Alternativas de reconstrucción mamaria inmediata

La mastectomía total por cáncer de mama produce una deformidad importante en las pacientes, con alteraciones severas de su autoestima, imagen corporal, sexualidad, y calidad de vida en general. El gold estándar en los países desarrollados es la reconstrucción mamaria inmediata y, actualmente existen pocas contraindicaciones absolutas para realizar alguna técnica de reconstrucción. Este artículo se describen las opciones reconstructivas (colgajos e implantes), tiempos de reconstrucción, ventajas y desventajas de ambas técnicas, potenciales complicaciones, y se propone un algoritmo de tratamiento. La elección de la técnica de reconstrucción debería ser decidida entre la paciente y su cirujano/a, considerando características físicas, factores relacionados con la enfermedad y tratamiento oncológico, y preferencias de las pacientes.

Total mastectomy for breast cancer treatment can be a cause of deformity and distress for patients, with severe impairment of self-esteem, body image, sexuality, and quality of life. In developing countries, immediate breast reconstruction is the gold standard, and there are only a few absolut contraindications for some technique of breast reconstruction. This article describes reconstructive options (flaps and allo-plastic material), reconstructive timing, pros and cons of both techniques, potential complications, and an algorithm of treatment is proposed. Choice of the reconstructive technique should be decided by the patient and her surgeon, considering physical characteristics, factors related with the disease and oncologic treatments, and patients' preferences.

FACE-Q craniofacial module: Part 2 Psychometric properties of newly developed scales for children and young adults with facial conditions.

BACKGROUND: The FACE-Q Craniofacial Module is a patient-reported outcome measure designed for patients aged 8 to 29 years with conditions associated with a facial difference. In part 1, we describe the psychometric findings for the original CLEFT-Q scales tested in patients with cleft and noncleft facial conditions. The aim of this study was to examine psychometric performance of new FACE-Q Craniofacial Module scales. METHODS: Data were collected between December 2016 and December 2019 from patients aged 8 to 29 years with conditions associated with a visible or functional facial difference. Rasch measurement theory (RMT) analysis was used to examine psychometric properties of each scale. Scores were transformed from 0 (worst) to 100 (best) for tests of construct validity. RESULTS: 1495 participants were recruited with a broad range of conditions (e.g., birthmarks, facial paralysis, craniosynostosis, craniofacial microsomia, etc.) RMT analysis resulted in the refinement of 7 appearance scales (Birthmark, Cheeks, Chin, Eyes, Forehead, Head Shape, Smile), two function scales (Breathing, Facial), and an Appearance Distress scale. Person separation index and Cronbach alpha values met criteria. Three checklists were also formed (Eye Function, and Eye and Face Adverse Effects). Significantly lower scores on eight of nine scales were reported by participants whose appearance or functional difference was rated as a major rather than minor or no difference. Higher appearance distress correlated with lower appearance scale scores. CONCLUSION: The FACE-Q Craniofacial Module scales can be used to collect and compare patient reported outcomes data in children and young adults with a facial condition.

Mucocele de glándulas de Blandin Nuhn. Caso inusual y revisión de la literatura / Mucocele da glândula Blandin Nuhn. Caso incomum e revisão da literatura / Mucocele of Blandin Nuhn glands. Unusual case and review of the literature

El mucocele asociado a las glándulas de Blandin Nuhn es un fenómeno de extravasación mucosa que ocurre en las glándulas salivales localizadas en la superficie ventral anterior de la lengua, son de tipo mixto, no encapsuladas, que forman parte del complejo de glándulas salivales menores de cavidad bucal. Objetivo: Se presenta el caso clínico de un paciente masculino que cursa la segunda década de vida con características clínicas peculiares de un mucocele de Blandin Nuhn. Caso clínico: Adolescente masculino de 14 años de edad presenta aumento de volumen localizado en superficie ventral de lengua, forma cilíndrica, de 3 meses de evolución y asintomático. Se realiza biopsia excisional para estudio histopatológico, el cual reporta fenómeno de extravasación mucosa y se establece la correlación clínico histopatológica. Conclusiones: Se debe fundamentar un diagnóstico correcto para proporcionar un tratamiento oportuno y evitar complicaciones en el paciente que afecten su calidad de vida.

