André Ricardo Dall'Oglio Tolazzi

Poland’s Syndrome: Different Clinical Presentations and Surgical Reconstructions in 18 Cases

BackgroundThe literature reports many variations of Poland’s syndrome. This article describes 18 cases of Poland’s syndrome in different stages of treatment, with variable clinical presentations and reconstructive techniques.MethodsThis study evaluated 15 females and 3 males, ages 2 to 43 years, for breast deformity, nipple–areolar complex position, pectoralis muscle malformation, thoracic deformities, and the presence of brachysyndactyly. Surgical treatment was performed for 14 patients, individualized for each case.ResultsFor the women, the hypoplastic breast was treated with a latissimus dorsi muscular flap associated with silicone gel implant in five cases. Two other patients still are receiving tissue expansion for a future muscular and prosthetic reconstruction. Prosthetic implants alone were used on the affected side in four cases. The nipple–areolar complex was reconstructed for two patients. Seven women underwent contralateral breast surgery: reduction mammoplasty in three cases, mastopexy in two cases, and prosthetic implants in two cases. The only man who underwent surgery was treated with endoscopic rotation of the latissimus dorsi muscle flap.ConclusionsThis study demonstrated several breast reconstruction options for patients with Poland’s syndrome, reinforcing the importance of an individualized treatment to achieve complete and adequate rehabilitation.

Oral glutamine does not prevent bacterial translocation in rats subjected to intestinal obstruction and Escherichia coli challenge but reduces systemic bacteria spread.

OBJECTIVE We investigated whether oral glutamine prevents bacterial translocation. METHODS Male Wistar rats were fed with isocaloric and isoproteic standard rat chow and randomly assigned to receive glutamine (GLN) or glycine administered through an orogastric tube at 1.5 g.kg(-1).d(-1) for 7 d. On day 8 of the study, the animals were anesthetized and intestinal obstruction was produced by ligature of the terminal ileum. A suspension containing 10(9) colony-forming units per milliliter of Escherichia coli ATCC 25992 was injected into the lumen of the ileum. Twenty-four hours later, blood was withdrawn, and mesenteric lymph nodes and fragments of spleen, liver, and lung were sent for microbiological analysis. Cultures were done on blood agar and MacConkey agar. Students t test and analysis of variance between two proportions were used. P < 0.05 was considered significant. RESULTS Rats in both groups lost body weight during the experiment (not significant). Mesenteric lymph node cultures were positive in both groups. The GLN group had a smaller percentage of E. coli in blood and organ cultures (65.45% versus 82.67% in the glycine group; P = 0.027). Positive cultures of blood, spleen, liver and lung also were higher on glycine group, although not significantly. CONCLUSIONS Oral GLN does not prevent bacterial translocation in rats after intestinal obstruction and E. coli challenge. No specific organ was protected by GLN. Nevertheless, its use was associated with a reduced number of positive E. coli cultures in blood and remote organs, and thus diminished bacteria spread. This association suggests a role for GLN in gut barrier protection, possibly by immune system enhancement.

Evaluation of molar teeth and buds in patients submitted to mandible distraction: long-term results.

Background: Despite all benefits offered by mandible distraction, complications and long-term consequences need to be evaluated to define its safety and morbidity. Forty mandible distractions were studied. Panoramic mandible radiographs obtained preoperatively, during distraction, and during the postoperative period were reviewed, with the intention of evaluating development and complications of molar buds and teeth in the distraction area. Methods: The mean patient age was 8.1 years. Twenty-five patients had craniofacial microsomia (one associated with a no. 10 facial cleft), five had temporomandibular joint ankylosis, two had familiar cases of auriculocondylar syndrome, one had a Tessier no. 30 facial cleft, and one had Treacher Collins syndrome. The severity of mandible hypoplasia was Pruzansky grade I in four cases, grade IIA in eight cases, grade IIB in 16 cases, and grade III in one case. Mean radiographic follow-up was 44.8 months. Results: Molar buds located in the distraction area erupted without any deformity or displacement in 18 sides (45 percent). Fourteen cases presented distalization of a dental bud to a superior position in the mandibular ramus (four migrated back to the original position). Six molar buds presented perforations, four had shape deformities (two caused by dental fracture), and two had dental root injuries followed by root absorption lately. One case developed a dentigerous cyst. Conclusions: Almost half of the patients did not have any molar bud or tooth alterations after mandible distraction, and more than 20 percent presented only bud distalization. Therefore, preventive bud enucleation or tooth extraction should be avoided before mandible distraction.

