Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolemic patients.

Hypertonic solutions effectively improve hemodynamic parameters in patients admitted to the emergency room. However, no significant differences in outcome were observed compared with standard isotonic treatment in most previously published studies. This study evaluates pretreatment prognostic factors that predict a beneficial effect of hypertonic solution in patients admitted to the emergency room with hemorrhagic hypovolemia in a prospective double-blind fashion. The patients (n = 212) were randomized upon admission to receive 250 mL intravenous (i.v.) bolus of hypertonic 7.5% NaCl + 6% dextran (HSD, n = 101), or isotonic 0.9% NaCl solutions (IS, n = 111) as the first treatment, followed by standard resuscitation. Pretreatment factors assessed were sex, age, cause of hypovolemia, revised trauma score (RTS), Glasgow index, and mean arterial pressure (MAP) on admission. Both groups were compared for survival at 24 h and 30 days postadmission. Infused volumes were registered. HSD administration significantly increased MAP and reduced i.v. crystalloid infusions to maintain hemodynamic parameters, compared with IS. There was no difference between groups in the number of blood transfusions administered. Overall complication rates in both groups were similar (24%). There was a significant difference (p < .03) in overall (30 days) survival rate between HSD (73%) and IS (64%) groups. The 24 h survival rate was significantly lower in IS (72%) compared with HSD (87%); p < .01. Multivariate analyses showed that RTS and MAP were identified as independent predictors for 24 h survival in the group that received HSD. When evaluated for overall survival rate, hypertonic infusion benefited significantly only patients with MAP < 70 mmHg (p < .01).

[Pulmonary lesion in electric injury: report of a case]. / Comprometimento pulmonar em trauma elétrico: relato de caso.

Major electrical injuries constitute approximately 5% of all admissions to Burn Units. Visceral complications are associated with a high mortality rate. The most common visceral lesions associated to electric burns are cardiac lesions. Pulmonary compromise is rare, if compared to inhalation injuries in termical burns. Although, when the entry or exit ports are the toracic wall, pleural effusion, hemotorax and pneumonitis may occur. A rare case of high-voltage electrical injury with massive pulmonary lesion is presented, regarding to clinical course and roentgenographic patterns.

[Electrical burns of the upper limbs]. / Queimaduras elétricas dos membros superiores.

During a period of 27 months, between 1991 and 1993, 15 patients with upper limb lesions caused by electrical hazards were admitted in the Burn Emergency Service of the Hospital das Clinicas-FMUSP. This lesion is usually a dramatic condition and requires a sound physiopathologic knowledge by the surgeon. These accidents may have permanent incapacitating sequelae, and due to long periods of treatment (2 months), social-economic costs are very high. Based on our experience, we suggest a less aggressive approach (no amputation at emergency), and a close continuous surveillance.

[Microsurgical reimplantation of scalp: case report]. / Reimplante microcirúrgico de couro cabeludo: relato de caso.

With the introduction of modern techniques in plastic surgery, severe injuries concerning the extremities and scalp are now amenable to surgical treatment. Successful reimplantation of the scalp either total or partial have been rarely reported in the literature. We treated a patient with avulsion affecting 2/3 of the scalp, the right ear and a cutaneous flap on right side of the face. We report here the initial care and operative procedure. The avulsed scalp was revascularized through microanastomoses of the temporal artery and vein. The reimplantation was well succeed and cosmetic results were satisfactory.

Associacao de labio duplo congenito superior e inferior / Association of upper and lower congenital double lip

O labio duplo congenito e deformidade pouco relatada na literatura, nao ha registro da associacao de labio duplo congenito bilabial. Consiste de prega mucosa localizada na borda livre do labio que e salientada a abertura da boca e ao sorriso. Histologicamente apresenta glandulas salivares mucosas de aspecto hipertrofico ou normal, com pouco tecido conjuntivo, recoberto por epitelio cornificado. Nao ha musculo. Apresentamos o relato de dois casos de associacao de labio duplo congenito bilabial tratados cirurgicamente pela resseccao em elipse das pregas mucosas com resultado estetico e funcional satisfatorio.

Tratamento dos angiomas do labio / Treatment of lip angiomas

Foram estudados 25 pacientes portadores de angiomas de labio, sendo 17 maduros (15 venosos, 2 complexos) e oito imaturos (7 tuberosos, 1 strawberry). Existem varios tipos de tratamento propostos pela literatura. Dentre os varios metodos, os autores, apos dez anos de experiencia, optaram preferencialmente por cirurgia, cirurgia mais embolizacao e corticoide sistemico. O uso de corticoide local e de agentes esclerosantes foram utilizados apenas como coadjuvantes da cirurgia. A cirurgia, realizada em uma ou mais etapas, se mostrou alternativa segura e eficiente para angiomas maduros, com excecao dos complexos, imaturos com complicacoes e imaturos que nao incluiram ate os cinco anos de idade.

[Association of congenital upper and lower double lip]. / Associação de lábio duplo congênito superior e inferior.

The frequency of the congenital double lip is scarcely mentioned in the literature. There is no previous report on the bilabial congenital double lip. This association consists of a mucosae fold at the free edge of the lip, which is projected at smiling and opening of the mouth. Histologically, the mucous salivary glands are either hypertrophic or normal with little connective tissue and covered by a cornified epithelium. There is no muscle tissue found. We present the report of two cases of bilabial congenital double lip treated surgically by the elliptical resection of the mucosae folds.

[Treatment of lip angiomas]. / Tratamento dos angiomas do lábio.

The experience with the treatment of 25 patients with angiomas of the lips is presented. Among the several methods of treatment indicated in the literature, the authors have experimented with surgery, surgery and embolization, and systemic corticotherapy. Local application of corticosteroids and sclerosing agents were used just as a complementary therapy to the surgery. Surgery performed in one or more stages when necessary, were considered a safe and reliable method for treatment of mature venous angiomas, as well as for immature ones with no involution after a period of five years.