Celina Siqueira Barbosa Pereira

Tratamento da miíase humana cavitária com ivermectina oral

Introduction: Human myiasis is relatively common. It is unpleasant not only for the patients affected by this parasitical disease, but also for the doctors that must treat them. It is more common in undeveloped and tropical countries, although there have been reports of myiasis all over the Planet. It usually affects the elderly, the ill and the mentally disabled, but there have also been reports in healthy patients. The larvae usually lay their eggs in necrotic or infected tissues, however they may also lay eggs in areas of the body that are apparently healthy. Treatment of this parasitic infection is basically through removal of the larvae, a painful and cumbersome task, sometimes made impossible in smaller cavities. There have also been reports of drugs used topically to facilitate the removal, but with frustrating results. Study design: Prospective randomized. Methods: This study used oral ivermectin (until 300 µg/Kg). This drug has already been reported for the treatment of other diseases. The patients were submitted to hepatic and renal function tests before and after treatment, and followed as out patients. Results: The larvae were eliminated in all patients and there were no abnormalities in the blood tests.

Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications

CONTEXT The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, but its real prevalence is unknown. CASE REPORT A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.

Analysis of histopathological aspects in acquired middle ear cholesteatoma

UNLABELLED Middle ear cholesteatomas are characterized by the presence of stratified squamous epithelium in this cavity with highly invasive properties causing bone destruction and it may lead to complications. AIM To study the histopathological features in acquired cholesteatomas of the middle ear, correlating this data with patient age. STUDY DESIGN clinical and experimental cross-sectional study. MATERIAL AND METHODS Samples were obtained from 50 patients submitted to otologic surgery for the removal of middle ear cholesteatomas from 2006 to 2007. Thirty four patients were adults and 16 were children. Samples were studied by histological analysis. RESULTS We found the presence of epithelial atrophy (78%), epithelial acanthosis (88%), hyperplasia of the basal layer (88%) and formation of epithelial cones (62%). There was a positive and significant correlation between histopathological variables (such as epithelial acanthosis, hyperplasia of the basal layer and formation of epithelial cones). Histopathological variables presented no statistical significant difference in both age groups (p>0,05). CONCLUSION Cholesteatomas have hyperproliferating characteristics with epithelial acanthosis, hyperplasia of the basal layer and the presence of epithelial cones in the matrix.

Anatomical Study of the Digastric Muscle: Variations in the Anterior Belly

El musculo digastrico esta formado por dos vientres musculares: uno anterior y otro posterior, unidos por un tendon intermedio. Esta localizado en la region cervical anterior. El vientre anterior divide en dos la region entre el hueso hiodes y la mandibula: lateralmente el trigono sub mandibular y medialmente el trigono submentoniano. Las variaciones anatomicas descritas en la literatura se refieren al vientre anterior y consisten en diferencias en la forma e insercion muscular. Este estudio de cohorte transversal tiene el objetivo de describir las variaciones anatomicas del vientre anterior del musculo digastrico. Diez regiones cervicales de cadaveres adultos masculinos fueron disecadas en el Departamento de Morfologia entre junio de 2004 y junio de 2006. Los musculos digastricos que presentaron variaciones anatomicas fueron fotografiados usando una camara Sony Cyber-shot DSC-T1 con un lente Cari Zeiss Vario-Tessar y sus vientres fueron medidos con un caliper. Variaciones anatomicas en el vientre anterior del musculo digastrico se observaron en cuatro individuos. Los casos 1 y 4 presentaron variacion unilateral derecha, con un vientre anterior anomalo. Los casos 2 y 3 presentaron variacion bilateral, con presencia de dos vientres supernumerarios. Las variaciones anatomicas observadas en este estudio se refieren solamente el vientre anterior, el cual ha sido descrito previamente por otros autores. Es importante considerar la ocurrencia de estas variaciones en el musculo digastrico cuando se diferencian masas cervicales y durante los procedimientos quirurgicos de la region anterior del cuello

