A Silastic Sheet found during Endoscopic Transnasal Dacryocystorhinostomy for Acute Dacryocystitis

PURPOSE: To report the case of a silastic sheet that was found during an endoscopic transnasal dacryocystorhinostomy for treatment of acute dacryocystitis with necrosis of the lacrimal sac. METHODS: A thirty-two year old male presented with painful swelling on the nasal side of his left lower lid two weeks prior to visiting this clinic. Fourteen years ago, the patient was involved in a traffic accident and underwent surgery to reconstruct the ethmoidal sinus. Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day. RESULTS: The surgical finding showed severe necrosis around the lacrimal sac and a 20 x 15-mm sized silastic sheet was found crumpled within the purulent discharge. The sheet was removed, the lacrimal sac was irrigated with an antibiotic solution, and a silicone tube was intubated into the lacrimal pathway. After surgery, the painful swelling on the nasal side of left lower lid resolved gradually, and there were no symptomatic complications three months later. CONCLUSIONS: We report the first case where a silastic sheet applied during a facial reconstruction had migrated adjacent to the lacrimal sac resulting in severe inflammation.

Experiência de três anos com os implantes de silastic contendo levonorgestrel / Three-year experience with silastic implants containing levonorgestrel

Os implantes de silastic contendo o progestogênio levonorgestrel foram testados como anticoncepcionais de longa duraçao em 325 mulheres. Durante os primeiros dois anos de exposiçao, nenhuma gravidez ocorreu. Após três anos completos de exposiçao, a taxa acumulada de gravidez foi O,83 por cento. As taxas acumuladas de continuaçao foram 8O,01 por cento aos 12 meses, 47,95 por cento aos 24 meses e 31,75 por cento aos 36 meses. O efeito colateral mais importante foi sangramento aumentado, e foi a razao principal para pedidos de remoçao. Outros efeitos colaterais importantes levando à remoçao foram hipomenorréia/amenorréia e aumento de peso. Conclui-se que os implantes de levonorgestrel sao muito eficazes para evitar uma gravidez durante os três primeiro anos de uso; a alta taxa de continuaçao demonstra a sua aceitabilidade. Os poucos efeitos colaterais justificam a possibilidade de oferecer este novo método anticoncepcional para as mulheres brasileiras.