ABSTRACT: Skin grafting is a simple and very useful surgical technique for wound repair, especially where there is difficulty in performing direct synthesis or other reconstructive techniques. low-intensity laser (LIL) has already been used successfully in cases where the graft was applied to wounds shortly after its creation. However, LIL still lacks standardization due to conflicting studies on its results. Thus, this study compared the effectiveness of continuous wave LIL with pulsed wave LIL in stimulating the healing of skin grafts, applied to newly created wounds in rabbits. For this purpose, 31 rabbits were distributed into: control group (CG, n = 10), continuous wave laser group (GLC; n = 10) and pulsed wave laser group (GLP; n = 11). Postoperative management was similar between all groups, with the exception of laser application, as indicated by the group. The GLC and GLP groups showed similar evolution, with a satisfactory healing process of the graft, unlike the GC group. These results were maintained in the microscopic evaluation, as the groups treated with laser showed less inflammation, better integration with the receptor area, greater re-epithelialization and collagenization. There was no difference in vascular density between the treatment groups on immunohistochemical analysis. The newly created wound was not able to provide nutrition for the skin graft in rabbits, but LIL is an efficient adjuvant therapy in stimulating healing between the recipient area and the graft, promoting full integration. However; although, statistically there was no difference in the form of light emission, pulsed or continuous, patients who received continuous wave LIL showed superior microscopic evolution.

RESUMO: A enxertia cutânea é uma técnica cirúrgica simples e bastante útil para o reparo de feridas, principalmente, quando há dificuldade em realizar a síntese direta ou outras técnicas reconstrutivas. O laser de baixa intensidade (LBI) já foi utilizado com sucesso em casos em que o enxerto foi aplicado em feridas logo após a sua criação. No entanto, a LBI ainda carece de padronizações, mediante estudos conflitantes sobre seus resultados. Desta forma, este trabalho objetivou comparar a eficácia da LBI de onda contínua com onda pulsada na estimulação da cicatrização de enxertos cutâneos, aplicados em feridas recém-criadas em coelhos. Para tanto, foram utilizados 31 coelhos distribuídos em: grupo controle (GC, n = 10), grupo laser onda contínua (GLC; n = 10) e grupo laser onda pulsada (GLP; n = 11). O manejo pós operatório foi semelhante entre todos os grupos, com exceção da aplicação do laser, conforme o grupo indicado. Os grupos GLC e GLP apresentaram evolução semelhante, com processo cicatricial satisfatório do enxerto, ao contrário do grupo GC. Tais resultados se mantiveram na avaliação microscópica, pois os grupos tratados com laser apresentaram menor inflamação, melhor integração à área receptora, maior reepitelização e colagenização. Não houve diferença na densidade vascular entre os grupos de tratamento na análise imuno-histoquímica. A ferida recém-criada não é capaz de fornecer nutrição para o enxerto cutâneo nos coelhos, mas a LBI é uma terapia adjuvante eficiente em estimular a cicatrização entre a área receptora e o enxerto, promovendo integração total. Entretanto, embora não houve diferença estatística na forma de emissão de luz, pulsada ou contínua, os pacientes que receberam LBI em onda contínua apresentam evolução microscópica superior.

Methotrexate is an antimetabolite analog to folic acid that competitively inhibits the enzyme dihydrofolate reductase and thymidylate synthetase, essential for the synthesis of DNA and RNA. It is widely used in dermatology and its adverse effects on the skin and mucous membranes are varied, including mild and severe reactions. The appearance of erosions and skin ulcers as a manifestation of methotrexate cytotoxicity are quite infrequent. These would represent an early cutaneous sign of pancytopenia due to marrow toxicity secondary to this drug. In most of the cases there are cutaneous diseases prior to ulceration, mainly psoriasis. In the absence of underlying dermatitis, the presence of ulcerations is very rare. We present eight cases of patients with cutaneous signs of methotrexate poisoning, with and without previous dermatoses. Most of them associated mucositis and bone marrow involvement. Treatment guidelines are recommended.

