Control of pain in patients undergoing gingivectomy and gingivoplasty with low intensity laser / Controle da dor em pacientes submetidos a gengivectomia e gengivoplastia com laser de baixa intensidade

Objective: To evaluate the efficiency of Laser Low Intensity (LLI) in pain control and reduction of analgesic consumption after gingivectomy and gingivoplasty. Methods: Twenty patients with gingival hyperplasia were randomly divided into two groups with 10 subjects each. In the test group it was applied after gingivectomy / gingivaplasty, low intensity laser in the operative wound and prescription only in case of pain, while in the control group only analgesia was performed in case of pain. Results: The laser was applied at 3 points in the region of periodontal surgery. The irradiation was performed in a single session, using diode laser (808 nm, 100nW, 100J / cm², 30 s). Pain was assessed by Visual Analogue Scale, as well as the amount of analgesics ingested by the patient. In the test group, 80% of the individuals did not report postoperative pain, those who reported symptomatology, were identified only as mild discomfort. The analysis of the data showed a statistically significant difference when compared to the higher postoperative pain between the groups (p = 0.026). However, there was no difference in the evaluation of analgesic use. Conclusion: Based on our results, it is suggested that LLI therapy decreases the intensity of postoperative pain in periodontal surgeries (AU)

Hyperparathyroidism in pregnancy and 99mTc-MIBI scintigraphy.

INTRODUCTION: Primary hyperparathyroidism (PHPT) during pregnancy can be responsible for serious maternal and foetal complications and should be treated by elective low-risk, minimally invasive surgery. Preoperative assessment of hyperfunctioning parathyroid glands is classically based on high-resolution neck ultrasound (US) and 99mTc-sestamibi/123I scintigraphy. However, administration of any radiopharmaceutical during pregnancy must be limited and justified and US alone may be sufficient to localize an abnormal parathyroid gland. CASE REPORT: We report the case of a 4-month pregnant woman with severe primary hyperparathyroidism, in whom US failed to localize the abnormal parathyroid gland. 99mTc-sestamibi scintigraphy was performed in preference to 18-fluorocholine (FCH)-PET/CT on the basis of a multidisciplinary decision. As 99mTc-MIBI demonstrated an hyperfunctioning right inferior parathyroid, 123I was not administered. A large right paravertebral parathyroid adenoma was successfully removed, as confirmed by decreased postoperative serum parathyroid hormone and calcium levels. The eutrophic newborn infant was delivered at term, with normal serum calcium and TSH levels. DISCUSSION: In pregnant women with primary hyperparathyroidism, US alone may be sufficient when it localizes the abnormal parathyroid gland, allowing elective low-risk minimally invasive surgery. Otherwise, a multidisciplinary approach is mandatory to select the radiopharmaceutical that can be safely used to identify the hyperfunctioning parathyroid gland with minimal risks for the foetus.

The influence of Citrate or PEG coating on silver nanoparticle toxicity to a human keratinocyte cell line.

Surface coating of silver nanoparticles may influence their toxicity, in a way yet to decipher. In this study, human keratinocytes (HaCaT cells) were exposed for 24 and 48h to well-characterized 30nm AgNPs coated either with citrate (Cit30 AgNPs) or with poly(ethylene glycol) (PEG30 AgNPs), and assessed for cell viability, reactive oxygen species (ROS), cytokine release, apoptosis and cell cycle dynamics. The results showed that Cit30 AgNPs and PEG30 AgNPs decreased cell proliferation and viability, the former being more cytotoxic. The coating molecules per se were not cytotoxic. Moreover, Ag(+) release and ROS production were similar for both AgNP types. Cit30 AgNPs clearly induced apoptotic death, while cells exposed to PEG30 AgNPs appeared to be at an earlier phase of apoptosis, supported by changes in BAX, BCL2 and CASP-3 expressions. Concerning the impact on cell cycle dynamics, both Cit30 and PEG30 AgNPs affected cell cycle regulation of HaCaT cells, but, again, citrate-coating induced more drastic effects, showing earlier downregulation of cyclin B1 gene and cellular arrest at the G2 phase. Overall, this study has shown that the surface coating of AgNPs influences their toxicity by differently regulating cell-cycle and cell death mechanisms.

