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ABSTRACT Objective: To evaluate the possible renal and hepatic alteration by root canal filling pastes in mice. Material and Methods: Fifty-four mice were divided into nine groups and received one polyethylene tube implant containing two filling pastes (CTZ or calcium hydroxide pastes). Empty polyethylene tubes were used as a negative control. All tubes were implanted subcutaneously in the back of the mice. After time intervals of 7, 21, and 63 days, 1.5 mL of blood was collected by cardiac puncture, and serum samples were used for serological testing. Urea, creatinine, aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) were evaluated. Data were analyzed by 2-way ANOVA (p<0.05). Results: When comparing CTZ and calcium hydroxide pastes and empty tubes and experimental time intervals, no significant differences in the results were found for any of the biochemical parameters analyzed (p>0.05). No differences were observed in the interactions (material*experimental time intervals) and the biochemical parameters analyzed (p>0.05). Conclusion: CTZ and calcium hydroxide pastes did not cause hepatic and renal alterations in mice, demonstrating the pastes' safety.

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Pacinian corpuscles are mechanoreceptors frequently found between the dermis and subcutaneous tissues of the hands and feet. They are responsible for sensitivity to vibration and pressure. Pacinian corpuscle hyperplasia is a rare cause of induration in the palms of the hands or the soles of the feet, often of unknown origin or occasionally related to neurofibromatosis. It can be characterized by magnetic resonance imaging and is included in the differential diagnosis of anechoic lesions on high-resolution soft tissue ultrasound. The definitive diagnosis is made through histopathologic examination. In this case report, we present the findings of a 29-year-old patient who presented with painful nodules on the palms of both hands, with typical findings on ultrasound and magnetic resonance imaging indicative of Pacinian corpuscle hyperplasia. We also discuss the imaging findings and the differential diagnosis through a non-systematic review. Pacinian corpuscle hyperplasia is a rare condition that can be readily identified by high-resolution ultrasound and magnetic resonance imaging, and it should be considered in the differential diagnosis of hand nodules.

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Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen.

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno.

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Objetivo: o presente estudo tem como objetivo reunir recomendações de cuidados considerando a prevenção e tratamento de lesões de pele induzidas pelo tratamento com quimioterápicos antineoplásicos, de acordo com os estudos e consensos atuais. Metodologia: realizou-se um estudo bibliográfico para levantamento das relações entre os principais fármacos antineoplásicos e suas intercorrências dermatológicas, bem como seus respectivos manejos, para subsidiar a orientação e aconselhamento aos profissionais de saúde que acompanham o paciente oncológico. Resultado: os principais problemas dermatológicos decorrentes do uso de antineoplásicos correspondem às lesões de pele, tais como a descoloração, hiperpigmentação, fotossensibilidade, eritemas, descamação e prurido. Também são recorrentes os efeitos adversos que acometem os pelos e cabelos, resultando em alopecia, e a modificação do crescimento e lesões nas unhas. Tratamentos específicos para cada caso são capazes de amenizar ou reverter os problemas. Conclusão: as reações adversas aos medicamentos envolvendo quimioterapia são frequentes na prática oncológica, e variam em termos de frequência e gravidade, atingindo diversos anexos cutâneos. O adequado manejo destes efeitos melhora a integridade da pele e demais estruturas, proporcionando a esses pacientes a melhoria da autoestima e da qualidade de vida.

Objective: the present study aims to gather care recommendations considering the prevention and treatment of skin lesions induced by treatment with antineoplastic chemotherapy, according to current studies and consensus. Methodology: a bibliographical study was carried out to survey the relationships between the main antineoplastic drugs and their dermatological intercurrences, as well as their respective management, to subsidize the guidance and counselling of health professionals who treat cancer patients. Result: the main dermatological problems arising from the use of antineoplastic agents correspond to skin lesions, such as discoloration, hyperpigmentation, photosensitivity, erythema, scaling and pruritus. Adverse effects that affect hair and body hair are also recurrent, resulting in alopecia, and the modification of growth and lesions on the nails. Specific treatments for each case can alleviate or reverse the problems. Conclusion: adverse drug reactions involving chemotherapy are frequent in oncology practice, and vary in terms of frequency and severity, affecting various skin appendages. Proper management of these effects improves the integrity of the skin and other structures, providing these patients with improved self-esteem and quality of life.

