RESUMO
O presente estudo avaliou a efetividade de simulador de sutura de silicone frente ao modelo usual em feltro e bastidor no desenvolvimento da habilidade em síntese cirúrgica. Vinte e seis alunos de Medicina Veterinária, sem vivência cirúrgica, foram distribuídos em dois grupos: o primeiro utilizou modelo de simulador em silicone e o segundo o simulador em bastidor e feltro. Em três encontros foram abordados conceitos sobre síntese, tipos de sutura e treinamento prático. Para avaliar sua experiência e percepções, os alunos responderam a um questionário e foram avaliados pelos professores na confecção dos padrões de sutura. Na avaliação do questionário, o simulador em silicone foi superior em sete das 10 questões. Na avaliação dos docentes, não houve diferença entre os grupos. Concluímos que ambos os modelos foram efetivos no desenvolvimento da habilidade cirúrgica, porém, a aceitabilidade dos alunos foi superior no modelo inovador.(AU)
This study compared the efficiency of a novel silicone model to a traditional low-fidelity method on the acquisition of surgical synthesis skills. Twenty-six veterinary students with no prior surgical training were randomly allocated into two groups: the first used a novel silicon model and second trained on a traditional set up. During three sessions, subjects such as synthesis, suture patterns, and suture practice were discussed. In order to assess the students experiences and perceptions, a questionary was applied. Students were also evaluated by teachers who scored their suture patterns. The questionary showed that the silicone model was superior in 7 out of 10 questions. No significant differences were detected between groups on the assessment by the teachers. This study shows that either model is effective for the development of suture skills. Nonetheless, the novel silicone model tested here has better acceptability when compared with the traditional model.(AU)
Assuntos
Técnicas de Sutura/veterinária , Silicones/administração & dosagem , Silicones/análise , Medicina VeterináriaRESUMO
O presente estudo avaliou a efetividade de simulador de sutura de silicone frente ao modelo usual em feltro e bastidor no desenvolvimento da habilidade em síntese cirúrgica. Vinte e seis alunos de Medicina Veterinária, sem vivência cirúrgica, foram distribuídos em dois grupos: o primeiro utilizou modelo de simulador em silicone e o segundo o simulador em bastidor e feltro. Em três encontros foram abordados conceitos sobre síntese, tipos de sutura e treinamento prático. Para avaliar sua experiência e percepções, os alunos responderam a um questionário e foram avaliados pelos professores na confecção dos padrões de sutura. Na avaliação do questionário, o simulador em silicone foi superior em sete das 10 questões. Na avaliação dos docentes, não houve diferença entre os grupos. Concluímos que ambos os modelos foram efetivos no desenvolvimento da habilidade cirúrgica, porém, a aceitabilidade dos alunos foi superior no modelo inovador.
This study compared the efficiency of a novel silicone model to a traditional low-fidelity method on the acquisition of surgical synthesis skills. Twenty-six veterinary students with no prior surgical training were randomly allocated into two groups: the first used a novel silicon model and second trained on a traditional set up. During three sessions, subjects such as synthesis, suture patterns, and suture practice were discussed. In order to assess the students experiences and perceptions, a questionary was applied. Students were also evaluated by teachers who scored their suture patterns. The questionary showed that the silicone model was superior in 7 out of 10 questions. No significant differences were detected between groups on the assessment by the teachers. This study shows that either model is effective for the development of suture skills. Nonetheless, the novel silicone model tested here has better acceptability when compared with the traditional model.
Assuntos
Medicina Veterinária , Silicones/administração & dosagem , Silicones/análise , Técnicas de Sutura/veterináriaRESUMO
ABSTRACT Purpose: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. Methods: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. Results: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. Conclusion: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.
