Tratamento de queloides e cicatrizes hipertróficas: Uma revisão descritiva / Treatment of keloids and hypertrophic scars: A descriptive review

Queloides e cicatrizes hipertróficas são lesões formadas a partir da resposta fibroproliferativa anormal ao processo de cicatrização de feridas, gerando uma proliferação excessiva do colágeno nas lesões. Geralmente, predominam em pacientes do sexo feminino e em indivíduos com tons de pele mais escuros. A abordagem terapêutica dessas cicatrizes pode ser indicada de acordo com alguns critérios, como déficit funcional, tamanho e tempo de cicatrização da ferida. Nesse sentido, o presente estudo objetivou realizar uma revisão descritiva da literatura, buscando as evidências de tratamento dos últimos cinco anos neste tema. A revisão foi realizada com base no guideline PRISMA, utilizando as bases de dados PubMed, LILACS, Cochrane Library, SCOPUS, Web of Science e Grey Literature, entre os anos de 2018 e 2022. Foram encontrados 740 artigos, dos quais 16 ensaios clínicos randomizados foram selecionados. Foi evidenciado que manejo do queloide apresenta abordagem multimodal, não havendo um padrão-ouro de tratamento, com taxa de recorrência baixa. Além disso, a terapia combinada de diferentes agentes pareceu ser superior ao uso isolado de métodos terapêuticos no tratamento dessas lesões.

Keloids and hypertrophic scars are lesions formed from the abnormal fibroproliferative response to the wound healing process, generating excessive collagen proliferation in the lesions. They generally predominate in female patients and individuals with darker skin tones. The therapeutic approach to these scars can be indicated according to criteria such as functional deficit, size, and wound healing time. In this sense, the present study aimed to conduct a descriptive review of the literature, seeking evidence of treatment over the last five years. The review was carried out based on the PRISMA guideline, using the databases PubMed, LILACS, Cochrane Library, SCOPUS, Web of Science, and Grey Literature between 2018 and 2022. Seven hundred forty articles were found, of which 16 randomized clinical trials were selected. It was demonstrated that keloid management presents a multimodal approach, with no gold standard of treatment with a low recurrence rate. Furthermore, combined therapy with different agents appeared superior to the isolated therapeutic methods in treating these injuries.

Perfil das cirurgias oncológicas e reparadoras de mama no norte do Brasil: Análise da última década / Profile of oncological and breast repair surgeries in northern Brazil: Analysis of the last decade

Introdução: O diagnóstico tardio do câncer de mama eleva o número de cirurgias, resultando em alta mortalidade e resultado pouco estético. Assim, é fundamental a instituição de procedimentos de reconstrução mamária. Método: Estudo descritivo, quantitativo e retrospectivo sobre as autorizações de internação hospitalar de pacientes submetidos a procedimentos cirúrgicos de mama em oncologia, no período de 2011 a 2020, cujo dados foram obtidos na plataforma DATASUS. Resultados: 7.529 cirurgias de câncer de mama e 1.949 cirurgias reparadoras foram realizadas na Região Norte. Houve aumento do número de procedimentos ao longo da década. Em todos os estados é possível perceber a diferença no número de municípios de residência, comparado aos municípios de internação. Conclusão: Necessita-se instituir centros de referência oncológica, garantindo tratamento individualizado e a reconstrução mamária.

Introduction: Late breast cancer diagnosis increases the number of surgeries, resulting in high mortality and unsightly results. Therefore, the institution of breast reconstruction procedures is essential. Method: Descriptive, quantitative, and retrospective study on authorizations for hospital admission of patients undergoing breast surgical procedures in oncology from 2011 to 2020, whose data were obtained from the DATASUS platform. Results: 7,529 breast cancer surgeries and 1,949 reconstructive surgeries were performed in the North Region. There was an increase in the number of procedures throughout the decade. In all states, it is possible to notice the difference in the number of municipalities of residence compared to the municipalities of hospitalization. Conclusion: It is necessary to establish oncological reference centers, guaranteeing individualized treatment and breast reconstruction.