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Background: The mechanism of fat reduction from radiofrequency occurs via the thermal stimulation of adipocyte metabolism, causing a lipase-mediated triglyceride enzyme degradation, apoptosis, and adipocyte rupture. Ultracavitation promotes fat reduction using adipose cell destruction through mechanical stimulus. The literature on the combination of these two physical agents, named ultrafrequency, is still scarce and requires consistent analysis of the effects of this therapy combination. Objective: The objective of this study was to investigate the effects of radiofrequency associated with ultracavitation in the treatment of abdominal subcutaneous tissue of women. Methods: This was a prospective, randomized clinical trial in which 45 participants were divided into three distinct groups: the control group (no treatment); ultracavitation group; and ultracavitation and radiofrequency (UCV+RF) group, each with 15 volunteers. The following variables were evaluated: weight, perimetry, plicometry, ultrasonography, treatment reactions, and patient satisfaction. Results: The participants in the UCV+RF group presented a more significant decrease in adipose tissue, which was verified through all the evaluation methods. Conclusion: Based on our results, the simultaneous application of ultracavitation and radiofrequency generated a reduction in localized adiposity superior to the isolated use of ultracavitation.

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Spirocerca lupi is the etiological agent of spirocercosis in canids from tropics and subtropics in the world. This parasite can lead to life threatening complications, including the formation of fibro and osteosarcomas. A 5-year-old crossbreed Maltese dog from Costa Rica was presented to a veterinary clinic with two nodules in the subcutaneous tissues of the cervical region. One of the nodules resolved with intramuscular antibiotic and anti-inflammatory treatment. However, the other nodule persisted and became purulent. The content of the nodule was excised releasing two coiled 3-cm reddish worms. Identity of the specimens was confirmed by amplifying an 850 bp fragment of the 18S rDNA. The obtained sequence showed 99.96% similarities with S. lupi from Hungary. The present study highlights the need of veterinary clinicians' awareness towards nematode aberrant migrations, and the require of molecular studies to gain insight into the parasite's evolutionary history.

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INTRODUCTION: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. METHODS: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. RESULTS: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). CONCLUSION: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.

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Abstract Introduction: This study aims to test the effect of phenytoin as an inhibitor of the process of dystrophic calcification in bovine pericardium and porcine leaflets implanted in the subcutaneous tissue of rats. Methods: Isolated segments of biomaterials were implanted subcutaneously in young rats. The study groups received 500 mg phenytoin per kilogram of diet per day. After 90 days, samples were collected and quantitative calcification assessment by optical microscopy, radiological studies with mammography, and atomic emission spectrometry were performed. Results: Inflammatory reaction was a frequent finding in all groups when analyzed by optical microscopy. The calcium level assessed by atomic absorption spectrophotometry was significantly lower in the study groups using phenytoin compared to the control groups (control bovine pericardium group X=0.254±0.280 µg/mg; study bovine pericardium group X=0.063±0.025 µg/mg; control porcine aortic leaflets group X=0.640±0.226 µg/mg; study porcine aortic leaflets group X=0.056±0.021 µg/mg; P<0.05). Radiologic studies revealed a statistically significant difference between the groups treated with and without phenytoin (not only regarding the bovine pericardium but also the porcine leaflets). Conclusion: The results obtained suggest that phenytoin reduces the calcification process of bovine pericardium segments and porcine aortic leaflets in subdermal implants in rats; also, the incidence of calcification in bovine pericardium grafts was similar to that of porcine aortic leaflets.

