Excessive Weight Favours Skin Physiology - Up to a Point: Another Expression of the Obesity Paradox.

BACKGROUND/AIMS: Recently classified as an epidemic by the WHO, obesity (as well as the state of being overweight) clearly affects significant populations across all ages. The relationship between obesity and some diseases (e.g. cardiovascular ones) is known, although many paradoxes remain to be explained. Very little information is available, however, regarding its impact on skin physiology and skin disease. This study aims to examine the influence of excessive weight on epidermal hydration and transepidermal water loss, key variables of skin water balance and skin biomechanics. METHODS: A convenience sample of 89 healthy female volunteers was selected and divided into 4 groups, according to their BMI (body mass index), as normal (control), overweight, obese (I and II), and morbid. Skin physiology was quantitatively assessed in all individuals in 4 anatomical areas using non-invasive biometrical analysis by reference instrumentation. Descriptive and comparative statistics were applied, adopting a confidence level of 95%. RESULTS: A non-linear alteration for all variables was detected as a function of BMI. CONCLUSION: Results suggest that excessive weight might favour skin performance within certain limits, reflecting a particular adaptation of the skin to the weight gain and body contour.

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap.

Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.

Evaluating pharmaceutical waste disposal in pediatric units / Evaluación del descarte de resíduos de fármacos en unidades pediátricas / Avaliação do descarte de resíduos de medicamentos em unidades pediátricas

Abstract OBJECTIVE To verify the disposal of pharmaceutical waste performed in pediatric units. METHOD A descriptive and observational study conducted in a university hospital. The convenience sample consisted of pharmaceuticals discarded during the study period. Handling and disposal during preparation and administration were observed. Data collection took place at pre-established times and was performed using a pre-validated instrument. RESULTS 356 drugs disposals were identified (35.1% in the clinic, 31.8% in the intensive care unit, 23.8% in the surgical unit and 9.3% in the infectious diseases unit). The most discarded pharmacological classes were: 22.7% antimicrobials, 14.8% electrolytes, 14.6% analgesics/pain killers, 9.5% diuretics and 6.7% antiulcer agents. The most used means for disposal were: sharps’ disposable box with a yellow bag (30.8%), sink drain (28.9%), sharps’ box with orange bag (14.3%), and infectious waste/bin with a white bag (10.1%). No disposal was identified after drug administration. CONCLUSION A discussion of measures that can contribute to reducing (healthcare) waste volume with the intention of engaging reflective team performance and proper disposal is necessary.

Resumen OBJETIVO Verificar el descarte de los resíduos de fármacos realizado en unidades pediátricas. MÉTODO Estudio descriptivo y observacional, realizado en un hospital universitario. La muestra de conveniencia estuvo constituida de los fármacos descartados durante el período de estudio. Se observaron la manipulación y el descarte durante la preparación y la administración. La recolección de datos ocurrió en horarios prestablecidos y fue llevada a cabo mediante instrumento pre validado. RESULTADOS Se identificaron 356 descartes de fármacos (el 35,1% en la clínica, el 31,8% en la unidad de cuidados intensivos, el 23,8% en la quirúrgica y el 9,3% en la infectología). Las clases farmacológicas más descartadas fueron: el 22,7% de antimicrobianos, el 14,8% de electrolitos, el 14,6% de analgésicos, el 9,5% de diuréticos y el 6,7% de antiulcerosos. Medios más utilizados: caja desechable para punzocortante con bolsa amarilla (30,8%), rebosadero del lavabo (28,9%), caja de punzocortante con bolsa naranja (14,3%) y basurero infectante con bolsa blanca (10,1%). No se identificó descarte tras la administración de los medicamentos. CONCLUSIÓN Se hace necesaria la discusión de medidas que contribuyan a la reducción del volumen de resíduos a fin de involucrar la actuación reflexiva del equipo y el descarte adecuado.

Resumo OBJETIVO Verificar o descarte dos resíduos de medicamentos realizado em unidades pediátricas. MÉTODO Estudo descritivo e observacional, realizado em um hospital universitário. A amostra de conveniência foi constituída pelos medicamentos descartados durante o período de estudo. Observaram-se a manipulação e o descarte durante o preparo e a administração. A coleta dos dados ocorreu em horários preestabelecidos e realizada por meio de instrumento pré-validado. RESULTADOS Identificaram-se 356 descartes de medicamentos (35,1% na clínica, 31,8% na unidade de cuidados intensivos, 23,8% na cirúrgica e 9,3% na infectologia). As classes farmacológicas mais descartadas foram: 22,7% antimicrobianos, 14,8% eletrólitos, 14,6% analgésicos, 9,5% diuréticos e 6,7% antiulcerosos. Vias mais utilizadas: caixa descartável para perfurocortante com saco amarelo (30,8%), ralo da pia (28,9%), caixa de perfurocortante com saco laranja (14,3%) e lixeira infectante com saco branco (10,1%). Não foi identificado descarte após a administração dos fármacos. CONCLUSÃO Faz-se necessária a discussão de medidas que contribuam para a redução do volume de resíduos, com o intuito de engajar a atuação reflexiva da equipe e o descarte adequado.

