Influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures.

BACKGROUND: Preoperative showering with antiseptic skin cleansers is common in elective operations, although the value of this procedure in reducing surgical wound infections has not been established. The authors designed a prospective study to assess the influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures. METHODS: Patients older than 18 years scheduled for elective and clean plastic surgery procedures on the thorax or abdomen were assigned randomly to the povidone-iodine group (n = 57) or to a control group (n = 57). Patients allocated to the povidone-iodine group took a shower with liquid detergent-based povidone-iodine 10% 2 hours before surgery. For the control group, no special instructions for showering were implemented before surgery. Quantitative skin cultures were obtained just before the preoperative scrub in the operating room. Samples were plated on hypertonic mannitol agar, blood agar, Sabouraud agar with chloramphenicol, and eosin-methylene blue agar. Samples were collected and processed, and results were assessed by blinded investigators. RESULTS: Staphylococcal skin colonization was significantly lower in the povidone-iodine group (p < 0.001). No microorganism growth was observed on 33 percent of the postshower skin cultures from patients in the povidone-iodine shower group compared with 0 percent of the cultures from patients in the control group. Colonies of fungi and enterobacteria were recovered in small amounts in both groups, and povidone-iodine showers did not significantly reduce skin colonization by these microorganisms. CONCLUSION: Single preoperative povidone-iodine showers are effective in reducing staphylococcal skin colonization before elective clean plastic surgical procedures on the thorax and abdomen.

Mastectomia: impacto auto-estima das pacientes / Mastectomy: impact in patients' self-esteem

O tratamento do câncer de mama provoca seqüelas físicas e psicológicas permanentes, as quais estão relacionadas ao procedimento cirúrgico. Mulheres submetidas à mastectomia radical modificada podem ter valores emocionais e afetivos alterados. Foi avaliada, por meio de um instrumento validado no Brasil, a auto-estima de pacientes submetidas à mastectomia por câncer de mama. Foram avaliadas 40 pacientes submetidas à mastectomia havia mais de 1 ano. Elas passaram por entrevistas com questionários específicos para auto-estima e para dados sociodemográficos. Outro grupo de 40 mulheres não portadoras de neoplasia mamária e um terceiro grupo com 15 mulheres submetidas a tratamento cirúrgico conservador foram avaliados como controle. Obtiveram-se os valores de p mediante os testes de Kruskal-Wallis, Mann-Whitney e qui-quadrado. Na Escala de Auto-estima de Rosenberg, 27% de todas as pacientes estudadas apresentaram escores superiores a 10, e a média total do grupo mastectomizado foi de 7,9 no grupo de cirurgia conservadora a média foi de 9,8 e no grupo-controle, 4. Esses resultados confirmam a baixa auto-estima das pacientes quando comparadas às do grupo sem neoplasia (p = 0,0001). Quando a mastectomia e a cirurgia conservadora foram correlacionadas por meio do teste de comparações múltiplas, não houve significância estatística. A conclusão foi que a perda da mama, ou parte dela, promove um impacto negativo na auto-estima das pacientes.

The treatment of breast cancer causes permanent physical and psychological sequelae, which are related to the surgical procedure. Women who underwent modified radical mastectomy may have altered affective and emotional values. Was evaluated using a validated instrument in Brazil, self-esteem of patients undergoing mastectomy for breast cancer. We evaluated 40 patients who underwent mastectomy had more than 1 year. They went through interviews with specific questionnaires for self-esteem and demographic data. Another group of 40 women not suffering from breast cancer and a third group with 15 women undergoing conservative surgery were evaluated as controls. We obtained p values by the Kruskal-Wallis, Mann-Whitney and chi-square. Scale Rosenberg Self-esteem, 27% of all patients studied had scores above 10, and the average total mastectomy group was 7.9 in the group of conservative surgery the average was 9.8 and in the control group 4. These results confirm the low self-esteem of patients when compared to those of patients without cancer (p = 0.0001). When mastectomy and conservative surgery were correlated through the test of multiple comparisons, no statistical significance. The conclusion was that the loss of the breast, or part of it promotes a negative impact on self-esteem of patients.

Estudo morfométrico do fígado de ratos submetidos a doses supra fisiológicas de tiroxina / Liver morphological study of rats submitted to supra physiologic doses of thyroxine

Tireotoxicose é o estado hipermatabólico causado pelo excesso de hormônios tireoidianos circulantes, que exercem sua funçäo praticamente em todos os tecidos. No presente estudo avaliou-se, por métodos estereológicos, o fígado de ratos tratados com doses supra fisiológicas de T4 (20µg/10g de peso de corporal) durante 20 dias. Os níveis séricos de T4 desses animais estavam significantemente elevados (p=0,02). Houve tendência a perda de peso corporal dos animais tratados em relaçäo ao grupo controle (p=0,10), enquanto o peso do fígado teve aumento, embora näo significativo (p=0,08). A proporçäo do parênquima lobular foi maior (p=0,05) e a fraçäo volumétrica do parênquima lobular ocupada pelas células de Kupffer foi significantemente menor (p=0,05) nos animais hipertireóideos que nos controles. Houve depleçäo que nos controles. Houve depleçäo significativa do glicogênio hepático na parênquima lobular, em relaçäo ao grupo controle (p=0,008). Concluiu-se, entäo, que a tireotoxicose provoca hiperplasia e/ou hipertrofia dos hepatócitos, com reduçäo das reservas energéticas.