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Objective: The aim of this study was to evaluate the subcutaneous tissue response after different protocols to photodynamic therapy (PDT). In Phase 1, were tested the diode laser (used for 1min) associated to the photosensitizer phenothiazine chloride solution (PCS) in different concentrations. In Phase 2 ­ the diode laser and LED were tested associated to two different photosensitizers, PCS and Curcumin, in different exposure times of light application. Material and Methods: After 7, 21 and 63-days the animals were euthanized and the subcutaneous tissue processed to histological analysis. Qualitative and semi-quantitative descriptions of the inflammatory process and immunohistochemical technique were performed. The obtained data were analyzed by Kruskal-Wallis and Dunn's post-test (α= 0.5). Results: On Phase 1, the tissue response was very similar among the groups. For the inflammatory infiltrate, PCS with concentration of 10mg/mL exhibited the most intense reaction (p > 0.05). On Phase 2, at 7-days period, the analyzed parameters presented small magnitude and after 21 and 63-days, all the parameters demonstrated tissue compatibility. Conclusion: Both photosensitizers presented proper tissue compatibility regardless the different concentrations used on Phase 1 and different durations of light exposure on Phase 2 (AU)

Objetivo: Este estudo avaliou a resposta do tecido subcutâneo após terapia fotodinâmica, utilizando na Fase 1 - laser diodo por 1min e solução fotossensibilizadora de cloreto de fenotiazina (CF) em diferentes concentrações e Fase 2 - laser diodo e LED e dois fotossensibilizadores, CF e Curcumina, em diferentes tempos de exposição da aplicação de luz. Material e Métodos: Após 7, 21 e 63 dias, foram realizadas descrições qualitativas e semiquantitativas do processo inflamatório e técnica de imunoistoquímica. Os dados foram analisados pelo pós-teste de Kruskal-Wallis e Dunn (α = 0,5). Resultados: Na Fase 1, a resposta do tecido foi muito semelhante. O infiltrado inflamatório, na concentração de 10 mg / mL, exibiu reação mais intensa (p > 0,05). Na Fase 2, aos 7 dias, os parâmetros analisados apresentaram pequena magnitude. Aos 21 e 63 dias, todos os parâmetros demonstraram compatibilidade com o tecido. Conclusão: Ambos os fotossensibilizadores apresentaram compatibilidade de tecido adequada, independentemente das diferentes concentrações utilizadas na Fase 1 e diferentes durações de exposição à luz na Fase 2 (AU)

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Resumen ANTECEDENTES: La fascitis necrosante es una infección rara del tejido subcutáneo y la fascia que rápidamente puede complicarse y poner en riesgo la vida; por esto siempre debe tenerse en mente la posibilidad de este diagnóstico. OBJETIVO: Describir un caso raro de fascitis necrosante genital aparecida luego de un parto instrumentado. CASO CLÍNICO: Paciente primigesta, de 30 años, con antecedente de infección vaginal por Ureaplasma. El parto instrumentado tuvo lugar a las 39 semanas; se reparó la episiotomía medio-lateral derecha, sin complicaciones, y se dio de alta del hospital a las 48 horas. Al quinto día de puerperio acudió a Urgencias por dolor perineal intenso y fiebre. Durante la auscultación se encontró un hematoma perineal y glúteo derecho, con eritema alrededor, indurado y con crepitación vaginal, con secreción hematopurulenta fétida. Reportes de laboratorio: leucocitosis y anemia. Los cultivos de la herida reportaron infección polimicrobiana. El ultrasonido pélvico evidenció dos colecciones debidamente delimitadas en planos dérmicos y musculares. Se indicó tratamiento con antibióticos de amplio espectro, lavado quirúrgico y desbridamiento quirúrgico diario durante 5 días. Después, se inició la terapia de cierre asistido por vacío (VAC) durante 7 días hasta lograr la granulación. Se continuó con lavados quirúrgicos durante 5 días más. El día 18 posparto se cerró la herida sin complicaciones. A la sexta semana de seguimiento la herida había cicatrizado, sin dolor, ni incontinencia fecal o urinaria: solo hipoestesia de la cicatriz, pero con evolución satisfactoria. CONCLUSIÓN: Lo ideal es establecer el diagnóstico lo más temprano posible para disminuir la morbilidad y mortalidad, ofrecer inmediatamente atención multidisciplanaria que permita conseguir los mejores desenlaces quirúrgicos e incrementar la supervivencia.

