Angiographic characteristics of the intermesenteric artery.

PURPOSE: The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) in 9-18% of human cadaver dissections. This is the first study describing the morphological and demographic characteristics of the IA based on in vivo imaging. METHODS: A total of 150 consecutive abdominal computed tomography (CT) angiographies of adult patients identified by sex and age were analyzed. The IA was assessed for its presence, point of origin, pathway, point of insertion, and diameter at its origin. The diameters of the SMA, IMA, and other arteries from which the IA originated and into which it inserted were measured by CT angiography using Radiant™ and Osirix MD™ software. RESULTS: The IA was found in 17 (51.5%) of the females and 60 (51.3%) of the males. The diameters of the SMA and IMA were larger in the males than in the females, but there was no sex difference in the diameter of the IA. The diameter of the SMA was larger than that of the IMA, and the diameter of the IA was smaller than that of the other arteries evaluated. An IA connecting the SMA and IMA trunks was found in 25.9% of the cases, while other connections between the branches of those trunks through an IA occurred less frequently. CONCLUSIONS: The intermesenteric artery is more frequently found than the literature refers and in most of cases directly connects the upper and lower arterial mesenteric circulations.

The left gastro-omental vessels are able to maintain the entire spleen blood supply.

The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.

O baço é suprido pelo fluxo sanguíneo da artéria e veia esplênicas. O objetivo desta comunicação é apresentar um baço ectópico suprido apenas pelo fluxo sanguíneo reverso proveniente dos vasos gastromentais esquerdos. Um paciente de 14 anos apresentou esplenomegalia pélvica suprida apenas por artéria e veia gastromentais esquerdas, conectadas aos vasos polares inferiores, que eram os únicos presentes nesse baço. Após a distorção do baço e a esplenopexia, o baço voltou às dimensões normais. Não houve intercorrências no acompanhamento do paciente. Em conclusão, os vasos gastromentais esquerdos são capazes de suprir o fluxo sanguíneo de todo o baço.

Omega Hepatojejunostomy and Hepatic Haemostasis Using the Electrocautery Greased with Lidocaine Gel.

Background: When the entire hepatic pedicle is invaded by a tumour, the treatment of cholestasis represents a challenge both for choosing the best drainage possibility and for performing the liver haemostasis during a surgical procedure. Case Report: A patient with progressive jaundice resulting from a remaining gastric tumour that invaded the gallbladder and the hepatic pedicle was successfully treated with biliary decompression using the omega hepaticojejunal shunt. The minor parenchymal bleeding was achieved with the electrocautery greased with lidocaine gel. When burned by the electrocautery, the lidocaine gel made a sealing crust that recovered all the liver parenchyma. Efficacious and stable haemostasis was immediately achieved. The patient had an uneventful early postoperative follow-up, and all cholestasis manifestations, including jaundice and pruritus, decreased since the first day. The patient survived nine months with asymptomatic low jaundice. Conclusion: In the presence of general involvement of the bile ducts, the omega hepaticojejunal shunt reduces the manifestations of cholestasis and improves the patient's quality of life. The electrocautery greased with lidocaine gel is inexpensive, easily available and efficacious method to achieve immediate hepatic haemostasis.

Single Supraclavicular Transverse Incision for Radical Neck Dissections.

BACKGROUND AIMS: To describe unilateral and bilateral modified radical neck dissections with access to the thyroid gland and all neck lymph node levels through a single supraclavicular transverse incision. Methods: Ten patients with thyroid or lip carcinomas were submitted to unilateral or bilateral neck dissection through a transverse supraclavicular neck incision. All anterior and lateral neck lymph nodes associated with surrounding fibrofatty tissue were dissected and removed, preserving both sternocleidomastoid muscles and internal jugular veins. Patients with thyroid carcinoma were also submitted to a total thyroidectomy during the same procedure. Results: This surgery was feasible in all patients, preserving oncological principles with no adverse event. Conclusions: A single supraclavicular transverse incision allows adequate access to all levels of the neck lymph nodes, minimises the risk of tissue breakdown and scar disorder, with good cosmetic results. This incision is indicated for radical lymphadenectomy and may be combined with other neck surgeries.