Correction of long term joint contractures of the hand by distraction. A case report.

Joint contractures are a common complication of hand trauma. The conventional treatment consists of arthrolysis, tenolysis and occasionally arthrodesis. Frequently, this does not achieve a good result, particularly when there has been a long delay in presentation. Progressive lengthening of a joint by distraction (joint distraction) allows the release of joint contractures even in cases of failure of traditional methods. We present a case of a delayed (20 years) work related traumatic flexion deformity of the PIP joint of the left index and middle fingers. This was the result of a complete division of both flexor tendons of both fingers. The range of movements, both active and passive, was limited to 90/100 degrees in the index finger and 95/100 degrees in the middle finger. Following joint distraction using our lengthening device (Antãotrade mark, Portugal) the patient was able to achieve an active and passive range of movements of 10/100 degrees for the PIP joint of the index finger and 40/100 degrees of the middle. This clinical case shows the simplicity and application of our technique for the correction of joint contractures.

Síndrome de brida amniótica: a propósito de un caso clínico / Amniotic band syndrome: case report

El síndrome de brida amniótica es una entidad rara que incluye un amplio espectro de anomalías, no existiendo dos fetos afectados por defectos exactamente idénticos.A pesar de que es conocido desde hace más de 3 siglos, no hay una definición precisa o una hipótesis clara relativa a su patogenia. Se describe un caso clínico en el que, tras un examen ecográfico fetal normal en el primer trimestre, se detecta una anomalía en la porción distal del miembro inferior izquierdo tras la ecografía del segundo trimestre y posteriormente un labio leporino. El estudio amnatomopatológico posnatal demostró la presencia del síndrome de brida amniótica. El análisis de este caso permitió sugerir datos a favor de una de las teorías patogénicas (AU)

[Revascularization and reimplantation of the upper extremity. 15-year-experience with 114 cases]. / Revascularizações e reimplantações do membro superior. 15 Anos de experiência com 114 casos.

Progress in micro or macro replantation has resulted in higher survival rates of formerly amputated parts. More amputated digits or limbs survive because the time of ischemia can be exceeded by using cold storage or perfusion. Homo or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation. A total of 114 microvascular extremity replantations/revascularizations with a survival rate of 77.2% were followed for an average of 15 years.

[Free flaps in the reconstruction of head and neck. Clinical experience]. / Retaehos livres na reconstrução da cabeça e pescoço. Experiência clínica.

The reconstruction of head and neck defects, due to trauma, tumor resection or other, begins with a careful assessment of the patient and the respective defect. Ideally, it ends with the successful reconstructive procedure that optimally restores form and function to the patient. Free flaps have often been used as a last resort reconstructive option in the head and neck because of the need for added technical skill, a longer operating time and a perception of poor reliability. This study reviews our experience with forty-eight patients submitted to microvascular reconstructive procedures. Twelve different kinds of free flaps have been involved as the preferred choice for free flap reconstruction of a specific defect of the head and neck. The latissimus dorsi flap was used for scalp and skull reconstruction, whereas the serratus anterior or rectus abdominis free flaps were used for the reconstruction of complex defects of the middle third of the face. The radial forearm flap and the free jejunal transfer have become the preferred choices for intraoral and pharyngo-esophageal reconstruction, respectively. Good results were obtained with both functional and social rehabilitation. There were three flap losses probably due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each free flap are discussed.

[Cutaneous reconstruction at the leg and foot level. Experience in 277 clinical cases]. / Reconstrução cutânea ao nivel da perna e do pe. Experiência em 227 casos clínicos.

The authors present their clinical experience of leg and foot reconstruction with 227 clinical cases. Based on these cases the authors analyse the use of 18 musculocutaneous, 53 axial, 72 septocutaneous and 84 free flaps, totalling 29 different kinds of flaps performed. Although no definitive conclusions can be drawn about which are the best flaps for foot and leg reconstruction, the preferential options are pointed out.