Mucoceles of the glands of BlandinNuhn consist in a mucus extravasation phenomenon that occurs in the salivary glands located in the anterior ventral surface of the tongue. They are mixed, not encapsulated, and part of the complex of minor salivary glands of the oral cavity. Objective: This paper presents the clinical case of a male patient in his second decade of life with peculiar clinical characteristics of a mucocele of the glands of Blandin-Nuhn. Clinical case: A 14-year-old male adolescent has an increase in volume located on the ventral surface of the tongue, of cylindrical shape, with three months of evolution and is asymptomatic. An excisional biopsy is performed for histopathological study, which reports mucosal extravasation phenomenon and a histopathological clinical correlation is established. Conclusions: A correct diagnosis should have a solid foundation in order to provide timely treatment and avoid complications for the patient that may affect quality of life

A mucocele associada às glândulas de Blandin Nuhn é um fenômeno de extravasamento de mucosa que ocorre nas glândulas salivares localizadas na superfície ventral anterior da língua, do tipo misto, não encapsuladas, que fazem parte do complexo de glândulas salivares menores da cavidade oral. Objetivo: É apresentado o caso clínico de um paciente do sexo masculino na segunda década de vida com características clínicas peculiares de uma mucocele de Blandin Nuhn. Caso clínico: Adolescente de 14 anos apresenta aumento de volume localizado na superfície ventral da língua, formato cilíndrico, evolução de 3 meses e assintomático. A biópsia excisional é realizada para estudo histopatológico, que relata o fenômeno do extravasamento da mucosa e a correlação clínica histopatológica é estabelecida. Conclusões: Um diagnóstico correto deve ser baseado para fornecer tratamento oportuno e evitar complicações no paciente que afetem sua qualidade de vida

Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort.

BACKGROUND: Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. OBJECTIVES: The authors evaluated the effect of BCS on QoL and the durability of this effect over time. METHODS: QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. RESULTS: Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. CONCLUSIONS: QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts.

Cuerpo extraño en uretra. Reporte de caso / Foreign body in the urethra. Report of a case

El hallazgo de cuerpo extraño uretral es una de las patologías menos comunes reportadas en la bibliografía médica y, por tanto, es de gran sorpresa para el especialista de urología. Debido a que no hay suficiente documentación, este tema despierta gran interés para el manejo futuro y en la instrucción a médicos de esta especialidad. Comúnmente, en estos casos hay un componente psicológico/psiquiátrico, sexual, autoerotismo o de abuso de sustancias psicotrópicas. De acuerdo a las características del cuerpo extraño, su localización y tipo de paciente, el tratamiento variará y su resultado final dependerá de estos factores. Presentamos el caso de un paciente varón de 52 años que acude a Emergencia con sintomatología respiratoria y dificultad urinaria de varios días de evolución, con antecedente de uso de drogas como base de cocaína y marihuana durante largo tiempo, además de prácticas sexuales grupales; se logra evidenciar de manera incidental un cuerpo extraño en la uretra. (AU)

The finding of foreign urethral body is one of the less common pathologies reported in medical literature, and therefore of great surprise to the Urology Specialist. In the absence of sufficient literature on the subject, this is an issue that arouses great interest for the future management and training doctors in this specialty. Typically, such cases have basic psychological / mental, sexual, and/or substance abuse component. According to the characteristics of the foreign body, its location and type of patient, treatment will vary and the outcome will depend on these factors; it is why a multidisciplinary assessment should be performed. We report the case of a 52-year-old male patient who came to Emergency Department with respiratory symptoms and urinary difficulty of several days duration, as background there was a history of long-term drug abuse as cocaine base and marihuana, also group sex activities; incidentally a foreign body in urethra was found. (AU)

