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The management of tar burns presents a wide range of possible approaches, and several strategies can be used to reduce the damage regarding the removal of tar adhered to the patient's skin. Tar residues should preferably be emulsified with solvent solutions. Due to the low incidence of tar burns, it has not yet been possible to select the appropriate agent for the removal of the adhered tar. In this article, we reported a case of a 47-year-old man with a tar burn in his forehead region and his both upper limbs treated with two different approaches and the outcomes. In the right upper limb, the removal of tar with oil-based on essential fatty acids was attempted at the time of hospital admission, whereas in the left upper limb, he was treated with 1% silver sulfadiazine cream, sterile gauze, and bandage. On the right upper limb, the treatment was eventually performed with debridement and split-thickness skin grafting. On the left upper limb, there was complete re-epithelialization of the burns. The more conservative approach of keeping a dressing with 1% silver sulfadiazine on the tar itself, followed by removing the material in the dressing changes was considered better than the immediate removal of tar with an oily solution, especially about pain. Our impression was that the application of 1% silver sulfadiazine cream at the time of the admission, as well as in the following days, may be beneficial for the removal of the tar in close contact with the skin. Possibly, this approach leads to less trauma to the skin and, eventually, simplifies the treatment of burns by hot tar.

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Introdução: No final de 2019, o mundo viu surgir uma nova síndrome respiratória denominada Covid-19, causada por um novo tipo de coronavírus, o Sars-CoV-2. Classificada como uma pandemia, ela tem causado impactos de magnitude ainda imensuráveis. Relato de caso: Homem de 57 anos desenvolveu ferida inguinal direita, após exploração cirúrgica por infecção de prótese usada em bypass femoro-poplíteo. A equipe de cirurgia plástica optou pelo tratamento com desbridamento cirúrgico, associado com terapia por pressão negativa para preparo do leito da ferida. No pós-operatório, apresentou síndrome respiratória aguda grave e suspeita de Covid-19, com necessidade de intubação e de cuidados intensivos. Foi colhido amostra para RT-PCR do Sars-CoV-2 e associado ao tratamento as medicações cloroquina e azitromicina. Apesar do tratamento intensivo, o paciente foi a óbito. O resultado do exame RT-PCR para o novo coronavírus foi positivo, sendo liberado dois dias após a morte. Discussão: A análise deste relato permite supor que o paciente provavelmente contraiu o novo coronavírus dentro do próprio hospital, pois o mesmo encontrava-se internado pelo período dos 35 dias anteriores à evolução para insuficiência respiratória. Esse fato, juntamente com sua evolução desfavorável, corrobora a orientação de minimizar ao máximo as internações e os procedimentos cirúrgicos a fim de promover maior segurança ao paciente e à equipe de saúde. Conclusão: Pacientes internados estão susceptíveis à infecção pelo novo coronavírus e podem configurar grupo de maior de risco, uma vez que muitos deles já se encontram debilitados.

Introduction: At the end of 2019, the world saw the emergence of a new respiratory syndrome called Covid-19, caused by a new type of coronavirus, Sars-CoV-2. Classified as a pandemic, it has caused impacts of considerable magnitude. Case Report: A 57-year-old man developed a right inguinal wound after surgical exploration for infection of a prosthesis used in a femur-popliteal bypass. The Plastic Surgery team opted for treatment with surgical debridement associated with negative pressure therapy to prepare the wound bed. In the postoperative period, he had severe acute respiratory syndrome and suspected Covid-19, requiring intubation and intensive care. A sample for RT-PCR of Sars-CoV-2 was collected, and the medications chloroquine and azithromycin were associated with the treatment. Despite intensive treatment, the patient died. The result of the RT-PCR test for the new coronavirus was positive, being released two days after death. Discussion: The analysis of this report allows us to suppose that the patient probably contracted the new coronavirus at the hospital, as he was hospitalized for 35 days before the evolution of respiratory failure. This fact, together with its unfavorable evolution, corroborates the orientation of minimizing hospitalizations and surgical procedures as much as possible to promote more safety for the patient and the health team. Conclusion: Inpatients are susceptible to infection with the new coronavirus and can set up a group at higher risk since many of them are already weakened.

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BACKGROUND AND OBJECTIVES: Achondroplasia is the most common form among the different types of osteochondrodysplasia that cause dwarfism. Dwarves develop obesity quite frequently and surgical treatment has shown greater efficacy, both for effective weight loss and long term maintenance. The objective of this report was to present the case of bariatric surgery with Y-en-Roux gastric bypass in an achondroplastic dwarf with morbid obesity. The different difficulties in the anesthetic management of this patient and the way they were dealt with were discussed in order to decrease intraoperative morbidity and mortality. CASE REPORT: This is a 29 years old female dwarf with achondroplasia and morbid obesity since childhood. She was 123 cm tall and weighed 144 kg at the time of admission to the Bariatric Surgery service. With a body mass index (BMI) of 95.18 kg.m2, she had several associated diseases especially of the respiratory system and osteoarticular system. After a long follow-up with diet, exercises, and psychological support, her clinical condition improved and she was referred for surgery: Y-en-Roux gastroplasty using the technique of Capella-Fobi. Intubation of the awake patient under direct laryngoscopy was difficult and a bronchofibroscope had to be used. Surgery was uneventful and the patient was maintained under total intravenous anesthesia with continuous infusion of remifentanil and propofol. She was extubated at the end of the surgery still in the operating room. CONCLUSIONS: The simultaneous comorbidities of achondroplasia and morbid obesity can hinder the anesthetic management, especially regarding the airways. A thorough pre-anesthetic evaluation is necessary to anticipate the conducts and minimize risks, therefore optimizing the evolution of anesthesia.

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A young woman with achondroplasia and morbid obesity (two disabling conditions) is presented. She underwent open Roux-en-Y gastric bypass (RYGBP). We emphasize preoperative preparation by a multidisciplinary team and the use of the 6-minute walk test to follow and assess mobility and quality of life.

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BACKGROUND: The authors evaluated the history of treatment in a population of patients awaiting gastric bypass surgery. METHODS: A standard questionnaire was used to evaluate the history of different therapeutic methods for weight loss in 312 patients between 13 and 70 years of age: 247 (79.2%) women and 66 (20.8%) men. RESULTS: BMI varied between 33.0 to 100.0 kg/m2. The most common therapeutic method for losing weight was the use of formulae containing amphetamines, n=270 (86.5%). Only a tendency could be found towards a difference between women and men regarding amphetamine utilization respectively: 218 (88.3%) vs 52 (80.0%); P=0.066. Patients used formulae for the first time at an average age of 22.5+/-8.0 years old (from 8 to 57 years old). 43.7% (n=118) of the patients who used amphetamines have never received any information about the drug, and 80.6% (n=216) regret using this option. Dry mouth was the most common side-effect reported, n=205 (81%). Women had more frequent reports of depression and tremors than men, 58.6% vs 40.0% (P=0.017) and 44% vs 25% (P=0.011) respectively. CONCLUSIONS: Amphetamines were used on a large scale in this population and a high level of side-effects were observed. Women used them more frequently than men, and noted a higher level of side-effects.

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