Evolución hacia la era digital de la cirugía ortognática: experiencia en un centro universitario / Evolution towards the digital era of orthognatic surgery: experience in a university center

Resumen Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y Método: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero de 2011 a agosto de 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% maloclusión clase III (n = 14), 28% maloclusión clase II (n = 6) y 5% desviación mandibular (n = 1). La planificación prequirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo > III fue 4,8% (n = 1). Conclusiones: En nuestra experiencia, las técnicas de cirugía ortognática son seguras. Las complicaciones de la serie fueron escasas y bien toleradas por los pacientes. Durante los últimos años y, de acuerdo a los avances tecnológicos, la incorporación de la planificación quirúrgica virtual 3D favoreció el desarrollo de la cirugía ortognática en nuestro centro.

Introduction: Technological advances have been incorporated into cranio-maxillo-facial surgery changing the clinical practice of surgeons. Aim: The aim of this article is to describe our experience in orthognatic surgery in the last 9-years, with the incorporation of 3D cephalometry. Materials and Method: A retrospective chart review was performed from January 2011 to August 2018 on patients undergoing Orthognatic Surgery. Demographic and surgical data, type of surgical planning, complications and long-term results were recorded. Results: A total of 21 patients underwent orthognatic surgery. Average age was 28 years (DE 8.1), 11 men (52.3%) and 10 women (47.61%). The principal surgeries performed were: 16 (76%) bimaxillary, 3 maxillary advancement surgery 3 (14%) and bilateral sagital split osteotomy 2 (10%). Ethiologies were: 14 patients (this 67%) with malocclusion class III, 6 patients (28%) with malocussion class II, and 1 patient (5%) with mandibular deviation. Virtual 3D presurgical planning was used in 11 patients (52%). The total of complications Clavien-Dindo > III was 4.8% (n = 1). None patient required reoperation. Satisfaction rate with the procedure was high. Conclusions: Based on our experience, orthognatic surgery techniques are safe. The complication rate was lower and well tolerated by patients. The introduction of virtual planning provided a better scenario to develop maxillo-facial surgery.

Upper Body Lift: serie de casos en un hospital clínico universitario entre los años 2013-2016: descripción de la técnica quirúrgica / Upper Body Lift: cases series from a clinical hospital between years 2013-2016, and description of the surgical technique

Introducción: En pacientes obesos la pérdida masiva de peso presenta efectos beneficiosos para la salud, sin embargo, suelen cursar con un excedente cutáneo que genera problemas físicos, afectando la calidad de vida. En casos severos las técnicas convencionales de contorno corporal, no permiten dar solución a grandes alteraciones, siendo necesario utilizar procedimientos más extensos. El Upper Body Lift es una técnica que ofrece un manejo integral del tronco superior. Objetivos: Describir una serie de casos de pacientes sometidos a Upper Body Lift y presentar la técnica quirúrgica. Material y Método: Serie de casos prospectiva entre enero del 2013 y junio de 2016, en un hospital clínico universitario. Se excluyó a pacientes con información incompleta u operados en otro centro. Se utilizó estadística descriptiva. Resultados: 8 pacientes manejados mediante Upper Body Lift, con edad 39,75 ± 9,37 años, 6 (75%) mujeres. Con pérdida de peso de 36,75 ± 9,11 Kg, alcanzando un IMC de 25,97 ± 2,35 Kg/m2. En hombres la región pectoral se manejó con liposucción y posterior injerto de pezón, en mujeres se realizó mastopexia sin implantes en 5 (83,33%). No se observó complicación mayor y en 4 casos (50%) se presentó complicación menor durante posoperatorio. Discusión: Esta serie presenta resultados similares a lo descrito por otros autores. Conclusiones: El Upper Body Lift es un procedimiento que ofrece un manejo integral y con buenos resultados, en pacientes con gran excedente cutáneo en tronco superior.

Introduction: Obese patients gets beneficial health effects with the massive weight loss, however they develop excessive redundant skin and become physical problems affecting their quality of life. In severe cases, the conventional body contouring techniques are not able to solve this large alterations, being necessary to use more extensive procedures. The Upper Body Lift is a technique that offers integral management of the upper trunk. Objectives: To describe a case series of patients submitted to Upper Body Lift and present the surgical technique. Materials and Methods: Prospective case series of patients with Upper Body Lift between January 2013 and June 2016 in a clinical hospital. Patients with incomplete information or operated in another center were excluded. Descriptive statistics was used. Results: 8 patients were included, age 39.75 ± 9.37 years, 6 (75%) women. Prior to the contouring surgery they lose 36.75 ± 9.11 kg, reaching a BMI of 25.97 ± 2.35 kg/m2. In men the chest region was managed with liposuction and subsequent nipple graft, in women mastopexy without implants was performed in 5. No major complications was observed, 4 had minor complications during the postoperative period. Discussion: This series presents similar results to those described by other authors. Conclusions: The Upper Body Lift offers comprehensive and successful management in patients with large upper body disturbance.

