Daniel Ongaratto Barazzetti

Sleep disorders among undergraduate students in Southern Brazil

PurposeSleep disorders are very common in the young, being a result of the typical lifestyle lived by young people or a sleep disease that requires assistance and treatment. Furthermore, according to previous findings, sleep alterations can favor the development of depressive mood disorder. This survey aimed to assess the prevalence and characteristics of sleep disorders in a young population sample and their association with depressive symptoms.MethodsWith a cross-sectional study design, self-administered questionnaires were applied to 1,180 undergraduate students. The Mini-Sleep Questionnaire (MSQ) and the Beck Depression Inventory were used to evaluate sleep disturbances and depressive symptoms, respectively. Bivariate and multivariate analyses were conducted, with the main findings being the presence of disrupted sleep (MSQ > 24), with an alpha error of 5%. The median point of the MSQ was 26 (P25–P75, 21–32 points).ResultsSleep alterations were found in 59.6%. The prevalence of depression was 9.3% (n = 110), mild depression being identified in 5.9% (n = 62), moderate in 3.4% (n = 40), and severe in 0.7% (n = 8) of the students. In logistic regression, female gender (OR, 1.48; CI 95%, 1.09–2.01; P = 0.012) and being depressed (OR, 4.42; CI 95%, 2.30–8.50; P < 0.001) were independent factors for disrupted sleep.ConclusionsSleep alterations are prevalent complaints among young people, being present in nearly 60% of the students. Female gender and being depressed are independent factors for having some form of sleep disorder.

Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral

Alguns dos individuos submetidos a cirurgia de coluna vertebral terao desfechos pos-operatorio desfavoraveis, independente do exito tecnico. Esse insucesso gera aumento da morbidade e dos custos socioeconomicos. Sabe-se que fatores psicossociais interferem na impressao do sujeito. Com o proposito de identifica-los, tem-se estimulado a busca de preditores prognosticos por meio de instrumentos de triagem. Porem, a eleicao do mais adequado pode ser dificil, ja que existe um grande numero de questionarios. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfacao, dor, depressao, disturbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicacoes e limitacoes dos instrumentos de avaliacao do paciente com doenca na coluna vertebral.

Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto

PURPOSE To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7.0. METHODS Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Students t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.

Factores de riesgo asociados a traumatismo al nacimiento

Antecedentes: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsion. Objetivo: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recien nacidos. Metodo: Estudio casos y controles, realizado en el periodo de julio/2004 a diciembre/2005, en la Division de Ginecologia y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadistico SPSS version 19.0. Los factores que obtuvieron nivel significativo 33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). Conclusion: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perimetro toracico igual o superior a 33cm.

Instruments of clinical and functional evaluation in spine surgery

Alguns dos individuos submetidos a cirurgia de coluna vertebral terao desfechos pos-operatorio desfavoraveis, independente do exito tecnico. Esse insucesso gera aumento da morbidade e dos custos socioeconomicos. Sabe-se que fatores psicossociais interferem na impressao do sujeito. Com o proposito de identifica-los, tem-se estimulado a busca de preditores prognosticos por meio de instrumentos de triagem. Porem, a eleicao do mais adequado pode ser dificil, ja que existe um grande numero de questionarios. Entre os aspectos abordados por eles, podemos citar: incapacidade funcional, qualidade de vida, satisfacao, dor, depressao, disturbios do humor e atividade funcional. O trabalho objetiva revisar as particularidades, indicacoes e limitacoes dos instrumentos de avaliacao do paciente com doenca na coluna vertebral.

