Alar cartilage-an alternative for spreader graft in primary rhinoplasty.

BACKGROUND: Alar cartilage can be very useful for tip and dorsum grafts. Depending on its size and thickness, it can be an important alternative for spreader grafts to improve endonasal functional deficiencies, correct deviated noses, and prevent inverted "V" deformities. Caucasian patients with bulbous tips are the most common candidates to achieve such benefits. It is easy to obtain and to frame into a desired graft. METHODS: The authors describe a surgical technique using the alar cartilages as spreader grafts. All Caucasian patients with bulbous tips who underwent primary rhinoplasty were included. All patients have been evaluated after 3 to 4 months and after 1 and 2 years by aesthetical and functional criteria. RESULTS: Thirty-four patients (28 female and 6 male) underwent this procedure between 2001 and 2015: 94% reported a better airflow, 91% reported very good aesthetic results and were very satisfied 2 years postoperatively, and 12% had nasal deviations that were corrected with a one side double-layered spreader grafts. Two patients presented supra-tip deformities and one patient had a columella scar that was revised surgically. No cases of inverted "V" deformity were reported 2 years postoperatively. CONCLUSIONS: Patients with functional satisfaction and with a straight and smooth dorsum seem to be the most important benefits that were achieved with this technique using alar cartilage spreader grafts, an alternative that can be offered to improve airflow and to prevent deviated and inverted "V" deformities. Level of Evidence: IV, therapeutic study.

Aspectos morfológicos e ultraestruturais de células sanguíneas de Crotalus durissus terrificus / Morphological and ultrastructural aspects of Crotalus durissus terrificus blood cells

A avaliação hematológica, de importância comprovada como um meio auxiliar de diagnóstico ao clínico de pequenos animais domésticos, vem se tornando comum em animais selvagens não apenas para a clínica, mas para a avaliação do manejo e como estudo auxiliar para a fisiologia das várias espécies. Tendo em vista o aumento da demanda para a produção de várias drogas de importância farmacêutica, a criação de serpentes peçonhentas vem se tornando comum a ponto destes animais já serem reconhecidos como sendo de produção. O conhecimento do manejo e da clínica destes animais ainda é escasso e a mortalidade é elevada nos criatórios, tornando urgente a ampliação destes. Embora alguns estudos hematológicos já tenham sido realizados em cascavéis (Crotalus durissus) os dados analisados ainda são insipientes, notadamente em relação à caracterização das células do sangue e poucos estudos em microscopia eletrônica foram realizados em serpentes. Com o objetivo de caracterizar as células sanguíneas morfologicamente, sob microscopia óptica e ultraestrutural, foram coletadas amostras de sangue de 52 de indivíduos da subespécie Crotalus durissus terrificus para a realização de esfregaços sanguíneos e avaliação ultraestrutural. Concluiu-se que a coloração hematológica de Giemsa permite a avaliação morfológica e a diferenciação das células sanguíneas em serpentes assim como a visualização de hemoparasitos. A avaliação ultraestrutural permite evidenciar as organelas celulares e a diferenciação entre as células, inclusive entre os tipos leucocitários, porém ainda são necessários outros estudos para que seja elucidada a hipótese da existência dos eosinófilos na espécie estudada assim como é necessária melhor caracterização dos grânulos dos azurófilos para que se confirme uma possível diferença entre os monócitos típicos e os azurófilos.(AU)