Avaliaçäo dos níveis séricos de 17-alfa-OH progesterona e androstenediona durante o ciclo estral em marräs (Sus scrofa domestica - Linnaeus, 1758) / Progesterone -17alfa-OH and androstenediona serum levels evaluation during the oestrus cycle in guilts (Sus scrofa domestica - Linnaeus, 1758)

No presente trabalho, foram utilizadas 21 fêmeas suínas, virgens, sexualmente aptas, criadas e mantidas sob condiçöes industriais, para observaçäo dos perfis hormonais séricos de 17-alfa-OH progesterona e androstenediona, durante o ciclo estral. As colheitas de sangue foram efetuadas sempre no mesmo intervalo, entre 8 e 10 horas. Cada animal foi submetido a 14 punçöes venosas, distribuidas nos dias zero, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 21, 22 e 23 do ciclo estral. Considerou-se o dia zero como o primeiro dia da fase estral, e o 23º dia como o primeiro do estro subseqüente. Os ensaios para dosagens hormonais foram executados utilizando-se a técnica de radioimunoensaio (RIE) em fase sólida e para isso foi empregado conjunto de reagentes comerciais (Coat-A-Count). Para o hormônio 17-(alfa-OH progesterona, foram encontrados valores médios que variaram entre 0,18 e 2,7 ng/ml e para o hormônio androstenediona esses valores oscilaram entre 0,08 e 0,24 ng/ml

A new approach in axillary hidradenitis treatment: the scapular island flap.

The scapular island flap technique has been used in the treatment of seven cases of axillary hidradenitis suppurativa. This flap, providing a smooth skin surface with good elastic properties, easily covers the axilla and permits the cutaneous reconstruction of the involved axillary tissue excision with satisfying aesthetic, functional results and a rapid local cicatrization. The donor site was closed by primary suture.

[Utilization of forearm island flaps in reconstructive surgery of the hand. Which one is the best option?]. / A utilização de retalhos antebraquiais em ilha na cirurgia reconstrutiva da mão. Qual a melhor opção?

The authors report their clinical experience after seventy-six forearm island flaps, and analyse the different possible forearm flap options in hand reconstructions. The different flaps-based on the radial, ulnar, interosseous and septocutaneous ulnar vessels-are compared in what, concerns the importance of the sacrificed artery, adverse sequelae of the donor area and their versatility to close large skin defects as well as their capacity to reach distal areas of the hand. Their ability to provide sensate coverage and to replace bone and tendons is also compared.

The distally based posterior tibial myofasciocutaneous island flap in foot reconstruction.

We report 3 cases of foot reconstruction with a distally based posterior tibial island flap incorporating both muscle and a fasciocutaneous part. The medial half of the soleus muscle which is included in the flap is well vascularised and can be used to fill cavities, for example after debridement of chronically infected wounds.

Halux pulp composite graft in nipple reconstruction.

We present a nipple reconstruction method that uses a composite graft of a constant halux's prominence. This technique, which has advantages over nipple reconstruction with toe pulp free grafts, has produced good results.

[The treatment of burn patients. What are the prospects for the northern area of Portugal?]. / Tratamento de queimados. Que perspectivas para a zona norte de Portugal?

The AA studied the distribution of age, sex, aetiology, and destiny of the 173 in-patients at the S. João Hospital (Central hospital that has no Burn Unit). In what concerns age, 38.1% are children less than 10 years old; the male/female ratio was 1.7:1. The fire and scalds are the most important aetiology. These findings are similar to those found in other countries (except in the Arabian Countries). Of these 99 burn patients have been treated in S. João Hospital, 71 patients were sent to the Burn Unit of Prelada Hospital and 3 to the Burn Unit of Coimbra University Hospital. These findings were compared to a Burn Unit of a Spanish Hospital (Alicante) which has 18 beds for adults and children, normally interning 132 patients per year. As the WHO suggest one special bed per 30,000 persons, we should be expected to have at least 110 beds for burn patients (we only have 9 beds at Prelada Hospital), the AA suggest the establishment of a Burn Unit at S. João Hospital, also due to the fact that is the only hospital that has a permanent emergency care for Plastic Surgery.