Resultados a largo plazo en calidad de vida en cirugía de contorno corporal: Fase IV en la cohorte Body-Qol® / Long-term outcomes in quality of life after body contouring surgery: Phase IV results in the Body-Qol® cohort

Introducción: La calidad de vida es uno de los resultados en cirugía de contorno corporal más importantes. La evidencia sobre la calidad de vida de estos pacientes a largo plazo es escasa. El objetivo de este estudio fue determinar si la calidad de vida obtenida en el postoperatorio temprano posterior a la cirugía de contorno corporal se mantiene a largo plazo. Métodos: Se diseñó un estudio de cohorte prospectiva compuesta por pacientes postoperados de cirugía de contorno corporal con más de un año de seguimiento. La calidad de vida fue medida con el instrumento Body-Qol®. Se compararon los puntajes preoperatorios, postoperatorios tempranos y postoperatorios tardíos. Se realizó el análisis estadístico con las pruebas de Kruskal-Wallis y Kolmogorov-Smirnov. Resultados: La cohorte se compuso de 112 pacientes con un seguimiento a largo plazo del 75%. En toda la cohorte la calidad de vida mejoró entre el preoperatorio (43,9 ± 14,1 puntos) y ambas mediciones postoperatorias (85,2 ± 16,8 postoperatorio temprano y 83,6 ± 13,5 postoperatorio tardío), siendo estadísticamente significativo (p < 0,0001). Entre el postoperatorio temprano y tardío no existió diferencia (p = 0,112). El análisis por dominios demostró la misma tendencia. Los pacientes con pérdida masiva de peso tuvieron puntajes preoperatorios menores, pero igualaron a la población estética en ambas mediciones postoperatorias. Conclusiones: La calidad de vida mejora significativamente posterior a la cirugía de contorno corporal de forma temprana, y esta mejoría es estable en el tiempo. Esto se observa tanto en los pacientes estéticos como en los posteriores a la pérdida masiva de peso.

Introduction: One of the most important outcomes in patients undergoing body-contouring surgery is quality of life. Data on long-term quality of life is deficient. The main purpose of this study is to determine if short-term QoL after body contouring surgery maintains in the long-term follow up. Methods: A cohort study was designed; patients with at least one-year follow-up from the surgery were included. Quality of life was measured with the Body-Qol© instrument. All patients answered the preoperative Body-Qol© and at least one measurement after one year of follow-up from body contouring surgery. The preoperative scores, short-term scores and long-term follow-up scores were compared. The statistical analysis was made with Kruskal-Wallis y Kolmogorov-Smirnov tests. Results: The cohort was integrated by 112 patients; the long-term follow-up was of 75%. Quality of life improved between the preoperative measure (43.9 ± 14.1 points) and both short-term and long-term measures (85.2 ± 16.8 early postoperative y 83.6 ± 13.5 late postoperative), which was statistically significant (P< .0001). There was no difference between the short-term and long-term measures (P = .112). The domain analysis demonstrated the same tendency. Massive weight loss patients had lower preoperative scores but improved more after BCS, reaching almost cosmetic values. Conclusions: Quality of life improves soon after surgery and is stable over time. This was observed for both massive weight loss and cosmetic patients.

Cambios en la calidad de vida en mujeres sometidas a aumento mamario: resultados preliminares de un estudio de cohortes / Changes in quality of life in women subjected to augmentation mammoplasty: preliminary results of a cohort study