Complications in liposuction: systematic review / Complicações em lipoaspiração: revisão sistemática

Liposuction is among the most performed plastic surgery procedures in Brazil. According to data from the International Society of Aesthetic Plastic Surgery (ISAPS), 231,604 liposuctions were performed, 15.5% of all aesthetic procedures in the country in 2019. Adopting liposuction as a single procedure or adjunct to other cosmetic procedures stimulated its technical evolution from simple fat aspiration to more sophisticated body shaping. Thus, this review aimed to systematically evaluate the published data regarding the complications found in liposuction. A review was conducted using PubMed, SciELO, LILACS, Cochrane Library, SCOPUS, Web of Science, and gray literature databases, published between 2016 and 2021, using the descriptors "Liposuction" and "Complications." A total of 187 articles were found in the searched databases, of which 16 were selected according to the outcome "to assess safety through the prevalence of complications in liposuction as a single procedure and associated with other procedures such as abdominoplasty and fat grafting." We found a mortality rate ranging from 0 to 0.06 among all procedures and a predominance of venous thromboembolism, hematoma, seroma, and hyperpigmentation concerning all complications, being more common when liposuction is associated with other procedures. Therefore, through this review, it was possible to verify that liposuction as a single procedure has lower complication rates when compared to liposuction combined with other procedures.

A lipoaspiração está entre os procedimentos da cirurgia plástica mais realizados no Brasil. Segundo dados da International Society of Aesthetic Plastic Surgery (ISAPS), foram totalizadas 231.604 lipoaspirações, 15,5% dentre todos os procedimentos estéticos realizados no país em 2019. A adoção da lipoaspiração como procedimento único ou coadjuvante a outros procedimentos cosméticos estimulou sua evolução técnica da simples aspiração de gordura para uma modelagem corporal mais sofisticada. Desse modo, esta revisão objetivou avaliar sistematicamente os dados publicados em relação às complicações encontradas na lipoaspiração. Foi realizada uma revisão utilizando os bancos de dados PubMed, SciELO, LILACS, Cochrane Library, SCOPUS, Web of Science e grey literature, publicados entre os anos de 2016 e 2021, através dos descritores "Liposuction" and "Complications". Foram encontrados 187 artigos nas bases de dados pesquisadas, dos quais 16 foram selecionados de acordo com o desfecho "avaliar a segurança através da prevalência de complicações na lipoaspiração como procedimento único e a associada a outros procedimentos como abdominoplastia e lipoenxertia". Encontramos uma taxa de mortalidade que varia de 0 a 0,06 dentre todos os procedimentos e um predomínio de tromboembolismo venoso, hematoma, seroma e hiperpigmentação em relação a todas as complicações, sendo mais encontradas quando a lipoaspiração é associada a outros procedimentos. Logo, por meio desta revisão foi possível constatar que a lipoaspiração como procedimento único apresenta menores taxas de complicações quando comparada à lipoaspiração combinada com outros procedimentos.

Th9 cytokines response and its possible implications in the immunopathogenesis of leprosy.

AIMS: Leprosy is an infectious-contagious disease whose clinical evolution depends on the interaction of the infectious agent with the immune response of the host, leading to a clinical spectrum that ranges from lepromatous leprosy (susceptibility, LL) to tuberculoid leprosy (resistance, TT). The immune response profile will depend on the pattern of cytokine production and on the activity of macrophages during infection. Classically, the clinical evolution of leprosy has been associated with Th1/Th2 cytokine profiles, but the role of new cytokine profiles such as T helper 9 (Th9) remains to be elucidated. METHODS: To evaluate the tissue expression profile of these cytokines, a cross-sectional study was conducted using a sample of 30 leprosy skin lesion biopsies obtained from patients with leprosy, 16 TT and 14 lepromatous LL. RESULTS: Immunohistochemical analysis revealed a significant difference in interleukin (IL)-9, IL-4 transforming growth factor (TGF)-ß and IL-10 levels between the two groups. IL-9 was more expressed in TT lesions compared with LL lesions. Higher expression of IL-4, IL-10 and TGF-ß was observed in LL compared with TT. IL-4, IL-10 and TGF-ß tended to be negatively correlated with the expression of IL-9, indicating a possible antagonistic activity in tissue. CONCLUSIONS: The results suggest that Th9 lymphocytes may be involved in the response to Mycobacterium leprae, positively or negatively regulating microbicidal activity of the local immune system in the disease.