TNF-R2 expression in acquired middle ear cholesteatoma

UNLABELLED Acquired middle ear cholesteatoma is a disease which promotes bone erosion resulting in potentially serious complications. The tumor necrosis factor alpha (TNF-α) is present in cholesteatoma and it is related to bone erosion, as shown by different authors. To understand the aggressiveness characteristics of cholesteatoma is necessary, however, to better address the presence and distribution of their receptors. OBJECTIVE To evaluate the expression of type 2 TNF-α receptor (TNF-R2) in fragments of cholesteatoma and correlate it to the degree of inflammation present. MATERIAL AND METHODS observational cross-sectional study, which analyzed 33 fragments of cholesteatomas through histological analysis and immunohistochemistry (using as primary antibody to TNF-R2 LabVision® brand). The evaluation was performed by means of a qualitative and semi-quantitative agreement with the observed intensity. For statistical analysis we used the Fisher exact test and Spearmans correlation coefficient (considered statistically significant when p < 0. 05). RESULTS The expression of TNF-R2 was present in all fragments, however a statistical analysis showed no correlation or association between inflammation and the expression of TNF-R2. CONCLUSIONS TNF-R2 is present in cholesteatoma of the middle ear, however, its expression is not directly related to the degree of inflammation observed in patients with this disease.

Experimental comparative study in rabbits of three different ways of cartilage graft fixation: suture, gelatin-resorcin-formaldehyde and butyl-2-cyanoacrylate

CONCLUSION The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. OBJECTIVE Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. MATERIALS AND METHODS Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. RESULTS There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).Conclusion: The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. Objective: Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. Materials and methods: Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. Results: There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).

Imunoexpressão da citoqueratina 16 e do antígeno nuclear Ki-67 no colesteatoma adquirido da orelha média

Introducao: Ocolesteatoma da orelha media e caracterizado pela presenca de epitelio escamoso estratificado queratinizado nesta cavidade, causando destruicao ossea e podendo levar a complicacoes. Algumas substâncias como a citoqueratina 16 e o Ki-67, marcadores de proliferacao celular, vem sendo utilizadas para estudar essa doenca. A CK 16 e um filamento proteico, situado no citoplasma das celulas epiteliais, caracteristico de epitelios hiperproliferativos. O Ki-67 e um antigeno nuclear que aparece nas celulas em estagio de proliferacao. Objetivo: O objetivo deste trabalho foi estudar a imunoexpressao da CK 16 e do Ki-67 no colesteatoma adquirido. Forma de estudo: Clinico prospectivo. Material e Metodo: Foram colhidas amostras de colesteatoma de 31 pacientes submetidos a cirurgia otologica, sendo 20 adultos e 11 criancas, no periodo de 1998 e 2000. Essas amostras foram submetidas a analise histologica e imuno-histoquimica para estudo da expressao da CK 16 e do Ki-67 na matriz do colesteatoma. Resultado: A analise dos resultados mostrou a presenca da CK 16 nas camadas suprabasais da matriz do colesteatoma e, do Ki-67, na camada basal, estendendo-se para as camadas suprabasais e, inclusive, para a camada apical da matriz. A reacao aos anticorpos anti-CK 16 e Ki-67 foi heterogenea. A correlacao entre a CK 16 e o Ki-67 suprabasal com variaveis morfologicas, como acantose do epitelio e hiperplasia da camada basal formando cones epiteliais em direcao a perimatriz, foi positiva e significativa. Tambem houve relacao positiva e significativa entre a CK 16 e o Ki-67 suprabasal e apical. Conclusao: Esses resultados permitem concluir que o colesteatoma tem caracteristicas hiperproliferativas, expressando a CK 16 e o Ki-67 na sua matriz.