Cirugía de contorno corporal en pacientes con pérdida masiva de peso en un hospital universitario: estudio de frecuencias / Body contouring surgery in patients with massive weight loss in a university hospital: study of frequencies

Resumen Introducción La pérdida masiva de peso en obesos, presenta efectos beneficiosos para la salud, sin embargo esto pacientes suelen cursar exceso de adiposidad y piel redundante, generando problemas físicos y psicológicos. La cirugía de contorno corporal busca modificar el contorno del cuerpo para lograr una armonía estética. Existen pocos estudios a nivel nacional que aborden la epidemiología de la cirugía de contorno corporal en pacientes con baja masiva de peso. Objetivos Describir una serie de pacientes con baja masiva de peso sometidos a cirugía de contorno corporal y sus complicaciones. Materiales Métodos Serie de casos prospectiva, de pacientes sometidos a cirugía de contorno corporal con antecedente de baja masiva de peso, entre enero de 2013 y junio de 2016, en un hospital universitario. Se excluyó a pacientes con información incompleta u operados en otro Centro. Utilizando estadística descriptiva. Resultados 120 pacientes con cirugía de contorno corporal y baja masiva de peso, con edad de 38,4 ± 10,4 años, 105 (87,5%) mujeres. La pérdida de peso fue en 110 (91.67%) con cirugía bariátrica. Alcanzando un IMC de 26,56 ± 3,26 Kg/m2, con una pérdida de peso 39,06 ± 14,1 7 Kg. Las cirugías más frecuentes fueron la abdominoplastía estándar 79 (65,83%) y la mastopexia con implantes 21 (17,5%). Uno (0,83%) presentó complicación mayor y 33 (27,5%) alguna complicación menor durante posoperatorio. Discusión Esta serie presenta resultados similares a lo descrito por otros autores, observándose una menor tasa de complicaciones en posoperatorio. Conclusiones La cirugía de contorno corporal en este grupo de pacientes es un procedimiento seguro, que ofrece solución a las secuelas corporales pospérdida masiva de peso según nuestra experiencia.

Introduction Massive weight loss in obese, has beneficial health effects, however patients usually presents excessive adiposity and redundant skin, that generates physical and psychological problems. The body contouring surgery helps to modify the contour of the body to achieve aesthetic harmony. There are few national studies that describe the epidemiology of body contour surgery in patients with massive weight loss. Objectives Describes a series of patients with massive weight loss with body contour surgery and its complications. Materials and Methods A prospective series of patients with body contouring surgery with a history of low body mass, between January 2013 and June 2016, in a university hospital. Patients with incomplete information or operated at another center were excluded. Descriptive statistics was used. Results 120 patients with body contouring surgery and low weight mass were included. Age of 38.4 ± 10.4 years, 105 (87.5%) were women. 110 (91.67%) were bariatric patients. BMI of 26.56 ± 3.26 kg/m2 and a weight loss of 39.06 ± 14.17 Kg were reached previous the contouring surgery. The most frequent surgery was the standard abdominoplasty 79 (65.83%), followed by mastopexy with implants 21 (17.5%). 1 (0.83%) presented major complication and 33 (27.5%) had a minor complication during the postoperative period. Discussion This series presents results similar to other authors, with a lower rate of postoperative complications. Conclusion The Body contouring surgery are safe procedures, which provides a solution to the bodily sequels after massive weight loss according to our experience.

Calcium nitrate addition to control the internal load of phosphorus from sediments of a tropical eutrophic reservoir: microcosm experiments.