RESUMO Objetivo: A estenose punctal pode resultar em sintomas como a epífora e diminuir significativamente a qualidade de vida dos pacientes. A inserção de um tampão perfurado é um procedimento fácil que é comumente usado como o primeiro passo do tratamento para a estenose punctal. Métodos: Dados clínicos, demográficos e de resultado foram coletados retrospectivamente de 54 olhos de 21 homens e 11 mulheres que consecutivamente se apresentaram em nossa Clínica de Oculoplástica e foram submetidos a inserção de um tampão de silicone perfurado Micro Flow. Todos os pacientes tinham epífora com estenose punctal. Resultados: Dos 54 tampões, 26 (48,1%) foram perdidos e 28 (51,8%) permaneceram no local. Destes últimos, 8 foram removidos devido a oclusão do tampão com secreção e conjuntivite recorrente, além disso, 2 migraram profundamente no canalículo vertical. Dos 54 tampões, apenas 18 (33,3%) foram bem tolerados com significativa melhora dos sintomas. Conclusão: A perda de tampões é um problema de destaque em pacientes implantados com tampões perfurados. Tampões de silicone falharam em 66,7% dos pacientes durante um seguimento médio de 14,2 meses.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Silicones/administração & dosagem , Síndromes do Olho Seco/cirurgia , Plug Lacrimal/efeitos adversos , Aparelho Lacrimal/cirurgia , Obstrução dos Ductos Lacrimais/terapia , Próteses e Implantes , Lágrimas , Síndromes do Olho Seco/complicações , Implantação de Prótese , Obstrução dos Ductos Lacrimais/etiologiaRESUMO
PURPOSE: Punctal stenosis can result in symptoms such as epiphora and can significantly reduce the quality of life of patients. Perforated punctal plug insertion is an easy procedure that is commonly used as the first step of treatment for punctal stenosis. METHODS: Clinical, demographic, and outcome data were retrospectively collected for 54 eyes of 21 males and 11 females who consecutively presented to our Oculoplastic Clinic and underwent silicone Micro Flow perforated punctal plug insertion. All patients had epiphora with punctal stenosis. RESULTS: Of the 54 plugs, 26 plugs (48.1%) were lost and 28 (51.8%) stayed in place. Of the latter, eight were explanted because of the occlusion of the plug with secretions and recurrent conjunctivitis; moreover, two plugs migrated deep into the vertical canaliculus. Of the 54 plugs, only 18 (33.3%) were well-tolerated with significant symptomatic improvement. CONCLUSION: Plug loss is a prominent problem in patients implanted with perforated punctal plugs. Silicone punctal plugs failed in 66.7% of our patients over a mean follow-up of 14.2 months.
Assuntos
Síndromes do Olho Seco/cirurgia , Aparelho Lacrimal/cirurgia , Obstrução dos Ductos Lacrimais/terapia , Plug Lacrimal , Silicones/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndromes do Olho Seco/complicações , Feminino , Humanos , Obstrução dos Ductos Lacrimais/etiologia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Implantação de Prótese , Plug Lacrimal/efeitos adversos , Lágrimas , Adulto JovemRESUMO
Comparative Anatomy deals with the study of the ontogenetic and phylogenetic changes of the vertebrates, requiring complementing the theoretical aspects with the observation of structures in specimens belonging to different taxonomic groups. The aim of the present study was to test the injection of silicone at room temperature in organs and trunk sections of Mustelus schmitti as an alternative to the plastination technique. Samples consisted in brain, eyes, heart, proximal end of the ventral aorta, digestive tract, spleen, pancreas, kidneys, testis and cross body section at a pre-caudal level. Material was fixed with formalin (10-5 %), dehydrated with growing concentrations of isopropyl (30 % - 50 % - 70 % - 90 % - 100 % - 100 %), impregnated with diluted commercial silicone and cured at room temperature. The whole process took 66 days. The brain was the unique organ that could not undergo the complete procedure because it did not resist the injection of silicone. The other pieces resulted in materials that characterised by being off-colour, dry, semi-flexible, lightweight, odourless, and non-toxic. They showed no signs of fungal colonization or bacterial degradation after two years of being obtained. Shrinkage was observed, which ranged among 2-25 % for total length, and from 5-26 % for maximum width (mean values: 14 and 15 %, respectively), being testicle the organ that suffered greater shrinkage in both dimensions. The degree of contraction in length and width for each of the samples was generally similar (difference £ 3 %), indicating that not striking deformation occurred. Deformation was observed only for the trunk section, eye, stomach, pancreas and valvular intestine. The technique did not affect the morphology of the structures, allowing the correct visualization of all the basic features required to recognise them. We conclude that this simple and economic method is an adequate alternative to be implemented for the conservation of small-size materials with educational purposes in Comparative Anatomy courses.
