Márcio Paulino Costa

Sensibility of the breast after reduction mammaplasty.

Changes in breast sensibility after reduction mammaplasty remain a controversial subject and most previous studies report only qualitative results. There is more accurate measuring of the sensibility of the skin with the Pressure-Specified Sensory Device (PSSD), which measures the pressure perception of the skin in grams per square millimeter. The evaluation of breast sensibility before and after reduction mammaplasty using the upper medial pedicle technique was undertaken in 25 patients. The PSSD was used to measure one dynamic point threshold in nine points of the breast during the preoperative period and 6 months after surgery. After surgery all patients had decreased sensation in all points studied, and this was significant. There are few reports of breast sensibility after mammaplasty using the PSSD, and the discrepancy in results reported using other methods of evaluation could be related to precision in evaluation.

Epidemiologia e tratamento das úlceras de pressão: experiência de 77 casos

Prolonged tissue crompression due to sitting, lying or wearing brace in a heathy person results in discomfort and pain due to local isquemia. The normal protective pahtways are interrupted, however, in paraplegics, quadriplegic or the signals are ignored in severely de hibilitade, eldery or chronic ill patients. The pressure sore develops in these patients. Few papers have been done in Brazil abour pressure sores, despite economic problem envolved with. The purpose of this paper is to evaluate the epidemiology, treatment and complications of pressure sores in the Hospital das Clinicas (University of Sao Paulo) from February 1997 to March 1999 in the Orthopedics Institute. A prospective study has been done. Data were evaluated as to the sex, age, sites, classification, type of treatment employed, length of stay and complications. The treatment was evaluated by the success rate and recurrence rate . The average follow-up period was 1 year and a half, ranging from 6 month to 2 years. 77 pressure sores in 45 patients were apraised. 36 men and 9 women, age range 17-64, mean 34,78 years. Of the patients, 100% had severe spinal cord injuries, and most of them victims of gun shot (60%). 93,3% of the wound were chronic (present longer than 3 months). 77,92% were treated by surgical procedures, and most of them with myocutaneous flaps (45%). The success rate changed with the site of the lesion: 80% trochanter, 84% sacrum and 66,6% ischium. The recurrence rate was 25%. The complication rate also changed with the site of the lesion: 84% trocanter, 64% sacrum and 50% isquium.

Mesenchymal bone marrow stem cells within polyglycolic acid tube observed in vivo after six weeks enhance facial nerve regeneration

Autografting is the gold-standard method for facial nerve repair with tissue loss. Its association with high-quality scaffolds and cell implants has disclosed distinct experimental outcomes. The aim of this study was to evaluate the functional and histological effects of bone marrow stem cells (BMSC) combined with polyglycolic acid tube (PGAt) in autografted rat facial nerves. After neurotmesis of the mandibular branch of the rat facial nerve, surgical repair consisted of nerve autografting (groups A-E) contained in pGAT (groups B-E), filled with basement membrane matrix (groups C-E) with undifferentiated BMSC (group D) or Schwann-like cells that had differentiated from BMSC (group E). Axon morphometrics and an objective compound muscle action potentials (CMAP) analysis were conducted. Immunofluorescence assays were carried out with Schwann cell marker S100 and anti-β-galactosidase to label exogenous cells. Six weeks after surgery, animals from either cell-containing group had mean CMAP amplitudes significantly higher than control groups. Differently from other groups, facial nerves with Schwann-like cell implants had mean axonal densities within reference values. This same group had the highest mean axonal diameter in distal segments. We observed expression of the reporter gene lacZ in nerve cells in the graft and distally from it in groups D and E. Group-E cells had lacZ coexpressed with S100. In conclusion, regeneration of the facial nerve was improved by BMSC within PGAt in rats, yet Schwann-like cells were associated with superior effects. Accordingly, groups D and E had BMSC integrated in neural tissue with maintenance of former cell phenotype for six weeks.

A utilização do tubo de ácido poliglicólico e FK506 na regeneração de nervos periféricos

Extensive losses of neural tissue preclude the repair performed by means of primary anastomosis. In those cases, nerve autograft is considered as the treatment of choice. The synthetic tube constituted by polyglycoic acid is an option for nerve graft. The FK506 is an immunosuppressive agent, which increases the neural regeneration rates in vivo and in vitro. The purpose of this study was to compare, in rats, the degree of neural regeneration, by using histological analysis, a count of the number of regenerated myelinated axons, and a functional analysis, obtained by interposing the autogenous graft (group A), polyglycoic acid tube (group B) and a combination of polyglycoic acid tube with FK506 (group C) in 5-cm defects of the sciatic nerve. Neuroma formation was observed only in group A. Groups B and C presented similar histological patterns. The quantitative analysis of the number of regenerated myelinated axons has determined that: 1) group B presented, in average, a lower number when compared to the other groups; 2) there was no significant difference between control group A and group C. For functional recovery, there was no statistically significant change between the three groups, despite the qualitative and quantitative histological differences seen.

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).

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.

