Treatment of orbital floor fracture with conchal cartilage

INTRODUCTION: The reconstruction of defects in the orbital floor after fractures poses a challenge to the plastic surgeon because besides the patient's aesthetic and reconstructive expectations, possible functional complications such as diplopia and facial paresthesia must be treated. This study aimed at reporting a series of cases in which conchal auricular cartilage was used for volumetric orbital and structural replacement of the floor. METHODS: Twenty-four patients, with surgery performed by the author, between 2013 and 2016, for pure (blow-out) or impure (conjugated to orbital margin injuries, such as zygoma and maxilla) orbital floor fractures, were evaluated. The repair technique involved autologous conchal cartilage graft in all cases. Patients were classified for the presence of preoperative complaints, including paresthesia and diplopia, and symptoms such as enophthalmia, as well as postoperative outcomes. RESULTS: The existence of concomitant lesions, such as zygomatic complex and maxillary fracture, as well as fractures with greater discontinuity in the orbital floor, may influence the success of reconstruction. Few patients exhibited postoperative complaints and only two (9.2%) required a new surgical approach. CONCLUSION: Autologous conchal auricular cartilage is a suitable material for reconstruction of defects in the post-fracture orbital floor, possessing various advantages, including ease of attainment, low morbidity, inconspicuous scar, and excellent adaptation to the shape of the orbital floor and consequent volumetric replacement

Neurofibromatosis type 1 with infraorbital nerve involvement: a case report

Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease with multiple clinical manifestations. Its most significant presentation is cutaneous or subcutaneous neurofibromas (myelin sheath tumors), which may be associated with other systemic manifestations such as caféau- lait spots and eye involvement. Neurofibromas can affect several peripheral nerves, including the facial nerves. This report presents a case of a 1-year-old patient with NF1 with right infraorbital nerve neurofibroma in which the proposed access for surgical treatment allowed adequate visualization of the tumor with good aesthetic results, preservation of the soft tissues, and normal facial growth

Use of pectoralis major fascia in dorsal nasal augmentation: case report

Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum

Fatores de risco para infecção de ferida cirúrgica em puérperas submetidas a cesarianas em hospital universitário de referência.

Backgound and Objectives: Surgical wound infections (SWI) postoperative complications are common and present significant morbidity and mortality with increased time and cost of hospitalization, especially for women undergoing cesarean delivery. Therefore, the aim of this study was to evaluate risk factors for IFC in the reference in high-risk pregnancies from public Belo Horizonte. Methods: A cohort study performed in a referral Maternity - HC / UFMG, 2011-2012, with notification of SWI by active surveillance. All patients undergoing cesarean section were included and telephone contact was performed up to 30 days postpartum. The database was entered in the Statistical Package for Social Sciences. Results: We identified 708 women undergoing cesarean section and telephone contact was achieved with 487 of them during postpartum period. In 14 cases criteria for diagnosis of SWI was full filled (2.9% rate). When comparing groups of women with and without SWI, only the number of digital vaginal examination (≥ 2) was statistically significant for SWI cases. Conclusion: In the case of IFC, the average of digital vaginal examination was below reported in literature. It is emphasized that the procedure should be performed when absolutely necessary, respecting the rules of asepsis. KEYWORDS: Cesarean section. Surgical wound infection. Epidemiological surveillance. Diseases notification. Postpartum period.Justificativa e Objetivos: Infecções de ferida cirúrgica (IFC) constituem complicações pós-operatórias comuns e apresentam importante morbimortalidade, com aumento no tempo e custo de hospitalização, especialmente para mulheres submetidas a parto cesariana. Por isso, o objetivo do presente estudo foi avaliar fatores de risco para IFC em serviço de referência em gestação de alto risco da rede pública de Belo Horizonte. Métodos: Estudo transversal realizado na maternidade do Hospital das Clínicas em Minas Gerais, de 2011 a 2012, com notificação de IFC por vigilância ativa. Todas as pacientes submetidas à cesárea no serviço foram incluídas e contato telefônico foi realizado até 30 dias pós-parto. Resultados: Identificaram-se 708 mulheres submetidas a cesariana, sendo 487 (68,8%) puérperas contatadas por telefone. Em 14 (2,9%) puérperas os dados fornecidos preencheram os critérios para diagnóstico de IFC. Na comparação entre grupos de mulheres com e sem IFC, apenas o número de toques vaginais (≥ 2) foi estatisticamente significativo para os casos IFC. Conclusão: Nos casos de IFC, o número médio de toques realizados está abaixo do observado na literatura. Ressalta-se que o procedimento deve ser realizado quando absolutamente necessário, respeitando-se as normas de assepsia

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file