Ana Rosa Pimentel de Figueiredo

Toxoplasmosis and mental retardation--report of a case-control study.

A case-control study evaluating the association between mental retardation and toxoplasmosis was conducted among 845 school children in Belo Horizonte, MG, Brazil. Cases (450) were mentally retarded children attending a public school for special education. Controls (395) were children from the regular public school system. Clinical and anthropometric examinations and interviews were carried out to determine risk factors for toxoplasmosis and mental retardation. Diagnosis of Toxoplasma gondii infection was based upon an indirect immunofluorescent test (IFA); 55% of cases and 29% of controls were positive. The Relative Odds of mental retardation in children with positive serology was 3.0 (95% CI 2.2-4.0). Maternal exposure to cats and contact with soil were associated with an increased risk of mental retardation. Retinochoroiditis was fourfold more prevalent among cases than controls and was only diagnosed in T. gondii IFA positive participants. Congenital toxoplasmosis, in its subclinical form, appears to be an important component in the etiology of mental retardation, especially in high risk (lower socio-economic) groups. The population attributable risk was estimated as 6.0-9.0%, suggesting the amount of mental retardation associated with this infection.

Estudo comparativo experimental de compósito bioativo de matriz polimérica para aplicação em cirurgia plástica ocular na substituição tecidual

OBJETIVO: Comparar dois novos biomateriais: composito a 10% (Escola de Engenharia da Universidade Federal de Minas Gerais - UFMG - Brasil) e composito a 20% (Escola de Engenharia da Universidade Federal de Minas Gerais - UFMG - Brasil), a dois materiais controles: Medpor® (Porex Surgical Inc. - EUA) e Polipore® (Homus Com. Ind. Ltda - Brasil). METODOS: Estudo experimental randomizado duplo cego: em 28 coelhos, 56 implantes foram colocados por via transconjuntival apos a remocao de fragmento de cartilagem da reborda orbitaria superior de ambas as orbitas, formando-se 4 grupos: Grupo I: Composito a 10%/Medpor®; Grupo II: Composito a 10%/Polipore®; Grupo III: Composito a 20%/Medpor®; Grupo IV: Composito a 20%/Polipore®. Apos permanencia media de 19,7 semanas, o material explantado foi avaliado histomorfometricamente em microscopia optica, e o estudo estatistico foi feito pelo teste t de Student. RESULTADOS: Nenhum implante sofreu extrusao, ocorrendo uma unica exposicao (Composito a 20%). Comprovado similar biocompatibilidade dos materiais nos quatro grupos. A histomorfometria no entanto revelou nos compositos a presenca estatisticamente significativa de pseudocapsula mais espessa, com aumento do numero de fibroblastos, maior quantidade de colageno e neovasos, e menor numero de celulas inflamatorias. Foi possivel detectar na interface implante-tecido nos compositos, a presenca de camada de hidroxiapatita carbonatada, funcionando como cola biologica. A integracao tecidual dos implantes atraves dos poros foi maior nos controles que nos compositos. CONCLUSAO: Os compositos foram aprovados quanto a biocompatibilidade, e apresentaram adicionalmente algumas vantagens sobre o Medpor® e o Polipore®.

Mitomicina C colírio como tratamento para granuloma piogênico em cavidade anoftámica

OBJETIVO: Avaliar a eficacia do uso topico de colirio de mitomicina C 0,02% (MMC 0,02%) no tratamento de pacientes com granuloma piogenico em cavidade anoftalmica. METODOS: Seis pacientes portadores de granuloma piogenico em cavidade anoftalmica foram submetidos ao tratamento com mitomicina C 0,02% instilada quatro vezes ao dia durante ciclos quinzenais e intervalo de 15 dias entre os ciclos. Os pacientes foram acompanhados semanalmente. RESULTADOS: Foram acompanhados seis pacientes dos quais um apresentou resolucao do granuloma piogenico ao final do primeiro ciclo de uso da MMC 0,02%. Em dois pacientes a MMC 0,02% foi eficaz na resolucao da lesao apos a segunda semana de tratamento (primeiro ciclo). Dois pacientes apresentaram resolucao completa do granuloma piogenico na quinta semana de uso da MMC 0,02% (inicio do segundo ciclo). Este farmaco foi ineficaz em apenas um paciente que persistiu com a lesao apos dois ciclos de tratamento. Nao foram observadas complicacoes decorrentes do uso de MMC 0,02% em nenhum dos pacientes. CONCLUSAO: A MMC 0,02% topica mostrou-se eficaz no tratamento de granuloma piogenico em cavidade anoftalmica, entretanto, diante de casuistica pequena, torna-se necessario estudo mais amplo, comparando a eficacia da MMC 0,02% com drogas ja utilizadas no tratamento desta lesao, tais como os esteroides e antimetabolicos.

