Hospital de Clínicas Universidade Federal do Paraná

Liposuction is widely performed for body contouring, but concerns regarding residual sagging and contour irregularities remain as limitations of this technique. Heat-emitting technologies aim to stimulate skin contraction, and radiofrequency (RF) energy is considered effective. However, patient satisfaction is essential to confirm its clinical benefit. This retrospective observational study analyzed the outcomes of 113 patients who underwent either conventional liposuction (n = 73) or liposuction followed by helium plasma RF (n = 40) performed by a single surgeon. Objective outcomes, complications, and the BODY-Q questionnaire were used to assess the procedural data and patient satisfaction. In the long-term subgroup, patients treated with helium plasma RF reported significantly higher BODY-Q scores for appraisal of excess skin across all comparisons: full long-term cohort (87.8 versus 73.8), subgroup without abdominoplasty (92.8 versus 64), and subgroup excluding lipoabdominoplasty-only cases (87.8 versus 73.4). Among patients who did not undergo abdominoplasty, satisfaction with the abdominal appearance was also significantly higher (68.8 versus 45). Although satisfaction scores for other regions favored the helium plasma RF group, these differences were not statistically significant. The helium plasma RF group had a lower abdominoplasty rate (30% versus 67.1%), higher aspirated volumes (3357.1 versus 2637.2 mL), and a significantly lower revision rate (12% versus 37.5%). The complication rates were similar between the groups (2.5% versus 2.7%). Liposuction followed by helium plasma RF was associated with favorable patient-reported satisfaction regarding abdominal contour and excess skin, lower revision and abdominoplasty rates, and higher aspirated volumes, with a safety profile comparable to that of conventional liposuction.

Background: Selective laser trabeculoplasty (SLT) is a first-line treatment for open-angle glaucoma (OAG) or ocular hypertension (OHT). However, the optimal SLT protocol remains unsettled. Randomized controlled trials (RCTs) comparing 180° and 360° SLT have yielded conflicting outcomes. This systematic review and meta-analysis aimed to determine which approach provides superior efficacy and safety. Methods: We searched PubMed, Embase, Cochrane, and Web of Science through November 8, 2025 for RCTs comparing 180° with 360° SLT in OAG or OHT. We excluded conference abstracts. The primary outcome was intraocular pressure (IOP). Secondary outcomes included treatment success, visual acuity, and adverse events. We assessed the risk of bias with the Cochrane risk-of-bias tool for randomized trials, and estimated mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Trial sequential analysis (TSA) evaluated the robustness of evidence. Results: We included six studies comprising 892 eyes. 180° SLT was associated with higher IOP at 1 month (MD 1.17 mmHg; 95% CI: 0.52–1.81; P<0.01; I2=36%), 3 months (MD 0.96 mmHg; 95% CI: 0.45–1.47; P<0.01; I2=0%), 6 months (MD 1.03 mmHg; 95% CI: 0.14–1.92; P=0.02; I2=58%), and 12 months (MD 1.63 mmHg; 95% CI: 0.66–2.60; P<0.01; I2=0%). Treatment success (RR 0.72; 95% CI: 0.58–0.90; P<0.01; I2=50%) and pain or discomfort rates (RR 0.63; 95% CI: 0.50–0.81; P<0.01; I2=0%) were lower with 180° SLT. There was no difference between groups in visual acuity (MD −0.002 logMAR; 95% CI: −0.029 to 0.026 logMAR; P=0.90; I2=41%) and adverse events risk (RR 1.08; 95% CI: 0.69–1.68; P=0.75; I2=0%). TSA showed robust evidence for the superiority of 360° vs. 180° SLT on IOP. Conclusions: 180° SLT was inferior to 360° SLT for IOP control and treatment success in OAG or OHT, yet it was associated with a lower risk of pain or discomfort. These findings support 360° SLT as the preferred protocol, though evidence is limited by the number of trials, heterogeneity, and follow-up. High-quality, long-term RCTs are required to validate these findings.