Estudo experimental comparativo entre o butil-2-cianoacrilato, a mistura gelatina-resorcina-formaldeído e sutura na estabilização de enxertos de cartilagem em coelhos

Os enxertos de cartilagem constituem-se em boa opcao tecnica para aprimoramento das rinoplastias. Procura-se um material para sua fixacao que seja de simples manuseio, e que provoque minima reacao tecidual. OBJETIVO: Comparar o uso do butil-2-cianoacrilato, mistura gelatina-resorcina-formaldeido (GRF) e sutura na estabilizacao de enxertos de cartilagem em coelhos. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Utilizaram-se 15 coelhos adultos da raca Nova Zelândia machos, de cujas orelhas foram ressecados 6 enxertos de cartilagem, fixados no periosteo da calvaria e unidos dois a dois com sutura, GRF e cianoacrilato. Apos 2, 6 e 12 semanas, grupos de 5 coelhos foram sacrificados e realizou-se avaliacao da distância de deslocamento do enxerto e analise histologica do processo inflamatorio tecidual e da adesao/deformidade das cartilagens. RESULTADOS: Houve deslocamento menor nas fixadas com GRF do que com cianoacrilato e sutura. O processo inflamatorio foi maior nos animais de 2 semanas, decaindo ate restar pequeno grau de fibrose em 12 semanas, de modo semelhante nas 3 fixacoes. Nao houve descolamento nem deformidade em nenhuma dupla de cartilagens fixada com sutura e o maior numero de cartilagens descoladas e deformadas se deu com o cianoacrilato. O numero de cartilagens deformadas foi diretamente proporcional ao numero de descoladas. Os dados foram significativos estatisticamente (p<0,05). CONCLUSAO: A mistura gelatina-resorcina-formaldeido mostrou ser um metodo de estabilizacao de enxertos de cartilagem em coelhos superior ao butil-2-cianoacrilato em todas as fixacoes, e a sutura na fixacao cartilagem-osso.

Estudo comparativo de aspectos histológicos e imunohistoquímicos entre o colesteatoma espontâneo do meato acústico externo e o colesteatoma adquirido da orelha média

AIM: A comparative analysis between the histological and the immuno histochemical (Ki-67 and CK-16) characteristics of spontaneous cholesteatomas of the external ear canal and acquired cholesteatomas of the middle ear was carried out. STUDY DESIGN: Case-control. MATERIAL AND METHOD: Fragments of external ear canal cholesteatomas were submitted to histological and immunohistochemical studies to evaluate the expression of CK-16 and of the nuclear antigen Ki-67 in the matrix cells. Results were compared to the same studies in acquired cholesteatomas of the middle ear. RESULTS: Histological and immunohistochemical aspects studied were identical in both types of cholesteatomas studied. DISCUSSION: This study suggests that cholesteatomas of the external ear canal are caused by na abnormal behavior of the cells of the epithelium of the external canal with hyperproliferative properties. This potential could be explained by the presence of CK-16 at a location where these markers are not usually found. The hyperproliferative characteristic of the external ear canal cholesteatoma is possible due to the presence of the K-67 nuclear antigen in the epidermal suprabasal cells. It is possible that the disease is caused by an interaction between CK-16 and the cytocines (TGF-alpha),which are present in the subepithelial connective tissue undergoing na inflammatory process. CONCLUSIONS: The histological (presence of epithelial cones) and immunohistochemical (expression of CK 16 and the nuclear antigen KI-67) characteristics of both the external ear canal and the acquired middle ear cholesteatomas are identical.

Comparative histological study on wound healing on rat's skin treated with Mitomycin C or Clobetasol propionate.

PURPOSE To compare histologically the action of Mitomycin C and that of Clobetasol propionate for surgical wound healing in rats. METHODS A circular skin fragment was surgically removed from 57 Wistar rats. Twenty-two animals were treated with Mitomycin C with topical medication in a single dose, 22 with Clobetasol propionate with a cream medication once a day for 15 days and 13 did not receive any medication. The animals were euthanized 30 and 60 days, and the scars subjected to histological examination. RESULTS The histological analysis on the samples did not show statistically significant differences regarding the quantities of fibroblasts, fibrocytes and vascular proliferation in the three groups, in the evaluations after 30 and 60 days. In the treated groups with Mitomycin C and Clobetasol there was a decrease in collagen concentration over the 30-day period and an increase in collagen concentration over the 60-day period, in comparison with the control group. CONCLUSIONS The actions of Mitomycin C and Clobetasol were equivalent and not interfere in fibroplasias and in angiogenesis. Both drugs initially cause a decrease in collagen over a 30-day period and an increase over a 60-day period, demonstrating a delay in the wound healing.