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INTRODUCTION: Vaginal delivery has several benefits for the parturient; however, during labor, some injuries, such as lacerations and/or episiotomy, can occur. Perineal pain may occur in the puerperium and can be aggravated in cases of perineal injury during childbirth, potentially impacting the physical and emotional aspects of the parturient. For this reason, it is necessary to use techniques that can relieve pain and edema in the immediate postpartum period, directly influencing recovery. OBJECTIVE: To compare the reduction of pain and improvement in healing using two techniques, namely photobiomodulation and cryotherapy, performed in the immediate postpartum period of up to 12 h, in parturients who suffered grade I and II lacerations and/or episiotomy. METHODS: Data collection was carried out through an evaluation questionnaire. Photobiomodulation was applied using the red and infrared laser from the DMC brand. The EVA and McGill scales were used for pain assessment, and the REEDA scale was used for the evaluation of edema and healing. RESULTS: The techniques were evaluated and applied to 56 patients, with 28 in each group (cryotherapy and LBI). Patients who received photobiomodulation showed superior improvement compared to cryotherapy. In the immediate postpartum period, there was a greater reduction in pain in favor of photobiomodulation (p = 0.008); and after 24 h, the difference was even more significant (p < 0.001).
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Crioterapia , Edema , Episiotomia , Lacerações , Terapia com Luz de Baixa Intensidade , Períneo , Período Pós-Parto , Humanos , Feminino , Crioterapia/métodos , Períneo/lesões , Episiotomia/efeitos adversos , Adulto , Edema/prevenção & controle , Edema/terapia , Edema/etiologia , Gravidez , Lacerações/terapia , Terapia com Luz de Baixa Intensidade/métodos , Doenças da Vulva/terapia , Vulva , Adulto Jovem , Medição da Dor , Parto Obstétrico/efeitos adversosRESUMO
OBJECTIVE: This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD: We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS: We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION: There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Couro Cabeludo , Ferida Cirúrgica , Humanos , Couro Cabeludo/cirurgia , Cicatrização , Infecção da Ferida Cirúrgica , CraniotomiaRESUMO
Resumen OBJETIVO: Describir la caracterización clínica, atención médica y quirúrgica de los casos de laceración poscoital y proponer un protocolo de atención para mejorar la calidad del diagnóstico y tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo de serie de casos de pacientes con diagnóstico de laceración vaginal poscoital atendidas en dos hospitales rurales entre 2017 y 2022. RESULTADOS: Se encontraron 6 pacientes que ingresaron al servicio de Urgencias con diagnóstico de laceración vaginal poscoital. Todas fueron intervenidas quirúrgicamente después de la lesión. La mediana de edad de las pacientes fue de 29.5 años (límites 19 y 68 años). Tres de las pacientes eran nuligestas e igual cantidad refirió coito por primera vez, 2 pacientes tenían una pareja estable y 2 nueva pareja. El tiempo transcurrido desde el coito hasta el momento de la atención tuvo una mediana de 2 horas (límites 1 y 3 horas). Solo 2 pacientes requirieron trasfusión de un paquete globular. El sitio de la laceración fue el fondo de saco vaginal posterior en 3 de los 6 casos; no se registraron decesos. CONCLUSIONES: La laceración poscoital es una urgencia rara que puede complicarse por la excesiva pérdida sanguínea, que es mayor si existe retraso en la búsqueda de atención y diagnóstico. Para obtener desenlaces favorables su tratamiento debe ser quirúrgico inmediato, basado en un protocolo estandarizado.
Abstract OBJECTIVE: To describe the clinical characterization, medical and surgical management of cases of postcoital laceration and to propose a management protocol to improve the quality of diagnosis and treatment. MATERIALS AND METHODS: Retrospective case series study of patients diagnosed with post-coital vaginal laceration seen in two rural hospitals between 2017 and 2022. RESULTS: We found 6 patients admitted to the emergency department with a diagnosis of postcoital vaginal laceration. All underwent surgical intervention following the injury. The median age of the patients was 29.5 years (range 19 to 68 years). Three of the patients were nulligestas and the same number reported having sexual intercourse for the first time, 2 patients had a regular partner and 2 had a new partner. The median time from intercourse to treatment was 2 hours (range 1 and 3 hours). Only 2 patients required a globule pack transfusion. The site of laceration was the posterior vaginal fornix in 3 of 6 cases; no deaths were recorded. CONCLUSIONS: Postcoital laceration is a rare emergency that may be complicated by excessive blood loss, which is increased if there is a delay in seeking care and diagnosis. For a favourable outcome, treatment should be immediate surgery based on a standardised protocol.
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ABSTRACT Purpose: One of the most important disadvantages of using Mini Monoka stents in pediatric canalicular laceration repair is premature stent loss. In this study, we aimed to compare clinical outcomes between the use of Mini Monoka and Masterka monocanalicular stents in children and discuss the potential causes of premature stent loss. Methods: The medical records of 36 patients who underwent surgical repair of canalicular lacerations were retrospectively reviewed. Children aged <18 years who underwent canalicular laceration repair with either Mini Monoka or Masterka and had at least 6 months of follow-up after stent removal were included in the study. The patients' demographics, mechanism of injury, type of stent used, premature stent loss, and success rate were analyzed. Success was defined as stent removal without subsequent epiphora and premature stent loss. Results: Twenty-seven children fulfilled our study criteria, and their data were included in the analyses. Mini Monoka was used in 14 patients (51.9%), whereas Masterka was used in 13 patients (48.1%). The preoperative clinical features, including age, sex, and mechanism of injury, were similar between the two groups. The mean age was 8.3 ± 5.5 years in the Mini Monoka group and 7.8 ± 5.9 years in the Masterka group (p=0.61). Three patients in the Mini Monoka group (21.4%) underwent reoperation due to premature stent loss. No premature stent loss was observed in the Masterka group. As a result, the rate of success was 78.6% in the Mini Monoka group, whereas it was 100% in the Masterka group (p=0.22). Conclusions: Even though the two groups did not show any statistically significant difference in success rate, we did not observe any premature stent loss in the Masterka group. Further studies with larger and randomized series are warranted to elaborate on these findings.
RESUMO Objetivo: Uma das desvantagens mais importantes do uso de stents Mini Monoka no reparo de lacerações canaliculares pediátricas é a perda prematura do stent. Neste estudo, objetivamos comparar os resultados clínicos dos stents monocanaliculares Mini Monoka e Masterka em crianças e discutir as possíveis causas da perda prematura do stent. Métodos: Foram incluídos nesta revisão retrospectiva 36 pacientes <18 anos de idade que se submeteram ao reparo cirúrgico de uma laceração canalicular com um stent Mini Monoka ou Masterka e tiveram pelo menos 6 meses de acompanhamento após a remoção do stent. Foram analisados os dados demográficos, o mecanismo da lesão, o tipo de stent utilizado, a ocorrência de perda prematura de stent e o sucesso da intervenção. O sucesso foi definido como a ausência de epífora após a remoção do stent, sem a perda prematura deste. Resultados: Vinte e sete pacientes preencheram os critérios do presente estudo e foram incluídos nas análises. O stent Mini Monoka foi usado em 14 pacientes (51,9%), enquanto o Masterka foi usado em 13 pacientes (48,1%). As características clínicas pré-operatórias, incluindo idade, sexo e mecanismo de lesão, foram semelhantes entre os dois grupos. A média de idade foi de 8,3 ± 5,5 anos no grupo Mini Monoka e de 7,8 ± 5,9 anos no grupo Masterka (p=0,61). Três pacientes do grupo Mini-Monoka (21,4%) tiveram que ser operados novamente por perda prematura do stent. Nenhuma perda prematura do stent foi observada no grupo Masterka. Como resultado, a taxa de sucesso foi de 78,6% no grupo Mini Monoka e de 100% no grupo Masterka (p=0,22). Conclusões: Embora nenhuma diferença estatisticamente significativa tenha sido detectada entre os dois grupos em termos de taxas de sucesso, não observamos nenhuma perda prematura de stent no grupo Masterka. São necessários mais estudos, com séries maiores e randomizadas, para chegar a maiores conclusões sobre esses achados.
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Adolescente , Criança , Pré-Escolar , Humanos , Stents , Lacerações , Estudos RetrospectivosRESUMO
SUMMARY OBJECTIVE: The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS: The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS: There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524). CONCLUSIONS: It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.
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El síndrome de banda amniótica (SBA) o complejo de disrupción de banda amniótica es aquella malformación congénita que ocurre como consecuencia de bridas amnióticas de etiología heterogénea, patogénesis que involucra una serie de manifestaciones clínicas fetales, tales como constricción, amputación y múltiples defectos craneofaciales, viscerales y de la pared del cuerpo. La prevalencia estimada de SBA oscila entre 1:15,000 y 1:1,200 nacidos vivos. Afecta a ambos sexos por igual. El diagnóstico prenatal puede sospecharse tan pronto como el primer trimestre tardío, cuando las imágenes por ultrasonido detectan anillos de constricción, amputaciones de extremidades y/o defectos craneofaciales. La terapia prenatal puede ofrecer una alternativa de tratamiento con la liberación de anillos de constricción bajo fetoscopia en aquellos fetos que se verían beneficiados con el procedimiento.
Amniotic band syndrome (ABS) or amniotic band disruption complex is a congenital malformation that occurs because of amniotic flanges of heterogeneous etiology, a pathogenesis that involves a series of fetal clinical manifestations, such as constriction, amputation, and multiple craniofacial, visceral and wall defects. The estimated prevalence of ABS ranges from 1:15.000 to 1:1.200 liveborn. It affects both sexes equally. Prenatal diagnosis may be suspected as early as the late first trimester when ultrasound imaging detects constriction rings, limb amputations and/or craniofacial defects. Prenatal therapy may offer an alternative treatment with release of constriction rings through fetoscopy in those fetuses that would benefit from the procedure.
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The Ehlers-Danlos syndrome (EDS) consists of a group of diseases characterized by defective collagen production or failure in its organization, resulting in changes in the strength and extensibility of connective tissue. This report describes the dermatological and histological findings observed in a 3-month-old crossbreed cat with rupture and detachment of skin in the thoracic limb and rupture of the skin in the cervical region. Upon dermatological examination, the cat presented fragile and hyperextensible skin in the cervical region and a skin extensibility index of 21%. Histopathological evaluation of the skin specimens revealed evident disorganization of collagen bundles in dermis and in the Masson's trichrome staining, follicular dysplasia was found. The presumptive diagnosis of EDS was made based on the clinical and histopathological findings. Sanger sequencing did not detect any mutated alleles for the c.3420delG mutation in COL5A1 gene, which was an autosomal dominant mutation previously been associated with Ehlers-Danlos syndrome in cats. The absence of this mutation in the reported cat suggests that other mutation may also be responsible for the development of cutaneous asthenia in this or maybe other genes related to collagen metabolism.
A síndrome de Ehlers-Danlos (EDS) consiste em um conjunto de doenças caracterizadas pela produção deficiente de colágeno ou falha em sua organização, resultando em alterações na resistência e extensibilidade do tecido conjuntivo. Este relato descreve os achados dermatológicos e histológicos observados em um gato mestiço de três meses de idade com ruptura e descolamento de pele do membro torácico e ruptura da pele na região cervical. Ao exame dermatológico, o gato apresentava pele hiper-extensível, fragilizada na região cervical e índice de extensibilidade cutânea de 21%. A avaliação histopatológica das amostras de pele revelou desorganização evidente dos feixes de colágeno na derme e pela coloração com tricrômico de Masson foi encontrada displasia folicular. O diagnóstico presuntivo de EDS foi realizado com base nos achados clínicos e histopatológicos. O sequenciamento de Sanger não detectou nenhum alelo mutado para a mutação c.3420delG no gene COL5A1, que é uma mutação autossômica dominante previamente associada à síndrome de Ehlers-Danlos em gatos. A ausência dessa mutação no gato relatado sugere que outra mutação também pode ser responsável pelo desenvolvimento de astenia cutânea neste gene ou em outro associado ao metabolismo de colágeno.
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Animais , Gatos , Ferimentos e Lesões/veterinária , Colágeno/análise , Síndrome de Ehlers-Danlos/veterinária , Astenia/veterinária , Análise de Sequência/veterinária , MutaçãoRESUMO
SUMMARY: Spinal cord regeneration after mechanical injury is one of the most difficult biomedical problems. This article evaluates the effect of poly(N-[2-hydroxypropyl]-methacrylamide) hydrogel (PHPMA-hydrogel) on spinal cord regeneration in young rats after lateral spinal cord hemi-excision (laceration) at the level of segments T12-T13 (TrGel group). The locomotor function score (FS) and the paretic hindlimb spasticity score (SS) were assessed according to Basso-Beattie-Bresnahan (BBB) and Ashworth scales, respectively, and compared to a group of animals with no matrix implanted (Tr group). Regeneration of nerve fibers at the level of injury was evaluated at ~5 months after spinal cord injury (SCI). One week after the SCI induction, the FS on the BBB scale was 0.9±0.5 points in the Tr group and 3.6±1.2 points in the TrGel group. In the Tr group, the FS in 5 months was significantly lower than in 2 weeks after SCI, while no significant changes in FS were detected in the TrGel group over the entire observation period. The final FS was 0.8±0.3 points in the Tr group and 4.5±1.8 points in the TrGel group. No significant changes in SS have been observed in the TrGel group throughout the experiment, while the Tr group showed significant increases in SS at 2nd week, 6th week, 3th month and 5th month. The SS in 5 months was 3.6±0.3 points on the Ashworth scale in the Tr group and 1.8±0.7 points in the TrGel group. Throughout the observation period, significant differences in FS between groups were observed only in 5 weeks after SCI, whereas significant differences in SS were observed in 2, 3 and 6-8 weeks post-injury. Glial fibrous tissue containing newly formed nerve fibers, isolated or grouped in small clusters, that originated from the surrounding spinal cord matter have been found between the implanted hydrogel fragments. In conclusion, PHPMA-hydrogel improves recovery of the hindlimb locomotor function and promotes regenerative growth of nerve fibers. Further research is needed to clarify the mechanism of this PHPMA-hydrogel effect.