Reference values for cardiac chamber quantification are essential for clinical decision-making. Brazil is a continental country with marked racial diversity and substantial regional socioeconomic and anthropometric variability, which may not be adequately represented in international echocardiographic standards. To establish reference echocardiographic measurements for healthy Brazilian adults and to investigate geographic and sex-related differences across Brazil's major regions. In this prospective, multicenter study, transthoracic echocardiograms were performed in 496 healthy volunteers (mean age 41 ± 15 years; 55% women) from five Brazilian regions. Left ventricular (LV) and left atrial (LA) dimensions, volumes, mass, ejection fraction, and global longitudinal strain (GLS) were analyzed in accordance with current guidelines. Comparisons were conducted by sex (Student's t test or Mann-Whitney U test) and by region (analysis of variance). Cardiac chamber dimensions and LV mass were greater in men, even after indexing for body surface area. LA volumes were also higher in men, although these differences were attenuated after indexing. Absolute LVGLS and right ventricle (RV) GLS (RVGLS) values were higher in women, whereas LA strain reservoir (LASr) was similar between sexes. Regionally, the Center-West exhibited significantly smaller LV volumes, a difference primarily driven by women, along with lower LVGLS and RVGLS (p < 0.001). In contrast, LA volumes were smaller in the Northeast region. No significant associations were observed between self-reported race and echocardiographic parameters, except for RVGLS and LASr, which were lower in White participants. This study establishes echocardiographic reference values in a nationally representative Brazilian cohort, confirms expected sex-related differences, and identifies previously unrecognized regional variations in cardiac chamber dimensions. These findings underscore the need for population-specific standards to ensure accurate cardiac quantification.

Objetivo: Avaliar a acurácia do Malnutrition Screening Tool (MST) para triagem do risco de desnutrição em pacientes com doença renal crônica (DRC). Métodos: Estudo observacional realizado em dois centros de diálise e no ambulatório de nefrologia. Foram incluídos pacientes com DRC estágios 4 e 5, em tratamento conservador ou em diálise. O MST foi aplicado por profissionais de saúde não nutricionistas. Como padrão de referência, utilizaram-se o Subjective Global Assessment (SGA) e o Malnutrition Clinical Characteristics (MCC), aplicados por nutricionista treinado. Resultados: Foram avaliados 127 pacientes (idade média 66 ± 14 anos). O MST identificou risco de desnutrição em 28% dos participantes, proporção semelhante à encontrada pelo SGA (28%) e pelo MCC (29%). A acurácia do MST foi de 95%, com sensibilidade de 89% em comparação ao SGA e 91% em relação ao MCC. A especificidade foi de 97%, com área sob a curva ROC de 0,94 para ambos os métodos de referência. A confiabilidade foi excelente (kappa = 0,88). Conclusão: O estudo demonstrou que o MST é um instrumento simples, preciso e altamente confiável para triagem do risco de desnutrição em pacientes com DRC estágios 4 e 5, podendo ser utilizado por diferentes profissionais da saúde.

