Lydia Masako Ferreira

Avaliação clínica e epidemiológica das úlceras por pressão em pacientes internados no Hospital São Paulo

BACKGROUND: To determine the profile of patients at the Hospital Sao Paulo with pressure ulcers (PU). METHODS: A prospective study was carried out. Seventy-eight patients with pressure ulcers were evaluated between May 1st and 31st of 2002. The questionnaire consisted of demographic and clinical data of the population, PU classification and Braden Scale. RESULTS: Concerning 78 patients with PU: 66.7% were over 61 years old (average: 64). The average period of hospitalization was 33 days. 68% (53) developed ulcers while hospitalized, of which 43.7% (34) were pre-ulcers. The most frequent causes of hospitalization were neurological diseases (29.5%) and cancer (29.5%). Regarding the classification of the pressure ulcers, all stages were found on the sacrum, being 24.4% (19) pre-ulcer, 38.5% (30) stage II, 11.5%(9) stage III and 12.8%(10) at stage IV. According to the Braden Scale, half of the patients hospitalized showed severe risk of PU development, while 20.5% (16) showed moderate risk and 19.3% (15) showed low risk. CONCLUSIONS: The study showed a high risk of PU development, indicating the importance of having knowledge about the main characteristics of the hospitalized patients who may develop pressure ulcers, and, thus, preventing them.

A clinical, prospective, randomized, double-blind trial comparing skin whitening complex with hydroquinone vs. placebo in the treatment of melasma.

Objectives To compare, in a double‐blind, randomized, prospective study, the clinical improvement of hyperpigmentation in 30 patients with melasma using hydroquinone or skin whitening complex topically on one side of the face vs. a placebo cream on the other. The study was performed during the period November 2000 to March 2001 at the Federal University of São Paulo, Escola Paulista de Medicina.

Is There an Ideal Animal Model to Study Hypertrophic Scarring

Wound healing in hypertrophic scarring and keloid animal models presents significant differences when compared with humans. A brief review is presented about hypertrophic scarring in animal models during the last 5 years. Models were described by animals and scientific artifices to cause hypertrophic scarring. They were divided into 1) heterologous hypertrophic scarring or keloid implants in immunodeficient animals (athymic mice and rats); 2) heterologous hypertrophic scarring or keloid implant in immune privileged site (hamster cheek pouch); 3) hypertrophic scarring or keloid induction via chemically mediated injury (guinea pigs); 4) hypertrophic scarring or keloid induction in anatomic specific site (rabbit ear); and the 5) porcine model. The ideal model would allow to research pathophysiology, histology, and molecular events during time and to test prophylactic and therapeutic treatments for humans. Some of these animals were useful to study specific steps of the scarring process and better understand abnormal wound healing, but none of them have a widespread use. Most recently, the female red Duroc pigs were validated as a new model, demonstrating its similarity to human conditions in different ways. Full-thickness human skin grafts in nude mice also represent improvement in the search of an ideal hypertrophic scarring animal model.

Vertical growth phase and positive sentinel node in thin melanoma

Sentinel node (SN) status is the most important prognostic factor for localized melanoma. Usually, patients with Breslow thickness of less than 1.0 mm are not included in SN protocols. However, the literature presents a rate ranging from 3 to 7% of nodal recurrence in thin melanoma. Ulceration, regression and high mitotic rate have been considered to be indications for an SN biopsy. The metastatic potential of the vertical growth phase is uncertain. To correlate pathological features in thin melanoma with SN metastasis, we reviewed 358 patients submitted to SN biopsy. Seventy-seven patients with lesions of 1 mm or smaller were included in the study group. Histological evaluation of the primary tumor included thickness, Clark level, mitotic rate, ulceration, regression, and growth phase. Lymphoscintigraphy was performed on all patients. Lymphatic mapping and gamma probe detection were both used for SN biopsy. Histological examination of SN consisted of hematoxylin-eosin and immunohistochemical staining. Median follow-up was 37 months. Six patients had micrometastases. Statistical analysis by the Fisher test showed that ulceration (P = 0.019), high mitotic rate (P = 0.008) and vertical growth phase (P = 0.002) were positively correlated with micrometastases. If other studies confirm these results, more melanoma patients must be submitted to SN biopsy.

Does quilting suture prevent seroma in abdominoplasty

Background: Seroma is the most frequent complication in abdominoplasty. Some patients are more prone to develop this complication. Ultrasound is a well-known method with which to diagnose seroma in the abdominal wall. The purpose of this study was to verify the efficacy of the use of quilting suture to prevent seroma. Methods: Twenty-one female patients who presented with abdominal deformity type III/A according to the authors’ classification of abdominal skin and myoaponeurotic deformity had undergone abdominoplasty. The selected patients should have had at least one of the following characteristics: body mass index greater than 25 kg/m2; weight loss greater than 10 kg; previous incision in the supraumbilical region; or present thinning of the subcutaneous in the area above the umbilicus. Ultrasound was performed for every patient from 15 to 18 days after the operation to search for fluid collection in the abdominal wall. Results: The average fluid collection found was 8.2 cc per patient. Only two patients underwent aspiration because ultrasound showed greater than 20 cc collected above the fascial layer. These patients did not present with recurrence of seroma after aspiration. Conclusion: The quilting suture seems to be an efficient technique with which to prevent seroma formation.

Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery.

Background: This prospective trial was designed to assess the impact of oncoplastic surgery on quality of life and self-esteem of breast cancer patients undergoing breast-conserving treatment. Methods: Forty-five patients with primary breast cancer to be treated with breast-conserving surgery and immediate partial breast reconstruction were assessed with regard to quality-of-life and self-esteem outcomes preoperatively and 6 and 12 months postoperatively. Another 42 breast cancer patients, treated by conservative surgery without breast reconstruction at least 1 year previously, were assessed for the control group. Validated questionnaires (Short Form-36, Brazilian version, and the Rosenberg-EPM Self-Esteem Scale) were used. Data were analyzed by using the Mann-Whitney and Friedman tests. Results: Participation rates at the follow-up assessments were 95.5 percent at the 6-month follow-up and 88.9 percent at the 12-month follow-up. Control and reconstruction groups were matched for age, body mass index, and demographic and oncologic aspects. At postoperative month 12, the breast reconstruction group had significantly better health status than the control group with regard to physical functioning (p < 0.000), health perception (p < 0.002), vitality (p < 0.007), social functioning (p < 0.02), role emotional (p < 0.02), mental health (p < 0.000), and self-esteem (p < 0.02). Compared with preoperatively, breast reconstruction group scores were significantly higher at 12 months postoperatively for seven of the eight dimensions of the Short Form-36: physical functioning (p < 0.01), role physical (p < 0.02), health perception (p < 0.02), vitality (p < 0.01), social functioning (p < 0.02), role emotional (p < 0.05), and mental health (p < 0.02). Self-esteem was also significantly better at 12 months (p < 0.02). Conclusion: Oncoplastic surgery had a positive impact on quality of life and self-esteem of patients undergoing breast-conserving treatment.

Health-related quality of life of primary caregivers of persons with paraplegia

Study Design:A cross-sectional descriptive study was performed with structured questionnaires and interviews conducted with 60 primary caregivers of persons with paraplegia (T1 to S2) owing to traumatic spinal cord injury (SCI).Objectives:The purpose of this study was the assessment of the health-related quality of life (HRQoL) of primary caregivers of persons with paraplegia owing to traumatic SCI.Setting:São Paulo, SP, Brazil.Methods:The HRQoL was assessed by the Short Form-36 (SF-36) health survey questionnaire and caregiver burden was evaluated by the Caregiver Burden Scale (CBS).Results:Among 60 caregivers evaluated, 49 (81.7%) were female, with mean age of 35.8 (SD=12.91) years, 16 (26.6%) being wives and 14 (23.4%) sisters of persons with paraplegia. It was found that the caregivers spend an average of 11.3 h/day caring for individuals with paraplegia. Twenty-three caregivers (38.3%) had a chronic disease and 32 (53.3%) were sole caregivers taking upon themselves the full responsibility of caring for the persons with paraplegia. The subjects reported lower scores on bodily pain and vitality than the other dimensions of the SF-36. The mean global CBS score was 1.71 (SD=0.50) and mean scores for each dimension ranged from 1.39 (SD=0.64) for emotional involvement to 2.44 (SD=0.79) for environment dimension.Conclusion:The primary caregivers of spinal cord-injured persons reported low scores on all of the SF-36 and CBS dimensions, bodily pain and vitality being the SF-36 dimensions that received the lowest scores.Sponsorship:Funding was provided by the Brazilian research agency CAPES.

Long-term follow-up of correction of rectus diastasis.

Background: Correction of rectus diastasis is a procedure performed by most surgeons during abdominoplasty. The purpose of this study was to demonstrate the long-term efficacy of the correction of rectus diastasis when plication of the anterior rectus sheath is performed with a nonabsorbable suture. Methods: Twelve female patients who underwent abdominoplasty were studied. Rectus diastasis was measured preoperatively with two computed tomographic scan slices: one above and one below the umbilicus. The bony levels where the slices were obtained served as a reference for the postoperative computed tomographic scans. During the operation, rectus diastasis was measured at the same levels as the preoperative scan slices. At the same time, the necessary force to bring the medial edge of the rectus muscle to the midline was measured with a dynamometer. Postoperative scans were obtained at 3 weeks and 6 months after the operation. A long-term follow-up scan was obtained from 76 to 84 months postoperatively for every patient. Results: The 3-week postoperative scan proved that the correction of rectus diastasis had been achieved by the procedure. Despite the fact that there were different levels of abdominal wall resistance and that the average weight gain in this period was 6.5 kg, the long-term computed tomographic scans showed that there was no recurrence of rectus diastasis in any patient of this series, both in the superior and inferior abdomen. Conclusions: Plication of the anterior rectus sheath with nonabsorbable suture appears to be a long-lasting procedure for correcting rectus diastasis.

Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon

Calcaneous tendon is one of the most damaged tendons, and its healing may last from weeks to months to be completed. In the search after speeding tendon repair, low intensity laser therapy has shown favorable effect. To assess the effect of low intensity laser therapy on the process of tissue repair in calcaneous tendon after undergoing a partial lesion.

Effect of low-level laser therapy (GaAlAs) on bone regeneration in midpalatal anterior suture after surgically assisted rapid maxillary expansion.

OBJECTIVE The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME). METHODS Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software. RESULTS Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group. CONCLUSION Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements.