ABSTRACT Objective To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. Method Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. Results No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. Conclusion High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

Objective: To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS). Methods: Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE]). Results: Total Cronbach’s alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms. Conclusion: The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

BACKGROUND: Tendon injury is one of the most frequent injuries in sports activities. TENS is a physical agent used in the treatment of pain but its influence on the tendon's healing process is unclear. OBJECTIVE: To evaluate the influence of TENS on the healing of partial rupture of the Achilles tendon in rats. METHOD: Sixty Wistar rats were submitted to a partial rupture of the Achilles tendon by direct trauma and randomized into six groups (TENS or Sham stimulation) and the time of evaluation (7, 14, and 21 days post-injury). Burst TENS was applied for 30 minutes, 6 days, 100 Hz frequency, 2 Hz burst frequency, 200 µs pulse duration, and 300 ms pulse train duration. Microscopic analyses were performed to quantify the blood vessels and mast cells, birefringence to quantify collagen fiber alignment, and immunohistochemistry to quantify types I and III collagen fibers. RESULTS: A significant interaction was observed for collagen type I (p=0.020) where the TENS group presented lower percentage in 14 days after the lesion (p=0.33). The main group effect showed that the TENS group presented worse collagen fiber alignment (p=0.001) and lower percentage of collagen III (p=0.001) and the main time effect (p=0.001) showed decreased percentage of collagen III at 7 days (p=0.001) and 14 days (p=0.001) after lesion when compared to 21 days. CONCLUSIONS: Burst TENS inhibited collagen I and III production and impaired its alignment during healing of partial rupture of the Achilles tendon in rats.

PURPOSE: This study is a systematic literature review and meta-analysis concerning the use of a testosterone synthetic analog, oxandrolone, and its use in severe adult burns. METHODS: Randomized prospective clinical studies, in English, Portuguese or Spanish, were sought on the following databases: MEDLINE, COCHRANE, EMBASE and LILACS. There was no restriction in relation to the publication date. RESULTS: This search produced 24 studies on MEDLINE and twelve articles were presented on the COCHRANE database .Sixteen were excluded due to the title not being related to this search or by including children. Of the eigth residual studies, after adaptation to the inclusion criteria, only four were selected. After analyzing the results, two were discarded since they did not present adequate patient characterization and the facts on these articles were analyzed differently from the others, hindering the meta-analysis. CONCLUSION: The analysis of the available data demonstrated significant benefits (p<0.05) considering lesser loss of corporal mass, lesser nitrogen loss, and shorter donor area healing time, when Oxandrolone was used, comparatively with the control group (placebo or not).

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ2 test. RESULTS: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ2=9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

Aproxima-se uma época na qual é fundamental a compreensão do processo cicatricial cutâneo frente à necessidade da restauração tecidual precoce, visando a diminuição das morbidades física, social e psicológica. O avanço no conhecimento acerca do controle das interações entre as células, a matriz e os fatores de crescimento dará maiores informações à Medicina Regenerativa, área de pesquisa emergente da bioengenharia médica. Entretanto, diante do dinamismo e complexidade da resposta cicatricial cutânea torna-se indispensável o entendimento do mecanismo de controle exercido pela interação e sinergismo do sistema nervoso cutâneo e o sistema nervoso central, via eixo hipotálamo-hipófise-adrenal, tema relevante, porém, pouco abordado. O presente estudo revisa a fisiologia neuro-imuno-endócrina da pele, responsável por suas múltiplas funções, e os distúrbios extremos do processocicatricial, como o excesso e deficiência de deposição da matriz extracelular.

There comes a time when the understanding of the cutaneous healing process becomes essential due to the need for a precocious tissue repair to reduce the physical, social, and psychological morbidity. Advances in the knowledge on the control of interaction among cells, matrix and growth factors will provide more information on the Regenerative Medicine, an emerging area of research in medical bioengineering. However, considering the dynamism and complexity of the cutaneous healing response, it is fundamental to understand the control mechanism exerted by the interaction and synergism of both systems, cutaneous nervous and central nervous, via hypothalamus hypophysis-adrenal axis, a relevant subject, but hardly ever explored. The present study reviews the neuro-immune-endocrine physiology of the skin responsible for its multiple functions and the extreme disturbances of the healing process, like the excess and deficiency of the extracellular matrix deposition.