La Anatomía Comparada abarca el estudio de los cambios ontogenéticos y filogenéticos sufridos por los vertebrados, requiriendo complementar los aspectos teóricos conla observación de estructuras en especímenes pertenecientes a los distintos grupos taxonómicos. El objetivo del presente trabajo fue testear la inyección de silicona a temperatura ambiente en órganos y secciones corporales de Mustelus schmitti como alternativa a la técnica de plastinación. Las estructuras seleccionadas fueron encéfalo, ojos, corazón, extremo proximal de aorta ventral, tracto digestivo, bazo, páncreas, riñón, testículo y sección transversal del cuerpo a nivel pre-caudal. El material se fijó con formaldehído (10-5 %), se deshidrató con concentraciones crecientes de alcohol isopropílico (30 % - 50 % - 70 % - 90 % - 100 % - 100 %), se impregnó con silicona comercial diluida y se curó a temperatura ambiente. El proceso completo duró 66 días. El encéfalo fue el único órgano que no resistió el tratamiento debido a su friabilidad. Las demás piezas dieron como resultado materiales incoloros, secos, semi-flexibles, livianos, inodoros y no-tóxicos. No se evidenciaron síntomas de colonización fúngica ni bacteriana luego de dos años de obtenidos. Se observó contracción del material que osciló entre 2-25 % para la longitud total, y entre 5-26 % para el ancho máximo (promedios: 14 y 15 %, respectivamente), siendo el testículo el órgano que mayor disminución registró en ambas dimensiones. El grado de contracción en longitud y en ancho fue generalmente similar para cada una de las muestras (diferencia £ 3 %), indicando que no ocurrió una deformación notoria. Solo se observó deformación en la sección corporal, ojo, estómago, páncreas e intestino valvular. La técnica no afectó la morfología de las estructuras, permitiendo la correcta visualización de todas las características diagnósticas requeridas para su reconocimiento. Concluimos que este método simple y económico representa una alternativa adecuada para ser implementada en la conservación de materiales de pequeño tamaño con fines educativos en los cursos de Anatomía Comparada.
Assuntos
Animais , Silicones/administração & dosagem , Preservação de Tecido/métodos , Peixes , Anatomia Comparada/educação , Temperatura , DissecaçãoRESUMO
Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.
Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Silicones/efeitos adversos , Granuloma de Corpo Estranho/cirurgia , Granuloma de Corpo Estranho/induzido quimicamente , Transplante de Pele/métodos , Silicones/administração & dosagem , Úlcera/induzido quimicamente , Celulite (Flegmão)/induzido quimicamente , Sepse , Extremidade Inferior , Eritema , Fasciite/induzido quimicamente , Injeções SubcutâneasRESUMO
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
Assuntos
Colágeno/administração & dosagem , Silicones/administração & dosagem , Uretra , Incontinência Urinária/tratamento farmacológico , Resinas Acrílicas/administração & dosagem , Adulto , Dimetilpolisiloxanos/administração & dosagem , Feminino , Glucanos/administração & dosagem , Humanos , Hidrogéis/administração & dosagem , Injeções/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Zircônio/administração & dosagemRESUMO
UNLABELLED: Injectable silicone has been used illegally for more than 60 years. Siliconoma is the term used to describe a foreign body reaction in the human body caused by the presence of silicone. The aim of this study is to report two cases of patients who underwent application of large volumes of injectable silicone with non-medical and unqualified professionals, which led to serious complications sometime after the procedure. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Assuntos
Reação a Corpo Estranho/induzido quimicamente , Silicones/efeitos adversos , Adulto , Nádegas , Feminino , Humanos , Injeções , Masculino , Silicones/administração & dosagemRESUMO
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
Assuntos
Adulto , Feminino , Humanos , Colágeno/administração & dosagem , Silicones/administração & dosagem , Uretra , Incontinência Urinária/tratamento farmacológico , Resinas Acrílicas/administração & dosagem , Dimetilpolisiloxanos/administração & dosagem , Glucanos/administração & dosagem , Hidrogéis/administração & dosagem , Injeções/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Zircônio/administração & dosagemRESUMO
BACKGROUND: Chronic musculoskeletal pain is highly prevalent worldwide. PRIMARY STUDY OBJECTIVE: The aim of this study was to evaluate the efficacy of Helical(®) microcoils, a new, noninvasive treatment for chronic musculoskeletal pain. DESIGN: This was a prospective, observational study. SETTING: The study was conducted at the main author's private clinic, in São Paulo, Brazil. PARTICIPANTS: We evaluated 20 physicians, from 2 different hospitals, who suffered from chronic musculoskeletal pain and volunteered to participate in the study. INTERVENTION: The Helical(®) microcoils were applied to the skin over the affected areas. Before and after the intervention, the physician-patients completed questionnaires and a visual analog scale. PRIMARY OUTCOME MEASURES: We quantified postintervention improvement or worsening of pain and muscle tension. RESULTS: Significant improvements in pain and muscle tension were observed in 95% of the physician-patients evaluated. The only side effect reported was mild pruritus at the application site, which occurred in 5 of the 20 cases. CONCLUSION: The use of Helical microcoils was found to be safe and efficacious in relieving muscle tension and pain.
Assuntos
Carbono/administração & dosagem , Terapias Complementares/instrumentação , Terapias Complementares/métodos , Tono Muscular/efeitos dos fármacos , Mialgia/terapia , Silicones/administração & dosagem , Administração Cutânea , Adulto , Brasil/epidemiologia , Carbono/farmacologia , Carbono/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Médicos/estatística & dados numéricos , Estudos Prospectivos , Silicones/farmacologia , Silicones/uso terapêuticoRESUMO
An adjuvant is a substance that enhances the antigen-specific immune response, induces the release of inflammatory cytokines, and interacts with Toll-like receptors and the NALP3 inflammasome. The immunological consequence of these actions is to stimulate the innate and adaptive immune response. The activation of the immune system by adjuvants, a desirable effect, could trigger manifestations of autoimmunity or autoimmune disease. Recently, a new syndrome was introduced, autoimmune/inflammatory syndrome induced by adjuvants (ASIA), that includes postvaccination phenomena, macrophagic myofasciitis, Gulf War syndrome and siliconosis. This syndrome is characterized by nonspecific and specific manifestations of autoimmune disease. The main substances associated with ASIA are squalene (Gulf War syndrome), aluminum hydroxide (postvaccination phenomena, macrophagic myofasciitis) and silicone with siliconosis. Mineral oil, guaiacol and iodine gadital are also associated with ASIA. The following review describes the wide clinical spectrum and pathogenesis of ASIA including defined autoimmune diseases and nonspecific autoimmune manifestations, as well as the outlook of future research in this field.
Assuntos
Adjuvantes Imunológicos/efeitos adversos , Doenças Autoimunes/imunologia , Fasciite/imunologia , Inflamação/imunologia , Miosite/imunologia , Síndrome do Golfo Pérsico/imunologia , Silicose/imunologia , Imunidade Adaptativa , Adjuvantes Imunológicos/administração & dosagem , Hidróxido de Alumínio/administração & dosagem , Hidróxido de Alumínio/efeitos adversos , Animais , Doenças Autoimunes/induzido quimicamente , Fasciite/induzido quimicamente , Humanos , Imunidade Inata , Inflamassomos/metabolismo , Inflamação/induzido quimicamente , Miosite/induzido quimicamente , Síndrome do Golfo Pérsico/induzido quimicamente , Silicones/administração & dosagem , Silicones/efeitos adversos , Esqualeno/administração & dosagem , Esqualeno/efeitos adversos , Síndrome , Receptores Toll-Like/metabolismoRESUMO
The injection of bulking agents has been described as a useful treatment of urinary and fecal incontinence. Among them, silicone implants have shown benefits in patients with internal anal sphincter (IAS) injury. We describe two patients with a history of hemorrhoidectomy and IAS injuries, which underwent placement of silicone implants. The implants were inserted into the intersphincteric space and the IAS under ultrasound guidance. The Wexner continente score fell from 17 and 19 before treatment, to 6 and 8 at six months follow up, respectively. Patients had no postoperative complications or implants migration. In our patients, injection of silicone implants improved fecal continence score, without postoperative complications or implants migration at six month follow up.
