The Isosceles Nasal Tip-Laser-Assisted Midline Assessment in Rhinoplasty.

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Eyebrow Lift: Open-Book ROOF Transposition and Orbicularis-Frontalis Sliding Maneuver.

This article delves into innovative surgical techniques, the open-book ROOF (retro-orbicularis oculi fat) transposition technique (OBRoof) and the orbicularis-frontalis sliding maneuver (OFS), designed for eyebrow and upper eyelid rejuvenation in the aging process. Emphasis is placed on understanding the dynamic changes occurring within the forehead and eyebrow envelope's five layers and their intrinsic relationships as well as the impact of the ROOF ptosis causing upper eyelid hooding. The OBRoof technique is highlighted for its effectiveness in addressing ptotic volume, offering a rejuvenated appearance by relocating volume to the supraciliary region.In the OFS, we explore the concept of extensive dissection above the upper border of the eyebrow to allow for free repositioning of the eyebrow. The stabilization is based on deep-plane facelift concepts, as the orbicularis oculi muscle corresponds to the superficial muscular aponeurotic system, and it is anchored to the deep layers (periosteum) by passing through the frontal muscle.In summary, this article provides a comprehensive exploration of innovative and minimally invasive techniques for eyebrow and upper eyelid rejuvenation, shedding light on their anatomical foundations, procedural intricacies, and the potential for achieving natural and lasting outcomes.

Precision Rhinoplasty Cylindric Burrs-Sidewall Aesthetics.

The development of power instruments has led to great advances in rhinoplasty. It has helped to reduce operating time, minimize damage to the surrounding soft tissues, and allow precision bony modification compared with the use of manual rasps. Burrs help ensure precise results by (i) creating a smooth transition between the lateral nasal sidewall and the face, (ii) treating bony asymmetries, and (iii) producing homogeneous upper and middle thirds that softy translate into the upper lateral cartilages. The aim of this paper is to show applications of cylindrical burrs in rhinoplasty surgery to treat the dorsal upper and middle thirds as well as lateral sidewalls of the nose, regardless of whether the dorsal preservation or structure technique is used. This approach offers a safe, fast, and precise technique that can be used in conjunction with piezo osteotomy to obtain the optimal outcomes.

Osteotomy Techniques in Preservation Rhinoplasty with an Analysis of a Radix-Skull Base Computed Tomography Series.

This study aims to explain our experience with dorsal preservation osteotomies, focusing on transverse, lateral, and dorsal aesthetic lines (DAL) osteotomies. We describe the utilization of a variety of surgical instruments, including osteotomes, saws, burrs, and piezo. This paper describes our concept of transcutaneous ultrasonic osteotomy, microedged-specific osteotomy, applying drills for lateral wall reshaping, and integrating piezo technology to establish new DAL. Furthermore, we present a radix-skull base computed tomography series analysis to evaluate the safety of transverse and radix osteotomies.

A Novel Treatment for Convex Lateral Crura: The Inverted Spanning Suture.

Rhinoplasty is one of the most complex and challenging procedures in plastic surgery, even for experienced surgeons. Among the steps leading to an aesthetic and functional nose, there is the nasal tip improvement. Today's approach to nasal tip is the product of different techniques shifting through time, mainly from a resection tendency, to preservation and suture use to reshape cartilages. Addressing the lateral crura is vital to an aesthetic nasal tip and it is frequently obtained by adequate suture techniques. The alar-spanning suture described by Perkins is one of such. Regardless of its importance, it was not able to improve convex crura in some cases. The inverted alar-spanning suture (ISS) is an adaptation designed to treat those cases with the suture alone. ISS is a novel technique that can lead to better results treating the convex lateral crura by distributing the force vector in a more effective way. New techniques in rhinoplasty have multiplied, bringing this procedure to a new level and keeping up with the updated notion of restoration instead of excision the ISS is a new, precise, approach to an old problem.

Biological Activity and Chemical Composition of Propolis Extracts with Potential Use in Vulvovaginal Candidiasis Management.

