Quantifying Dynamic Deformity After Dual Plane Breast Augmentation.

BACKGROUND: Dynamic breast deformity (DBD) is characterized by visible distortion and deformity of the breast due to contraction of the pectoralis major muscle after submuscular breast augmentation; fortunately, in most cases, this is not a clinically significant complaint from patients. The purpose of this study is to present a simple method for objectively measuring DBD in patients submitted to dual plane breast augmentation (DPBA). METHODS: We studied 32 women, between 18 and 50 years old, who underwent primary DPBA with at least 1 year of follow-up. Anthropometric landmarks of the breast were marked, creating linear segments. Standardized photographs were obtained both during no pectoralis contraction (NPC) and during maximum pectoralis muscle contraction (MPC); measurements of the linear segments were taken through ImageJ imaging software, and both groups were compared. RESULTS: We found statistically significant differences in all analyzed segments when comparing measurements of the breasts during NPC and MPC (p < 0.001). CONCLUSION: Our study proposes a novel, standardized method for measuring DBD after DPBA. This technique is reproducible, allowing for objective quantification of the deformity in any patient, which can be valuable for both patients and surgeons, as it allows for a more thorough discussion on DBD, both pre- and postoperatively, and may help both patients and surgeons to make more informed decisions regarding potential animation deformities after breast augmentation. LEVEL OF EVIDENCE V: 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 .

Tumores da mão parte III: tumores de pele da mão / Tumors of the hand, Part III: Skin tumors of the hand

O tumor de pele da mão corresponde ao câncer primário mais comum dessa região. Apesar de proporcionalmente cobrir uma pequena superfície do corpo, corresponde a uma parte considerável de todos os tumores de pele. O objetivo principal deste trabalho é mostrar de forma simples e clara as lesões mais prevalentes e encontradas no ambulatório médico, de uma forma que este pode ser usado para consulta e orientação do profi ssional médico das mais diversas especialidades, objetivando um diagnóstico rápido e assertivo, que interferirá positivamente no desfecho da doença. Nesta terceira parte do trabalho são abordados fundamentos, conceitos, classifi cações e abordagens para o melhor prognóstico do paciente.

Skin tumor of the hand is the most common primary cancer of this region. Although covering a proportionally small surface of the body, it accounts for a substantial part of all skin tumors. The main aim of this work is to show simply and clearly the most prevalent injuries found in the outpatient clinic, so that it can be used by healthcare providers from various specialties as a consultation and guidance resource, aiming at a quick and assertive diagnosis that will interfere positively with disease outcome. This third part of the work covers the fundamentals, concepts, classifi cations and approaches for a better prognosis.

Tumores da mão parte II: Tumores ósseos da mão / Hand tumors – Part II: bone tumors of the hand

Tumores ósseos da mão podem ser divididos em benignos, malignos ou metastáticos. Os benignos são os mais comuns, sendo que destes os encondromas são os mais prevalentes (1). A incidência de tumores na mão é relativamente baixa; entretanto, caso esses tumores sejam malignos, podem ser localmente invasivos e comprometer a função da mão. Geralmente para tumores benignos é realizada ressecção intralesional do tumor; porém, para tumores malignos pode ser necessária ampla excisão ou até eventualmente amputação para que não ocorra recidiva tumoral. Este trabalho foi desenvolvido no Serviço de Cirurgia da Mão e Microcirurgia Reconstrutiva do Hospital São Lucas da PUCRS. Nosso objetivo é relatar os principais tipos de tumores da mão, dividindo-os em benignos e malignos, e orientar os médicos que realizarão seu primeiro atendimento em relação à clínica, exames necessários e opção de tratamentos.

Bone tumors of the hand can be divided into benign, malignant or metastatic. Benign tumors are the most common, and of these enchondromas are the most prevalent (1). The incidence of tumors in the hand is relatively low. If these are malignant tumors, however, they may be locally invasive and compromise the function of the hand. Generally for benign tumors intralesional tumor resection is performed, but malignant tumors can require wide excision or possibly even amputation so as to avoid tumor recurrence. This work was developed in the Service of Hand Surgery and Reconstructive Microsurgery at Hospital São Lucas of PUCRS. Our aim here is to describe the main types of hand tumors, dividing them into benign and malignant, and guide physicians seeing their fi rst patient with regard to clinical practice, necessary examinations and treatments choices.

Tumores da mão parte I: tumores de partes moles da mão / Hand tumors – Part I: Soft tissue tumors

Os tumores de partes moles da mão, principalmente os benignos como os cistos sinoviais, são queixas comuns, principalmente em consultas a cirurgiões da mão. Este trabalho tem por objetivo revisar os principais tipos de tumores de partes moles da mão, desde a sua apresentação clínica até uma revisão objetiva sobre seus diagnósticos e melhores opções terapêuticas. Visa auxiliar, também, na decisão de referência do paciente com uma lesão nodular ou cística da mão a um médico especialista após uma consulta ao médico generalista. As particularidades anatômicas e funcionais da mão tornam o estudo e o conhecimento das suas patologias fundamentais para um adequado manejo dos pacientes.

The soft tissue tumors of the hand, especially the benign ones such as synovial cysts, are common complaints, particularly in hand surgeons consultations. This work aims to review the main types of soft tissue tumors of the hand, from their clinical presentation to an objective review of their diagnoses and the best therapeutic options. It also aims to help in the decision to refer the patient with a nodular or cystic lesion of the hand to a medical specialist after consultation with the general practitioner. The anatomical and functional particularities of the hand make the study and knowledge of its conditions crucial for proper management of patients.

Osteoporosis prevalence and associated factors in patients with COPD: a cross-sectional study.

BACKGROUND: Osteoporosis is one of the systemic features of COPD. OBJECTIVE: To determine the prevalence of osteoporosis in a sample of COPD out-patients, and investigate the correlation between T-score (a comparison of the patient's bone mineral density to that of a healthy 30-year-old of the same sex and ethnicity) and several factors suggested to be associated with osteoporosis. METHODS: In a cross-sectional study, we conducted dual-energy X-ray absorptiometry bone mineral density scans of the hips and lumbar spine, and collected data on smoking and alcohol habits, menopausal status, comorbidities, inhaled and oral corticosteroid dose and duration of treatment, previous bone fractures, pulmonary function tests, calcium intake (via questionnaire on food frequency), vitamin D intake (via questionnaire on sunlight exposure), and physical activity (via the International Physical Activity Questionnaire). RESULTS: We evaluated 95 patients. Forty (42%) were osteoporotic, 40 (42%) were osteopenic, and 15 (16%) had normal bone mass. We found significant bivariate correlations between femoral-neck T-score and body mass index (r = 0.551, P < .001), and femoral-neck T-score and International Physical Activity Questionnaire total activity score (r = 0.378, P < .001). There was a significant inverse relationship between femoral-neck T-score and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) index (r = -0.246, P = .02). We also found significant correlations between T-score and FEV(1) (r = 0.251, P = .01), forced vital capacity (r = 0.229, P = .03), percent-of-predicted functional residual capacity (r = -0.415, P < .001), inspiratory capacity (r = 0.252, P = .01), ratio of inspiratory capacity to total lung capacity (r = 0.241, P = .02), and absolute and percent-of-predicted diffusing capacity of the lung for carbon monoxide (r = 0.366, P < .001, and r = 0.338, P = .003, respectively). CONCLUSIONS: We identified a high prevalence of osteoporosis and osteopenia in out-patients with COPD. Patients with osteoporosis had more severe COPD than patients with normal bone mass.