OBJETIVO: As fraturas mandibulares podem levar a grandes prejuízos estéticos, funcionais e financeiros e suas características epidemiológicas têm sofrido alterações em diversas localidades. Para detectar estas mudanças, foi realizado este estudo, cujo objetivo foi comparar os dados de pacientes com fraturas mandibulares atendidos no Hospital São Paulo (UNIFESP-EPM) no período de junho de 1999 a março de 2002 aos de pacientes atendidos de janeiro de 1991 a março de 1996. MÉTODOS: Foram comparados o sexo e faixa etária mais acometidos, locais mais fraturados do osso, lesões associadas, tratamento e complicações de 98 pacientes com fratura de mandíbula, atendidos pelo Setor de Cirurgia Craniofacial da Disciplina de Cirurgia Plástica UNIFESP-EPM no período de junho de 1999 a março de 2002 aos mesmos dados de 166 pacientes atendidos de janeiro de 1991 a março de 1996. RESULTADOS: O sexo e a faixa etária mais acometidos ainda são os mesmos. Os acidentes de transporte, como principais causas de fraturas mandibulares, foram substituídos pelas agressões. Houve diminuição de lesões associadas e de fraturas múltiplas na mandíbula, provavelmente associadas à mudança etiológica. O local mais acometido continua sendo o corpo. O tratamento mais utilizado nos dois grupos foi a fixação com miniplaca, e o número de complicações diminuiu, provavelmente devido à melhora do padrão de atendimento. CONCLUSÃO: Houve mudanças nas características epidemiológicas das fraturas mandibulares na população de São Paulo e o conhecimento das mesmas possibilita a instituição de medidas preventivas e de tratamento adequadas.

BACKGROUND: Mandible fractures can result in esthetic, functional and financial problems and their epidemiological patterns have changed in many locations. This study was carried out to detect these changes, aiming to compare data of patients with mandible fractures treated at the São Paulo Hospital (UNIFESP-EPM) from June 1999 to March 2002 with data of patients treated from January 1991 to March 1996. METHODS: Information on most affected gender and age, most often fractured mandible segment, associated injuries, treatment and complications of 98 victims of mandible fracture admitted from June 1999 to March 2002 were compared to the same data of 166 patients treated from January 1991 to March 1996. RESULTS: the most affected gender and age ranges remain the same. Aggressions surpassed traffic accidents as the main etiology. Incidence of associated injuries and multiple fractures in the mandible decreased, a fact probably related to the change in etiology. The most affected segment is still the body of the mandible. The most used type of treatment in both samples was internal rigid fixation with miniplates and the number of complications decreased, due to the higher standard of patient care. CONCLUSION: Mandible fractures in the São Paulo population have undergone epidemiological changes and this knowledge enables local authorities to establish adequate measures for prevention and treatment.

Objetivo: apresentar um caso de melanoma cutâneo na infância, submetido à biópsia de linfonodo sentinela. Descrição: criança de 12 anos de idade, portadora da síndrome do nevo displásico, desenvolveu melanoma em dorso. A biópsia excisional revelou melanoma (Breslow = 1,5 mm), sendo submetida a tratamento cirúrgico da lesão, com ampliação de margem de 2cm e biópsia de linfonodo sentinela. O exame anatomopatológico não mostrou doença residual. O exame do linfonodo sentinela não mostrou metástases ao exame histopatológico por hematoxilina eosina, nem à imunohistoquímica (S100 e HMB45). No entanto, a pesquisa de RNA mensageiro da tirosinase por RT-PCR se mostrou positiva. A paciente não mostrou sinais de metástase ou recidiva local nestes doze meses iniciais de seguimento. Comentários: o melanoma é raro em crianças, corresponde a menos de 1% dos tumores da infância. Inúmeros trabalhos mostram o aumento da incidência mundial do melanoma. Em cerca de 70%, se originam de nevos melanocíticos pré-existentes, e nos 30% restantes, eles surgem de novo. Dada a agressividade do melanoma, a sobrevida depende do diagnóstico precoce. A biópsia do linfonodo sentinela tem contribuído na decisão de se realizar ou não a linfadenectomia completa, e alguns autores já estão utilizando a mesma em crianças.

Objective: to present a case of a child who was subjected to sentinel lymph node biopsy for cutaneous melanoma. Description: a 12 year-old child with Dysplastic Nevus Syndrome developed melanoma on the lumbar region. The excision biopsy revealed a melanoma with depth of 1.5 mm. The patient was submitted to amplification of the margins 2 cm in all directions and the sentinel node was also excised. The histopathological exam did not show residual disease. Sentinel on exam did not show metastases either under hematoxylin-eosin stain or immunohistochemistry (S-100 and HMB45). Therefore, RT-PCR for tyrosinase mRNA was positive. The patient has been followed for twelve months without evidence of recurrence. Comments: childhood melanoma is rare, corresponding to less than 1% of malignant tumors in children. Data point to a worldwide increase in its incidence. Melanoma occurs in melanocytic lesions in 70% and in the remaining 30% it occurs de novo. Melanoma is very aggressive, so the survival depends on an early diagnosis. Sentinel lymph node biopsy has selected patients to complete lymphadenectomy. Some authors have been using this technique in childhood melanoma.