Abstract BACKGROUND: Necrotizing fasciitis is a rare infection of the subcutaneous tissue and the fascia that is rapidly progressive and deadly, requiring early and aggressive surgical debridement to decrease mortality. The objective of this study was to describe a rare case of genital necrotizing fasciitis after operative vaginal delivery. CLINICAL CASE: A 30 years old primiparous woman with a history of vaginal infection by Ureaplasma. Instrumented delivery was attended at 39 weeks, repairing right mid-lateral episiotomy without complications and discharge after 48 hours. On the fifth day of the puerperium she went to the emergency department for severe perineal pain and fever, finding perineal hematoma and right gluteus with erythema around, indurated and with vaginal crepitation with fetid hemato-purulent secretion. The laboratories reported leukocytosis and anemia, wound cultures showed polymicrobial infection and pelvic ultrasound diagnosed 2 well-defined collections in dermal and muscular planes. Management was initiated with broad-spectrum antibiotics plus washing and daily surgical debridement for 5 days. Subsequently, it was placed with VAC therapy for 7 days until granulation was achieved; and then, surgical washes were continued for 5 more days. On the 18th day, the wound was closed without complications. In her sixth week of follow-up she has a scarred wound, without pain or fecal or urinary incontinence; only refers to hypoesthesia of the scar, but with satisfactory evolution. CONCLUSION: The ideal is to establish the diagnosis as early as possible to decrease morbidity and mortality, immediately offer multidisciplinary care that allows the best surgical outcomes to be achieved, and increases survival.

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ABSTRACT Objective: To report a rare case of inverse Kipplel-Trenaunay. Case description: A 16-year-old girl with a grayish-depressed plaque on her left thigh. Angioresonance showed a vascular malformation affecting the skin and subcutaneous tissue. Comments: Inverse Klippel-Trenaunay is a Klippel-Trenaunay syndrome variation in which there are capillary and venous malformations associated to hypotrophy or shortening of the affected limb. Modifications on the limb's length or width result from alterations in bones, muscles, or subcutaneous tissues. It has few described cases. Further clinical and molecular studies must be performed for a proper understanding.

RESUMO Objetivo: Relatar um caso raro de Klippel-Trenaunay inverso. Descrição do caso: Menina de 16 anos com placa deprimida acinzentada na coxa esquerda, evidenciando-se, por meio de angioressonância, uma malformação vascular, acometendo a pele e tecidos subcutâneos. Comentários: Klippel-Trenaunay inverso é uma variante da síndrome de Klippel-Trenaunay em que há malformação capilar e venosa associada à hipotrofia ou encurtamento do membro afetado. Pode envolver acometimento ósseo, muscular ou subcutâneo, modificando o comprimento ou a circunferência do membro. Há poucos casos descritos, e mais estudos clínicos e moleculares precisam ser realizados para seu correto entendimento.

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The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

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Abstract The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

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RESUMEN La hidatidosis es una infección zoonótica que puede invadir múltiples órganos en el ser humano. Sin embargo, el tejido subcutáneo es el órgano menos afectado por esta enfermedad, cuando esto ocurre se aprecia escasa sintomatología, lo que ocasiona periodos prolongados de enfermedad asociado a diagnóstico tardío y a una pobre respuesta a la terapia antiparasitaria. La sierra central del Perú es la zona con mayor prevalencia, presumiblemente por las inadecuadas medidas de saneamiento ambiental, la falta de educación y las casi inexistentes medidas de control de la enfermedad. Con el objetivo de discutir los problemas relacionados a la localización subcutánea y su probable fisiopatología, reportamos dos casos de hidatidosis subcutánea que se presentaron con lesiones tumorales de evolución prolongada y que no afectaron al hígado ni a los pulmones y que finalmente fueron tratados mediante extirpación quirúrgica debido a la falta de respuesta al tratamiento con albendazol.