Objetivo Determinar los cambios en calidad de vida en mujeres sometidas a mamoplastia de aumento o mastopexia con prótesis, usando el instrumento validado Breast-Q®. Materiales y métodos Estudio de cohortes prospectivo. Se incluyeron todas las pacientes operadas de mamoplastia de aumento o mastopexia de aumento en el Hospital Clínico de la Universidad de Chile entre octubre de 2013 y mayo de 2014. La calidad de vida (CdV) se midió con el instrumento validado Breast-Q®. Se realizó estadística descriptiva y analítica para evaluar el cambio global en CdV y por dominios considerando estadísticamente significativo un valor p < 0,05. Resultados En el periodo estudiado se operaron 58 pacientes, 33 (56,9%) completaron el instrumento Breast-Q® en el preoperatorio y 25 (75,7%) de ellas en el postoperatorio. La CdV subió de un 49,7% a un 82,5% (p < 0,001); analizando por dominio hubo mejoría en autoestima (52% a 88%, p < 0,001), autoimagen (22% a 80%, p < 0,001) y vida sexual (31% a 86%, p < 0,001). Los síntomas físicos empeoraron desde un 94% a 75% (p < 0,001). Conclusiones El aumento mamario mejora la CdV, específicamente la autoestima, la autoimagen y la vida sexual, pero las molestias físicas aumentan. La satisfacción global fue alta.

Objective To determine the changes in the quality of life of women subjected to augmentation mammoplasty or a prosthesis mastopexy, using the validated tool Breast-Q®. Materials and methods A prospective cohorts study was conducted that included operated on for augmentation mammoplasty or augmentation mastopexy in the Hospital Clínico de la Universidad de Chile (HCUCH) between October 2013 and May 2014. The quality of life (QoL) was measured using the Breast-Q® validated tool. Descriptive and analytic statistics were performed to evaluate the overall change in QoL and by domains, considering a p<.05 as statistically significant. Results A total of 58 patients were operated on, of whom 33 (56.9%) completed the Breast-Q® questionnaire before surgery, and 25 (75.7%) of them in the post-operative period. The quality of life increased from 49.7% to 82.5% (p<.001). When analysed by domain, there was an improvement in Self-esteem (52% to 88%, p<.001), Self-image (22% to 80%, p<.001) and Sex Life (31% to 86%, p<.001). The physical symptoms increased from 75% to 94% (p<.001). Conclusions Breast augmentation improves the quality of life, in particular, self-esteem, self-image, and sex life, but physical discomforts increased. The overall satisfaction was high.

Estrategias de reanimación facial: resultados preliminares de un estudio de cohorte / Results of a face reanimation protocol in patients with facial paralysis

Objetivo: El objetivo de este trabajo es presentar el protocolo de reanimación facial y determinar los resultados del tratamiento quirúrgico de la parálisis facial. Materiales y métodos: Se realizó un estudio de cohorte prospectiva con todos los pacientes que ingresaron en el Hospital Clínico de la Universidad de Chile (HCUCH) y se sometieron al protocolo de reanimación facial, desde el año 2008 al 2014. Los resultados quirúrgicos se evaluaron según el protocolo de medición directa publicado por Mantkelow. Se utilizó estadística descriptiva para caracterizar la muestra y analítica para determinar el cambio en la excursión de la comisura labial como indicador de movilidad facial. Resultados: Desde el año 2008 hasta la fecha se han intervenido 21 pacientes, de los cuales 6 han completado su protocolo de tratamiento y período de seguimiento. La edad promedio fue de 35 años, el seguimiento promedio alcanzó los 22 meses. La excursión de la comisura labial postoperatoria promedio alcanzó los 12,8 mm, lo que significa una mejoría significativa, con un promedio de 7 mm respecto al preoperatorio. La excursión postoperatoria promedio del labio superior fue de 5,9 mm, lo que también constituye una mejoría significativa respecto al preoperatorio. Conclusiones: Existe una mejoría significativa en la movilidad facial en los pacientes sometidos al protocolo de reanimación facial. Si bien estos cambios pueden parecer pequeños en magnitud, implican un cambio profundo en la calidad de vida. Con el fin de optimizar resultados resulta esencial una terapia de rehabilitación especializada, con terapias individualizadas.