Early use of CO2 lasers and silicone gel on surgical scars: Prospective study.

INTRODUCTION: Some publications have shown good aesthetic results for scars through the early application of fractional CO2 lasers on elective surgery scars. The aim of this randomized, double-blinded clinical trial was to compare the aesthetic quality of the scar from a group of patients submitted to super-pulsed fractional CO2 laser applications (10,600 nm fractional CO2 , set at a density of 20% and an energy of 10 mJ, a scanner of 03 × 03 mm, and a pulse repetition time of 0.3 seconds) in contrast with the other group that used only the silicone gel on the scar after plastic surgery. METHOD: A prospective study was conducted by analyzing 42 patients with recent scars of up to three weeks in patients with a I-IV Fitz-Patrick skin phototype. The scars were evaluated aesthetically in the second and sixth months by applying the Vancouver scale. RESULTS: At 2 months of treatment, the statistical data showed a discrete superiority in the LASER group's treatment, as compared to that of the SILICONE group, in both percentage and significance concerning flexibility (P = 0.05) and pigmentation (P = 0.01). Laser group presented better results in the sixth month (P = 0,03). CONCLUSION: The early use of the fractional CO2 laser contributed to improving the aesthetic quality of scars from elective surgeries in the second and in the 6th months. Lasers Surg. Med. 49:570-576, 2017. © 2017 Wiley Periodicals, Inc.

Spleen function after preservation in a physiological solution.

BACKGROUND: The purpose of this study was to evaluate the morphology and function of implanted autogenous spleen tissue after 24 h of preservation in a physiological solution. MATERIAL AND METHODS: Thirty-five male rats were divided into seven groups (n = 5): group 1, without surgical procedure; group 2, total splenectomy; group 3, total splenectomy and immediate implant of autogenous spleen tissue; group 4, total splenectomy and preservation of the entire spleen in lactated Ringer solution at room temperature for 24 h, followed by spleen sectioning and implantation; group 5, total splenectomy, followed by spleen sectioning and preservation in lactated Ringer solution at room temperature for 24 h and subsequent implantation of the slices; group 6, total splenectomy and preservation of the entire spleen in lactated Ringer solution at 4°C for 24 h, followed by spleen sectioning and implantation; and group 7, total splenectomy, the spleen was sliced and preserved in lactate Ringer solution at 4°C for 24 h, followed by implantation of the slices. After 90 d, scintigraphic studies using sulfur colloid labeled with 99mTc of the liver, lungs, spleen, implants, and a blood clot were performed. Hematological (erythrogram, leukogram, and platelets) and histologic studies were carried out. RESULTS: The autogenous splenic implants regenerated in all animals that received those implants preserved at 4°C and immediately after excision. The scintigraphic study showed a better phagocytic function in groups 1, 3, 6, and 7. No difference was observed in the hematological study. CONCLUSIONS: Spleen tissue preserved in lactated Ringer solution at 4°C for 24 h maintains its vitality and capacity to recover hematological and phagocytic functions.

Prevention of abdominal adhesions and healing skin after peritoniectomy using low level laser.

BACKGROUND: Adhesions commonly occur after abdominal surgery and can cause bowel obstruction, chronic abdominal pain, and infertility. Their prevention remains a challenge. OBJECTIVES: To evaluate the effects of the application of low-level lasers on the prevention of adhesions and scarring of the skin after peritoniectomia. METHOD: Twenty-four New Zealand breed male rabbits, approximately 2 months of age, were randomly divided into 3 groups (n = 8): GC-control group not subjected to laser, GL1-group with laser application at a dose of 0.2 J, and GL2-group with laser application at a dose of 3.6 J. All animals received a longitudinal midline incision and a bilateral resection of the peritoneal fragment, measuring 3 × 1 cm(2) . The animals received a laser treatment of one application every 24 hours, beginning at the time of surgery and lasting for a period of 4 days. After 14 days post-surgery, the animals were killed and adhesion formation was evaluated qualitatively and quantitatively by means of a laparotomy shaped inverted "U", which allowed for the verification of the broad wall of the abdominal cavity and organs. Differences were considered significant at P < 0.05. RESULTS: The adhesion formation was observed in 100% of the rabbits from groups GC and GL1, as compared to 37.5% of the rabbits from group GL2 (P < 0.01). The evaluation of the vascularization and tenacity of adhesions among the groups showed no significant difference. In groups CG and GL1, 72% and 83% of adhesions were verified between visceras, respectively whereas in GL2 occurred among abdominal wall. The tensile strength of the skin between the groups was not significant (P = 0.3106). The resistance of abdominal wall segments without skin he resistance of skin segments between groups GL2 and GC were higher than in GL1 (P = 0.01). CONCLUSION: Low-level LASER is effective in preventing intra-abdominal adhesions in rabbits without compromising strength and healing of the abdominal wall.

