Guilherme Bueno de Oliveira

Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands

OBJECTIVE To compare a long-term carpal tunnel syndrome (CTS) on nerve conduction studies (NCS) in hands treated non-surgically. METHOD We retrospectively selected 261 symptomatic CTS hands (166 patients), all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV) < or =46.6 m/s (wrist to index finger, 14 cm) and distal motor latency (DML) > or =4.25 ms (wrist to APB, 8 cm). RESULTS 92.8% were women; mean age was 49 years (20-76); the mean interval between NCS was 47 months (12-150). In the first exam, the median sensory nerve action potential (SNAP) and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis

BACKGROUND Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects. OBJECTIVES To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones. METHODS Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment. RESULTS McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure. CONCLUSIONS The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.

Epidemiological study of 740 areas treated with cryolipolysis for localized fat

Introduction: A non-invasive alternative for the treatment of localized fat is cryolipolysis that, by freezing adipocytes, reduces fat volume in the region where the procedure was performed. Objective: To statistically describe the experience of a referral center for this procedure. Methods: A cross-sectional study with 251 patients undergoing cryolipolysis was carried out with the epidemiological analysis of patient data. Results: Thirty-eight males and 213 females underwent the procedure, with a total number of 740 treated areas. The anterior abdomen (lower third) was the most popular region, with 45.30% of cases. Eighty-eight percent were satisfied or very satisfied with the result. Nearly all cases required 2 or more sessions to achieve this degree of satisfaction. Conclusions: Cryolipolysis is a noninvasive method for the selective reduction of fat that has shown efficacy in reducing the subcutaneous tissue, with minimal and reversible side effects in this study

Exuberant clinical picture of Buschke-Fischer-Brauer palmoplantar keratoderma in bedridden patient

Buschke-Fisher-Brauer keratoderma is a rare hereditary autosomal dominant disease of incomplete penetrance. Important differential diagnoses include other palmoplantar keratinization disorders, acquired or hereditary, which is done based on the histopathological findings. This diagnosis alerts especially about the possibility of associated neoplasms. Treatment involves topical keratolytic agents, usually with little efficacy, or with long-term systemic retinoids with follow-up of exuberant collateral effects.

Correction of volumetric aging of hands: comparative study between calcium hydroxyapatite and hyaluronic acid

Introduction: Signs of aging usually arise more intensely on the face, neck, and hands, in the form of considerable loss of volume, which is a common indicator of aging. Objective: To compare the duration, and adverse effects of two types of subcutaneous fillers in the treatment of the volumetric aging of hands. Methods: Group A: four patients who used the same amount of the products in both hands; Group B: four patients who used greater amounts of calcium hydroxyapatite in one of the hands and Group C: four patients who used greater amounts of hyaluronic acid also in one of the hands.The patients were evaluated through changes in a validated scale for hand aging, recorded by digital photographs before and 1,3,6,9,12,15 and 18 months after the procedure. Results: In Group A the patients had the same duration for both fillers; in Group B patients treated with hydroxyapatite calcium had longer duration; in Group C, the patients treated with hyaluronic acid presented longer duration. Adverse effects were more frequent with the use of calcium hydroxyapatite. Conclusions: It can be concluded that the filler duration is proportional to the volume injected for both fillers, and that hyaluronic acid is safer for the treatment of this cosmetic irregularity.

Imiquimod and curetage for the treatment of molluscum contagiosum: a comparative study

Introduction: Molluscum contagiosum is a skin infection caused by a poxvirus. In the literature there are descriptions of different therapeutic approaches of this infection. Objective: To evaluate the efficacy of imiquimod – isolated and associated with curettage – in the treatment of molluscum contagiosum. Methods: Group A: 20 patients used 5% imiquimod cream 3 times a week for 6 weeks. Group B: 10 patients used a creamy base 3 times a week, for 6 weeks. After the initial 6 weeks, all patients underwent curettage. Results: Group A: 31% decrease in the number of lesions in the 6th week, with a curettage effectiveness of 97.6%; Group B: 4.8% increase in the number of lesions in the 6th week, with a curettage effectiveness of 81.1%.The mean value for the pain level during curettage was 1.8 for Group A and 3.0 for Group B. Conclusions: Due to the facts that the rate of cure of contagious molluscum lesions increased and the pain decreased when the curettage procedure was conducted after the use of the immunomodulator, it was possible to conclude that the association of 5% imiquimod cream to the curettage may be a therapeutic possibility.

Treatment of the orbicularis oculi muscle’s lower portion with microdoses of botulinum toxin: a 300 cases series

Introduction: The use of botulinum toxin in the periorbital muscles is aimed at reducing expression lines in that site, correcting the eyebrows’ height and treating blepharospasm. However, the application of botulinum toxin in this area can lead to undesirable side effects, such as ptosis, edema in the lower eyelids, artificial appearance of the demarcation area between the orbicularis muscle’s treated area and the malar region, ectropion and hematomas. Objective: To treat the dynamic wrinkles in the lower portion of the orbicularis oculi muscle through injections of microdoses of botulinum toxin. Methods: A prospective monocentric study with the analytical longitudinal observation of 300 patients undergoing treatment with botulinum toxin microdoses in the lower eyelids’ rhytids was carried out. Sociodemographic data, patient satisfaction, dose quantification and complications were analyzed. Results: Sixty-six percent of the patients showed a total improvement of the wrinkles after the first session. The other required an additional session. Eighty-six percent preferred the treatment with this therapeutic modality. Conclusions: Despite the great benefit offered by the classic injection points for the treatment of periorbital rhytids types I to III, the authors observed the need to treat rhytids type B (presence of wrinkles on the lower eyelid). Due to the high rate of complications in this region, microdoses of botulinum toxin were proven to be effective and safe.