Assuntos
Canal Anal , Incontinência Fecal/cirurgia , Próteses e Implantes , Silicones , Adulto , Idoso , Feminino , Humanos , Injeções , Masculino , América do Norte , Indução de Remissão , Silicones/administração & dosagemRESUMO
BACKGROUND: This study aimed to evaluate manometric parameters that may explain improvement in anal incontinence using a silicone bulking agent. METHODS: Incontinent patients having internal sphincter defects were prospectively selected and injected with a silicone bulking agent. Manometry and endoanal ultrasound were performed before and 3 months after injections. Twenty continent healthy volunteers were used only for manometric comparison. RESULTS: Thirty-five patients (28 females; mean age 60.3 years) and 20 controls entered this study. Patients had lower resting and squeeze pressures compared with controls (P < .05). Length of the high-pressure zone increased from 1 to 1.7 cm postinjection (P = .002). Asymmetry index showed a significant change postinjection (P < .001). CONCLUSION: Despite considerable clinical improvement, no significant increase in manometric pressures was noted posttreatment. There was significant improvement in both high-pressure zone and asymmetry index, and these findings may explain the mechanism of action of the bulking agent injected.
Assuntos
Canal Anal/fisiopatologia , Materiais Biocompatíveis/administração & dosagem , Incontinência Fecal/fisiopatologia , Incontinência Fecal/terapia , Silicones/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/diagnóstico por imagem , Canal Anal/patologia , Estudos de Coortes , Endossonografia , Incontinência Fecal/etiologia , Feminino , Humanos , Injeções , Masculino , Manometria , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Adulto JovemRESUMO
Local and systemic complications following injected silicone have been described, especially after cosmetic procedures by unlicensed practitioners. We report a retrospective case series of acute pneumonitis following silicone injection to the buttock. Medical records, pulmonary function tests, blood arterial gases, chest radiographs, and high-resolution computed tomography scans were reviewed. Five patients with acute pneumonitis after injected silicone were identified. All cases were men with a mean age was 25 years. Three patients had the procedure performed by the same practitioner. The amount of injected silicone ranged from 30 to 500 ml. The onset of clinical symptoms began as early as 24 h after injection to as late as 15 days. All cases had diffuse, peripheral, occasionally wedge-shaped opacities on high-resolution computed tomography. At presentation the mean oxygen saturation was 84%. All were treated with steroids and had clinical resolution of their illness within 1 month of presentation. Injection of silicone can lead to serious pulmonary complications but treatment with steroids seems to be beneficial.
Assuntos
Técnicas Cosméticas/efeitos adversos , Pneumonia/induzido quimicamente , Silicones/efeitos adversos , Doença Aguda , Adulto , Nádegas , Humanos , Injeções , Licenciamento em Medicina , Masculino , México , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Estudos Retrospectivos , Silicones/administração & dosagem , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
A reconstituição cirúrgica de nervos em humanos, em cães e em diversos animais de laboratório é bastante utilizada e tem indicações clínicas e experimentais importantes. No entanto, em eqüinos há poucas informações sobre esta prática. Há relatos sobre a excessiva proliferação de tecido conjuntivo e a formação de neuromas à neurorrafia experimental, mesmo quando se utilizam tubos de silicone para condução do crescimento axonal. O presente estudo teve o objetivo de acrescentar informações sobre o processo de reparação de nervos periféricos em eqüinos por meio de implante de tubo de silicone preenchido ou não com colágeno. Para tanto, foram utilizados oito eqüinos, alocados em dois grupos: GI-13 semanas e GII-26 semanas de observação. Foi realizada secção dos nervos ulnares (NUs) e dos ramos cutâneos laterais dos 17º nervos torácicos (NTs), bilateralmente, seguindo tubulização, realizada em cada animal, alternando-se tubos de silicone vazios (TS), em um dos antímeros, ou preenchidos com solução de colágeno (TSC), no contralateral, deixando-se um espaço de 5mm entre os cotos. Nenhuma alteração foi encontrada ao exame do aparelho locomotor e as primeiras reações positivas ao teste de sensibilidade cutânea nos NUs e NTs com TS e TSC foram observadas a partir da 9ª semana, em ambos os grupos. Ao final do período de observação, verificou-se, macroscopicamente, que os nervos encontravam-se envolvidos por tecido conjuntivo e o interior da câmara estava preenchido por tecido de coloração esbranquiçada, de forma cilíndrica, interligando os cotos proximal e distal. Microscopicamente, constatou-se a presença de axônios mielinizados interligando os cotos, as células de Schwann e o processo de remielinização do coto distal, principalmente no TSC. Em ambos os grupos, não houve formação de neuromas e o processo inflamatório limitou-se às áreas perineurais. Concluiu-se que o implante de tubo de silicone conduz à regeneração de NUs e NTs de eqüinos...