ABSTRACT Hydatidosis is a zoonotic infection that can invade many organs in the human being. Nevertheless, the subcutaneous tissue is the less affected organ by this disease. When this disease appears, little symptomatology is observed, which causes prolonged periods of disease associated to delayed diagnosis and a poor answer to the antiparasitic therapy. The central mountain range of Peru is the geographical zone with the greatest prevalence, presumably due to the inadequate measures of environmental sanitation, the lack of education and the almost non-existent control measures of the disease. With the aim to discuss the problems related to the subcutaneous location and its probable physiopathology, this study reports two cases of subcutaneous hydatidosis that appeared with tumor lesions with a prolonged evolution and that did not affect the liver or the lungs and which were finally treated by means of surgical removal due to the lack of response to treatment with albendazol.

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SUMMARY BACKGROUND: The aim of the study was to describe and correlate the skin, subcutaneous tissue, and superficial fascia thickness assessed by ultrasonography (US) with the lumbar erector spinae muscles contractile properties evaluated by tensiomyography (TMG). METHODS: A cross-sectional descriptive study with 50 healthy participants was performed. The point of maximum lordosis in the lumbar region of the right erector spinae was evaluated by US and TMG. First, the skin, subcutaneous tissue, and superficial fascia thicknesses (cm) were assessed by US. Second, the five contractile TMG parameters were analyzed from the right erector spinae muscles belly displacement-time curves: maximal radial displacement (Dm), contraction time (Tc), sustain time (Ts), delay time (Td), and half-relaxation time (Tr). Finally, correlation analyses using Pearson (r for parametric data) and Spearman (rs for non-parametric data) coefficients were performed. RESULTS: A strong negative correlation was shown between Dm and subcutaneous tissue thickness (rs=-0.668; P<.001). Furthermore, moderate negative correlations were observed between Dm and skin thickness (r=-0.329; P=0.020) as well as Tr and subcutaneous tissue thickness (rs=-0.369; P=0.008). The rest of the parameters did not show statistically significant correlations (P >.05). CONCLUSION: Therefore, the lumbar erector spinae contractile properties during TMG assessments, especially Dm and Tr, may be widely correlated by the skin and subcutaneous tissue thickness.

RESUMO CONTEXTO: O estudo foi elaborado para descrever e correlacionar a pele, o tecido subcutâneo e a espessura da fascia superficial avaliados pelo ultrassom (EUA) com as propriedades contráteis do músculo eretor da coluna lombar avaliadas por tensiomiografia (TMG). MÉTODOS: Foi realizado um estudo descritivo transversal com 50 participantes saudáveis. O ponto de lordose máxima na região lombar da coluna ereta direita foi avaliado pelos EUA e TMG. Primeiro, a pele, o tecido subcutâneo e as espessuras da fáscia superficial (cm) foram avaliadas pelos EUA. Em segundo lugar, os cinco parâmetros TMG contráteis foram analisados a partir das curvas de deslocamento-tempo da barriga do músculo eretor da espinha direita: deslocamento radial máximo (Dm), tempo de contração (Tc), tempo de sustentação (Ts), tempo de atraso (Td) e meio tempo de relaxamento (Tr). Finalmente, foram realizadas análises de correlação usando os coeficientes Pearson (r para dados paramétricos) e Spearman (rs para dados não paramétricos). RESULTADOS: Uma correlação forte negativa foi mostrada entre Dm e espessura subcutânea do tecido (rs = −0,668; P < 0,001). Além disso, foram observadas correlações moderadas negativas entre Dm e espessura da pele (r = −0,329; P = 0,020), bem como a espessura subcutânea do tecido (rs = −0,369; P = 0,008). O restante dos parâmetros não mostrou correlações estatisticamente significativas (P > 0,05). CONCLUSÃO: Portanto, as propriedades contráteis do eretor da espinha lombar durante as avaliações TMG, especialmente Dm e Tr, podem ser amplamente correlacionadas com a pele e a espessura subcutânea do tecido.

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ABSTRACT Necrotizing fasciitis is a severe infection of the subcutaneous tissue characterized by necrosis of the superficial fascia and overlying skin and is usually associated with previous trauma and comorbidities. Periorbital necrotizing fasciitis is rare and commonly causes visual loss and soft tissue defects. A better prognosis relies critically on early diagnosis, prompt medical treatment, and timely surgical intervention. We describe a rare case of periorbital necrotizing fasciitis in the absence of an inciting event. A 55-year-old female patient presented with acute painful swelling and redness of the right upper eyelid that spread to both eyelids bilaterally within 24 h. We swiftly started the patient on intravenous antibiotic therapy, and we surgically debrided the necrotic tissue the following day. We performed two further procedures to improve eyelid closure and appearance. Despite the severe presentation, timely antibiotic therapy and proper surgical interventions led to a successful outcome in this case.

RESUMO Fasciite necrosante é uma infecção grave do tecido subcutâneo, caracterizada pela necrose da fáscia superficial e da pele sobrejacente. Traumas prévios e cormobidades geralmente estão associados à fasciite necrosante. Fasciite necrosante periorbital é rara. Perda visual e defeitos em tecidos moles são as morbidades mais comuns. Diagnóstico precoce, tratamento clínico rápido e intervenção cirúrgica oportuna levam a um melhor prognóstico. Reportamos um caso incomum de fasciite necrosante periorbital bilateral sem eventos desencadeantes. Uma paciente de 50 anos apresentou edema e eritema na pálpebra superior direita, que progrediu em 24 horas para ambas pálpebras bilateralmente. Ela era previamente hígida. A paciente foi submetida a debridamento cirúrgico do tecido necrótico, no mesmo dia. A paciente foi submetida a outras duas cirurgias, o que melhorou o fechamento palpebral e a aparência. Apesar da gravidade da doença, antibioticoterapia e cirurgias oportunas foram cruciais para o desfecho bem sucedido deste caso.

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OBJECTIVE: The aim of this study was to investigate the biocompatibility of methylene blue at different pH levels through the method of implantation in subcutaneous tissue. MATERIALS AND METHODS: Eighty-four sterilized polyethylene tubes were allocated in the subcutaneous tissue of 28 rats, each one receiving four tubes, set into four groups: group tube (G-T)-empty tube, fibrin group (G-F)-tube filled with fibrin sponge, group methylene blue pH 7 (G-MB/pH 7)-tube filled with fibrin sponge soaked by methylene blue (100 µg/ml) at pH 7.0, and group methylene blue pH 1 (G-MB/pH 1)-tube filled with fibrin sponge and soaked by methylene blue (100 µg/ml) at pH 1.0. After 7, 15, and 30 days, seven animals from each group were euthanized, and the tubes involved by the surrounding tissue were removed and fixed with 4% buffered formaldehyde solution. The collected pieces were processed and histological sections (4 µm) were stained with hematoxylin and eosin and analyzed by light microscopy. Scores were assigned to analysis of histopathologic parameters. The results were statistically analyzed by the Kruskal-Wallis test (p ≤ 0.05). RESULTS: At 7 and 30 days, the G-MB/pH 1 group showed no significant difference in the G-T control group, while G-MB/pH 7 had a significant increase on tissue reaction, also when compared to G-T. At 15 days, there was no statistical difference between the groups. CONCLUSION: Within the limits of this study, it is concluded that methylene blue at pH 1.0 provides better biocompatibility than at pH 7.0.

