Supraperiosteal application of hyaluronic acid with cannula: Is it possible?

INTRODUCTION: The aging process occurs in all anatomical layers of the face; therefore, rejuvenation should not be limited to the dermic signs of aging (Aesthet Surg J. 2018;38:73) The treatment with fillers in strategic points can reconstruct young anatomy, providing natural results (Aesthet Surg J. 2018;38:73). There are two instruments used for facial application of hyaluronic acid: cannula and needle. Both of them have advantages and disadvantages. OBJECTIVE: In this study, we aim to compare the limitations of application with cannula by cutaneous ultrasound when compared to the needle by ultrasound, since some injectors suggest that one of the disadvantages would be the inability to reach certain application plans (periosteum). MATERIALS AND METHODS: A 52-year-old female patient was treated with 22 mg/ml hyaluronic acid (Juvéderm® Voluma), guided by high-frequency ultrasound (LogicE device, Logic brand (GE Healthcare), with high-frequency linear probe (L8-L18i-RS). The left hemiface was treated with a 27G needle and the right hemiface with a 5 cm 22G cannula (SoftFil®). CONCLUSION: This study proved that, in the malar/zygomatic and the chin region, it is possible the cannula and needle reached the supraperiosteal region. In the temporal region, the cannula did not reach the supraperiosteal plane.

Definition of the Mandibular Angle Using Botulinum Toxin Type A: A New Technique for the Improvement of Mandibular Contour and Definition.

While the injection of botulinum toxin type A (BoNTA) in the neck area, for face contouring through the blockade of the platysmal bundles, and in the mandibular body line has previously been explored, reports of its application for the demarcation of the mandibular angle are more limited. This article described a new technique of BoNTA injection in the mandibular angle for the improvement of contour and definition. At roughly 15 days after application in 30 patients, better visualization of the mandibular angle and its contours was evident and, consequently, smoothing of the appearance of sagging around the mandible with no adverse effects was noted. Further investigation of this technique is warranted.

Fotoexposição: Hábitos e Conhecimento de Estudantes de Medicina / Sun Exposure: Habits and Knowledge of Undergraduate Medical Students

Introdução: é conhecimento básico na formação médica que a radiação ultravioleta pode provocar diversos danos à pele e que a fotoproteção é importante para evitar tais prejuízos. Essa informação deve ser aprofundada e discutida durante a graduação em qualquer área das ciências da saúde. Ainda, acredita-se que o impacto da informação deve resultar na aplicação do conhecimento na rotina de quem o recebe. Por isso, o trabalho buscou identificar em uma determinada instituição de ensino se alunos de medicina adquirem e tornam prático esse ensinamento. Objetivo: avaliar o conhecimento sobre exposição solar de alunos de medicina correlacionando com a aplicabilidade dessa informação nos seus hábitos. Material e Métodos: foi realizado um estudo descritivo transversal com 207 estudantes do Curso de Medicina da Universidade de Passo Fundo - RS - de julho a dezembro de 2016. Os dados foram obtidos através de questionário padronizado autoaplicativo. Resultados: 93,6% dos alunos entrevistados responderam que já haviam recebido instruções sobre fotoproteção. 84,4% já haviam cursado a disciplina de dermatologia e, desses, 77,3% já haviam atendido pacientes com câncer de pele. Porém, 29,6% de todos os alunos entrevistados relataram utilizar protetor solar diariamente. Conclusão: os dados apontam que os estudantes avaliados sabem que a exposição solar inadequada tem por consequência efeitos nocivos sobre a pele, porém não apresentam o hábito de fotoproteção. O conhecimento está presente, porém não é aplicado.(AU)

Introduction: It is basic knowledge in medical training that ultraviolet radiation can cause extensive damage to the skin and that sun protection is important to avoid such damages. This information should be deepened and discussed among undergraduate students in any field of health sciences. In addition, it is believed that the impact of information should result in the application of knowledge in the routine of who receives it. Therefore, this work aimed to identify whether medical students of a given educational institution have acquired this information and put it into practice. Objective: To evaluate the knowledge of medical students about sun exposure correlating it with the applicability of this information in their routine. Material and Methods: This was a crosssectional, descriptive study was carried out with 207 students attending Medical School at the University of Passo Fundo - RS - from July to December 2016. The data were obtained through a standardized self-applicable questionnaire. Results: 93.6% of students said they had received instruction on photoprotection; 84.4% had already attended the dermatology course, of which 77.3% had been in contact with skin cancer patients. However, only 29.6% of all students interviewed reported using sunscreen daily. Conclusion: The results showed that the surveyed students know that inadequate sun exposure has harmful effects on the skin, but do not have the habit of photoprotection. Knowledge is present but it is not applied. (AU)

Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison.

Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor whose etiology remains uncertain. It clinically presents itself by angiomatous papules or nodules located on the head and neck. Many controversies in the literature are found in relation to angiolymphoid hyperplasia with eosinophilia and Kimura's disease - its main differential diagnosis - due to their clinical and histopathological similarities. However, currently, most studies agree that they are distinct diseases. The present case illustrates a characteristic description of angiolymphoid hyperplasia with eosinophilia and also highlights the main differences with Kimura's disease.

Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison

Abstract Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor whose etiology remains uncertain. It clinically presents itself by angiomatous papules or nodules located on the head and neck. Many controversies in the literature are found in relation to angiolymphoid hyperplasia with eosinophilia and Kimura's disease - its main differential diagnosis - due to their clinical and histopathological similarities. However, currently, most studies agree that they are distinct diseases. The present case illustrates a characteristic description of angiolymphoid hyperplasia with eosinophilia and also highlights the main differences with Kimura's disease.

Tratamento de cicatriz de queimadura com luz intensa pulsada e laser ablativo fracionado Erbium: YAG / Treatment of burning scars with intense pulsed lip and fractionated ablative laser Erbium: YAG / Tratamiento de cicatrices por quemaduras con luz intensa pulsada y láser ablativo fraccionado Erbio: YAG

Cicatrizes decorrentes de queimadura acarretam grandes danos físicos e emocionais aos pacientes. Seu tratamento permanece um desafio na prática clínica. O uso atual de tecnologias a laser e luz, como o laser ablativo fracionado e a luz intensa pulsada (LIP), tem se mostrado eficaz na recuperação estética e funcional da pele acometida. Este trabalho tem por objetivo a demonstração do resultado do tratamento de cicatriz de queimadura extensa com LIP e laser ablativo fracionado Erbium: YAG a partir do relato de caso de uma paciente de 38 anos vítima de queimadura por chama direta aos 6 anos de idade. A paciente apresentou melhora clínica significativa no aspecto estético e funcional da lesão. O uso desses métodos combinados apresenta resultados favoráveis para o tratamento desses casos.

Scars resulting from burning causes great physical and emotional damage to patients. Its treatment remains a challenge in clinical practice. Current use of laser and light technologies, such as fractional ablative laser and intense pulsed light (ILP), have been shown to be effective in aesthetic and functional recovery of affected skin. This work aims to demonstrate the results of the treatment of extensive burn scarring with ILP and fractional ablative laser Erbium:YAG relating the case report of a 38-year-old female victim of direct flame burn at 6-years-old. The patient presented significant clinical improvement in the aesthetic and functional aspect of the lesion. The use of these combined methods presents favorable results for the treatment of these cases.

Las cicatrices resultantes de quemaduras causan grandes daños físicos y emocionales a los pacientes. El tratamiento sigue siendo un reto en la práctica clínica. El uso actual de tecnologías láser y de luz, tales como el láser ablativo fraccionado y la luz pulsada intensa (LPI) han demostrado ser herramientas eficaces para la recuperación estética y funcional de la piel afectada. Este trabajo tiene como objetivo mostrar el resultado del tratamiento de una cicatriz extensa por quemadura usando LPI y láser ablativo fraccional Erbio:YAG a partir del caso clínico de una paciente de 38 años de edad víctima de quemaduras por fuego directo (llama) a los 6 años de edad. La paciente mostró una mejoría clínica significativa en el aspecto estético y funcional de la lesión. El uso de estos métodos combinados mostró resultados favorables para el tratamiento de este tipo de casos.

Siliconoma: Report of Two Cases.

UNLABELLED: Injectable silicone has been used illegally for more than 60 years. Siliconoma is the term used to describe a foreign body reaction in the human body caused by the presence of silicone. The aim of this study is to report two cases of patients who underwent application of large volumes of injectable silicone with non-medical and unqualified professionals, which led to serious complications sometime after the procedure. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comprehensive Treatment of Periorbital Region with Hyaluronic Acid.

