Tretinoin Peeling

BACKGROUND: Topical tretinoin has been used for a long time to improve photoaged skin, but this therapy takes quite a few months to show some clinical changes. Because of that, we think tretinoin peeling would be an excellent choice for improvement of photoaged skin. OBECTIVE: Our objective was to show the clinical and histologic modifications of the skin after five sessions of tretinoin peeling. METHODS: The authors studied the clinical and histologic modification that occurred in 15 female patients after conducting tretinoin peeling procedures twice a week in concentrations of 1-5%. Conventional sectioning of punch biopsy specimens was conducted before and after the treatment. RESULTS: Clinical improvement was observed in the skin texture and appearance. Through histologic examinations, a decrease in the corneous layer and an increase in the epidermal thickness were noticed, inducing an improvement of its stratification, as well as the formation of cristae cutis. CONCLUSION: It was concluded that the peeling conducted with serial tretinoin showed good clinical and histologic results, especially for the treatment of photoaged skins I and II, melasma, ephelis, and acne degree I, as well as being practical, quick, and easily accomplished with no side effects.     

Dynamic Cardiomyoplasty as a Therapeutic Alternative: Current Status

Dynamic cardiomyoplasty was proposed as an alternative surgical treatment for severe cardiomyopathies and has been performed worldwide in more than 1,000 patients. Patients indicated for this procedure are specifically those with dilated or ischemic cardiomyopathies. The ventricular function improvement observed after dynamic cardiomyoplasty derived from the direct action of synchronized skeletal muscle flap contraction and from a girdling effect that helps to reverse chamber remodeling and to decrease ventricular wall stress. Although long-term benefits of this procedure may be limited by skeletal muscle flap ischemic compromise, technological advances incorporated in the new myostimulators will possibly decrease this complication incidence. Clinical improvement has been reported as a consistent finding in cardiomyoplasty follow-up and the overall 5-year survival after this procedure ranges from 39 % to 54 %. On the other hand, the mortality after cardiomyoplasty has been significantly higher for patients in persistent New York Heart Association functional class IV, showing that this procedure needs to be indicated earlier than the heart transplantation. In this regard, only the results of an ongoing randomized trial will potentially define cardiomyoplasty influence on the survival of patients with severe heart failure. In the meantime, however, there are clearly several functional class III patients whose quality of life and exercise capacity have worsened despite the use of maximum medical therapy, justifying dynamic cardiomyoplasty indication.     

Non-invasive monitoring of pulmonary capillary wedge pressure in heart failure

OBJECTIVE: To evaluate the usefulness of pulsed Doppler (PD) mitral flow E wave deceleration time (EDcT) to detect and quantify changes of pulmonary capillary wedge pressure (PCWP) in patients (pt) with dilated chronic heart failure (CHF) submitted to tailored therapy. METHODS: In 14 pt with dilated cardiomyopathy (DCM) (59.4+/-10.0 years, 11 males, sinus rhythm), admitted to the ICU because of worsening CHF, serial simultaneous hemodynamic and echocardiographic studies were performed (3-5/pt; overall 49 evaluations). PD mitral flow register was used to measure EDcT and correlated with PCWP at each study. RESULTS: PCWP ranged from 36 to 3 mmHg (17.6+/-8.8) and EDcT from 271 to 52 ms (104.9+/-42.4). The correlation between EDcT and PCWP was -0.65 (PCWP=31.7-0.134EDcT). Using this equation to calculate PCWP, individual absolute values difference (identity error - IE) was 5.6+/-3.5 mmHg (0.4-14.6). In 29 cases (59.2%) IE was >5 mmHg, defined as major error. Considering EDcT percent change (delta%EDcT) and PCWP variation (deltaPCWP) in serial evaluations, we found a correlation of -0.87 (deltaPCWP=-2.83-0.19 delta%EDcT). Using this equation, the IE was 2.3+/-1.6 mmHg (0-5.2) and there were only two (6%) major errors (P<0.0001). CONCLUSIONS: In pt with DCM and advanced CHF, EDcT shows a reasonable correlation with PCWP, but when it is used to calculate PCWP the IE to hemodynamic values is often large. However, our results with EDcT percent change in serial evaluations using a first simultaneous invasive determination, suggest that this technique is reliable for monitoring PCWP and can be particularly useful for pt submitted to tailored therapy.     

Human gingival glycosaminoglycans in cyclosporin-induced overgrowth

Glycosaminoglycans in normal and cyclosporin‐induced gingival overgrowth were extracted by papain digestion and purified by Mono Q‐FPLC chromatography. The purified glycosaminoglycans were analyzed by agarose gel electrophoresis and by the pattern of degradation products formed by chondroitin lyases on HPLC chromatography. Our results on the glycosaminoglycan composition showed presence of chondroitin 4‐ and 6‐sulfate, dermatan sulfate, heparan sulfate and hyaluronic acid in both normal gingiva and cyclosporin‐induced gingival overgrowth. The total and relative amounts of glycosaminoglycans were similar between normal and overgrown gingiva. This suggests that the glycosaminoglycan composition is not changed in cyclosporin‐induced gingival overgrowth. Our present biochemical results conflict with histochemical and biosynthetic data previously reported by other groups. Those studies suggested that the affected tissues contained higher levels of glycosaminoglycans and that cyclosporin induced comparably high levels of these compounds in in vitro cultures of gingival fibroblasts. Therefore, these discrepant results suggest that a cyclosporin‐induced increase on gingival glycosaminoglycans still remains an open question. The implications of these conflicting results are discussed.     