Background: The deformity caused by facial paralysis has important functional and psychological consequences. Aim:To report a face reanimation protocol and the results of surgical treatment of facial paralysis.Materials and methods: Prospective intervention of 25 patients aged 8 to 79 years (13 males) with facial paralysis, between 2008 and 2014. Surgical results were evaluated using measurements according to Mantkelow protocol. Results: Patients were followed for 22 months. Postoperative excursion of the labial commissure reached 12.8 mm, which was 7 mm better than before surgery. The postoperative excursion of the upper lip was 5.9 cm, which also represented an improvement. Conclusions: There is a significant improvement in facial movements in these patients subjected to the face reanimation protocol. Although changes are of low magnitude, they have an impact in their quality.

Introducing the Body-QoL®: A New Patient-Reported Outcome Instrument for Measuring Body Satisfaction-Related Quality of Life in Aesthetic and Post-bariatric Body Contouring Patients.

OBJECTIVE: To develop a new patient-reported outcome instrument (PRO) to measure body-related satisfaction quality of life (QoL). METHODS: Standard 3-phase PRO design was followed; in the first phase, a qualitative design was used in 45 patients to develop a conceptual framework and to create preliminary scale domains and items. In phase 2, large-scale population testing on 1340 subjects was performed to reduce items and domains. In phase 3, final testing of the developed instrument on 34 patients was performed. Statistics used include Factor, RASCH, and multivariate regression analysis. Psychometric properties measured were internal reliability, item-rest, item-test, and test-retest correlations. RESULTS: The PRO-developed instrument is composed of four domains (satisfaction with the abdomen, sex life, self-esteem and social life, and physical symptoms) and 20 items in total. The score can range from 20 (worst) to 100 (best). Responsiveness was 100 %, internal reliability 93.3 %, and test-retest concordance 97.7 %. Body image-related QoL was superior in men than women (p < 0.001) and decreased with increasing age (p = 0.004) and BMI (p < 0.001). Post-bariatric body contouring patients score lower than cosmetic patients in all domains of the Body-QoL instrument (p < 0.001). After surgery, the score improves by on average 21.9 ± 16.9 (effect size 1.8, p < 0.001). CONCLUSIONS: Body satisfaction-related QoL can be measured reliably with the Body-QoL instrument. It can be used to quantify the improvement in cosmetic and post-bariatric patients including non- or minimally invasive procedures, suction assisted lipectomy, abdominoplasty, lipoabdominoplasty, and lower body lift and to give an evidence-based approach to standard practice. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Catecholaminergic and cholinergic systems of mouse brain are modulated by LMN diet, rich in theobromine, polyphenols and polyunsaturated fatty acids.

The possible modulatory effect of the functional LMN diet, rich in theobromine, polyphenols and polyunsaturated fatty acids, on the catecholaminergic and cholinergic neurotransmission, affecting cognition decline during aging has been studied. 129S1/SvlmJ mice were fed for 10, 20, 30 and 40 days with either LMN or control diets. The enzymes involved in catecholaminergic and cholinergic metabolism were determined by both immunohistological and western blot analyses. Noradrenalin, dopamine and other metabolites were quantified by HPLC analysis. Theobromine, present in cocoa, the main LMN diet component, was analysed in parallel using SH-SY5Y and PC12 cell lines. An enhanced modulatory effect on both cholinergic and catecholaminergic transmissions was observed on 20 day fed mice. Similar effect was observed with theobromine, besides its antioxidant capacity inducing SOD-1 and GPx expression. The enhancing effect of the LMN diet and theobromine on the levels of acetylcholine-related enzymes, dopamine and specially noradrenalin confirms the beneficial role of this diet on the "cognitive reserve" and hence a possible reducing effect on cognitive decline underlying aging and Alzheimer's disease.

The Body-QoL(®): patient reported outcomes in body contouring surgery patients [corrected].