Environmental sustainability is an increasing challenge in the pharmaceutical field, leading to the search for eco-friendly active ingredients. Among natural ingredients, propolis arises as an excellent alternative, being a complex substance with pharmacological properties. This work aims to explore the potential of propolis as a new pharmaceutical ingredient for the replacement of conventional vulvovaginal antifungals. Propolis extracts were obtained by Ultrasound-Assisted Extraction using different solvents (water, water/ethanol (50:50, v/v), and ethanol). Afterwards, the extracts were characterized regarding total phenolic content (TPC), antioxidant/antiradical activities, radical scavenging capacity, antifungal activity against strains of Candida species, and viability effect on two female genital cell lines. The aqueous extract achieved the best TPC result as well as the highest antioxidant/antiradical activities and ability to capture reactive oxygen species. A total of 38 phenolic compounds were identified and quantified by HPLC, among which ferulic acid, phloridzin and myricetin predominated. Regarding the anti-Candida spp. activity, the aqueous and the hydroalcoholic extracts achieved the best outcomes (with MIC values ranging between 128 and 512 µg/mL). The cell viability assays confirmed that the aqueous extract presented mild selectivity, while the hydroalcoholic and alcoholic extracts showed higher toxicities. These results attest that propolis has a deep potential for vulvovaginal candidiasis management, supporting its economic valorization.

Monkeypox Infection With Primarily Mucosal Involvement.

ABSTRACT: Since May 2022, several nonendemic countries face a monkeypox outbreak, with clinic and epidemiological characteristics distinct from the classic ones. Primarily affecting the sexually active population, these cases present with mucocutaneous lesions mainly localized in perioral, genital, and anal areas. A retrospective study was conducted in a tertiary center in Lisbon, to characterize the population diagnosed with monkeypox infection with primarily mucosal involvement.

Cable and Mirror Sutures and the Nasal Septum Sublaminar Dissection.

Managing the nasal septum (NS) position is crucial in septorhinoplasty. The analysis and the preparation of the anterior nasal spine and the quadrangular cartilage as well as the strategy defined to efficiently stabilize the septum will dictate considerably the success of the result. Moreover, what we see in the surgical table can suffer modifications during the healing process because of poor fixation or the cheese-wire effect of the cartilage. We will present a logical sequence and tools to achieve a proper and stable position of the NS and the nasal pyramid. The sublaminar (supraperichondral) dissection of the quadrangular cartilage as an option to the subperichondral one and the use of cable and mirror sutures to three-dimensionally positioning and stabilizing the NS will be described.

Immunoglobulin G4-related constrictive pericarditis and the importance of a thorough workup: a case report.

BACKGROUND: Constrictive pericarditis remains a problematic diagnosis and a thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related pericardial disease is an unusual cause of pericardial constriction. We report a challenging diagnostic case of pericardial constriction due to IgG4-related disease. CASE PRESENTATION: A 68-year old male with a history of inferior myocardial infarction with right ventricle (RV) involvement was thrice-hospitalized due to marked ascites and peripheral oedema. Systemic congestion was initially attributed to RV dysfunction due to previous infarction. Yet, at the final admission, a re-assessment echocardiogram followed by cardiac computed tomography, magnetic resonance and right heart catheterization raised a possible diagnosis of constrictive pericarditis with a finding of abnormal pulmonary venous return. Patient therefore underwent pericardiectomy and surgical correction of pulmonary venous return. Pericardium histology revealed an IgG4-related pericardial constriction. Patient was later discharged on corticosteroids with marked symptomatic improvement. CONCLUSION: IgG4-related disease remains a rare cause of pericardium constriction while also presenting a challenging diagnosis in everyday clinical practice. This case exemplifies the difficulties faced by clinicians when reviewing a possible case of constrictive pericarditis, while highlighting the importance of a multimodality assessment.

Surgical versus transcatheter aortic valve replacement in low-risk patients: A long-term propensity score-matched analysis.

BACKGROUND: Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real-world data are scarce. METHODS: Single-center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score-matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. RESULTS: A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life-threatening bleeding, emergent cardiac surgery, new-onset atrial fibrillation, and need for renal replacement therapy. Hospital length-of-stay and 30-day mortality were similar. At a median follow-up of 4.5 years (IQR 3.0-6.9), treatment strategy did not influence all-cause mortality (HR 1.19, 95% CI 0.77-1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71-3.41, p = 0.26). ES II remained the only independent predictor of long-term all-cause mortality (adjusted HR 1.40, 95% CI 1.04-1.90, p = 0.029). CONCLUSION: In this low surgical risk severe aortic stenosis population, we observed similar rates of 30-day and long-term all-cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short-term, while the Heart Team remains essential to assess both options on the long-term.