Closed glabellar myotomy: a new surgical approach to treat wrinkles without scarring

Introduction: Hyperactivity of the glabellar musculature and resulting wrinkles are frequent complaints in the field of plastic surgery. Treatment consists of blocking the involved muscles. We propose a closed approach for the treatment of glabellar musculature. Methods: Seventy-eight patients underwent operation between April 2012 and August 2015. Myotomy includes the use of markings and polyglactin 0 wire or steel wire, passing through the marked lines several times, entering the eyebrow and using the juxtaperiostal plane, returning through the same orifice of the needle toward the entry hole, and using the subcutaneous plane. Results: Good results were obtained in all cases by preventing glabellar muscle activity during the period evaluated (at least 1 year), with improvement in wrinkles and muscle hyperactivity. The complications observed included temporary paresthesia in the frontal region (35 cases) and partial recurrence (4 cases). There was no case of total recurrence. The options for long-term surgical treatment of glabellar wrinkles are myotomy, partial neurotomy, or myectomy. Closed glabellar myotomy prevents some possible complications associated with these options, reduces the surgical time, requires the use of conventional surgical instruments, eliminates scarring, and causes asymmetric correction, less edema, and fewer bruises. Conclusion: Closed glabellar myotomy seems to be a good alternative compared to other traditional surgical options, because it eliminates scarring, allows correction of asymmetry, and presents good long-term results. ■ ABSTRACT

Reconstrução imediata do couro cabeludo com retalho de transposição baseado na artéria temporal superficial pós-ressecção oncológica

DOI: 10.5935/2177-1235.2018RBCP0047 Introdução: Os tumores mais comuns envolvendo o couro cabeludo incluem carcinoma basocelular, carcinoma espinocelular e melanoma maligno. A ressecção desses tumores pode causar defeitos variados e complexos. Há vários algoritmos para o tratamento desses defeitos. A reconstrução ideal irá depender da avaliação criteriosa de cada caso de acordo com diversos fatores. A técnica escolhida para a reconstrução deve priorizar o melhor resultado funcional e estético possível, com mínimo de morbidade do sítio doador. Métodos: Relato de caso. Foram revisados o prontuário e os registros fotográficos de um caso de reconstrução imediata com retalho local após ressecção de tumor de couro cabeludo, e realizada revisão bibliográfica. Resultados: Paciente foi submetido à ressecção de tumor de couro cabeludo e à reconstrução imediata com retalho local, com evolução favorável. Conclusão: Existem diversas opções para a reconstrução do escalpo, sendo o retalho local de transposição baseado na artéria temporal superficial, seguida de enxertia da área doadora, uma excelente opção de reconstrução do couro cabeludo. ■ RESUMO

Rhinophyma: a surgical treatment option

Introduction: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. Methods: A review of medical and photographic records of a case of rhinophyma was conducted. Results: The patient was underwent surgical treatment with favorable outcomes. Conclusion: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option. ■ ABSTRACT

Pectus excavatum and breast asymmetry: correction with breast augmentation

Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients. ■ ABSTRACT

Partial reconstruction of a nose based on a nasolabial flap after the resection of a squamous cell carcinoma involving the nasal septum, columella, and upper lip

INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing. INTRODUCAO: Reconstrucoes de defeitos complexos na face constituem um desafio para os cirurgioes. Apos resseccao da lesao, o reparo nasal e dificil, ja que possui uma variedade de tecidos e area local doadora reduzida para reconstrucao. Ja as lesoes de labio possuem como principal dificuldade a restauracao da funcao, priorizando a integridade da estrutura esfincteriana, a continencia oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrucao dessas areas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrucao nasal e de labio superior em dois tempos cirurgicos, utilizando retalho nasogeniano, apos defeito complexo causado por resseccao de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do genero feminino, 56 anos, apresentou CEC de progressao avancada em regiao nasal da columela, terco anterior do septo e parte do labio superior. A paciente foi submetida a reconstrucao com retalho nasogeniano e, em segundo momento cirurgico, ao enxerto de cartilagem costal para reconstrucao de columela. Apresenta evolucao com boa integracao e viabilidade dos enxertos e retalhos. O resultado estetico foi satisfatorio. CONCLUSAO: A utilizacao de retalho nasogeniano como opcao terapeutica para a reconstrucao parcial de nariz e de labio superior apresentou desfechos funcionais/esteticos favoraveis. Alem disso, a segmentacao do procedimento cirurgico traz seguranca na utilizacao dos retalhos locais, principalmente em individuos de dificil cicatrizacao.