The periorbital subunit is one of the first facial regions to show signs of aging, primarily due to volume depletion of the soft tissue and bony resorption. Surgical and office-based nonsurgical procedures form an important basis for periorbital rejuvenation. It is important to make a detailed clinical evaluation of the patient to indicate the most appropriate procedure to be performed. With the objective of showing a nonsurgical procedure for the rejuvenation of the periorbital area, the authors describe a technique of applying fillers in the upper and lower periorbital regions, paying attention to the anatomy of this facial region and the type of product to be used besides the expected results of the procedure and its possible adverse effects and complications. The nonsurgical rejuvenation of the periorbicular region with hyaluronic acid is a new and innovative technique. In the opinion of the authors, it is a great aesthetic impact area and consequently brings high satisfaction to patients.

Congenital agminated melanocytic nevus--case report.

Agminated nevus is a cluster group of melanocytic nevi confined to a localized area of the body. There are many pigmented lesions described in the literature as agminated, such as blue nevi, multiple lentigines and Spitz nevi, but only a few cases of congenital agminated melanocytic nevi have been described. We report a case of a male child who presented with congenital agminated nevi, emphasizing the importance of physical examination, dermoscopy, histopathological evaluation, differential diagnosis and follow up to rule out the possibility of dysplastic or malignant changes.

Congenital agminated melanocytic nevus - case report / Nevo melanocitico congenito agminado - relato de caso

Agminated nevus is a cluster group of melanocytic nevi confined to a localized area of the body. There are many pigmented lesions described in the literature as agminated, such as blue nevi, multiple lentigines and Spitz nevi, but only a few cases of congenital agminated melanocytic nevi have been described. We report a case of a male child who presented with congenital agminated nevi, emphasizing the importance of physical examination, dermoscopy, histopathological evaluation, differential diagnosis and follow up to rule out the possibility of dysplastic or malignant changes.

Nevo agminado é um conjunto de lesões melanocíticas confinadas a uma área do corpo. Existem muitas lesões descritas na literatura como agminada s, como nevos azuis, lentigos múltiplos, nevo de Spitz, mas existem poucos casos de nevos melanocíticos agminados congênitos descritos. Relatamos o caso de um paciente do sexo masculino que se apresentou com um nevo agminado congênito, enfatizando a importância do exame físico, dermatoscopia, avaliação histológica, diagnóstico diferencial e seguimento para descartar a possibilidade de alterações displásicas ou malignas.

Hipotensão intracraniana espontânea tratada com tamponamento sanguíneo peridural: relato de caso / Spontaneous intracranial hypotension treated with epidural blood patch: case report

JUSTIFICATIVA E OBJETIVOS: Hipotensão intracraniana espontânea (HIE) é uma síndrome caracterizada por cefaleia postural associada à baixa pressão liquórica e que desaparece rapidamente ao decúbito. A terapia varia de tratamento conservador a procedimentos invasivos, como a realização de tampão sanguíneo peridural. O objetivo deste estudo foi apresentar o caso de uma paciente com cefaleia postural secundária à HIE tratada com tampão sanguíneo peridural. RELATO DO CASO: Paciente do sexo feminino, 33 anos, branca, há 7 meses com quadro de cefaleia ortostática diária, holocraniana, acompanhada de náuseas e vômitos, desencadeada pelo ortostatismo e aliviada pelo decúbito. Sem história de punção dural ou outra causa de fístula. História prévia de enxaqueca há mais de 10 anos. Ao exame neurológico sem déficits, porém com dificuldade para deambular devido a tonturas e cefaleia. Punção lombar evidenciou hipotensão liquórica. Foi realizado tampão sanguíneo peridural em nível de L3-L4 com 20 mL de sangue autólogo, sem intercorrências e com resolução da cefaleia. CONCLUSÃO: O tampão sanguíneo peridural foi uma opção efetiva no tratamento da HIE não solucionada com o tratamento conservador.

BACKGROUND AND OBJECTIVES: Spontaneous intracranial hypotension (SIH) is a syndrome characterized by postural headache associated to CSF hypotension, which is rapidly resolved with decubitus. Therapy varies from conservative approaches to invasive procedures, such as epidural blood patch. This study aimed at presenting a case of postural headache secondary to SIH and treated with epidural blood patch. CASE REPORT: Female patient, 33 years old, Caucasian, for seven months suffering from daily orthostatic holocrainal headache, followed by nausea and vomiting, triggered by orthostatism and relieved by decubitus. No history of dural puncture or other reason for fistula. Previous history of migraine for more than ten years. Neurological evaluation has shown no deficits, however she had difficulties to walk due to dizziness and headache. Lumbar puncture has shown CSF hypotension. An epidural blood patch was performed in L3-L4 with autologous blood, without intercurrences and resolving her headache. CONCLUSION: Epidural blood patch was effective to treat SIH not resolved with conservative approaches.