Evaluating pharmaceutical waste disposal in pediatric units.

OBJECTIVE: To verify the disposal of pharmaceutical waste performed in pediatric units. METHOD: A descriptive and observational study conducted in a university hospital. The convenience sample consisted of pharmaceuticals discarded during the study period. Handling and disposal during preparation and administration were observed. Data collection took place at pre-established times and was performed using a pre-validated instrument. RESULTS: 356 drugs disposals were identified (35.1% in the clinic, 31.8% in the intensive care unit, 23.8% in the surgical unit and 9.3% in the infectious diseases unit). The most discarded pharmacological classes were: 22.7% antimicrobials, 14.8% electrolytes, 14.6% analgesics/pain killers, 9.5% diuretics and 6.7% antiulcer agents. The most used means for disposal were: sharps' disposable box with a yellow bag (30.8%), sink drain (28.9%), sharps' box with orange bag (14.3%), and infectious waste/bin with a white bag (10.1%). No disposal was identified after drug administration. CONCLUSION: A discussion of measures that can contribute to reducing (healthcare) waste volume with the intention of engaging reflective team performance and proper disposal is necessary. OBJETIVO: Verificar o descarte dos resíduos de medicamentos realizado em unidades pediátricas. MÉTODO: Estudo descritivo e observacional, realizado em um hospital universitário. A amostra de conveniência foi constituída pelos medicamentos descartados durante o período de estudo. Observaram-se a manipulação e o descarte durante o preparo e a administração. A coleta dos dados ocorreu em horários preestabelecidos e realizada por meio de instrumento pré-validado. RESULTADOS: Identificaram-se 356 descartes de medicamentos (35,1% na clínica, 31,8% na unidade de cuidados intensivos, 23,8% na cirúrgica e 9,3% na infectologia). As classes farmacológicas mais descartadas foram: 22,7% antimicrobianos, 14,8% eletrólitos, 14,6% analgésicos, 9,5% diuréticos e 6,7% antiulcerosos. Vias mais utilizadas: caixa descartável para perfurocortante com saco amarelo (30,8%), ralo da pia (28,9%), caixa de perfurocortante com saco laranja (14,3%) e lixeira infectante com saco branco (10,1%). Não foi identificado descarte após a administração dos fármacos. CONCLUSÃO: Faz-se necessária a discussão de medidas que contribuam para a redução do volume de resíduos, com o intuito de engajar a atuação reflexiva da equipe e o descarte adequado.

Defying standard criteria for digital replantation: A case series.

INTRODUCTION: There is much controversy regarding the current indications and contraindications for digital replantation. PRESENTATION OF CASE: Three patients with absolute contraindications for digital replantation according to classical criteria are presented (Case 1: multilevel amputation of the hand and fingers; Case 3: avulsion of the thumb; Case 4: index amputation proximal to the insertion of the flexor digitorum superficialis). In addition a patient with a very distal digital amputation (Case 2), whose indication for replantation is controversial is also presented. In all cases, the patients were replanted and showed good functional and aesthetical results. DISCUSSION: Most authors advocate that the classical indications for replantation have been validated by experience, are predicated on the potential for long-term function, and should be followed in most if not all cases. However, some surgeons have been adopting a more liberal attitude with good results. CONCLUSION: The clinical cases presented in this paper suggest that the standard criteria for digital replantation should not be followed rigidly but instead should be regarded as a general guide.

Abdominoplasty and thoraco-epigastric flaps for large anterior trunk defects after dermatofibrosarcoma protuberans wide resection: Two illustrative cases.