Hematological evaluation, important for the diagnostic by the small domestic animal clinician, has become common in wildlife clinic, and for handling and study of the physiology of various species. Given the increased demand for drug production of pharmaceutical importance, the breeding of venomous snakes has become common and is already recognized as production. Knowledge of the management and clinics of snakes is still insufficient and their mortality is high. Although some hematological studies have already been conducted in the rattlesnake (Crotalus durissus), the analyzed data are still insufficient, especially with respect to the characterization of blood cells, and few electron microscopy studies have been performed on snakes. In order to characterize morphologically blood cells with light and ultrastructural microscopy, blood samples from 52 individuals of subspecies of Crotalus durissus terrificus were collected to perform blood smears and ultrastructural evaluation. It was concluded that hematologic Giemsa staining allows morphological evaluation and differentiation of the blood cells as well as of snake hemoparasites. The ultrastructural evaluation will highlight the cell organelles and differentiation between cells, including leukocyte types; although still further studies are needed to elucidate the hypothesis of eosinophils in the species studied as also is necessary a better characterization of azurophilic beads to confirm a possible difference between the typical monocyte and the azurophilic.(AU)

Aesthetic Plastic Surgery Checklist: A Safety Tool.

INTRODUCTION: About one in ten patients experiences iatrogenic events, and more than half of these occur in the perioperative environment. The objective of this study was to develop a complete and functional checklist for aesthetic plastic surgery and test it in patients who would undergo elective plastic surgeries. METHODS: Patient data were collected from a general hospital and the particular clinic between October 2013 and October 2015, through history, physical examination, diagnosis, laboratory tests, pre-, during, and postoperatively, and complications. An expanded safety checklist was developed and optimized for aesthetic plastic surgery based on the model presented by the WHO in 2009 with reference to the information related to the prevention of more frequent complications in this specialty. RESULTS: The tool was applied to 486 patients, of whom 430 (88 %) were women and 56 (12 %) were men. The most frequently performed procedure was liposuction with 30 % of cases, and the most widely used type of anesthesia (39 %) was local anesthesia + sedation. The greater adherence of professionals to the checklist was the group of residents (98 %). The observed complications were seromas (7 %), other complications unrelated to the wound (3 %), and hematoma (0.2 %) in only one patient who underwent facelift. CONCLUSION: The use of the checklist in addition to allowing data collection and the identification of potential risks promoted favorable changes in the attitudes of some professionals and generated interest in patient safety and teamwork. LEVEL OF EVIDENCE IV: This journal requires that the 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 .

Evolução e manejo do acidente loxoscélico / Evolution and management of loxoscelic accident

Os acidentes com aranhas do gênero Loxosceles podem apresentar variadas evoluções clínicas, dificultando a realização do diagnóstico e a escolha correta de uma medida terapêutica. Este artigo de revisão tem como objetivo abordar os principais mecanismos de evolução, principais desfechos e os tratamentos de escolha para o acidente Loxocélico.

Loxosceles spider accidents may present various clinical developments, therefore hindering the correct diagnosis and the correct choice of therapeutic measures. This review article aims to approach the Loxosceles accident evolution mecanisms, main courses of development and it's main treatments options.

Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms.

The authors performed a systematic review of strategies to reduce delays in admission into PACUs from ORs. The purpose of this article was to evaluate for managers how to choose interventions based on effectiveness and practicality. The authors discuss optimization methods that can be used to sequence consecutive cases in the same OR, by the same surgeon, on the same day, based on the objective of reducing delays in PACU admission due to the unavailability of unfilled PACU beds. Although effective, such methods can be impractical because of large organizational change required and limited equipment or personnel availability. When all physical beds are not full, PACU nurse staffing can be adjusted. Statistical methods can be used to ensure that nursing schedules closely match the times that minimize delays in PACU admission. These methods are effective and practical. Explicit criteria can be applied to assist in deciding when to assign other qualified nurses to the PACU, when to ask PACU nurses to work late, and/or when to make a decision on the day before surgery to add more PACU nurses for the next day (if available). The latter would be based on statistical forecasts of the timing of patients' admissions into the PACU. Whether or not all physical beds are full, the risk of delays in PACU admission is relatively insensitive to economically feasible reductions in PACU length of stay. Such interventions should be considered only if statistical analysis, performed by using computer simulation, has established that reducing PACU length of stay will reduce delays in admission at a manager's facility.