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Este estudo teve como objetivo avaliar a biocompatibilidade, através de análise histopatológica e de imuno-histoquímica, de um novo cimento reparador à base de MTA com alta plasticidade: MTA HP (Angelus Londrina, PR). O MTA branco (Angelus Londrina, PR), e um material a base de óxido de zinco e eugenol (IRM, Dentsply, Petrópolis, RJ) foram utilizados como referências para comparação. Para isso, trinta ratos machos de linhagem Wistar tiveram inoculados no tecido subcutâneo um tubo de polietileno vazio (controle negativo) e mais três tubos, cada um preenchido com um dos materiais testados. Os animais foram eutanasiados após 7, 30 e 60 dias da implantação dos tubos e as amostras foram fixadas e incluídas em parafina. Os cortes histológicos foram corados com hematoxilina e eosina e tricômico de gomori para avaliação das reações inflamatórias e a presença de angiogênese foi realizada utilizando o marcador VEGF (do inglês vascular endothelial growth factor). Os cortes também foram corados com Picrosirius Red para quantificar as fibras colágenas do tipo I e tipo III, assim como a coloração de Weigert foi realizada para observar as fibras elásticas. Os dados não-paramétricos foram analisados usando o ensaio de Kruskal-Wallis seguido do teste de Dunn. Os níveis de significância adotados foram de 5% (P < 0,05). Os resultados mostraram diferença significativa da resposta inflamatória após 60 dias entre os grupos IRM e tubo vazio (P < 0,05). O MTA HP apresentou biocompatibilidade similar ao MTA branco e ao grupo controle negativo em todos os períodos experimentais. Além disso, após 7 dias o MTA HP estimulou a angiogênese de forma menos acentuada que o MTA branco, assim como apresentou inicialmente um remodelamento mais lento da matriz extracelular quando comparado ao MTA branco e o IRM. Foi observado uma diminuição da espessura da cápsula fibrosa, da quantidade de fibras elásticas e da imonumarcação com VEGF em todos os grupos experimentais e controle negativo ao longo do processo de cicatrização. Após 60 dias os grupos experimentais apresentaram matriz extracelular com tecido conjuntivo mais maduro, com predominância de fibras colágenas do tipo I. De acordo com os resultados obtidos no presente estudo, pode-se concluir que o novo cimento reparador com alta plasticidade, MTA HP, apresentou-se biocompatível em todos os períodos experimentais, com resultados similares aos grupos controle negativo e experimentais com MTA branco e IRM.

This study evaluated the biocompatibility, through histopathological analysis and immunohistochemistry of a new repair cement based on MTA with high plasticity: MTA HP (Angelus Londrina, PR). White MTA (Angelus Londrina, PR), and a material based on zinc oxide and eugenol (IRM, Dentsply, Petrópolis, RJ) were used as references for comparison. Thirty male Wistar rats had inoculated into the subcutaneous tissue an empty polyethylene tube (negative control) and three more tubes, each filled with one of the tested materials. The animals were euthanized after 7, 30 and 60 days of tube implantation and the specimens were fixed and embedded in paraffin. The sections were stained with hematoxylin and eosin and gomori trichrome to assess inflammatory reactions, and the presence of angiogenesis was performed using the VEGF (vascular endothelial growth factor) marker. The sections were also stained with Picrosirius Red to quantify as type I and type III collagen fibers, as well as a Weigert staining was performed to observe elastic fibers. Non-parametric data were analyzed using the Kruskal-Wallis assay followed Dunn's test. The significance levels adopted were 5% (P < 0.05). The results demonstrated a significant difference in inflammatory response after 60 days between IRM and empty tube groups (P < 0.05). MTA HP showed similar biocompatibility to the White MTA and the negative control group in all experimental periods. Furthermore, after 7 days MTA HP stimulated less pronounced angiogenesis than White MTA, as it initially exhibited slower extracellular matrix remodeling when compared to White MTA and IRM. A decrease in the thickness of the fibrous capsule, the amount of elastic fibers and the immunostaining with VEGF in all experimental groups and control throughout the healing process was observed. After 60 days, the experimental groups presented extracellular matrix with more mature connective tissue, with predominance of type I collagen fibers. According to the results obtained in the present study, it can be concluded that the new repair cement with high plasticity, MTA HP, was biocompatible in all the experimental periods, presenting similar results to the control and experimental groups with White MTA and IRM.