Elastic rubber strips to heal large wounds of the body wall.

BACKGROUND/PURPOSE: Closure of large wounds is a difficult surgical challenge. This article reports on the effective closure of large surgical wounds using elastic rubber strips. METHODS: One to 3 circular elastic rubber strips were sutured by applying moderate tension to the opposite edges of 30 large wounds in 28 patients. The strips were sutured in a successive "X" fashion by crossing one over the other. These rubber strips were replaced when they ruptured or after their tension had reduced because of the closure of the wounds. RESULTS: Complete closure of the wounds was achieved with no further need for any surgical procedure or device. One patient with laparostomy and colostomy presented with difficulty on adapting the colostomic bag, and the rubber strips were removed. The rubber strip had little effect on a large wound of the skull. In the late postoperative follow-up, 3 of the 15 closed laparostomies developed incisional hernias, and all these patients were subjected to hernioplasties with good results. CONCLUSION: The use of circular elastic rubber strips maintained at moderate tension is a simple, effective, and inexpensive surgical option for healing large wounds. It is readily available at any hospital and requires no extensive surgical experience.

Megavoltage radiotherapy effects on organs of the reticuloendothelial system.

PURPOSE: To study the uptake capacity of cells from the reticuloendothelial system after irradiation with high-energy X-rays. METHODS: Eighteen male Wistar rats were distributed in three groups: group A (n = 6): control, unirradiated animals studied alongside animals from group B; group B (n = 6) and group C (n = 6): animals irradiated and studied after 24 and 48 hours, respectively. The rats were anesthetized and placed on a 10 MV linear accelerator. Next, they were irradiated in the abdominal region, with 8 Gy. Twenty-four (groups A and B) and 48 hours later (group C), a colloidal carbon solution (1 mL/kg) was intravenously injected in the tail vein. Fifty minutes later, the spleens and livers were withdrawn and prepared to be studied. Kupffer cells and splenic macrophages containing carbon pigments were counted in an optical microscope. Arithmetic means were calculated for each group and compared among them. RESULTS: X-rays were associated with a reduced number of Kupffer cells containing colloidal carbon, proliferation and enlargement of biliary ducts, hypoplasia, and hepatocyte necrosis. In the irradiated spleen, the colloidal carbon uptake was concentrated in the marginal zone around the white pulp, with an inexpressive uptake of pigments by macrophages from white and red pulps. CONCLUSIONS: The X-rays in the rat abdomen are associated with a reduction in the Kupffer cells uptake of colloidal carbon, hepatocyte disorders, bile duct proliferation, and splenic uptake of colloidal carbon concentrated in the marginal zone.

Effects of face mask on pulse rate and blood oxygenation.

OBJECTIVE: The World Health Organization and Centers for Disease Control and Prevention recommend the use of face masks in public. This study aimed to evaluate the effects of face masks on pulse rate and partial blood oxygen saturation in patients without cardiorespiratory disorders. METHODS: A total of 150 volunteers of both sexes were divided into three groups (n=50) according to age (children, young adults, and older adults). The partial blood oxygen saturation and pulse rate were measured for each volunteer using a digital oximeter while wearing a facial mask and remaining at rest. The masks were removed for two minutes, and partial blood oxygen saturation and pulse rate were remeasured. The materials and types of masks used were recorded. The t -test for paired samples was used to compare the mean values obtained before and after removing the masks. RESULTS: The most frequently used mask was a two-layered cloth (64.7%). A decrease in pulse rate was observed after removing the face mask in males, particularly in children (p=0.006) and young adults (p=0.034). Partial blood oxygen saturation levels increased in young adult males after mask removal (p=0.01). CONCLUSION: The two-layer cotton tissue face masks are associated with a higher pulse rate and reduced arterial blood oxygen saturation without associated clinical disorders, mainly in adult men with a lower tolerance to breathing and ear discomfort.