The main objective of this study was to perform laboratory experiments on calcium nitrate addition to sediments of a tropical eutrophic urban reservoir (Ibirité reservoir, SE Brazil) to immobilize the reactive soluble phosphorus (RSP) and to evaluate possible geochemical changes and toxic effects caused by this treatment. Reductions of 75 and 89% in the concentration of RSP were observed in the water column and interstitial water, respectively, after 145 days of nitrate addition. The nitrate application increased the rate of autotrophic denitrification, causing a consumption of 98% of the added nitrate and oxidation of 99% of the acid volatile sulfide. As a consequence, there were increases in the sulfate and iron (II) concentrations in the sediment interstitial water and water column, as well as changes in the copper speciation in the sediments. Toxicity tests initially indicated that the high concentrations of nitrate and nitrite in the sediment interstitial water (up to 2300 mg L(-1) and 260 mg L(-1), respectively) were the major cause of mortality of Ceriodaphnia silvestrii and Chironomus xanthus. However, at the end of the experiment, the sediment toxicity was completely removed and a reduction in the 48 h-EC50 of the water was also observed. Based on these results we can say that calcium nitrate treatment proved to be a valuable tool in remediation of eutrophic aquatic ecosystems leading to conditions that can support a great diversity of organisms after a restoration period.

Assessment of the acute toxicity of eutrophic sediments after the addition of calcium nitrate (Ibirité reservoir, Minas Gerais-SE Brazil): initial laboratory experiments / Toxicidade aguda de sedimentos eutrofizados (Represa Ibirité, Minas Gerais-SE, Brasil) após adição de nitrato de cálcio: experimentos iniciais de laboratório

This study evaluated the acute toxicity of sediment in a eutrophic reservoir after remediation with a calcium nitrate solution to retain phosphorus. The study involved microcosms of surface sediments and water from the sediment-water interface in the Ibirité reservoir. This reservoir, located in the vicinity of metropolitan Belo Horizonte (Minas Gerais, SE Brazil), is a water body that receives treated effluents from an oil refinery (REGAP-Petrobras), as well as high loads of untreated urban effluents from the city of Ibirité and surrounding areas and industrial effluents from a major industrial park. Incubation times of the treatment experiments were: t = 0, t = 5, t = 10, t = 25, t = 50, t = 85 and t = 135 days. One control microcosm and three treated microcosms were analysed in each time interval. Acute toxicity of water samples was assessed with Ceriodaphnia silvestrii Daday, 1902 and that of bulk sediment samples with Chironomus xanthus Rempel, 1939. Toxicity tests were carried out concomitantly with chemical analyses of dissolved inorganic nitrogen species (ammonia, nitrate and nitrite), sulfate and metals in the water samples of the microcosms. Acid volatile sulfides (AVS), simultaneously extracted metal (SEM) and potentially bioavailable metal were analyzed in bulk sediment samples. Neither of the tested organisms showed toxicity in the control microcosm samples. The water column of the treated microcosm showed toxicity to C. silvestrii, starting at t = 10 days, while the sediment pore water toxicity started at t = 0 day. However, toxicity was found to decline from t = 85 days to t = 135 days. Sediments showed toxicity to C. xanthus during the entire experiment, except at the longest incubation time (t = 135 days). The overall results indicate that nitrate, which reached concentrations exceeding 1,200 mg N-NO3- L-¹ in the sediment pore water of the treated microcosms, was most probably responsible for the toxicity of the samples. Although the calcium nitrate technology proved effective in retaining phosphorus, promoting sediment oxidation via denitrification, from the ecotoxicological standpoint and under the experimental conditions of this study, the application of nitrate for remediation of the sediments in the Ibirité reservoir did not prove effective up to a period of 135 days of incubation. However, we presume that after longer periods of incubation, treated sediments may recover their ability to sustain a benthic community. More advanced experiments are planned involving longer incubation times, thus extending the denitrification process, which may lead to a higher phosphorus retention capacity and to more complete abatement of sediment toxicity.