BACKGROUND: This study aimed to design a new patient-reported outcome (PRO) instrument to measure patient satisfaction after body-contouring procedures such as liposculpture, abdominoplasty, body-lift, thigh-lift, and arm-lift. METHODS: Phase 1a involved an extensive literature review, 16 in-depth patient interviews, and expert focus groups with 5 plastic surgeons to develop a conceptual framework for the outcomes deemed important for body image and preliminary PRO instruments. In phase 1b, the preliminary instrument was tested with a second independent sample of 29 patients with whom simple interviews were additionally performed. In the second sample, scale reliability was calculated. RESULTS: In phase 1a, the domains identified for the conceptual framework included clothing and body image, sexual and affective life, self-image and self-esteem, social relationships, and physical symptoms. In phase 1b, the scale internal consistency was 91.5 %. CONCLUSIONS: When psychometric evaluation is completed, the Body-Shape-Related Quality of Life instrument and its subscales will provide a reliable tool for plastic surgeons, researchers, and patients to use in measuring the impact and effectiveness of body-contouring procedures from the patient's perspective. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-B.

Superficial musculoaponeurotic system flap in partial parotidectomy and clinical and subclinical Frey's syndrome. Cosmesis and quality of life.

BACKGROUND: Frey's syndrome (FS), facial depression, and noticeable scar may have an impact on patient's quality of life after a parotidectomy. The superficial musculoaponeurotic system (SMAS) flap has been used to ameliorate those effects. METHODS: Forty-seven consecutive parotidectomies were analyzed; SMAS flap was performed in 26 of them. We investigated clinical FS, subclinical FS, and cosmetic satisfaction, and compared SMAS flap versus cases where this was not done. RESULTS: By performing the SMAS flap, the occurrence of clinical FS was reduced; however, there was no significant difference. Nonetheless, there was a significant difference in the perspiration intensity in favor of the group with SMAS flaps. In the cases we studied, the cosmetic satisfaction was high, even though facial contour-filling techniques were not used. CONCLUSIONS: Provided that the intensity of sweating is the main factor affecting the quality of life after surgery in patients, performing a SMAS flap renders the intervention worthwhile.

Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: a meta-analysis.

BACKGROUND: The purpose of this study was to determine whether suction-assisted lipectomy (SAL) decreases the incidence of early cardiovascular disease risk factors or its biochemical and clinical risk indicators. METHODS: A systematic review of the literature was performed by conducting a predefined, sensitive search in MEDLINE without limiting the year of publication or language. The extracted data included the basal characteristics of the patients, the surgical technique, the amount of fat extracted, the cardiovascular risk factors and the biochemical and clinical markers monitored over time. The data were analysed using pooled curves, risk ratios and standardised means with meta-analytical techniques. RESULTS: Fifteen studies were identified involving 357 patients. In all of the studies, measurements of predefined variables were recorded before and after the SAL procedure. The median follow-up was 3 months (interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure. CONCLUSIONS: Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.

Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children.

BACKGROUND: The purpose of this clinical study was to establish liposuction and lipoinjection as a noncosmetic procedure in children to correct lipodystrophies. METHODS: Liposuction, fat injection, or a combination of both was performed on 30 patients between 1994 and 2006 at Roberto del Rio Hospital or Clinica Alemana, Santiago, Chile. Liposuction was indicated in patients with excessive amounts of fatty tissue or tumor-like swelling. Combined liposuction and lipoinjection was performed on patients with deficit and excess in soft tissues. Lipoinjection was used for patients with soft-tissue insufficiencies. Samples of fat obtained by liposuction were submitted to histopathologic examination. Traditional tumescent technique was used for liposuction. The supernatant obtained by simple filtration was used for fat injection. Short- and long-term postoperative follow-up included registration of complications and assessment of aesthetic and functional outcome. The kappa test was used for statistical analysis. RESULTS: Thirty patients, nine boys and 21 girls, were operated on, with an average age of 11 years (range, 4 to 17 years). A total of 43 procedures were performed: 27 liposuctions, 10 lipoinjections, and six combined procedures. Average hospital stay was 1.1 days. Of a total 20 patients who underwent liposuction, six required revision. Histopathologic study showed 19 lipomatoses and one lipoblastomatosis. Cosmetic outcomes based on Strasser scale were as follows: six excellent, 19 good, four mediocre, and one poor. CONCLUSIONS: Liposuction and lipoinjection as sole or combined procedures are safe methods for the pediatric population. They are well tolerated, with a low rate of complications and satisfactory aesthetic results.