Hepatic artery disorders associated with alcoholism.

OBJECTIVE: We aimed to characterize the relationship between severe chronic alcoholism and hepatic arterial wall disorders in humans. METHODS: We obtained hepatic arteries from 165 patients undergoing liver transplantation who were placed into two etiological groups: an Alcoholism group and a Non-alcoholism group. We compared the age, sex, lipid profile, and histologic characteristics of the hepatic arteries (normal, reduction in luminal diameter of ≤10%, or atherosclerosis) of the participants in the two groups using multifactor analyses. RESULTS: The Alcoholism group comprised 58 men and 40 women and the Non-alcoholism group comprised 63 men and 4 women. The mean ages of the groups were 52.5 ± 9.6 years and 44.2 ± 13.8 years, respectively. There were no circulating lipid abnormalities in any of the participants. In women, arterial disorders were found at a younger age than in men. Hepatic arterial disorders were more frequent in the non-alcoholic participants, and women with alcoholism showed less arterial narrowing. CONCLUSION: The heavy consumption of alcoholic beverages is associated with a lower incidence of atherosclerosis of the hepatic artery in humans.

Validation of low anterior resection syndrome score in Brazil with Portuguese.

PURPOSE: This study was performed to investigate the convergent validity, discriminative validity, and reliability of the Brazilian version of the low anterior resection syndrome (LARS) score in a population with low educational and socioeconomic levels. METHODS: The LARS score was translated into the Portuguese language by forward- and back-translation procedures. In total, 127 patients from a public hospital in Brazil completed the questionnaires. The convergent validity was tested by comparing the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module 30 (QLQ-C30) and with patients' self-reported quality of life. For the discriminative validity, we tested the ability of the score to differentiate among subgroups of patients regarding neoadjuvant radiotherapy, type of surgery, and tumor distance from the anal verge. The test-retest reliability was investigated in a subgroup of 36 patients who responded to the survey twice in 2 weeks. RESULTS: The LARS score demonstrated a strong correlation with 5 of 6 items from the EORTC QLQ-C30 (P<0.05) and good concordance with patients' self-reported quality of life (95.3%), confirming the convergent validity. The score was able to discriminate between subgroups of patients with different clinical characteristics related to LARS (P<0.001). The agreement between the test and retest showed that 86.1% of the patients remained in the same LARS category, and there was no significant difference between the LARS score numerical values (P=0.80), indicating good reliability overall. CONCLUSION: The Brazilian version of the LARS score is a valid and reliable instrument to assess postoperative bowel function in a population with low educational and socioeconomic levels.

The impact of colonoscopy for colorectal cancer screening.

BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death. Prevention of this neoplasm should be achievable by screening programs in asymptomatic patients. The objective of the present paper is to assess colonoscopic findings in asymptomatic people submitted to screening. METHODS: A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases, and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel cleansing, polyps, angioectasias, diverticular disease, inflammation, and neoplasm were also verified. Polyps were classified according to their size, number, and location. RESULTS: Colonoscopic alterations were detected in 99 individuals: polyps in 64.3 %, diverticular disease in 27.9 %, inflammatory mucosal alterations in 9.7 %, melanosis coli in 2.6 %, and angioectasias in 7.8 %. There was an increasing incidence of polyps in individuals older than 50 years. Multivariate logistic regression showed age and sex as predictive factors for polyps [odds ratio (OR) = 1.43; 1.19 < OR < 2.67]. CONCLUSIONS: The results of this investigation revealed a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.

Dwarfism associated with wandering splenomegaly.

