Comprehensive and Global Approach of Soft-Tissue Deformities in Craniofacial Neurofibromatosis Type 1.

BACKGROUND: To present a single-institution experience in the comprehensive and global soft-tissue surgical approach of patients with craniofacial neurofibromatosis type 1 (NF-1). METHODS: A retrospective analysis of patients with craniofacial NF-1 (n = 20) who underwent craniofacial soft-tissue reconstruction between 1993 and 2014 was conducted. Surgical treatment was individualized according to age, functional and/or aesthetic impairment, neurofibroma types, anatomical location, size, and patient/family and surgical team preferences, regardless of previously published compartmental grading systems. The surgical results were classified based on 2 previously published outcome rating scales (craniofacial symmetry improvement and need for additional surgery). RESULTS: All patients underwent en bloc translesional surgical excisions, 12 facial suspension, 3 eyebrow suspension, 2 ear suspension, 9 lateral canthopexy, 5 horizontal shortening of the tarsus of lower eyelid, and 1 horizontal shortening of the tarsus of upper eyelid. The degree of craniofacial symmetry improvement was considered "mostly satisfactory" (75%), and the overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.50, with variations according to the spectrum of soft-tissue involvement. CONCLUSIONS: According to the experience and surgical outcomes presented in this study, the soft-tissue surgical approach of the craniofacial NF-1 should be global, comprehensive, and individualized.

Progressive frontal morphology changes during the first year of a modified Pi procedure for scaphocephaly.

PURPOSE: The purpose of this study was to quantify the changes in frontal morphology in patients with scaphocephaly treated with a modified Pi procedure. METHODS: Consecutive scaphocephalic patients (n = 13) who underwent surgery before 12 months of age that had more than 1 year of follow-up and standard preoperative, 3-month, and 1-year photographs were included. Anthropometric measurements were used to document the craniofacial index. Computerized photogrammetric analyses of five craniofacial angles (bossing angle, nasofrontal angle, angle of facial convexity, and angle of total facial convexity) were also performed. RESULTS: Comparisons of the preoperative and postoperative direct anthropometric measurements of the cephalic index showed a significant (all p < 0.05) increase in the postoperative period, with no significant differences in early versus late postoperative period comparisons. Comparisons of the preoperative and postoperative computerized photogrammetric measurements of the craniofacial angles showed a significant (all p < 0.05) reduction (bossing angle, angle of facial convexity, and angle of total facial convexity) and increase (nasofrontal angle) in the early and late postoperative periods. CONCLUSIONS: Frontal morphology significantly changed over the first year of the modified Pi procedure.

Depressão e perfis sociodemográfico e clínico de idosos institucionalizados sem déficit cognitivo / Depression and sociodemographic and clinical profiles of institutionalized elderly without cognitive deficit

Objetivo: investigar a prevalência de sintomas depressivos em idosos institucionalizados sem déficit cognitivo, em Pouso Alegre-MG, e traçar seu perfil sociodemográfico e clínico. Método: estudo transversal e descritivo. Foram selecionados 46 idosos em duas instituições asilares, sem comprometimento cognitivo ou sensorial, que aceitaram participar do estudo e assinaram o termo de consentimento livre e esclarecido. Foi aplicado um formulário para a coleta de dados sociodemográficos e clínicos e a Escala de Depressão Geriátrica (GDS-15 itens). Os dados foram submetidos à análise estatística descritiva. Resultados: o principal motivo da institucionalização foi a falta de apoio familiar e econômico. Os idosos apresentavam as seguintes características: 83% femininos e 17% masculinos; 74% brancos e 26% não-brancos; média de idade de 75,3 anos; 57% solteiros e 30% viúvos; 96% católicos; 61% sem escolaridade, 37% com ensino fundamental incompleto e 2%, completo; 72% recebiam um salário mínimo e 28% sem renda. O uso de medicamentos apresentava média de 5,8 por paciente, 38% faziam uso de mais de seis medicamentos por dia, sendo as drogas mais usadas, perfazendo 76%, aquelas com efeito no aparelho cardiovascular. A pontuação pela GDS-15 com ponto de corte 6 mostrou que 65% dos idosos apresentavam pontuação para depressão, 63% depressão leve (escore de 6 a 10) e 2% depressão grave (escore >10). Conclusão: foi observada elevada taxa de depressão na população estudada, sendo a falta de apoio familiar a principal causa da institucionalização.

Objective: to investigate the prevalence of depressive symptoms in institutionalizedelderly without cognitive deficit, in Pouso Alegre-MG, and draw the sociodemographic and clinical profile. Method: cross-sectional and descriptive study. 46 elderly, without cognitive or sensory impairment, who agreed to participate in the study and signed free and clear terms of consent, were selected in two nursing homes. It was applied a form for sociodemographic and clinical data collection and the Geriatric Depression Scale (GDS - 15 items). The data were submitted to descriptive statistic analysis. Results: the main reason for the institutionalization was the lack of family and economic support. The elderly presented the characteristics as follows: 83% females and 17% males; 74% white and 26% non-white; median age 75,3 years; 57% single and 30% widower; 96% catholic; 61% no education, 37% with incomplete primary education and 2% complete; 72% received a minimum wage and 28% with no income. The use of medication presented the 5,8 average per patient, 38% used more than six medications a day, and the mostly used drugs, about 76%, were those with effects on the cardiovascular system. The GDS-15 with cut-off point 6 showed that 65% of the elderly presented points for depression, 63% mild depression (score from 6 to 10) and 2% severe depression (score >10). Conclusion: it was observed high depression rates in the population under study; the lack of family support was the main reason for the institutionalization.