Angiotensin II inhibition during myocardial ischemia-reperfusion in dogs: effects on leukocyte infiltration, nitric oxide synthase isoenzymes activity and left ventricular ejection fraction.

Leukocyte infiltration and activation in myocardial reperfusion injury may be modulated by nitric oxide synthase isoforms. Angiotensin II influences leukocyte activation directly or by nitric oxide generation mechanisms. The effects of angiotensin II inhibition before reperfusion on myocardial function, leukocyte accumulation and nitric oxide synthase were evaluated on three groups of eight dogs. They were submitted to occlusion of the left anterior descending coronary artery for 90 min, followed by 120 min of reperfusion. The first group received captopril, the second losartan and the third received normal saline solution. Left ventricular ejection fraction significantly improved after reperfusion in the groups under captopril (15+/-5.1%, p=0.029) and losartan (16+/-4.3%, p=0.014) when compared to the control group (7+/-2.5%). Myeloperoxidase activity was significantly lower in captopril group (6.6+/-1.0 U/100 mg, p=0,036) and losartan (6.8+/-1.7 U/100 mg, p=0.044) than in the control group (12.5+/-4.7 U/100 mg). Significant difference on constitutive nitric oxide synthase activity was not observed when all three groups were compared simultaneously (10.1+/-1.8 versus 8.5+/-1.3 versus 7.3+/-1.9 fM/mg/min, p=0.447). Inducible nitric oxide synthase activity was significantly lower in the losartan group (9.0+/-4.1 fM/mg/min) than in the captopril (29.2+/-5.1 fM/mg/min, p=0.0001) and control groups (26.2+/-4.6 fM/mg/min, p=0.0001). Angiotensin II inhibition reduced leukocyte infiltration and improved left ventricular ejection fraction during reperfusion by angiotensin-converting enzyme inhibition or by angiotensin II type 1 receptor blocker. This was observed without influencing the constitutive nitric oxide synthase activity. Only losartan reduced inducible nitric oxide synthase activity but did not influence the leukocyte infiltration and myocardial contractile function.

Efeitos hemodinâmicos imediatos da infusäo rápida de soluçäo hipertônica de cloreto de sódio-dextran-70 para tratamento de choque hemorrágico em cäes / Early Hemodynamic Effects of the Rapid Infusion of NaCl/Dextran Hypertonic Solution as Treatment for Hemorrhagic Shock in Dogs

PURPOSE--To study the early hemodynamic effects of the rapid infusion of 7.5g/dl NaCl/ 6g/dl dextran-70 solution in dogs submitted to hemorrhagic shock. METHODS--Mongrel dogs were anesthetized with pentobarbital and a electromagnetic flowmeter probe was placed around the ascending aorta or the portal vein. By external bleeding the arterial pressure was lowered to 40mmHg and held for 30min. The animals received a 4ml/kg infusion of the hypertonic solution in 90s. Arterial blood pressure and flow were registered continuously during 3min and the derived hemodynamic variables were calculated at regular time intervals. RESULTS--The total plasma protein concentration decreased and the cardiac output showed a continuous elevation during the infusion. The arterial blood pressure showed two oscillations and then decreased during a short period of time. This moment was coincident with the initial increase of the portal flow and preceded the elevation of the systemic vascular resistance and the arterial pressure. CONCLUSION--The rapid infusion of hypertonic NaCl/dextran solution to dogs in hemorrhagic shock determines immediate and intense hemodynamic effects. During the infusion period there is volemic expansion and the cardiac output increases rapidly. The arterial pressure shows oscillations and decreases as a consequence of visceral arterial dilation before starting its final elevation that occurs as the vascular resistance increases