Implications of Transaxillary Breast Augmentation: Lifetime Probability for the Development of Breast Cancer and Sentinel Node Mapping Interference

The article entitled ‘‘Implications of Transaxillary Breast Augmentation: Lifetime Probability for the Development of Breast Cancer and Sentinel Node Mapping Interference’’ by Arturo Prado and Patricio Leniz, from Division of Plastic Surgery, School of Medicine, Clinical Hospital, JJ Aguirre University of Chile is an updated article and deserves some consideration. Currently, transaxillary breast augmentation is being performed worldwide. Among main incisions, transaxillary access has gained popularity because of good aesthetic results and the possibility of minimizing scar visibility [3,4,6,12,14]. As we know, women currently have an average risk of 13.2% (often expressed as 1 in 8) for receiving a diagnosis of breast cancer at some time in their lives [10]. From an epidemiologic point of view, as this population ages, breast cancer among women with previously augmented breasts can be expected to increase. Conservative oncologic surgery is a current tendency for the treatment of early breast cancers, and pathologic analysis of axillary lymph nodes is the single most important predictor of long-term survival [2,5,11,13]. As mastologists perform sentinel node staging for adequate treatment of breast cancer, they are very concerned about any previous surgery involving the axilla. To date, little literature is available on the interference of transaxillary breast implants in future sentinel lymph node detection. Munhoz et al. [9], in a preliminary study, performed lymphoscintigraphy preand postoperatively on a transaxillary breast augmentation patient. They did not observe alterations in sentinel node localization, and thus concluded that sentinel node assessment in the setting of prior breast implant augmentation through the transaxillary approach is feasible. Authors of the discussed paper explained very well the importance of an untouched sentinel node for preservation of axillary drainage and prevention of breast cancer spread through ways other than the axilla. However, their study with a limited number of cadavers did not elucidate how sentinel node damage could be avoided during the introduction of a high cohesive gel implant through an axillary approach. The authors simply laid the implant over the axilla and measured the prosthesis diameter movement during implant insertion into the pocket. An important unexplored aspect of the study was observation of lymphatic vessels after implant insertion. The authors observed lymphatic vessels without this maneuver, after simply laying the implant over the axillary area. The mammary gland and its skin envelope have a common origin and share the same lymphatic drainage pathways. On the basis of this, the breast is essentially a single unit with a specialized lymphatic system that presents preferential drainage through selected channels to a designated (sentinel) lymph node in the lower axilla [1]. Periareolar blue dye injection is a good and simple method for identifying axillary lymphatic structures. Some authors compare it with peritumoral radiocolloid injection used to identify the lymphatic metastasis route [1,7,8]. As we know, transaxillary breast augmentation can damage lymphatic vessels during subcutaneous tunnel dissection for introduction of the implant into the breast pocket. Thus, some landmarks need to be defined so damage to lymphatic structures can be Correspondence to R. M. Graf, M.D., Ph.D.; email: ruthgraf@bsi.com.br Aesth. Plast. Surg. 31:322 324, 2007 DOI: 10.1007/s00266-006-0204-7

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones

Background/Aims: The management of patients with silent or asymptomatic gallstones remains controversial. The objective of this study is to determine the complications of laparoscopic cholecystectomy performed to treat patients under 50 years of age with asymptomatic gallstones. Method: 207 patients, 13–49 years of age with asymptomatic gallstones, were subjected to laparoscopic cholecystectomy. There were 161 (78%) women and 46 (22%) men. Results: Operative time varied from 25 to 95 min, with an average of 42 min. The length of hospitalization varied from 12 h to 2 days. In no patient was the operation converted to laparotomy. There was neither mortality nor major complications. The following minor complications were observed: vomiting in 43 patients (20.7%), fever in 16 (7.7%), minor skin infection in 7 (3.3%), and keloid in 2 (0.9%). Conclusion: It is concluded from this study that laparoscopic cholecystectomy is a safe procedure in the treatment of patients under 50 years of age with asymptomatic gallstones.

Doppler Ultrasound Evaluation of Facial Transverse and Infraorbital Arteries: Influence of Smoking and Aging Process

BackgroundPlastic surgeons are always concerned about integrity of facial vascularization in smokers and elderly candidates for face-lifting. Using Doppler ultrasound, this study aimed to evaluate influence of chronic smoking and aging on facial transverse and infraorbital artery blood flow.MethodsFor this study, 40 healthy volunteer women were submitted to bilateral Doppler ultrasound of facial transverse and infraorbital arteries. Volunteers were divided into three groups: group 1 (13 nonsmoking women ages 18–33 years), group 2 (13 nonsmoking women ages 55–70 years), and group 3 (14 smoking women ages 55–70 years). Blood flow parameters measured were peak systolic velocity, end-diastolic velocity, resistivity index, and pulsatility index.ResultsChronic smoking did not cause statistically significant alterations in peak systolic velocity in any of the arteries. However, there was a significant augmentation of end-diastolic velocity and a reduction in resistivity and pulsatility index in both arteries. Aging process did not significantly alter any of the parameters evaluated. Findings in both sides of the face were similar for both arteries.ConclusionsChronic smoking significantly altered end-diastolic velocity, resistivity, and pulsatility index in regional arterial circulation of the face. Aging process, however, did not significantly influence any of blood flow parameters studied.

Quantitative Analysis of Aesthetic Results: Introducing a New Paradigm

When perusing a plastic surgery journal or attending a plastic surgery meeting, it is evident that the results shown in any given aesthetic presentation are considered by some to be excellent, whereas others deem the same results to be average or less than optimal. This disparity occurs when the interpretation of posttreatment results is based solely on subjective opinion. Certainly, the task of quantifying the results of aesthetic surgery (rather than just subjectively assessing their quality) is immense, but it is essential for aesthetic surgery to follow the trend toward evidenced-based medicine (EBM) that is becoming ingrained in the fabric of the medical profession as a whole. In fact, the quantification of aesthetic surgery results has more far-reaching ramifications than simply determining objective measures by which results can be judged. Objectively assessing the results of our cosmetic surgeries has the potential to change the way surgery is performed. As we all learn more about the philosophies behind EBM (eg, in the Editorial1 by Dr. Felmont Eaves and Dr. Andrea Pusic in this month’s issue, on page 117), it is helpful to also find support among colleagues who have begun implementing it in their own practices. To that end, we would like to share with you the ways in which adding quantitative outcomes assessment, which is the cornerstone of EBM, has changed some of our own clinical approaches. Rigorous research has been conducted and published on how to quantify (instead of merely qualify) patient satisfaction outcomes.2-4 However, as Millard5 taught us, patient satisfaction or dissatisfaction with surgical results should never dissuade us from critically evaluating the results themselves objectively. Thus, it is necessary for us, as plastic surgeons, to adopt a two-pronged approach to the critical evaluation of our surgical results: we must understand our patients’ …

A ação dos ácidos graxos de cadeia curta na cicatrização de anastomoses colônicas: estudo experimental em ratos