Dwarfism associated with splenomegaly during teenage years is known. The purpose of this report was to present the first case of dwarfism associated with wandering splenomegaly. A 14-year-old boy presented a wandering splenomegaly and torsion of the splenic pedicle associated with a retarded growth and sexual underdevelopment characterized by lack of sexual maturity and absence of secondary sexual physical appearance. The patient was submitted to detorsion of the spleen, and splenopexy. After the surgery, the patient grew up, and his sexual characteristics developed to normal. The size of the spleen reduced from the 22 × 16 × 13 cm to 14 × 12 × 10 cm after the surgical procedure. This is the first report of dwarfism associated with wandering splenomegaly, which was successfully treated without partial or total splenectomy. After releasing the venous blood flow, the spleen reduced its dimension and the patient grew up to the expected family size.

ANATOMICAL VARIATIONS OF PORTAL VENOUS SYSTEM: IMPORTANCE IN SURGICAL CLINIC.

AIM: Knowledge of the portal system and its anatomical variations aids to prevent surgical adverse events. The portal vein is usually made by the confluence of the superior mesenteric and splenic veins, together with their main tributaries, the inferior mesenteric, left gastric, and pancreaticoduodenal veins; however, anatomical variations are frequent. This article presents a literature review regarding previously described anatomical variations of the portal venous system and their frequency. METHODS: A systematic review of primary studies was performed in the databases PubMed, SciELO, BIREME, LILACS, Embase, ScienceDirect, and Scopus. Databases were searched for the following key terms: Anatomy, Portal vein, Mesenteric vein, Formation, Variation, Variant anatomic, Splenomesenteric vein, Splenic vein tributaries, and Confluence. RESULTS: We identified 12 variants of the portal venous bed, representing different unions of the splenic vein, superior mesenteric vein, and inferior mesenteric vein. Thomson classification of the end of 19th century refers to the three most frequent variants, with type I as predominant (M=47%), followed by type III (M=27.8%) and type II (M=18.6%). CONCLUSION: Thomson classification of variants is the most well-known, accounting for over 90% of portal venous variant found in clinical practice, inasmuch as the sum of the three junctions are found in over 93% of the patients. Even though rarer and accounting for less than 7% of variants, the other nine reported variations will occasionally be found during many abdominal operations.

Splenic, hepatic, renal and pulmonary clearance dysfunction associated with high-energy X-rays.

PURPOSE: To verify the high-energy X-rays effects on the blood clearance of colloidal particles by the spleen, liver, kidneys, and lungs. MATERIALS AND METHODS: Seventeen male Wistar rats were distributed into three groups. Group 1 (n = 5) - control - non-irradiated animals, group 2 (n = 6) - irradiated animals studied 24 h after irradiation, and group 3 (n = 6) - irradiated animals studied 48 h after irradiation. The animals were anesthetized and irradiated with a non-fractionated 8 Gy dose in the abdominal region divided into two parallel and opposite fields, 4 Gy was given to the anteroposterior and 4 Gy to the posteroanterior. This high dose of high-energy X-rays causes extensive cell killing, tissue disorganization and break down cell to cell communication. According to the groups, 50 µCi of technetium-phytate were injected into the right internal jugular vein. After 30 minutes, the liver, spleen, kidneys, and lungs were removed. The clot was harvested from the abdominal cavity two minutes after the sectioning of the abdominal aorta and cava vein. The organs and clot were placed into plastic flasks to be weighed and studied for the emission of radioactivity in a gamma radiation detector. The uptake function of each organ was calculated based on the count of gamma rays emitted per minute and normalized with the organ mass, having as a reference the radioactivity count of a standard sample. The arithmetic mean of each organ uptake was calculated and compared among the groups. RESULTS: After irradiation, the spleen uptake of colloidal radiopharmaceutical was greater, while the hepatic, renal, and pulmonary uptake were lower. The renal uptake decreased slower than the hepatic and pulmonary uptake. CONCLUSIONS: A single high dose of high-energy X-rays enhances the splenic clearance function, while it reduces the hepatic, renal, and pulmonary clearance until 48 h after irradiation, with a rapid deterioration of the hepatic and pulmonary uptake function.

Hemostasis of the liver, spleen, and bone achieved by electrocautery greased with lidocaine gel.