Pityrosporum folliculitis: renal transplantation case report

Pityrosporum folliculitis is caused by the fungus Pityrosporum ovale. It is characterized by the presence of pruriginous follicular papulae and papulae-pustules in face, upper part of the trunk, and upper limb root. It is more prevailing in places with hot and humid climates. Its incidence can be associated with either immunosuppressive or chemotherapy states secondary to pathologies. We report herewith a case of pityrosporum folliculitis in a patient who had previously underwent kidney transplantation and these result of the itraconazol therapeutics given.     

Efficacy of the nocturnal bite plate in the control of bruxism for 3 to 5 year old children

Bruxism occurs in nearly 60% of children between 3 and 5 years, with important repercussions to the different components of the stomatognathic system. Nevertheless, there is little information in the literature about this topic. The aim of this study was to compare two groups of children with bruxism. One group was not submitted to treatment, serving as a control. To the other group, nocturnal bite plate was made. Cast models were made for both groups, to evaluate the progression of wear facets, during 8 months. The results are as follows: The 4 children of the control group displayed increased wear facets during the study period. On the other hand, of the 5 children that used nocturnal bite plate, showed no increase of wear facets, even after the removal of the device. From this study, we can conclude that the use of nocturnal bite plate is efficient against bruxism in 3- to 5-year-old children.     

Use of omentum pedicled graft to protect great vessels in gastric transposition for pharyngoesophageal cancer

BACKGROUND AND OBJECTIVES: Transmediastinal gastric transposition and pharyngogastric anastomosis is perhaps one of the most widely accepted methods for restoration of the alimentary continuity after pharyngoesophageal resection. The need of neck dissection, mediastinal tracheostomy, and previous radiotherapy may favor exposure and rupture of major vessels. Protection with omentum may prevent this complication. A comprehensive review of omentum flap use in surgery was undertaken. METHODS: A modified omentum pedicled flap was used in 6 out of 36 patients submitted to total pharyngolaryngoesophagectomy and gastric transposition (PLE>). RESULTS: None of the patients had major vessel rupture as compared with a 13% carotid and innominate artery rupture of a series of 30 patients previously operated on without omentum pedicled flap protection. CONCLUSIONS: The omental pedicled flap, performed as described, may provide reliable protection for carotid and innominate artery exposure, adding little time to the procedure.     

Initial care and outcome of glioblastoma multiforme patients in 2 diverse health care scenarios in Brazil: does public versus private health care matter?

Background

The aim of this study was to describe the epidemiological and survival features of patients with glioblastoma multiforme treated in 2 health care scenarios—public and private—in Brazil.

Methods

We retrospectively analyzed clinical, treatment, and outcome characteristics of glioblastoma multiforme patients from 2003 to 2011 at 2 institutions.

Results

The median age of the 171 patients (117 public and 54 private) was 59.3 years (range, 18–84). The median survival for patients treated in private institutions was 17.4 months (95% confidence interval, 11.1–23.7) compared with 7.1 months (95% confidence interval, 3.8–10.4) for patients treated in public institutions (P < .001). The time from the first symptom to surgery was longer in the public setting (median of 64 days for the public hospital and 31 days for the private institution; P = .003). The patients at the private hospital received radiotherapy concurrent with chemotherapy in 59.3% of cases; at the public hospital, only 21.4% (P < .001). Despite these differences, the institution of treatment was not found to be an independent predictor of outcome (hazard ratio, 1.675; 95% confidence interval, 0.951–2.949; P = .074). The Karnofsky performance status and any additional treatment after surgery were predictors of survival. A hazard ratio of 0.010 (95% confidence interval, 0.003–0.033; P < .001) was observed for gross total tumor resection followed by radiotherapy concurrent with chemotherapy.

Conclusions

Despite obvious disparities between the hospitals, the medical assistance scenario was not an independent predictor of survival. However, survival was directly influenced by additional treatment after surgery. Therefore, increasing access to resources in developing countries like Brazil is critical.     

Radiofrequency catheter ablation of an accessory pathway in a patient with Wolff-Parkinson-White and Kartagener's syndrome

We report a case of a manifest left free wall accessory pathway in a patient with Kartagener's syndrome and recurrent episodes of orthodromic atrioventricular reentrant tachycardia. To the best of our knowledge, it is the first report of Wolff-Parkinson-White syndrome associated with Kartagener's syndrome. Situs inversus and mirror image dextrocardia occurred with no additional detectable cardiac structural abnormalities. Diagnostic and therapeutic electrophysiological study was carried out via transaortic approach and a left-to-right reversal of monoplane fluoroscopic image.