RESUMEN: La regeneración de la médula espinal después de una lesión mecánica es uno de los problemas biomédicos más difíciles. Este artículo evalúa el efecto del hidrogel de poli (N- [2-hidroxipropil] -metacrilamida) (PHPMA-hidrogel) sobre la regeneración de la médula espinal en ratas jóvenes después de la hemiescisión lateral de la médula espinal (lesión) a nivel de los segmentos T12 - T13 (Grupo TrGel). La puntuación de la función locomotora (FS) y la puntuación de espasticidad parética de las patas traseras (SS) se evaluaron de acuerdo con las escalas de Basso- Beattie-Bresnahan (BBB) y Ashworth, respectivamente, y se compararon con un grupo de animales sin matriz implantada (grupo Tr). Se evaluó la regeneración de las fibras nerviosas al nivel de la lesión ~ 5 meses después de la lesión de la médula espinal (LME). Una semana después de la inducción de SCI, el FS en la escala BBB fue 0,9 ± 0,5 puntos en el grupo Tr y 3,6 ± 1,2 puntos en el grupo TrGel. En el grupo Tr, el FS en 5 meses fue significativamente menor que en 2 semanas después de SCI, mientras que no se detectaron cambios significativos en FS en el grupo TrGel durante el período de observación. El FS final fue de 0,8 ± 0,3 puntos en el grupo Tr y de 4,5 ± 1,8 puntos en el grupo TrGel. No se han obser- vado cambios significativos en SS en el grupo TrGel durante el experimento, mientras que el grupo Tr mostró aumentos significativos en SS en la 2ª semana, 6ª semana, 3º mes y 5º mes. La SS en 5 meses fue de 3,6 ± 0,3 puntos en la escala de Ashworth en el grupo Tr y de 1,8 ± 0,7 puntos en el grupo TrGel. A lo largo del período de observación, se observaron diferencias significativas en FS entre los grupos solo en 5 semanas después de la LME, mientras que se observaron diferencias significativas en SS en 2, 3 y 6-8 semanas después de la lesión. Entre los fragmentos de hidrogel implantados se observó tejido fibroso glial que contenía fibras nerviosas recién formadas, aisladas o agrupadas en pequeños grupos, que se originaban a partir de la materia de la médula espinal circundante. En conclusión, PHPMA-hydrogel mejora la recuperación de la función locomotora de las patas traseras y promueve el crecimiento regenerativo de las fibras nerviosas. Se requieren más estudios para aclarar el mecanismo del efecto de hidrogel PHPMA.
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Animais , Ratos , Poli-Hidroxietil Metacrilato/administração & dosagem , Traumatismos da Medula Espinal/terapia , Hidrogel de Polietilenoglicol-Dimetacrilato/administração & dosagem , Traumatismos da Medula Espinal/fisiopatologia , Ratos Wistar , Recuperação de Função Fisiológica/efeitos dos fármacos , Modelos Animais de Doenças , Regeneração da Medula Espinal/efeitos dos fármacosRESUMO
PURPOSE: To evaluate the performance of full-thickness (FT) versus partial-thickness (PT) sutures in a full-thickness corneal wound in an animal model. METHODS: This is a prospective, experimental, comparative, longitudinal study. A 6-mm linear, full-thickness corneal incision was performed on the right eye of eight domestic pigs. Eyes were randomly assigned for repair with interrupted PT (80-90% depth) sutures or FT 10-0 nylon sutures. Anterior segment OCT, corneal pachymetry and clinical photographs were obtained 1, 4 and 8 weeks postoperatively. Corneal thickness, depth of suture placement, perilesional edema, coaptation of wound edges and complications were noted. Histopathologic examination was performed at 8 weeks. RESULTS: 100% of the eyes with FT sutures developed a linear, less opaque scar. 100% of the eyes with PT developed a dense, opaque stromal scar (p = 0.02). Vascularization of the cornea was present in 75% of PT group and 25% in the FT group (p = 0.50). As the corneas healed, there was a marked trend toward thicker corneas in the PT group versus FT group with a median difference of - 63 µm at week 1 [median 788 µm vs. 725 µm, (p = 0.11)], - 38 µm at week 4, (724 µm vs. 686 µm, (p = 0.63)) and - 47 µm median difference at week 8 with (670 µm vs. 623 µm, (p = 0.06)). Histopathology showed disorganization of the collagen fibers and the formation of a retrocorneal fibrous membrane in the PT group. CONCLUSIONS: The FT group presented less corneal edema at week 8 with a more linear and less opaque scar. Histopathology showed a better-organized scar and endothelialization without the formation of a fibrous membrane.
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Lesões da Córnea , Animais , Córnea/cirurgia , Estudos Longitudinais , Modelos Teóricos , Estudos Prospectivos , SuturasRESUMO
Abstract Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p<0.05 were considered significant. Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the "hands-off" method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.
Resumo Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos. Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p<0,05. Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica "sem mãos" [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas. Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.
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Humanos , Feminino , Gravidez , Recém-Nascido , Lacerações/etiologia , Lacerações/epidemiologia , Períneo/lesões , Estudos Transversais , Estudos Retrospectivos , Fatores de Risco , Parto Obstétrico , EpisiotomiaRESUMO
Resumo Objetivo Descrever o uso da cola cirúrgica no reparo do trauma perineal no parto normal. Métodos Estudo série de casos realizado em três momentos (até 2 horas, 12-24 horas e 36-48 horas após o parto), em Itapecerica da Serra, SP. Foram incluídas mulheres que tiveram parto normal com trauma perineal com indicação de sutura (laceração de primeiro ou segundo graus e episiotomia). O trauma perineal foi reparado exclusivamente com cola cirúrgica Glubran-2®. Avaliou-se: intensidade da dor perineal (Escala Visual Numérica com 11 pontos), processo de cicatrização (escala REEDA de 15 pontos), satisfação com o reparo (escala Likert de 5 pontos). Os dados foram analisados de forma descritiva e inferencial comparando os três momentos. Resultados A técnica de aplicação da cola e a quantidade necessária foram definidas em uma amostra de 19 mulheres. Destas, 78,9% tiveram laceração de primeiro grau, 15,8% de segundo grau e 5,3% episiotomia. Os desfechos nos momentos 1, 2 e 3, foram respectivamente: ausência de dor (73,6%, 94,7% e 89,4%); escore ≤1 na escala REEDA (94,7%, 78,9% e 84,2%); 100% satisfeitas com o reparo em todos os momentos. Não houve diferença pelo teste de Friedman para dor e satisfação. O processo de cicatrização mostrou diferença, porém sem confirmação no pós-teste hoc. Conclusão A aplicação da cola mostrou-se viável para avaliação em uma amostra maior de mulheres, pois os resultados sugerem boa aceitação pelas mulheres e dor de baixa intensidade ou ausente, cicatrização adequada e alta satisfação com o reparo nas primeiras 48 horas após o parto.