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Leiomyosarcomas are sarcomas that originate within smooth muscle cells and generally occur in older patients. These tumours account for 10% of all soft-tissue sarcomas. Metastases occur most commonly to the lungs, kidneys, and liver. Cutaneous metastases may also occur but are usually a very rare and late event. We present a case of a 46-year-old woman who developed subcutaneous metastasis to the axilla, arm and breast after surgical resection of the primary tumour. The patient maintained controlled disease with surgical resections and clinical follow-up, initiating chemotherapy one year after the diagnosis of metastatic disease.

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Resumo Os novos materiais restauradores em desenvolvimento devem evitar danos aos tecidos dentários. Portanto, o objetivo deste estudo foi avaliar a biocompatibilidade de uma marca comercial de cimento de ionômero de vidro convencional (CIV) modificado com microfibras de celulose (CIV+MC) ou nanocristais de celulose (CIV+NC) através da implantação de três amostras em tecido subcutâneo na região dorsal de 15 ratos Rattus norvegicus albinus. Cada rato recebeu um exemplar de cada cimento, resultando nos seguintes grupos (n=15): Grupo CIV (controle, n=15), Grupo CIV+MC e Grupo CIV+NC. Nos intervalos de 7, 30 e 60 dias os animais foram sacrificados e os seguintes aspectos foram avaliados histologicamente: tipo de células inflamatórias, fibroblastos, vasos sanguíneos, macrófagos, células gigantes, tipo de reação inflamatória e espessura da cápsula (µm). Estes eventos foram quantitativamente classificados conforme os escores: (-) ausente, (+) suave, (++) moderado e (+++) intenso. Os resultados foram analisados estatisticamente pelo teste Kruskal-Wallis e pós-teste Mann-Whitney. Aos 7 dias, o Grupo CIV+NC demonstrou um nível mais elevado de reparação tecidual porque havia maior quantidade de fibroblastos (p=0,022) e uma menor quantidade de macrófagos (p=0,008) e células mononucleares (p=0,033). Neutrófilos e células gigantes estavam ausentes em todos os períodos experimentais. Aos 60 dias, o Grupo CIV+NC apresentou cápsula de tecido fibroso com espessura mais reduzida (26,72±2,87 µm) em comparação ao Grupo CIV+MC (41,21±3,98 µm (p=0,025). No geral, todos os materiais apresentaram satisfatória biocompatibilidade, no entanto, o cimento de ionômero de vidro modificado com nanocristais de celulose proveu reparação tecidual mais avançada comparativamente aos demais materiais avaliados.

Developing new restorative materials should avoid damage to tissue structures. This study evaluated the biocompatibility of a commercial dental glass ionomer cement (GIC) mechanically reinforced with cellulose microfibers (GIC+CM) or cellulose nanocrystals (GIC+CN) by implantation of three test specimens in subcutaneous tissue in the dorsal region of 15 Rattus norvegicus albinus rats. Each rat received one specimen of each cement, resulting in the following groups (n=15): Group GIC (Control), Group GIC+CM and Group GIC+NC. After time intervals of 7, 30 and 60 days, the animals were sacrificed and the following aspects were histologically evaluated: type of inflammatory cells, fibroblasts, blood vessels, macrophages, giant cells, type of inflammatory reaction and capsule thickness (µm). These events were scored as (-) absent, (+) light, (++) moderate and (+++) intense. The results were statistically analyzed by Kruskal-Wallis test and Mann-Whitney post test. At 7 days, Group GIC+NC showed more favorable tissue repair because quantitatively there were more fibroblasts (p=0.022), fewer macrophages (p=0.008) and mononuclear cells (p=0.033). Polymorphonuclear neutrophils and giant cells were absent in all experimental periods. At 60 days, test specimens in Group GIC+NC were surrounded by a fibrous tissue capsule with reduced thickness (26.72±2.87 µm) in comparison with Group GIC+CM (41.21±3.98 µm) (p=0.025). In general, all biomaterials showed satisfactory biocompatibility, but glass ionomer cement modified with cellulose nanocrystals showed a more advanced tissue repair.

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