Postural control in women with breast hypertrophy

OBJECTIVES: The consequences of breast hypertrophy have been described based on the alteration of body mass distribution, leading to an impact on psychological and physical aspects. The principles of motor control suggest that breast hypertrophy can lead to sensorimotor alterations and the impairment of body balance due to postural misalignment. The aim of this study is to evaluate the postural control of women with breast hypertrophy under different sensory information conditions. METHOD: This cross-sectional study included 14 women with breast hypertrophy and 14 without breast hypertrophy, and the mean ages of the groups were 39±15 years and 39±16 years, respectively. A force platform was used to assess the sensory systems that contribute to postural control: somatosensory, visual and vestibular. Four postural conditions were sequentially tested: eyes open and fixed platform, eyes closed and fixed platform, eyes open and mobile platform, and eyes closed and mobile platform. The data were processed, and variables related to the center of pressure were analyzed for each condition. The Kruskal-Wallis test was used to compare the conditions between the groups for the area of center of pressure displacement and the velocity of center of pressure displacement in the anterior-posterior and medial-lateral directions. The alpha level error was set at 0.05. RESULTS: Women with breast hypertrophy presented an area that was significantly higher for three out of four conditions and a higher velocity of center of pressure displacement in the anterior-posterior direction under two conditions: eyes open and mobile platform and eyes closed and mobile platform. CONCLUSIONS: Women with breast hypertrophy have altered postural control, which was demonstrated by the higher area and velocity of center of pressure displacement.

Evaluation of the systemic use of riluzole in post-traumatic facial nerve regeneration: experimental study in rabbits.

Conclusions. Riluzole promoted increase and/or preservation of axon density in the animals treated with this drug as compared to the control group; it did not increase the mean diameter of facial nerve fibres as compared to the non-treated group; and it did not provide a better functional motor recovery than in the control group. Objective. Traumatic peripheral facial paralysis is a frequent affection. In incomplete nerve injuries, systemic drugs acting on regeneration may decrease the patients period of morbidity. This study aimed to determine the effect of the drug riluzole on regeneration of the facial nerve of rabbits submitted to post-traumatic facial paralysis. Materials and methods. Eighteen rabbits were submitted to compression of the facial nerve and divided into control (A) and treated (B) groups. The animals were sacrificed 4 weeks after the injury and their nerves were studied regarding density of myelinated axons and measure of external axon diameters. Results. Partial functional recovery was observed within 2 weeks and complete recovery 5 weeks after injury. Mean neural density was 12 679.7 axons/mm2 (SD±237.5) in group A, and 19 073.8 axons/mm2 (SD±3549.9) in group B. Group A presented less than two-thirds the density of group B. There was no statistical difference in axon diameters between the studied groups.

Surgical treatment of endocrine exophthalmos by removal of orbital fat: clinical experience

PURPOSE To report a series of 73 patients with endocrine exophthalmos treated by removal of orbital fat using the transpalpebral approach during the period 1989 to 1999. METHODS The operation was performed according to the technique described by Olivari. Aesthetic analysis was done preoperatively and postoperatively (more than 6 months after surgery). The number of complications was also observed. RESULTS The average volume of resected fat was approximately 7.6 mL per orbit. No major complication was observed. In 9 patients with epiphora, all improved. One patient developed postoperative diplopia and 5 complained of temporary diplopia. Appearance improved in 62 patients (85%). CONCLUSION Surgical removal of orbital fat associated with endocrine exophthalmos provides consistent improvement in appearance with a low rate of complications. Additional procedures may be indicated to improve the cosmetic outcome.

Tubo de ácido poliglicólico e GM1 na regeneração de nervos periféricos

INTRODUCAO: A auto-enxertia de nervo e considerada tratamento de escolha nas grandes perdas de tecido neural que nao permitam a reparacao atraves de anastomose primaria. Nesses casos, o tubo sintetico a base de acido poliglicolico e uma alternativa para enxertia de nervo. Por outro lado, muitos estudos tem enfatizado a importância dos fatores neurotroficos na regeneracao neural: o monossialotetraesosilgangliosideo (GM1), um dos principais glicoesfingolipides do tecido nervoso de mamiferos, e tido como potencializador dos efeitos desses fatores. OBJETIVO: Comparar, em ratos, o grau de regeneracao neural, utilizando analise histologica, contagem do numero de axonios mielinizados regenerados e analise funcional com a utilizacao do neurotubo e do GM1. METODOS: Essa avaliacao foi obtida com a interposicao de enxerto autogeno (grupo A), tubo de acido poliglicolico (grupo B) e da associacao do tubo de acido poliglicolico a administracao de GM1 (grupo C) em defeitos de 5 mm no nervo ciatico. RESULTADOS: Foi observada formacao de neuroma apenas no grupo A. Os grupos A e C apresentaram padroes histologicos semelhantes, exceto que os axonios regenerados do grupo C apresentavam-se mais organizados e mielinizados que o grupo A. CONCLUSAO: Na recuperacao funcional, nao houve diferenca estatisticamente significativa entre os tres grupos, a despeito das diferencas histologicas qualitativas e quantitativas verificadas.