Resumen Objetivo Describir el uso de pegamento quirúrgico para reparar traumas perineales en partos vaginales. Métodos Estudio serie de casos realizado en tres momentos (hasta 2 horas, de 12 a 24 horas y de 36 a 48 horas después de parto), en Itapecerica da Serra, estado de São Paulo. Se incluyeron mujeres que tuvieron parto vaginal con trauma perineal e indicación de sutura (desgarro de primer o segundo grado y episiotomía). El trauma perineal fue reparado exclusivamente con pegamento quirúrgico Glubran-2®. Se evaluó la intensidad del dolor perineal (Escala Visual Numérica de 11 puntos), el proceso de cicatrización (Escala REEDA de 15 puntos) y la satisfacción respecto a la reparación (Escala Likert de 5 puntos). Los datos fueron analizados de forma descriptiva e inferencial, comparando los tres momentos. Resultados La técnica de aplicación del pegamento y la cantidad necesaria fueron definidas en una muestra de 19 mujeres. De ellas, el 78,9 % tuvieron un desgarro de primer grado, el 15,8 % de segundo grado y el 5,3 % episiotomía. Los resultados de los momentos 1, 2 y 3 fueron, respectivamente: ausencia de dolor (73,6 %, 94,7 % y 89,4 %); puntuación ≤1 en la escala REEDA (94,7 %, 78,9 % y 84,2 %); 100 % satisfechas con la reparación en todos los momentos. No se observó diferencia de dolor y satisfacción con la prueba de Friedman. El proceso de cicatrización mostró diferencia, pero sin confirmación en la prueba post hoc. Conclusión La aplicación del pegamento demostró ser viable para un análisis con una muestra mayor de mujeres, ya que los resultados sugieren buena aceptación por parte de las mujeres, dolor de baja intensidad o ausente, cicatrización adecuada y alta satisfacción respecto a la reparación en las primeras 48 horas después del parto.
Abstract Objective To describe the use of surgical glue to repair perineal trauma during normal delivery. Methods This is a case series study, which was carried out in three moments (up to 2 hours, 12-24 hours and 36-48 hours after delivery) in Itapecerica da Serra, SP. Women who had a normal delivery with perineal trauma with a suture (first or second degree laceration and episiotomy) were included. Perineal trauma was repaired exclusively with Glubran-2® surgical glue. Perineal pain intensity (11-point Visual Numeric Scale), healing process (15-point REEDA scale), satisfaction with repair (5-point Likert scale) were assessed. Data were analyzed in a descriptive and inferential way comparing the three moments. Results The technique of applying the glue and the required amount were defined in a sample of 19 women. Of these, 78.9% had first-degree lacerations, 15.8%, second-degree lacerations and 5.3%, episiotomy. The outcomes at moments 1, 2 and 3 were absence of pain (73.6%, 94.7% and 89.4%), score ≤1 on the REEDA scale (94.7%, 78.9% and 84, two%); 100% were satisfied with the repair at all times. There was no difference by the Friedman test for pain and satisfaction. The healing process showed a difference, but without confirmation in the hoc post-test. Conclusion The glue application proved to be viable for assessment in a larger sample of women, as the results suggest good acceptance by women and low or no pain, adequate healing and high satisfaction with the repair in the first 48 hours after delivery.
Assuntos
Humanos , Feminino , Períneo/lesões , Adesivos Teciduais , Lacerações/terapia , Período Pós-Parto , Enfermagem ObstétricaRESUMO
In the midst of our nation's growing primary care provider shortage and subsequent overutilization of the emergency room (ER), urgent care centers represent an accessible, convenient, and affordable alternative for the management of "urgencies" or nonemergent illnesses and injuries. Despite the presence of competent healthcare providers and a wide array of services at urgent care centers, patients continue to pursue care in the ER for urgencies. School nurses may utilize urgent care centers for the evaluation and management of students with nonemergent medical or traumatic chief complaints. This article discusses the field of urgent care medicine, describes the pediatric services provided at urgent care centers, and summarizes the capabilities of centers to deal with potential urgencies versus emergencies in children and adolescents based on their chief complaint.