Surgical nerve repair in humans, dogs and laboratory animals is widely utilized for important clinical and experimental purposes. However, in horses there is scarce information. Neuroma and excessive conjunctive proliferation are reported. The aim of the present study was to add information about the repair process utilizing implant of silicone tubes with or without collagen in nerve regeneration of horses. Eight horses were allocated in two groups: GI-13 weeks and GII-26 weeks of observation. A complete section of the ulnar nerves (UNs) and of the lateral cutaneous branch of the 17th thoracic nerves (TNs), bilaterally, was followed by repair with silicone tubes alternately filled with (STC) or without collagen (ST), with a 5mm gap between stumps. Clinical evaluation was performed weekly, by cutaneous sensitivity testing of the region innervated by the respective operated nerves and physical examination of the thoracic limbs. No alterations were found in the locomotor apparatus. The first positive reactions to the cutaneous test occurred at the 9th week post-surgery. At the end of the observation period it was verified, grossly, that the nerves were involved by conjunctive tissue and the lumen of the tube was filled by a whitish tissue, in a cylindrical shape. The ends nerves were interconnected. Microscopically, myelinated axons and Schwann cells were present in the gap between the stumps. In the GII the number of myelinated fibers was greater. The distal nerve showed remyelination process. There was no presence of neuroma and the inflammatory process was limited to the perineural areas. It was concluded that the implant of silicone tubes results in regeneration of UNs and TNs of horses without formation of neuromas and that de addition of collagen promotes an increase in the number of myelinated fibers.
Assuntos
Animais , Colágeno/uso terapêutico , Equidae , Cavalos , Regeneração Nervosa , Próteses e Implantes , Silicones/administração & dosagem , Silicones/uso terapêuticoRESUMO
The purpose of this study was to design and evaluate a 32P patch for brachytherapy of skin diseases. We employed Phosphoric-32P-acid and Chromic 32P-phosphate in combination with natural rubber or silicone to produce the patches. Stability studies in vitro to evaluate the leakage of radioactivity, autoradiographic studies to evaluate homogeneity and shielding, as well as therapeutic efficacy in an animal model of skin cancer of the selected 32P patch were performed. The 32P-silicone-patch demonstrated its safety for external application. Tumor growth was arrest and complete regressions of tumors were seen in some other cases with 40 Gy applied in a single-dose scheme. In conclusion, the 32P-silicone-patch is easy to prepare and use in the treatment of skin diseases.