INTRODUCTION: Excision of large dermatofibrosarcoma protuberans in the anterior aspect of the trunk often results in large surgical defects that frequently dictate the need for microsurgical reconstruction. However, this option is not always available. PRESENTATION OF CASE: The authors describe two patients with very large anterior trunk dermatofibrosarcoma protuberans: one in the epigastric region and the other in the hypogastric region. In the patient with the hypogastric tumor, a classical abdominoplasty flap associated with umbilical transposition was used to cover the skin defect after muscle and fascial plication, and placement of a polypropylene mesh. In the patient with the epigastric tumor, a synthetic mesh was also placed, and the skin and subcutaneous defect was reconstructed with a reverse abdominoplasty flap and two thoraco-epigastric flaps. In both cases, complete closure was possible without immediate or late complications. DISCUSSION: The local options described in this paper present several potential advantages compared to microsurgical reconstruction, namely they are easier and faster to perform and teach; they provide a good skin color and texture match; they are not associated with distant donor site morbidity; follow-up is usually less cumbersome; the post-operative hospital stay tends to be shorter; they are less costly; they are less prone to complete failure. CONCLUSION: The authors believe that these two patients clearly show that local flaps, although frequently neglected, continue to be valid options for reconstructing large anterior trunk defects, even in the current era of microsurgery enthusiasm.

Macromastia: a risk factor for carpal tunnel syndrome?

PURPOSE: To evaluate the prevalence of carpal tunnel syndrome (CTS) in a cohort of women with macromastia and to assess the evolution of the CTS signs and symptoms after breast surgery. POPULATION: A series of 123 women was evaluated. CTS was defined by co-existence of symptoms, two physical findings and electrophysiological evaluation. One year after reduction mammaplasty, the 22 patients who had been diagnosed CTS were re-evaluated. RESULTS: CTS group of women had a mean age of 38.8 years, mean body mass index of 28.5 kg/m(2) and mean breast size of 35.9 cm. Age and nipple-to-sternal notch distance were statistically significantly associated with CTS (p = 0.001 and p = 0.001, respectively). A year after surgery 15 patients were re-assessed: nine patients reported absence or improvement of CTS symptoms while six patients reported symptoms persistence or worsening. CONCLUSION: Age, breast size, but not body mass index, have a positive correlation with the CTS.

[Stevens-Johnson syndrome and toxic epidermal necrolysis: a 15-year retrospective study]. / Síndroma de Stevens-Johnson e necrólise tóxica epidérmica: um estudo retrospectivo de 15 anos.

Stevens-Johnson Syndrome (SJS), Overlap Syndrome (OS) and Toxic Epidermal Necrosis (TEN) are rare medical emergencies associated with a high morbidity and mortality. The literature on the characteristics of these diseases in Portugal is scarce. A retrospective study was conducted based on the clinical notes of the 20 patients admitted to São José Burn Unit in the previous 15 years with the diagnosis of SJS, OS or TEN. Most patients had TEN (65%), followed by OS (25%) and SJS (10%). Average age was 57,1 ± 19,0 years. The mean duration of stay in the Burn Unit was 12,6 ± 7,8 days. Mortality was 50%, being significantly higher than the 16,4% overall mortality in the general Burn Unit population in the same period (p < 0,01). The mean surface area involved was 43,9 ± 28,6 %. Allopurinol was the causal agent most frequently implicated (35%) followed by UV light exposure (15%). Fourteen patients (70%) were treated with steroids in the first days, whereas six patients were treated conservatively (30%). Mortality was inferior in the patients treated with steroids (42,8 vs. 66,7%), even though this difference did not reach statistical significance. Infection rates were not significantly different between the two groups. SCORTEN score proved to be a good predictor of mortality. Further studies are needed to reduce mortality in these diseases.

Cancer de ovario no Centro de Referencia da Saude da Mulher: epidemiologia / Ovarian cancer in the Woman's Health Reference Center: epidemiology

Registrar fatores epidemiologicos de raca, paridade, tabagismo, tipagem sanguinea, cirurgia previa e...

Tumores bordeline de ovario / Bordeline ovarian tumors

Analisar os dados epidemiologicos, estadiamento cirurgico e prognostico dos tumores Bordeline de ovario. No periodo de 1992 a 1996, 19 pacientes foram...

Inversöes térmicas e a relaçäo com os sistemas atmosféricos e a poluiçäo do ar na regiäo da Grande Säo Paulo e de Cubatäo / Inversions thermal and the relation of atmospheric system and air pollution in the Great Säo Paulo and Cubatäo

Analisam-se os dados de inversöes térmicas, em determinados períodos, para a regiäo da Grande Säo Paulo e para a Regiäo de Cubatäo. Estabelecem-se correlaçöes entre alguns parâmetros que caracterizam tais inversöes e a concentraçäo de material particulado. Além disso estuda-se a influência dos sistemas atmosféricos sobre a dispersäo dos poluentes.