Assuntos
Instituições de Assistência Ambulatorial , Emergências/enfermagem , Encaminhamento e Consulta , Serviços de Enfermagem Escolar , Criança , Humanos , Estados UnidosRESUMO
Devido às instalações em que são criados e à sua natureza, os equinos comumente envolvemse em acidentes que resultam, quase que em sua totalidade, em lesões nos membros em variados níveis de gravidade. Feridas localizadas nas extremidades distais são, em geral, complicadas pela falta de tecido de revestimento, má circulação, movimento articular, maior predisposição para contaminação e consequente infecção. Além disso os equinos apresentam particularidades relacionadas ao processo de cicatrização cutânea, sendo comum nessa espécie a formação de tecido de granulação exuberante, acarretando um tempo maior para a recuperação clínica e resolução da ferida. Diversos tratamentos têm sido descritos na literatura com o objetivo de prevenir ou reduzir a granulação exuberante em equinos, porém, ainda não há descrição de um protocolo para o tratamento de feridas crônicas nessa espécie. O objetivo deste trabalho é relatar dois casos de equinos com feridas lacerantes em membros pélvicos, com o crescimento de tecido de granulação exuberante, tratado topicamente com sulfato de cobre a 20%. Esse método de tratamento mostrou-se eficaz, de baixo custo e fácil realização, constituindo uma possível terapia para feridas crônicas com hipergranulação em cavalos, principalmente nos casos em que a ressecção cirúrgica do tecido não for possível de ser realizada.(AU)
Due to the facilities in which horses are reared and their nature, they usually are involved in accidents that most of the times result in limb injuries of varying degrees of severity. Wounds located at the distal extremities are generally complicated by lack of lining tissue, poor circulation, joint movement, increased predisposition to contamination and consequent infection. Furthermore, skin healing in horses have particular characteristics, with exuberant granulation tissue formation being common in this species, leading to a longer time for clinical recovery and wound resolution. Several treatments have been described in the literature to prevent or reduce exuberant granulation in horses. However, no protocol has been described for the treatment of chronic wounds in this species. This paper aims at reporting two cases of horses with lacerating wounds in the hind limbs, with exuberant granulation growth, topically treated with 20% copper sulfate. This method of treatment has been shown to be effective, inexpensive, and easy to perform, being a possible therapy for chronic wounds with hypergranulation tissue in horses, especially in cases where surgical resection of the tissue is not possible.(AU)
Assuntos
Animais , Sulfato de Cobre/uso terapêutico , Ferimentos e Lesões/veterinária , Cicatrização/efeitos dos fármacos , Tecido de GranulaçãoRESUMO
Devido às instalações em que são criados e à sua natureza, os equinos comumente envolvemse em acidentes que resultam, quase que em sua totalidade, em lesões nos membros em variados níveis de gravidade. Feridas localizadas nas extremidades distais são, em geral, complicadas pela falta de tecido de revestimento, má circulação, movimento articular, maior predisposição para contaminação e consequente infecção. Além disso os equinos apresentam particularidades relacionadas ao processo de cicatrização cutânea, sendo comum nessa espécie a formação de tecido de granulação exuberante, acarretando um tempo maior para a recuperação clínica e resolução da ferida. Diversos tratamentos têm sido descritos na literatura com o objetivo de prevenir ou reduzir a granulação exuberante em equinos, porém, ainda não há descrição de um protocolo para o tratamento de feridas crônicas nessa espécie. O objetivo deste trabalho é relatar dois casos de equinos com feridas lacerantes em membros pélvicos, com o crescimento de tecido de granulação exuberante, tratado topicamente com sulfato de cobre a 20%. Esse método de tratamento mostrou-se eficaz, de baixo custo e fácil realização, constituindo uma possível terapia para feridas crônicas com hipergranulação em cavalos, principalmente nos casos em que a ressecção cirúrgica do tecido não for possível de ser realizada.
Due to the facilities in which horses are reared and their nature, they usually are involved in accidents that most of the times result in limb injuries of varying degrees of severity. Wounds located at the distal extremities are generally complicated by lack of lining tissue, poor circulation, joint movement, increased predisposition to contamination and consequent infection. Furthermore, skin healing in horses have particular characteristics, with exuberant granulation tissue formation being common in this species, leading to a longer time for clinical recovery and wound resolution. Several treatments have been described in the literature to prevent or reduce exuberant granulation in horses. However, no protocol has been described for the treatment of chronic wounds in this species. This paper aims at reporting two cases of horses with lacerating wounds in the hind limbs, with exuberant granulation growth, topically treated with 20% copper sulfate. This method of treatment has been shown to be effective, inexpensive, and easy to perform, being a possible therapy for chronic wounds with hypergranulation tissue in horses, especially in cases where surgical resection of the tissue is not possible.