El metotrexato es un antimetabolito análogo al ácido fólico que inhibe competitivamente la enzima dihidrofolato reductasa y timidilato sintetasa, indispensables para la síntesis de ADN y ARN. Se utiliza ampliamente en dermatología y sus efectos adversos en la piel y mucosas son variados, incluyendo reacciones leves y graves. Las erosiones y úlceras cutáneas como manifestación de citotoxicidad por metotrexato son infrecuentes y representarían un signo cutáneo temprano de pancitopenia por toxicidad medular secundaria a dicha droga. En la mayoría de los casos existen enfermedades cutáneas previas a la ulceración, principalmente psoriasis. En ausencia de dermatitis subyacente, la presencia de ulceraciones es excepcional. Se presentan ocho casos de pacientes con signos cutáneos de intoxicación por metotrexato, con y sin dermatosis previas. En la mayoría hubo asociación de mucositis y compromiso medular. Se recomiendan pautas de tratamiento.

Abstract: Infantile myofibromatosis is a mesenchymal disorder characterized by the fibrous proliferation of the skin, bone, muscle and viscera. It is the most common fibrous tumor in childhood. We present a newborn with skin and bone disease without visceral involvement, who showed good response to vinblastine and methotrexate. Clinical features, etiology, diagnosis, and treatment are reviewed.

El propósito de este artículo es dar prioridad a Gestión de Calidad Total (GCT) prácticas y examinar su importancia relativa en la implementación de GCT en pequeñas y medianas empresas (PYME) de la industria de dispositivos médicos, utilizando el método de Analytical Hierarchy Process (AHP). Modelación matemática fue el método de investigación adoptado. La elección de AHP también se basó en la necesidad de adquirir conocimientos de diferentes empresas. Algunas implicaciones se pueden destacar. Dos factores estratégicos (Sistema de Gestión de Calidad y Planificación de la Calidad) y un factor táctico (Gestión de procesos) están fuertemente correlacionados y indicados por los expertos como tener la mayor importancia. Por último, el método AHP desarrollado en el presente estudio ha demostrado ser útil para dar prioridad a las prácticas relativas a la aplicación de la GCT en las empresas de dispositivos médicos. Los resultados pueden ser información útil para los administradores de dispositivos médicos que trabajan en las principales prácticas con el fin de mejorar el rendimiento de la GCT.

The purpose of this article is to prioritize Total Quality Management (TQM) practices and examine their relative importance in TQM implementation in medical device small and medium enterprises (SME) using the Analytic Hierarchy Process (AHP) method. Mathematical modeling was the research method adopted in this article. The choice of AHP was based on the need to acquire knowledge from different companies and prioritize the most important TQM practices. Some implications are highlighted. Two strategic factors (Quality Management System and Quality Planning) and one tactical factor (Process Management) are strongly correlated and indicated by experts as having the major importance. Finally, The AHP method developed in the present study was shown to be useful for prioritizing practices relating to the implementation of TQM in medical device companies. The results can provide useful information to medical device managers to work upon the main practices in order to improve TQM performance.

Onychomadesis is the spontaneous, complete shedding of the nail from its proximal side, without pain or inflammation, following nail matrix arrest. This disorder is uncommon in children and it can occur in fingernails, toenails or both. It may be secondary to systemic disorders, Kawasaki disease, bullous dermatoses, drugs, paronychia, stress and radiotherapy. Since 2000, Hand, Foot, and Mouth Disease (HFMD) has been described as a cause of onychomadesis, and has been associated with outbreaks of this condition in different regions of the world. HFMD is an infection characterized by vesicular and erosive stomatitis in combination with a vesicular eruption in palms and soles. It occurs in small children during summer and autumn months, and it is caused by coxsackie virus. We present a study that reflects the current situation of onychomadesis in Argentinian children and shows a strong association between this disorder and HFMD, suggesting that onychomadesis is a new manifestation of a previously known disease.

La onicomadesis es el desprendimiento completo y espontáneo de la uña desde su extremo proximal, sin dolor o inflamación, consecutivo a la detención de la función de la matriz ungular. Es rara en los niños y puede afectar las uñas de las manos o de los pies. Puede ser secundaria a enfermedades sistémicas, enfermedad de Kawasaki, dermatosis ampollares, fármacos, paroniquia, estrés y radioterapia. Desde el año 2000, la enfermedad de boca, mano y pie (EBMP) se ha descrito como causa de onicomadesis y ha ocasionado brotes epidémicos en distintas regiones del mundo. La EBMP es una infección caracterizada por una estomatitis vesicular y erosiva asociada a una erupción vesicular palmoplantar. Afecta a los niños pequeños en verano y otoño, y es causada por el virus coxsackie. Presentamos un estudio que muestra la situación actual de la onicomadesis en niños de la Argentina, con una fuerte asociación entre esta alteración y EBMP previa, siendo, probablemente, una nueva manifestación de una enfermedad ya conocida.