrumentaci'pon segmentaria con barras de Luque en un segundo tiempo. Se midieron las cifosis radiográficasmente (método de Cobb) y se clasificaron de acuerdo a su lesión neurológica (clasificación de Frankel). El promedio de la angulación cifótica preoperatoria, 69 grados, se redujo a 47 grados postoperatoriamente y a 50 grados en su última medición (se perdieron 3 grados de corrección). Veintitrés pacientes (76.7 por ciento) recuperaron una función neurológica normal (Frankel E); seis pacientes (20 por ciento) pudieron caminar con ayuda de muletas axilares (Frankel D) y un paciente realiza la marcha asistido por muletas axilares y con aparato maslopodálico bilateral (Frankel B). Tuvimos una complicación significativa con deterioro neurológico. Otras complicaciones fueron protrusión y ruptura de las barras, infección supurativa superficial, entre otras, que se manejaron sin mayor deterioro. En conclusión, se obtuvieron buenos resultados ya que se corrigió la cifosis y cambió por lo menos un grado de mejoría neurológica por lo cual algunos pasaron de B a E en la clasificación neurológica de Frankel utilizando el tratamiento completo de descompresión por vía anterior y fijación posterior.