Assuntos
Animais , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/veterinária , Sulfato de Cobre/uso terapêutico , Tecido de GranulaçãoRESUMO
Resumen: OBJETIVO: Realizar una caracterización demográfica, clínica e imagenológica de una serie de casos de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y transversal de una serie de casos de pacientes con diagnóstico de mastitis granulomatosa idiopática atendidas en el Hospital Universitario Dr. José Eleuterio González, Monterrey, NL, entre enero 2015 y diciembre 2019. Criterio de inclusión: pacientes mayores de 18 años con diagnóstico histológico de mastitis granulomatosa idiopática en ausencia de un agente etiológico específico. Criterios de exclusión: pacientes con cuadro de mastitis relacionado con una patología específica o con algún antecedente de traumatismo-laceración reciente en la mama. Variables de estudio: información demográfica (edad, escolaridad, estado civil, etc.), proceso-método diagnóstico, hallazgos por imagen y tratamientos indicados. RESULTADOS: Se incluyeron 20 pacientes con edad promedio de 32 años, 17 en edad fértil, y el resto en la posmenopausia. Las 20 pacientes tuvieron, al menos, 1 embarazo de término sumado a un periodo variable de lactancia. 19 tenían enfermedad unilateral, la mayoría en la mama izquierda (60%). El hallazgo principal al establecer el diagnóstico: en 20 una tumoración, 15 de 20 eritema y 11 mastalgia. El reporte radiológico mediante BIRADS fue de IVA en 12, IVB en 6 y 1 tanto para II y III. En todas las pacientes se comprobó el diagnóstico con estudio histopatológico. Doce recibieron tratamiento inicial con prednisona, 7 con antibióticos y AINES y un caso con escisión quirúrgica. CONCLUSIONES: La mastitis granulomatosa idiopática es una enfermedad rara de prevalencia aún desconocida, con un comportamiento benigno de tipo inflamatorio crónico, cuya patogenia permanece aún desconocida. Al ser una enfermedad con un diagnóstico por exclusión, obliga al estudio histopatológico para establecer el diagnóstico definitivo, idealmente mediante la toma de una biopsia con Tru-cut. Aunque se han planteado varias alternativas terapéuticas, en la actualidad no existe un protocolo universal que justifique un tratamiento en forma generalizada. La resección de la lesión con márgenes amplios asociada o no con corticoides orales, sigue siendo el tratamiento más indicado.
Abstract: OBJECTIVE: To perform a demographic, clinical and imaging characterization of a series of cases of idiopathic granulomatous mastitis. MATERIALS AND METHODS: Observational, retrospective and cross-sectional study of a series of cases of patients diagnosed with idiopathic granulomatous mastitis, at Hospital Universitario "Dr. José Eleuterio González in Monterrey, Mexico between January 2015 and December 2019. The study comprised all patients older than 18 years old who had histological diagnosis of idiopathic granulomatous mastitis in the absence of a specific agent. Patients with mastitis related to a specific pathology or with a history of recent breast trauma/laceration were excluded. Variables to determine are demographic information (age, education, marital status, etc.), diagnostic process/method, imaging findings and treatment. RESULTS: 20 patients with an average age of 32 years were included, 17 of childbearing age, and the rest at menopause. All patients had at least one full-term pregnancy and a variable lactation period. 19 presented the disease unilaterally, 60% in the left breast. Clinical presentation: 20 presented tumor, 15 erythema and 11 mastalgia. Imaging: BIRADS IVA in 12, IVB in 6 , III in 1 and II in 1. Diagnostic confirmation was performed in all patients by histopathological study. 12 received initial treatment with prednisone, 7 with antibiotics and NSAIDs, and one case with surgical excision. CONCLUSIONS: Idiopathic granulomatous mastitis is a rare benign and chronic inflammatory disease of unknown prevalence and pathogenesis. It mainly affects women of reproductive age. Imaging studies usually report nonspecific findings. It requires histopathological study to establish a definitive diagnosis, as it is a disease with diagnosis by exclusion, ideally by taking a Tru-cut biopsy. Although several therapeutic alternatives have been proposed, currently there is no universal protocol for treatment, however, resection of the lesion with wide margins associated or not with oral corticosteroids prevails as the most widely used treatment nowadays.
RESUMO
BACKGROUND: Extensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. METHODS: We present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. RESULTS: At one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. CONCLUSIONS: Second EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. LEVEL OF EVIDENCE: IV (Case Series).
Assuntos
Hallux/lesões , Hallux/cirurgia , Músculo Esquelético/cirurgia , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Adulto , Pé , Humanos , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Dedos do Pé , Transplante Autólogo , Transplante Homólogo , Adulto JovemRESUMO
Há controvérsia quanto ao uso da episiotomia por não existir consenso sobre sua realização. O objetivo foi encontrar fatores de risco envolvidos nas lesões perineais, em uma maternidade de baixo risco, bem como estudar a evolução do uso da episiotomia nos quatro primeiros anos de implementação do Programa de Humanização do Parto. Foi feita uma avaliação retrospectiva analítica, qualitativa, entre os anos de 2014 e 2017, com uma amostra de 4.303 gestantes. Percebeu-se que houve relação significativa entre a ocorrência de laceração perineal e o uso de indutores do parto. Quanto à realização da episiotomia, houve relação significativa com os fatores de risco: primiparidade, indução, posição de litotomia e uso do fórceps. Houve também aumento significativo na ocorrência de lacerações ao longo dos quatro anos, com aumento das lesões leves. A frequência da episiotomia também mostrou diferença significativa, porém, sem manter constância com o passar do tempo.(AU)