77 Background: Total neoadjuvant therapy (TNT) improves overall survival (OS) while maintaining local recurrence-free survival (LRFS) in locally advanced rectal cancer (LARC). Real-world data are essential to refine patient selection and outcomes. Methods: Multicentre retrospective study of LARC patients treated with TNT in three Brazilian cancer centres. Outcomes: sphincter preservation and survival endpoints. Kaplan–Meier estimated survival; log-rank compared groups; Cox regression identified prognostic factors. Results: A total of 281 patients were analyzed (median age 58 [22–83], follow-up 31 [6–69 months]). Key baseline characteristics: T4 19%, N2 28%, extramural vascular invasion (EMVI) 15%, positive MRF (MRF+) 29%, lower rectum 64%, grade 3 tumors 5%, signet-ring 4%; treatment: IMRT 66%, 3D-CRT 34%, short-course radiotherapy (SCRT) 50%, long-course radiotherapy (LCRT) 50%; neoadjuvant chemotherapy regimens included CAPOX 61%, FOLFOX 35%, FOLFIRINOX 3%, and capecitabine monotherapy 1%. Overall, 212 (76%) underwent surgery and 65 (23%) were managed with watch-and-wait (WW). Pathological complete response (pCR) was achieved in 21%. Sphincter preservation was 78%. Absence of pCR (HR 3.14, 95% CI 1.32–7.47, p=0.009) and MRF+ (HR 2.14, 95% CI 1.21–3.77, p=0.009) predicted worse RFS; WW (HR 0.45, 95% CI 0.21–0.96, p=0.038) and mid- vs. lower-rectal tumors (HR 0.51, 95% CI 0.26–0.99, p=0.046) predicted improved RFS. Absence of pCR (HR 3.67, 95% CI 1.43–9.46, p=0.007) and MRF+ (HR 2.43, 95% CI 1.34–4.41, p=0.004) were associated with worse distant disease-free survival (DDFS). Grade 3 tumors and signet-ring histology were associated with worse LRFS. Three-year RFS, DDFS, LRFS, and OS were 74%, 75%, 93%, and 89%, respectively. No difference in LRFS or OS was observed between SCRT and LCRT (HR for OS 2.0, 95% CI 0.93–4.32, p=0.072). Radiotherapy technique (IMRT vs 3D-CRT) did not affect LRFS. Prognostic factors for worse OS included signet-ring histology, MRF+, EMVI, grade 3 tumors, and distal tumor location. Conclusions: TNT in Brazilian LARC patients achieved outcomes consistent with international series. pCR and MRF were key prognostic factors. No LRFS or OS difference was observed between SCRT and LCRT, supporting the adoption of different TNT strategies in clinical practice.

Recurrent respiratory papillomatosis (RRP) is a benign, HPV 6/11-driven airway disease with frequent recurrences, often requiring multiple surgeries and imposing significant clinical and economic burdens. This narrative review synthesizes evidence from 2010–2025 on epidemiology, pathogenesis, clinical features, and therapies, emphasizing advances like bevacizumab, immune checkpoint inhibitors, and gene therapy (PRGN-2012, announced for FDA approval as Papzimeos™ on August 14, 2025). A structured literature search in PubMed, Scopus, and Web of Science identified 26 studies (clinical trials, cohorts, reviews). Key findings: HPV vaccination reduced juvenile RRP (JoRRP) incidence by &gt;90% in vaccinated populations (e.g., Australia). Bevacizumab prolongs surgery-free intervals (up to 85% response rate systemically), while PRGN-2012 achieved a 51% complete response (no surgery for ≥12 months) with sustained benefits &gt;2 years and mild adverse events, pending confirmation in peer-reviewed publications. INO-3107 reduced mean surgeries from 4.1 to 0.9 over two years, with an 86% overall response rate (ORR) in Year 2. Traditional adjuvants like cidofovir remain relevant in low-resource settings. Multimodal strategies (surgery, anti-angiogenics, immunotherapy) shift toward disease modification. Enhanced vaccination and biomarker research are crucial for global control.

Esophageal perforation is a life-threatening condition associated with high morbidity and mortality, particularly when diagnosis or treatment is delayed. Foreign body ingestion is a known cause of esophageal injury and may result in severe complications requiring surgical intervention. We report the clinical course and therapeutic management of a young adult who developed cervical esophageal perforation after deliberate ingestion of multiple foreign bodies associated with acute cocaine intoxication and self-induced emesis. The patient presented with cervical pain, extensive subcutaneous emphysema, and pneumomediastinum and underwent exploratory cervicotomy with primary esophagorrhaphy. The postoperative course was complicated by hemopneumothorax requiring thoracoscopic drainage and subsequent esophageal fistulization, which was successfully managed conservatively. This case highlights the diagnostic challenges, multidisciplinary decision-making, and potential complications associated with esophageal perforation secondary to deliberate foreign body ingestion in high-risk patients.