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Introduction: The demand for surgery to correct gynecomastia has increased due to the many patients undergoing bariatric treatments. Most patients require extensive removal of excess skin, and fatty tissue, repositioning the nipple-areolar complex, and adjusting the areola volume. This study aims to describe the correction technique for grade III gynecomastia using a horizontal scar without a vertical scar, with repositioning of the nipple-areolar complex. Method: Prospective study of 27 male patients diagnosed with Simon grade III gynecomastia, operated in a private clinic between January 2013 and August 2020, using the horizontal scar technique with transposition of the nipple-areola complex and without a vertical scar. Results: 27 patients underwent surgery over 7.5 years, all ex-obese, previously submitted to weight loss treatment. Age ranged from 17 to 74 years, mean age of 52 years. The weight of the removed parts ranged from 175 to 758 grams, an average of 376 grams. Complications were 1 case of late hematoma (3.7%), 1 case of seroma (3.7%), and 2 cases of hypertrophic scarring (7.4%). Conclusion: Surgical treatment of grade III gynecomastia using the horizontal scar technique, without a vertical scar and with repositioning of the nippleareolar complex, proved to be effective, with low morbidity and good aesthetic results.

INTRODUÇÃO: A cicatrização é processo complexo, com diferentes fases. Embora exista grande variedade de plantas medicinais poucas têm sido investigadas com intenção de melhorar a cicatrização de órgãos e tecidos, dentre elas, a Orbignya phalerata (babaçu). OBJETIVO: Analisar comparativamente as alterações tensiométricas e histológicas na cicatrização de anastomoses colônicas proporcionadas pelo uso do extrato aquoso do mesocarpo do babaçu (Orbignya phalerata). METODOS: Utilizaram-se 40 ratos Wistar, machos, separados em dois grupos de vinte, denominados grupos controle e experimento, Os ratos de cada grupo foram divididos em dois sub-grupos de 10 animais cada e avaliados no terceiro e sétimo dia de pós-operatório. Realizaram-se colotomia e colorrafia em plano único. Os animais do grupo controle receberam no ato operatório dose única de solução salina isotônica em dose e via de administração semelhantes ao grupo experimento e os do grupo experimento receberam extrato aquoso de babaçu em dose de 50 mg/kg/peso, concentração de 25 mg/ml por via intraperitoneal. Foram analisados os seguintes parâmetros: a) avaliação macroscópica da parede e cavidade abdominal; b) avaliação tensiométrica da anastomose (pressão e ruptura); c) características histológicas da anastomose. RESULTADOS: O exame macroscópico evidenciou a presença de aderências em todos os animais, sendo estatisticamente maior no grupo experimento de três dias quando comparados com o grupo controle. Nos animais do grupo de sete dias não houve diferença. Não houve ocorrência de deiscência de anastomose, fístulas, abscessos e/ou hemorragia. Com relação à tensiometria, constatou-se que a média de ruptura dos grupos controle e experimento tanto para os animais do grupo de três dias (25,4 mmHg - 14,8 mmHg) quanto para os de sete dias (183 mmHg - 175 mmHg), foram iguais, não ocorrendo diferença estatisticamente significante. A análise histológica dos animais do grupo de três dias mostrou diferença estatisticamente significante no grupo experimento em relação ao controle na variável mononuclear, enquanto que, no sétimo dia, houve diferença estatisticamente significante favorável ao grupo experimento em todas as variáveis quando comparadas com o de controle. CONCLUSÃO: Ocorreu efeito favorável no uso do extrato aquoso do mesocarpo do babaçu no processo de cicatrização da anastomose colônica, não havendo diferença significante na avaliação tensiométrica entre os grupos controle e experimento.INTRODUCTION: Healing is a highly complex process with different phases. Because some medicinal plants have antiinflamatory properties, they could influence the wound healing process. There are many species of medicinal plants used for research, among them the Orbignya phalerata (Babassu). PURPOSE: To analyze, comparatively, the tensiometric and histologic alterations in the healing process of colon anastomosis with the use of aqueous extract of the babaçu mesocarp. METHODS: Forty Wistar male rats were used, divided in two groups of 20 animals named control and experimental group. Each group was further divided in two sub-groups of 10 animals and evaluated on the third and seventh post-operative days. Colotomy and one suture line coloraphy was performed in all animals. The control group received an intraperitoneal single dose of isotonic saline solution at the time of the surgery. The animals from the experimental group received babassu aqueous extract dose with 50mg/kg/weight, concentration of 25 mg/ml dose, with the same administration method. The following parameters were evaluated: a) macroscopic appearance of abdominal wall and cavity; b) tensiometric evaluation of anastomosis (bursting pressure); c) histologic characteristics of anastomosis. RESULTS: The macroscopic examination showed the presence of adherences in all animals with statistical significance in the ones from the experimental group at third day when compared to the control group. No difference was observed in the seventh-day group. No fistulae, abscesses and/or hemorrhage were observed. In regard to the tensiometric variation, the bursting pressure for the control and experimental groups, both for the third day (25.4 mmHg - 14.8 mmHg) and at seventh (183 mmHg - 175 mmHg), were similar with no significant difference. Histological analysis for the third day showed significant difference in the experimental group in relation to the controls, in regard the presence ofto mononuclear ones whereas at seventh day there was significant statistical difference in all variables from the experimental group compared to the control one. CONCLUSION: A favorable effect with administration of the aqueous extract of the babaçu mesocarp was seen in histological parameters of the healing process of colon anastomosis however there was no difference in the tensiometric evaluation between the control and experimental group.

The authors report two cases of traumatic chylothorax. They were caused by gunshot wounds producing thorax transfixing injuries and lhe chilothorax was subsequently diagnosed during lhe thoracic drainage follow-up, a chilous colar was noticed in lhe drainage output. This was confirmed with a Sudam 111 stain. Both cases were treated conservatively with Total Parenteral Nutrition according to the current literature. One of the cases, in its evolution, required surgical treatment due to a persistent high output fistulae.

In de past 50 years, maternal mortality rates have declined, in contrast, the number of deaths due to injury during pregnancy is on the rise. The authors report a case of 24° week pregnant woman victim of penetrating abdominal trauma by gunshot who sustained a grade I11 transfixing injury of the uterine fundus. Treatment was conservative regarding the fetus. Hysteroraphia of the injuries was executed with closure of both penetrating orifices. Obstetrical-gynecological evaluation and echogram documented letal viability in the post-operative period. Post-operative follow-up was performed with periodical echograms up to delivery on the ninth month. Clinical findings, treatment and follow-up will be discussed.