There is controversy regarding the use of episiotomy, as there is no consensus about its performance. The objective was to find risk factors involved in perineal lesions in a low-risk maternity hospital, as well as to study the evolution of the use of episiotomy in the first four years of the implementation of the Humanization of Childbirth Program. Was made a retrospective analytical evaluation, qualitative, between 2014 and 2017, with a sample of 4.303 pregnant women. It was perceived that there was a significant relationship between the occurrence of perineal laceration and the use of induction of Childbirth. Regarding the episiotomy, there was a significant relationship with risk factors: primiparity, induction, lithotomy position and use of forceps. There was also a significant increase in the occurrence of lacerations over the four years, with an increase in mild injuries. The frequency of episiotomy may also be significant, however, without keeping up with the passage of time.(AU)
Assuntos
Humanos , Feminino , Gravidez , Períneo/lesões , Lacerações/complicações , Parto Humanizado , Episiotomia/efeitos adversos , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Pelvic floor interventions during pregnancy could reduce the impact of pregnancy and delivery on the pelvic floor. OBJECTIVE: To determine the effects of pelvic floor interventions during pregnancy on childbirth-related and pelvic floor parameters. SEARCH STRATEGY: PubMed, Embase, and LILACS were searched for reports published during between 1990 and 2016 in English, Spanish, or Portuguese. The search terms were "pregnancy," "pelvic floor muscle training," and related terms. SELECTION CRITERIA: Randomized controlled trials with healthy pregnant women were included. DATA COLLECTION AND ANALYSIS: Baseline and outcome data (childbirth-related parameters, pelvic floor symptoms) were compared for three interventions: EPI-NO (Tecsana, Munich, Germany) perineal dilator, pelvic floor muscle training, and perineal massage. MAIN RESULTS: A total of 22 trials were included. Two of three papers assessing EPI-NO showed no benefit. The largest study investigating pelvic floor muscle training reported a significant reduction in the duration of the second stage of labor (P<0.01), and this intervention also reduced the incidence of urinary incontinence (evaluated in 10 trials). Two of six trials investigating perineal massage reported that a lower rate of perineal pain was associated with this intervention. CONCLUSION: Pelvic floor muscle training and perineal massage improved childbirth-related parameters and pelvic floor symptoms, whereas EPI-NO showed no benefit.
Assuntos
Terapia por Exercício/métodos , Trabalho de Parto/fisiologia , Diafragma da Pelve , Feminino , Alemanha , Humanos , Parto , Períneo , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária/prevenção & controleRESUMO
Background: Reproductive management in horses when performed with malpractice or by an unqualified person can cause many lesions of various degrees. When the rectum is affected it can compromise the mucous layer of the rectal ampulla and may even cause total perforation of this intestinal segment. Once the rectum ruptured, its contents gets into the abdominal cavity and generates severe abdominal infection, which may cause intense adhesions between organs and even to the abdominal wall and requires a particular intensive intervention. This work reports the use of peritoneal lavage protocol in three horses with septic peritonitis caused by rectal laceration, correlating with post-mortem findings.Cases: Three horses were referred to the Veterinary Hospital Rancho Belo Vista, in the city of Serra - ES, with an accident report during reproductive management in different properties. In all cases, blood loss and loss of continuity of the rectal mucosa were reported by the technicians. Patients were referred at different post-accident times. When they arrived at the hospital, they were examined and a sample of blood and peritoneal fluid were collected and sent to the laboratory. They presented intense apathy, mucosa coloration ranging from hyperemic to pale with halo toxemia, high cardiac and respiratory rate, reduction of globular volume and prolonged time of capillary refill. Patients were given fluid therapy support with lactated Ringers solution and systemic therapy protocols such as antibiotic therapy, peritoneal lavage with antibiotic containing solution and anticoagulant, and other supportive treatments were instituted. Peritoneal lavages were instituted every eight hours, in the first 48 hours and every twelve hours, until five days were completed. All patients had to be sacrificed. Euthanasia occurred at different times according to response to treatment and onset of clinical signs of shock.[...]
Assuntos
Feminino , Animais , Cavalos , Lavagem Peritoneal/métodos , Lavagem Peritoneal/veterinária , Peritonite/complicações , Peritonite/veterinária , Aderências Teciduais/veterináriaRESUMO
Background: Reproductive management in horses when performed with malpractice or by an unqualified person can cause many lesions of various degrees. When the rectum is affected it can compromise the mucous layer of the rectal ampulla and may even cause total perforation of this intestinal segment. Once the rectum ruptured, its contents gets into the abdominal cavity and generates severe abdominal infection, which may cause intense adhesions between organs and even to the abdominal wall and requires a particular intensive intervention. This work reports the use of peritoneal lavage protocol in three horses with septic peritonitis caused by rectal laceration, correlating with post-mortem findings.Cases: Three horses were referred to the Veterinary Hospital Rancho Belo Vista, in the city of Serra - ES, with an accident report during reproductive management in different properties. In all cases, blood loss and loss of continuity of the rectal mucosa were reported by the technicians. Patients were referred at different post-accident times. When they arrived at the hospital, they were examined and a sample of blood and peritoneal fluid were collected and sent to the laboratory. They presented intense apathy, mucosa coloration ranging from hyperemic to pale with halo toxemia, high cardiac and respiratory rate, reduction of globular volume and prolonged time of capillary refill. Patients were given fluid therapy support with lactated Ringers solution and systemic therapy protocols such as antibiotic therapy, peritoneal lavage with antibiotic containing solution and anticoagulant, and other supportive treatments were instituted. Peritoneal lavages were instituted every eight hours, in the first 48 hours and every twelve hours, until five days were completed. All patients had to be sacrificed. Euthanasia occurred at different times according to response to treatment and onset of clinical signs of shock.[...](AU)