O uso de implantes de compósito bioativo de biocerâmica em matriz polimérica na reconstrução do complexo zigomático orbitário: novas perspectivas em biomateriais

PURPOSE To evaluate through clinical and tomographic parameters implant behavior in orbital zygomatic reconstruction in six patients. METHODS The subjects for this preliminary study consisted of six anophthalmic socket patients (3 patients presented residual orbital zygomatic deformities after complex facial fractures and 3 patients presented orbital zygomatic retraction after enucleation and radiotherapy to treat retinoblastoma in infancy). These deformities were surgically corrected with this composite implant. This study was approved and authorized by the Universidade Federal de Minas Gerais Ethical Committee for Research in Human Subjects (ETIC 203/04). Clinical data and tomographic images were utilized to assess the outcome of this study. RESULTS There were no complications and tomographic findings revealed no implant reactions or migration and a good maintenance of soft tissue projection in the operated areas was achieved. Success of outcome in this preliminary study were encouraging. CONCLUSION This study will be continued enrolling a larger sample and longer follow-up. Composite biomaterials have presented a good outcome in facial reconstructive surgery. The composite implants in this group have a good biocompatibility and combined with national technology can reduce costs providing more possibilities to many more patients.

Trichiasis: diagnosis and management: Long-term follow-up of 216 cases

The authors conducted a thorough investigation of the files for the purpose of studying the clinical characteristics of trichiasis as well as of defining standards for a more appropriate approach to the treatment of this condition. A total of 216 cases of trichiasis were studied. The following topics were analyzed: (1) etiology, (2) clinical characteristics, (3) procedures carried out, (4) results.The observations were based on comparison of the data of this study with those in the literature and they reflect the experience of the authors in this matter. The conclusions are: (1) trichiasis results from an inflammatory-cicatricial process and must be distinguished from distichiasis and entropion; (2) marginal inflammations, mainly atopic ones, have overtaken trachoma as the principal cause of trichiasis; (3) surgical planning depends essentially on any concurrence with entropion and the extent of the eyelid margin affected by the trichiasis.

Diplopia vertical persistente pós-facectomia e tireoidopatia associadas

The authors report a case of a 69 year-old woman who developed persistent vertical deviation and diplopia after extracapsular cataract surgery and had a positive past history of thyroid disease. The authors emphasize the need of for detailed orbit propedeutics in order to rule out restrictive strabismus associated with post-facectomy diplopia.

Rhinoplasty Complications and Reoperations: Systematic Review

Introduction This article is related to complications of rhinoplasty and its main causes of reoperations. Objectives The objective of this study is to perform a systematic review of literature on complications in rhinoplasty. Data Synthesis The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review. Conclusion The main results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of p = 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.

Acquired restrictive strabismus in infancy associated with neurofibromatosis type 2

Dear Editors: We would like to add some new information regarding the patient described in the paper entitled, “Surgical treatment of acquired restrictive strabismus in infancy: case report”, published in Arquivos Brasileiros de Oftamologia in 2009. We stated that the diagnosis in the reported case was unclear despite extensive investigations. After surgical treatment of acquired restrictive strabismus, the child described remained stable with no other symptoms for approximately 7 years. By the age of 14 years, he developed left hand palsy and skin tumors. One year later, he started experiencing the beginnings of a hearing loss. Magnetic resonance imaging (MRI) of the brain revea led bilateral tumors indicative of vestibular schwannoma (Figure 1). Subsequently, the patient was referred to the Neurofibromatosis Reference Center of the Universidade Federal de Minas Gerais for further evaluation. Diagnosis of neurofibromatosis type 2 (NF2) was then established according to MRI demonstrating bilateral vestibular schwannomas associated with cutaneous schwannomas. NF2 is a dominant, autosomal disease characterized by bilateral vestibular schwannomas with multiple nervous system and skin tumors and is often associated with ocular abnormalities. Although classically considered a disease of adults, the initial signs and symptoms of NF2 may be evident in childhood and often goes unre cognized. Diagnosis is difficult in the majority of cases because of its rarity. Initial manifestations of NF2 differ between children and adults. The first sign of disease severity in patients with early-onset NF2 predominantly comprise ocular presentations and weakness in lower motor neuron extremities as opposed to impairment of the eighth nerve in cases of late disease onset. Approximately 50% of NF2 patients present with strabismus, ty pically associated with tumors and palsies of cranial nerves III, IV, and VI. Although restrictive strabismus is not commonly reported in patients with NF2, it is possible that it was associated with early onset of NF2 in our patient.

Tratamento cirúrgico de estrabismo restritivo adquirido na infância: relato de caso

The authors describe a severe and rare case of restrictive strabismus, acquired during the first semester of life, in a previously normal baby. They discuss the possibility of inflammatory or infectious disease as the primary cause. Surgical management was challenging, after three procedures and required the cooperation of strabismus and orbit specialists and also a wide incision for orbital surgery.