Purpose - To study the early hemodynamic effects of the rapid infusion of 7.5g/dl NaCl/ 6g/dl dextran-70 solution in dogs submitted to hemorrhagic shock. Methods - Mongrel dogs wore anesthetized with pentobarbital and a electromagnetic flowmeter probe was placed around the ascending aorta or the portal vein. By external bleading the arterial pressure was lowered to 40mmHg and held for 30min. The animals received a 4ml/kg infusion of the hypertonic solution in 90s. Arterial blood pressure and flow were registered continuously during 3min and the derived hemodynamic variables were calculated at regular time intervals. Results - The total plasma protein concentration decreased and the cardiac output showed a continuous elevation during the infusion. The arterial blood pressure showed two oscillations and then decreased during a short period of time. This moment was coincident with the initial increase of the portal flow and preceded the elevation of the systemic vascular resistance and the arterial pressure. Conclusion - The rapid infusion of hypertonic NaCl/dextran solution to dogs in hemorrhagic shock determines immediate and intense hemodynamic effects. During the infusion period there is volemic expansion and the cardiac output increases rapidly. The arterial pressure shows oscillations and decreases as a consequence of visceral arterial dilation before starting its final elevation that occurs as the vascular resistance increases

Ligadura da artéria coronária direita do cäo: efeitos hemodinâmicos e patológicos / Right coronary artery occlusion in the dog: hemodynamic and pathologic effects

Objetivo - Verificar alterações hemodinâmicas e patológicas determinadas pela ligadura da artéria coronária direita do cão anestesiado e submetido a pericardiotomia. Métodos - Dez cães, mestiços, anestesiados com pentobarbital sódico, foram submetidos a toracotomia direita para ligadura da artéria coronária direita em sua origem, mantendo-se o pericárdio aberto. Pressões e débito cardíaco foram medidos em dois períodos antes da ligadura da artéria e em três após. A seguir os corações foram retirados para a injeção de geléia de bário nas artérias coronárias e confirmação da oclusão através de radiografias. Três animais foram mantidos vivos por 48 horas para posterior exame anátomo-patológico. Resultados - O exame das radiografias mostrou oclusão alta da artéria coronária direita, comprometendo a vascularização da parede livre do ventrículo direito. O exame anátomo patológico revelou infarto isquêmico de cerca de três quartos dessa região e septo normal. A oclusão determinou discreta redução (14%) do índice cardíaco e da pressão arterial sistêmica média, sem alteração das pressões venosa central e arterial pulmonar, embora pudesse ser observada acentuada dilatação do ventrículo direito...

Purpose - To assess the hemodynamic and pathologic effects of the right coronary artery occlusion in anesthetized dogs submitted to pericardiotomy. Methods - Ten mongrel dogs were anesthetized with pentobarbital and submitted to a right thoracotomy, pericardiotomy and ligation of the right coronary artery. The pericardium was kept opened throughout the entire experiment. The circulatory pressures and the cardiac output were determined twice before and three times after the right coronary artery ligation. The hearts were then excised, barium was injected in the coronary arteries and radiographs were taken to confirm the artery occlusion. Three dogs were kept alive to later pathologic examination of the hearts. Results - The observation of the radiographs showed proximal occlusion of the right coronary artery and absence of the right ventricle free wall vascularization. There was ischemic necrosis of about three quarters of this area, whereas the septum was normal. The cardiac index and the sistemic mean arterial decreased 14% without significant variation of the central venous and the pulmonary artery pressures, although marked right ventricular dilation was observed...

Infarto agudo do miocardio: medidas para tratamento convencional / Acute myocardial infarction: measure of convencional treatment

Em relaçao ao infarto agudo do miocardio, progressos recentes tem determinado mudanças na atitude do medico, para o diagnostico e a terapeutica. Ecocardiograma, radioisotopos e ECG dinamico permitem diagnosticos funcionais mais precisos. Sob o aspecto terapeutico, a preservaçao do miocardio isquemico por reperfusao precoce, tem mostrado a possibilidade de alterar a evoluçao natural do infarto, constituindo-se assim no aspecto de maior interesse atual naarea terapeutica

Cloreto de sódio hipertônico durante isquemia miocárdica aguda experimental: efeitos hemodinâmicos sistêmicos e regionais / Soduim chloride hypertonic during experimental acute myocardial ischemia: systemic and regional hemodynamic effects