Repeated treatments with albendazole enhance Th2 responses to Ascaris Lumbricoides, but not to aeroallergens, in children from rural communities in the Tropics.

Geohelminth infections are associated with modulation of immunity to parasite antigens and aeroallergens. To investigate the possibility that this modulation is affected by anthelmintic treatment, we compared cytokine responses in children who were treated with repeated doses of albendazole over 1 year versus those in children who had were not treated. Whole-blood samples were cultured with Ascaris antigen and house dust mite and cockroach allergens, and levels of interleukin (IL)-5, IL-13, interferon-gamma, and IL-10 were measured. Anthelmintic treatment was associated with enhanced production of Th2 cytokines in response to parasite antigen but did not affect responses to aeroallergens. The data indicate that long-term treatment may be associated with increased Th2 antiparasite immunity.

Areola-nipple perception threshold to faradic electricity: a new measure of sensibility of the breasts.

BACKGROUND: We describe a new method to study the sensibility of the nipple-areola complex of the breast with faradic electricity delivered through an electromyographic device used to monitor peripheral nerve conduction. METHODS: The objective results of faradic pulses (2-50 mA per pulse) delivered to the nipple-areola complex of the breast through a Nihon-Kohden II machine (Evoked potential/Electromyographs, Nihon-Kohden Co., Japan) were evaluated in normal volunteers to get a basal measure that was defined by the patient as "a soft electric discharge." The measures were recorded and their output discharges averaged (at least 5 to each complex). RESULTS: Twenty-eight volunteers with normal breasts, 28 patients with breast hypertrophy before and after breast reduction, and 28 patients before and after breast augmentation were studied. The faradic pulses were perceived from 1.5 to 3.5 mA in the areola and from 3 to 5.5 mA in the nipple in the control group and from 4.5 to 7.0 mA in the areola and from 6.5 to 9.5 mA in the nipple in the breast hypertrophy group with no significant changes before and after surgery. In the breast augmentation group the faradic pulses were very similar to the volunteers that had normal breasts, but 13 months after breast augmentation with silicone gel prosthesis, a difference was found because all the patients had a higher threshold and three cases had lost sensibility of the nipple-areola complex. CONCLUSION: In normal breasts the areola had a lower threshold for faradic pulses compared to the nipple. Hypertrophic breasts had a higher threshold to the faradic stimulation than normal subjects in the pre- and postoperative period. Hypoplastic breasts before breast augmentation had a perception threshold similar to that of the normal volunteers but after breast augmentation this perception was much higher.

Full-face carbon dioxide laser resurfacing: a 10-year follow-up descriptive study.

BACKGROUND: The purposes of this study were to retrospectively compare the 1-, 5-, and 10-year cosmetic outcomes of full-face carbon dioxide laser resurfacing using the SilkTouch technology, and analyze its advantages, disadvantages, and long-term results. METHODS: Photographic results of full-face carbon dioxide laser resurfacing were evaluated after 1, 5, and 10 years. Statistical analysis considered surgeon and patient satisfaction based on a predetermined cosmetic visual analogue scale. Patients and two plastic surgeons unfamiliar with the cases evaluated objective postresurfacing results using Beausang's grading system and a modified wrinkle assessment scale. RESULTS: One hundred fifty-nine patients were treated and 46 patients completed 1-, 5-, and 10-year follow-up. Combined aesthetic procedures to the full-face carbon dioxide resurfacing were transcutaneous upper lid/lower lid transconjunctival blepharoplasty and endoscopic brow lifts in 15 patients. After 1 year, some relapse occurred, but the overall aesthetic result remained very good. At 5 and 10 years, respectively, 32 and 20 percent of the sample maintained good-quality skin texture; 22 and 19 percent achieved correction of skin pigmentation without scars; and 88 and 98 percent needed correction of recurrent rhytides, jowling, and redundant skin. Permanent hypopigmentation was found in four cases (8.7 percent). CONCLUSIONS: The authors' early experience with the carbon dioxide laser was excellent, but after 1 year, they noticed lines of demarcation between treated and nontreated skin or persistent erythema. After 5 and 10 years, advantages were maintenance of good skin texture, ablation of fine wrinkles, and long-term correction of skin pigmentation. Disadvantages included permanent hypopigmentation of the mandible-neck junction, telangiectasia, and possible accentuation of skin redundancy.