Assuntos
Braquiterapia/métodos , Radioisótopos de Fósforo/administração & dosagem , Neoplasias Cutâneas/radioterapia , Animais , Compostos de Cromo/administração & dosagem , Compostos de Cromo/química , Sistemas de Liberação de Medicamentos/métodos , Feminino , Histocitoquímica , Camundongos , Camundongos Endogâmicos SENCAR , Fosfatos/administração & dosagem , Fosfatos/química , Ácidos Fosfóricos/administração & dosagem , Ácidos Fosfóricos/química , Radioisótopos de Fósforo/química , Planejamento da Radioterapia Assistida por Computador , Distribuição Aleatória , Borracha/administração & dosagem , Borracha/química , Silicones/administração & dosagem , Silicones/químicaRESUMO
Objetivo: Avaliar a segurança e eficácia da injeção transesfincteriana de silicone para o tratamento da incontinência anal, assim como correlacionar os resultados clínicos, ultra-sonográficos e manométricos. Métodos: Pacientes incontinentes foram submetidos à manometria e ultra-sonografia anorretal, índice de incontinência (II) e instrumento de qualidade de vida (FIQL), antes e após injeção do silicone (PTQ) sob anestesia local e profilaxia antibiótica. Os critérios de inclusão foram: incontinência anal, lesão isolada ou múltipla do músculo esfíncter interno do ânus, associada ou não à lesão isolada, em um quadrante, do músculo esfíncter externo do ânus. O instrumento FIQL utilizado inclui quatro domínios: estilo de vida, comportamento,depressão e constrangimento.Os parâmetros da manometria foram: pressão média de repouso (PMR), pressão média (PMCV) e máxima (PmaxCV) de contração voluntária, zona de alta pressão (ZAP) e índice de assimetria (IA). Após três meses de tratamento, os pacientes foram reavaliados através do II, FIQL, manometria e ultra-sonografia anorretal. Um grupo controle composto por 10 homens e 10 mulheres continentes e sem história prévia de cirurgia anorretal foi submetido à manometria após consentimento informado. Resultados: Foram estudados 35 pacientes, 28 mulheres e sete homens com idade média de 60,3 (19-80) anos, antes e após injeção do silicone anal. As complicações observadas incluíram dois hematomas (5,7%), um abscesso anal (2,8%), dor anal em dois pacientes (5,7%) e dificuldade evacuatória em um paciente (2,8%). Notou-se uma melhora do índice médio de incontinência de 11,3 para 4,3 (p < 0,001). Houve melhora de todos os domínios estudados no instumento FIQL (p<0,0001)...
Aim: To evaluate safety and efficacy of trans-sphincteric silicone injection for the treatment of anal incontinence and to assess correlation between clinical and physiological results. Methods: Incontinent patients prospectively selected by clinical and physiological evaluation underwent trans-sphincteric silicone injection (PTQ) under local anesthesia. Eight channel manometry with asymmetry index and anal ultrasound were performed before and after injections. Incontinence scale (IS) and quality of life instrument (FIQL scale) were applied before and after injection.Inclusion criteria were: anal incontinence, isolated or multiple injury of the internal anal sphincter associated or not to small, restricted, external anal sphincter defect. FIQL scale included four domains: life-style, behavior, depression and embarrassment. Manometry evaluation included mean resting pressure (MRP), mean squeeze pressure (MSP), maximal squeeze pressure (MaxSP), high-pressure zone (HPZ) and asymmetry index (AI). After 3 months of treatment the patients had been reevaluated through the IS, FIQL scale, manometry and ultrasound. A controlled group of 20 healthy volunteers (10 men and 10 women) underwent anal manometry. Results: 35 patients (28 women and seven men) with a mean age of 60.3 (19-80) years were evaluated. Complications observed were two anal hematomas (5,7%), one perianal abscess (2.8%), two patients complained of anal pain (5,7%) and one patient required assistance for defecation (2,8%). Mean incontinence score improved significantly after injection: 11, 3 to 4,3 (p < 0.001). Significant improvement in the FIQL scale was noticed in all domains (p < 0.0001). Incontinent patients had significantly lower anal pressures when compared to controls (p < 0.05)...
Assuntos
Humanos , Canal Anal , Incontinência Fecal , Incontinência Fecal/terapia , Manometria , Qualidade de Vida , Silicones/administração & dosagemRESUMO
Mergulha no universo dos travestis e desvenda uma realidade pouco conhecida, longe da glamorização e dos estereótipos. A dor da beleza é revelada através da figura da Bombadeira, profissional conhecida no meio por mudar as formas de suas pacientes através de implantes clandestinos de silicone industrial. Aborda também o modo de vida dos travestis, quem são, como vivem, o que desejam, mostram o seu cotidiano e suas relações familiares e conjugais...