O presente trabalho visou à avaliação da toxicidade aguda da aplicação de solução de nitrato de cálcio, como procedimento para remediação dos sedimentos de um reservatório eutrofizado com vistas à retenção de fósforo. O estudo foi realizado através de microcosmos com sedimento e amostras de interface sedimento-água da Represa Ibirité. A represa, situada na região metropolitana de Belo Horizonte (Minas Gerais, Brasil), é corpo receptor de efluentes tratados de refinaria de petróleo (REGAP-Petrobras), de altas cargas de esgoto sanitário não tratado da cidade de Ibirité e áreas vizinhas, e de efluentes industriais de importante parque industrial. Os tempos de incubação dos experimentos foram: t = 0, t = 5; t = 10; t = 25; t = 50; t = 85; e t = 135 dias. Em cada um deles, foram analisadas amostras de um microcosmo-controle e três microcosmos-tratamento. A Ceriodaphnia silvestrii Daday, 1902 foi o organismo utilizado para avaliação da toxicidade aguda das amostras de água, enquanto que o Chironomus xanthus Rempel, 1939 foi empregado para a avaliação do sedimento integral. Paralelamente aos testes de toxicidade, foram realizadas análises químicas da série nitrogenada (amônia, nitrato e nitrito), sulfato, e metais nas amostras de água. Nos sedimentos foram analisados os sulfetos volatilizáveis por acidificação (SVA), metais extraídos simultaneamente (MES) e metais potencialmente biodisponíveis. Tanto as amostras de água como dos sedimentos totais dos microcosmos-controle não se mostraram tóxicos aos organismos testados. As amostras de água de interface sedimento-água dos micorocosmos-tratamento foram tóxicas para a C. silvestrii desde o tempo t = 10 dias e as amostras de águas intersticiais, desde o período t = 0. No entanto, foi notada uma diminuição da toxicidade do tempo t = 85 para t = 135 dias. Para o organismo C. xanthus, os sedimentos em tratamento se mostraram tóxicos durante todo o experimento, exceto no tempo t = 135 dias. Os resultados mostraram que o nitrato, com concentração superior a 1.200 mg N-NO3- L-¹ nas amostras de água intersticial dos sedimentos dos microcosmos-tratamentos, é a causa mais provável da toxicidade das amostras. Embora a tecnologia de adição de nitrato tenha se mostrado eficaz na retenção de fósforo nos sedimentos, pois causa a oxidação dos sedimentos através do incremento substancialmente da taxa de desnitrificaçao, do ponto de vista ecotoxicológico e para as condições experimentais deste trabalho, a aplicação do nitrato como forma de intervenção para remediação dos sedimentos da Represa Ibirité não se mostrou adequada até o período de 135 dias. Após este período, presume-se que os sedimentos tratados possam recuperar a capacidade de sustentar uma comunidade bentônica. Experimentos mais avançados foram planejados, visando um tempo de incubação mais estendido, que, por conseguinte, pode levar a uma maior capacidade de retenção de P e ao abatimento total da toxicidade dos sedimentos e da água, devido a um maior avanço do processo da desnitrificação.

Report on the study of home water meters in Osaka City

Se describe la evolución en la instalación de medidores de agua domicilarios en Osaka desde sus inicios hasta los medidiores automáticos actuales. Se presentan además datos sobre consumo de agua desde 1908 a 1912; y distintos tipos de medidores automáticos señalando sus características principales

[Energy metabolism and experimental malignant tumor development]. / Metabolismo energético e desenvolvimento de tumor malígno experimental.

Weight loss in cancer can be attributed to anorexia and/or increased energy expenditure. In order to understand the contribution of these variables, 36 Wistar rats fed regular diet were randomly distributed in 3 groups: T (12) bearing Walker 256 carcinosarcoma; PF (12) pair fed with T group and C (12) as control group; another group--D (12)--in which rats were fed with low protein (1%) diet. Caloric intake, body and tumor weight were measured daily. Indirect calorimetry was done sequentially each 4 days. After 2 weeks of tumor growth there was significant reduction of caloric intake and carcass weight in T group compared to those of C group. There was no difference in carcass weight between T and PF group. After 3 weeks it was significantly reduced in T group (55.7 Kcal/m2/h against 75.0 of N and 65.1 of PF group). Walker 256 carcinosarcoma is an hypometabolic tumor and the host weight loss associated to its development is due to anorexia.

Hepatitis B surface antigen in the serum of infants after deliver from asymptomatic carrier mothers.

A survey of sera of 5,993 pregnant women for hepatitis B surface antigen in Tokyo revealed 139 asymptomatic carriers (2.3%), essentially the same as that of a control population of comparable age group (2.2%). None of 59 specimens of cord blood of their newborn infants was positive for HBsAg according to an immune adherence hemagglutination assay. In 11 mother-child pairs in whom follow-up was possible for more than seven months, HBsAg was detected in the sera of eight infants within the first six months, after birth, with antigenemia persisting throughout the observation period, while antigenemia was not detected in the remaining three. The subtype of HBsAg was identical for each mother-child pair. The antigen was detected in sera of two of the infants after appropriate incubation periods of 123 and 133 days, respectively, whereas in others it was detected as early as 5 and 13 days after delivery.