Short-chain fatty acids (SCFA) derive from the fermentation of fibbers ingested in the diet and act as a cell substrate of the colonic mucosa. The object aim of the present study was to evaluate the action of SCFA in colonic wound healing .Sixteen female rats were used, divided into 2 groups of 8 animals each. In the control group (HC) the animals underwent Hartmann procedure and post-operative infusion of isotonic saline solution per rectum for 7 days. In the experimental group (HA) saline solution was replaced by isomolar solution with SCFA. In the animals of the control group, the average bursting pressure of the rectal stump was 128.37 mm Hg, and 137.25 mm Hg in the experimental group (p=0.5693). Histologic evaluation with hematoxicilin and eosin was similar in both groups studied. The collagen densitometry analysis showed a significantly greater concentration of the mature collagen (type I) in the experimental group when compared with the control group (p=0.0094). Greater concentration of total collagen was found in the experimental group when compared to the control group (p=0.0371). It was concluded that rats who underwent intraluminal infusion of SCFA have greater concentration of mature and total collagen in the suture line of the rectal stump, when compared with to the control group.

Análise da cicatrização da bexiga com o uso do extrato aquoso da Orbignya phalerata (babaçu): estudo controlado em ratos

INTRODUCTION: Wound healing is a complex process that deals with different biological and immunological systems and is essential to keep the organism integrity. Three well-defined phases occur: inflammatory, proliferative and maturation. A failure or lengthy phase may result in a delay or absence of it. PURPOSE: The aim of this paper is to analyse comparatively the histological alteration provided by the use of the aqueous extract of Orbignya phalerata, in the healing process of bladder surgical wounds. METHODS: Forty adult, male Wistar rats were used. The experimental procedure consisted of a longitudinal 2cm long bladder incision and single layer interrupted suture of 5-0 poliglactine 910. Post-operatively, the rats were randomly divided into two groups of 20. The substance was not used in the control group. The Orbignya phalerata aqueous solution was used in the study group. The animals were observed and killed three and seven days later. Comparative histological analysis was accomplished between the groups. Resuts: Significant statistical differences were observed in the neo-formation variables (p= 0,001), chronic inflammation (p= 0,002) and fibroblastic proliferation (p= 0,023). Acute inflammation was very evident in the control group. CONCLUSION: The time factor of wound healing showed homogeneity between experimental and control groups, however faster in the experimental one. The Orbignya phalerata had a favoring healing effect in the surgical incision on rats bladder.

Avaliação da integração de enxerto de pele com a utilização do 2-octilcianoacrilato: estudo experimental em ratos

A fixacao dos enxertos de pele total atraves da sutura demanda tempo cirurgico relativamente longo. O surgimento de adesivos teciduais tem se apresentado com varias aplicacoes clinicas, constituindo alternativa a sutura convencional. O objetivo deste estudo e avaliar a eficacia do adesivo 2-octilcianoacrilato, quando comparado a sutura simples, na fixacao de enxertos de pele total, analisando-se a integracao do enxerto. Foram retirados enxertos de pele total de 1 cm2, bilateralmente, do dorso de nove ratos machos, com peso medio de 150 gramas. A pele retirada para a enxertia foi recolocada sobre o defeito, a fixacao foi realizada atraves de sutura continua com fio monofilamentar de nailon 4-0 no lado esquerdo e adesivo de 2-octilcianoacrilato no lado direito. Os aspectos clinico e histologico da integracao do enxerto foram analisados no 7o e 14o dia de pos operatorio. Utilizou-se o software Sens-a-Ray para comparacao de resultados. Evidenciamos maior integracao do enxerto de pele total no lado do adesivo de 2-octilcianoacrilato (80%) em comparacao ao lado da sutura continua (44%), sendo que houve perda total do enxerto do lado da cola de 2-octilcianoacrilato em 11,1% do casos comparado a 33,3% da sutura continua. O tempo medio da fixacao do enxerto no grupo da cola de 2-octilcianoacrilato foi de 23 segundos, contra 4 minutos da sutura convencional. Foi demonstrado uma maior integracao e um menor tempo de fixacao do enxerto no grupo do adesivo 2- octilcianoacrilato.