Progressive tension sutures in the prevention of postabdominoplasty seroma: a prospective, randomized, double-blind clinical trial.

BACKGROUND: The purpose of this study was to evaluate the seroma reduction capabilities of progressive tension sutures and compare them with the conventional use of drains. METHODS: Sixty female patients were randomized into four groups: group 1 (control, no drains, and no progressive tension sutures), group 2 (progressive tension sutures alone), group 3 (drains alone), and group 4 (progressive tension sutures and drains). All patients underwent a classic abdominoplasty and drains were left for 7 days in the corresponding groups. Clinical and ultrasound assessments were performed 2 weeks after the operation by blinded evaluators. Punctures, volumes, nonseroma complications, and aesthetic outcome were also measured. RESULTS: Surgical time was 50 minutes longer in groups 2 and 4. Drain outputs were higher in group 3 than in group 4. The clinical and ultrasound seroma frequency was 35 percent and 90 percent respectively, without significant differences among the groups. The control group was interrupted at 10 patients because of considerably larger seromas and an increased amount of punctures needed for treatment. No differences were found in the other groups. There were no differences with respect to complication rates and aesthetic outcome after follow-up. CONCLUSIONS: Progressive tension sutures increase surgical time, reduce drain outputs, and have the same clinical and ultrasound seroma frequency as the use of drains alone. The combination of both methods simultaneously does not add any advantages. However, complications and interventions increase if at least one of them is not used. The mechanism of action of progressive tension sutures could be the compartmentalization of the fluid collection under the flap facilitating absorption.

Use of aerosolized bovine-prepared fibrin glue for skin fixation after primary open rhinoplasty: a prospective randomized and controlled trial.

BACKGROUND: Fibrin glue has been used in diverse areas of plastic surgery. To the authors' knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty. METHODS: A prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated. RESULTS: A computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain. CONCLUSIONS: Fibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.

Nonresective shrinkage of the septum and fat compartments of the upper and lower eyelids: a comparative study with carbon dioxide laser and Colorado needle.

BACKGROUND: The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a low-range grid of electrocautery with a Colorado microdissection needle. METHODS: Thirty-six patients underwent a four-lid blepharoplasty. During surgery, after exposure (not opening) of the septum and assessment of the amount of bulging by gentle globe compression, a grid spray of electrocautery (right eye) and carbon dioxide laser (left eye) was applied over the entire septum until shrinkage and correction of the bulging was achieved. Preoperative, postoperative day 15, and 1-year follow-up photographs were evaluated using an objective grading system by blinded surgeons. For statistical analysis, the Wilcoxon matched-pairs signed-ranks test was used, with p < 0.05 indicating statistical significance. RESULTS: All the patients completed the 15-day evaluation, but only 32 completed the 1-year follow-up. No major eye or eyelids complications were observed. There were no statistical differences in surgical time and postoperative pain on either side. In this study, laser fat-septum shrinkage achieved substandard results compared with electrocautery when analyzed as a continuous variable, but it did not influence the categorical Strasser scale final result in the short- and long-term follow-up. CONCLUSIONS: The method described is simple and safe, and provides a subtle but long-lasting, adequate result. No statistical clinical differences were observed between the electrocautery and laser fat-septum shrinkage techniques.