Despite advances in surgical techniques, achieving hemostasis of the liver, spleen, and bone during major surgery, especially after trauma, is still difficult. I describe a new procedure my colleagues and I devised to achieve parenchymatous hemostasis using electrocautery greased with lidocaine gel. After achieving good results in experimental studies and obtaining approval from our ethics committee, we used electrocautery greased with lidocaine gel for hemostasis in the following 36 procedures: multisegmental hepatectomy to remove hepatic tumors (n = 6); partial hepatectomy to allow hepatojejunostomy for intrahepatic biliary obstruction (n = 10); laparoscopic liver biopsy (n = 4); subtotal splenectomy (n = 8; for portal hypertension in 5 patients, splenic ischemia in 2, and Gaucher's disease in 1); laparoscopic splenic biopsy (n = 1); and bone resection (n = 7; as pelvic-femoral resection in 6 patients and to remove a rectal tumor invading the coccyx in 1). This procedure was easy to perform and achieved complete hemostasis of the minor blood vessels in all patients. No postoperative bleeding occurred and the follow-up course was satisfactory. Electrocautery greased with lidocaine gel is an inexpensive, readily available, and efficient method to achieve hemostasis of minor vessels in hepatic, splenic, and bone operations.

Splenectomy is associated with sexual dysfunctions and decreased libido.

The removal of the spleen due to disease or trauma may be followed by disorders due to the asplenism, including immunodeficiency, hematological and metabolic diseases, mainly dyslipidemia, which can lead to sepsis, pulmonary embolism and early death. Although patients frequently report sexual disinterest after splenectomy, this feature has been experimentally studied only in a translational investigation performed by the same group of this work. To study libido and other sexual functions after the complete removal of the spleen in humans. This study was performed on 60 healthy adults, 30 men and 30 women, after more than 1 year of total splenectomy to treat isolated splenic trauma. The International Index of Erectile Function was applied to men and the Female Sexual Function Index to women. The analysis compared the responses obtained in the periods before and after the splenectomy. Laboratory tests with hematological and biochemical analyses, including sex hormones, were performed in all patients. The pre- and postoperative results were compared in each group using the paired t-test, with each patient being his or her own control and with significance to p < 0.05. A decrease in libido and an increase in sexual dysfunction was observed after splenectomy in all men and women, p < 0.001. All postoperative laboratory tests showed normal values in both genders. Asplenia is associated with a marked decrease in libido and intense sexual dysfunction in both men and women, with normal hematological and biochemical laboratory tests, including hormonal exams.

Wandering splenomegaly reduction after splenopexy.

INTRODUCTION AND IMPORTANCE: A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy. CASE PRESENTATION: A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure. CLINICAL DISCUSSION: The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle. CONCLUSION: Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.

A New Classification of the Lateral Dermatochalasis of Upper Eyelids.

Eyelid dermatochalasis is an abnormal distention of the upper eyelid. This article presents a new classification of the lateral dermatochalasis (LDC) of the upper eyelids, which compares the pre- and post-blepharoplasty results and matches its results with those of the well-established Jacobs classification (JEC). METHODS: LDC classification includes four degrees: grade zero-absence of dermatochalasis; grade 1-lower edge of dermatochalasis above the intersection of the lacrimal caruncle with the edge of the upper eyelid; grade 2-between the intersection of the lacrimal caruncle with the edge of the upper eyelid and the lower edge of the iris at the pupillary midpoint; and grade 3-lower edge of dermatochalasis below the lower edge of the iris. This study was conducted in 100 dermatochalasis cases in patients between 38 and 79 years of age (mean = 59.3) and submitted to upper blepharoplasty. RESULTS: No statistically significant association was found between the LDC and JEC methods (P = 0.583). In both classifications, the eyelid dermatochalasis was reduced after blepharoplasty (P < 0.001). However, changes in the degrees of dermatochalasis before blepharoplasty were detected in 100% by LDC, and 41% by JEC. The degree of improvement of dermatochalasis observed by LDC after blepharoplasty showed greater specificity. CONCLUSIONS: This new classification, LDC, is specific for the lateral eyelid dermatochalasis, which is based on exact anatomical points, and is easy to perform. LDC is superior to JEC, easy to be applied, and effective and specific in detecting variations in dermatochalasis after blepharoplasty.