Em cäes anestesiados, analisaram-se os efeitos hemodinâmicos sistêmicos e regionais da infusäo intravenosa de 1 ml/kg de cloreto de sódio a 10 g/dl (10%), durante oclusäo da artéria coronária descendente anterior. Os efeitos sistêmicos foram discretos e transitórios durando aproximadamente 10 minutos. Houve reduçäo discreta na pressäo arterial devida a um decréscimo na resistência vascular sistêmica, com elevaçäo concomitante no débito cardíaco e volume sistólico. Os efeitos regionais foram a reduçäo progressiva da resistência coronária e o aumento discreto do fluxo coronário retrógrado. Ao contrário dos efeitos sistêmicos, essas alteraçöes persistiram durante todo o período de observaçäo. Assim, nas condiçöes experimentais utilizadas, o cloreto de sódio hipertônico mostrou melhorar a perfusäo do miocárdio isquêmico, sem causar alteraçöes significativas na circulaçäo sistêmica

Valor do índice cardiotorácico na avaliaçäo do comportamento cardíaco em miocardiopatias dilatadas / Value of cardiothoracic index in the evaluation of cardiac performance in dilated cardiomyopathies

Foram estudados 118 portadores de miocardiopatia, com idades de 18 a 72 anos (média 32 anos). Todos os pacientes foram submetidos à radiografia de tórax, sendo calculado o índice cardiotorácico (ICT). Com os resultados obtidos os pacientes foram divididos em dois grupos: grupo I, 50 pacientes, ICT < 0,50 - sem cardiomegalia; grupo II, 58 pacientes, ICT >- 0,50 - com cardiomegalia. Em 97 pacientes foi realizado estudo ecocardiográfico, calculando-se a variaçäo do encurtamento sistólico do ventrículo esquerdo (deltaD%). Em 83 pacientes foi realizado estudo fonomecanocardiográfico, tendo sido calculado o quociente sistólico (QS). Correlacionou-se o ICT com QS e com deltaD% e, paralelamente, QS com deltaD%. O estudo de correlaçäo entre as variáveis mostrou coeficiente de determinaçäo (r2) de 0,44 e 0,54 para QS e deltaD%, respectivamente, em relaçäo ao ICT e de 0,61 para correlaçäo entre QS e deltaD%. Na análise individual dos valores do grupo I, somente 5 casos (11,9%) para QS e 5 casos (11,9%) para deltaD% apresentavam-se alterados. No grupo II, somente 4 casos (9,75delta) para QS e 3 casos (5,5%) para deltaD% apresentavam-se normais. Apesar de näo haver um comportamento linear entre as variáveis, concluímos que ICT >- 0,50 corresponderam a 90% dos pacientes com QS >- 0,40 e com deltaD% < 0,30. Ao considerar ICT >- 0,52 a relaçäo passa para 100% em ambos os métodos

Estudo comparativo dos efeitos hemodinâmicos sistemicos e regionais dos antagonistas do cálcio durante infarto agudo do miocardio experimental / Comparative study of systemic and regional hemodynamic effects of calcium antagonists during experimental acute myocardial infarction

Foram comparados os efeitos hemodinâmicos sistêmicos e regionais na área isquêmica da administraçäo endovenosa de verapamil (VP; 08 mg/kg), nifedipina (NF; 10 microng/kg) e findilina (FD; 3 mg/kg) durante oclusäo d artéria coronária descendente anterior em cäes. Osbervou-se queda da resistência coronária regional com as três drogas, havendo aumento o fluxo coronário retrógrado com VP e FD mas nä com NF. VP e FD determinaram também reduçöes da freqüência cardíaca, melhorando a relaçäo oferta/demanda de oxigênio na área isquêmica. A pressäo arterial idastólica foi realizada nos três grupos, havendo no entanto variaçäo mais importantes com VP. Conclue-se existirem diferenças hemodinâmicas importantes entre os efeitos dos antagonistas do cálcio, que devem ser consideradas ao se cogitar de seu uso em pacientes durante isquemia miocárdica