Use of the pitanguy large flap demarcator in thigh dermolipectomy with a medioanterior scar extension.

BACKGROUND: Thigh dermolipectomy is one the most challenging procedures for the treatment of postobesity deformities. Excessive tissue on the medial portion of the thigh is associated with the poor results of the classic approach. Recently, different techniques have been proposed with the goal of improving the results. The current study presents an alternative technique for thigh dermolipectomy using the Pitanguy flap demarcator with a medioanterior scar extension. METHODS: From January 2002 to July 2005, the authors prospectively followed up patients undergoing thigh dermolipectomy using the Pitanguy flap demarcator for marking resection areas and the medioanterior scar extension. RESULTS: Eight patients ranging in age from 30 to 54 years and with a weight loss of 30 to 59 kg were submitted to the medioanterior extension thigh dermolipectomy. All the patients displayed important soft tissue laxity and redundancy at the lower limbs. The postoperative follow-up period ranged from 5 to 40 months. The results attained were considered satisfactory, and few complications were observed. CONCLUSIONS: The poor results of previous procedures were disappointing to many patients and discouraged many others from undergoing thigh dermolipectomy. Using the Pitanguy flap demarcator for markings and the medioanterior scar extension, satisfactory results were increasingly common, and a growing number of patients may be encouraged to undergo thigh dermolipectomy procedures.

Relative implant volume and sensibility alterations after breast augmentation.

BACKGROUND: Recent studies have provided diverging results regarding the factors that may affect sensibility after primary breast augmentation. Implant volume is believed to be an important factor, but the relation of implant size to breast volume has not been adequately addressed. In addition, the literature shows that a conflict exists when the periareolar and inframammary approaches are compared. This study aimed to refine the volumetric analysis comparing the implant and final breast size as well as the intrinsic association of these two factors with postoperative sensory alteration of the breast. METHODS: A prospective study investigated patients who underwent aesthetic breast augmentation between June 2004 and October 2005 (i.e., a 16-month period) at the Ivo Pitanguy Institute. The sensibility in nine regions of the breast was tested before and after surgery using Semmes-Weinstein monofilaments. Breast sizers were used to compare the pre- and postoperative breast volumes. Statistical analysis of the data took into consideration the relative volume of the implant, the surgical approach, the presence of minor complications, the breast-feeding history, and the subjective evaluation of sensory changes in the patients. RESULTS: A total of 37 patients who underwent breast augmentation were examined preoperatively. The relative volume of the implant was found to be associated with sensibility alterations. No difference was found between the periareolar and inframammary incision approaches. Other factors such as previous breast-feeding, minor complications, and subjective alterations were not associated with sensory alterations. CONCLUSIONS: The study findings suggest that larger implants and smaller breasts show an increased association with postoperative sensory alterations of the breast. Plastic surgeons and their patients should be aware of this possibility. Implant volume should be considered together with breast size to avoid sensory complications, and this is summarized in the concept of relative volume.

Endometriose e sua apresentação na forma de hérnia da parede abdominal / Endometriosis and presentation as abdominal wallherniation

Revisar incidência, sintomatologia e melhor conduta relacionada à endometriose em sua apresentação incomum como hérnia da parede abdominal. Foi realizada uma revisão na Medline focada unitermos "endometriose" e "hernia". A manifestação de endometriose extraperitoneal deve ser sempre lembrada na avaliação de massa da parede abdominal em mulheres em idade fértil. A sintomatologia mais comum é de dor cíclica. A exploração cirúrgica ser indicada e o aspecto macroscópico da lesão é sugestivos do diagnóstico. Cirurgiões e ginecologistas devem estar preparados para trabalharem juntos. O alto grau de suspeição é chave na avaliação pré-operatória de paciente feminina em idade fértil apresentando massa na parede abdominal. A conduta mais adequada aponta para exploração da lesão extraperitoneal e laparoscopia como método diagnóstico e terapêutico da cavidade abdominal.

Common variants in the lipoprotein lipase gene in Brazil: association with lipids and angiographically assessed coronary atherosclerosis.

Lipoprotein lipase is the rate-limiting enzyme in the lipolysis of plasma triglyceride-rich lipoproteins. We studied six variants (T-93G, D9N, N291S, PvuII, HindIII and S447X) in the lipoprotein lipase (LPL) gene in 309 non-diabetic patients with angiographically assessed coronary artery disease and in 197 controls in a southern Brazilian population of European descent. The HindIII H-allele was associated with lower triglycerides (p < 0.01) and higher high-density lipoprotein cholesterol (p = 0.03) levels, and the S447X mutation was associated with lower triglyceride levels (p < 0.01) in males, but not females. No other significant lipid associations were observed. Haplotypes were derived from these two sites (HindIII/S447X), and carriers of H-S and H-X haplotypes showed lower triglycerides (p < 0.01) and increased high-density lipoprotein cholesterol (p = 0.01) levels when compared to the H+S haplotype in males. In this gender, the H-X haplotype was associated with a protective effect (OR = 0.36, 95%CI = 0.13-0.97) for significant disease (> or = 60% of luminal coronary stenosis), even controlling for other classical risk factors.

Implicações do fumo na gustação e na olfação: revisando o tema / Implications of Smoke Habit in Gustation and in Olfaction: reviewing the theme

Entre os diversos malefícios causados pelo tabagismo, os efeitos na gustação e na olfação não têm sido abordados pela literatura especializada nacional. Realizou-se um estudo de revisão sobre o tema. Há um predomínio de estudos que se dedicam à investigação da gustação. A exposição ao fumo parece alterar significativamente os dois sistemas quimiorreceptores. A capacidade gustativa está comprometida, quanto à percepção de substâncias salgadas, amargas e doces-principalmente as duas últimas -, bem como à impressão hedônica global (prazer). Dessa forma, a preferência alimentar pode variar. Já na olfação, há alterações ultraestruturais no epitélio, perda na habilidade de identificação de odores (hiposmia) e sensação de queimação e dor na mucosa. Talvez com o esclarecimento da importância desses dois sistemas sensórios e de suas patologias, possam ser efetuados novas revisões e estudos sobre o tema em nosso meio.

Among the variety of general health smoking habit consequences, the effects on gustation and on olfacion have not been reported in the national specialized literature. We did a review study about the issue. There is a predominance of study inquirements on gustation. The smoking habit seems to affect both sensory systems. The gustatory capacity is compromised by a reduction in taste sensibility to salty, bitter and sweet substances (specially the last two), as well by a diminish global hedonic impression (pleasure). Therefore, alimentary preferences may change in smokers. The olfaction is compromised by ultra-estrucutral epithelial alterations. The smell identification ability is reduced (hyposmia), and a sensation of burn and pain on the mucosa is also established. The importance of understanding both sensory systems and their pathology suggests new study requirements among our academic staff.