Liver damage in obese patients.

BACKGROUND: Hepatic steatosis, nonalcoholic steatohepatitis and cryptogenetic cirrhosis are frequent in an obese population. Therefore, it is wise to submit all obese patients with significant alterations in hepatic function tests to transparietal liver biopsy. The aim of this study is to determine the hepatic conditions of morbidly obese patients during bariatric surgery by means of a wedge liver biopsy, to avoid any eventual hepatic damage being ascribed to the surgical procedure. METHODS: This prospective study entails 216 consecutive patients, whose work-up included liver function tests, before undergoing vertical gastroplasty and wedge liver biopsy. Histology was assessed for hepatic steatosis, necroinflammatory activity and liver fibrosis/cirrhosis. RESULTS: Abnormal preoperative liver function tests were detected in 65 patients, in 52 unexpectedly. Histologically, significant steatosis was found in 168 patients (77.8%); necroinflammatory activity in 13 (6.0%); liver fibrosis in 46 (21.3%), 5 of whom (2.3%) were found to have an asymptomatic and unknown liver cirrhosis. CONCLUSION: In morbidly obese patients, the incidence of histological liver damage is very high, despite acceptable liver function tests. In addition to steatosis, however, a "second hit" to induce necrosis and inflammation, favoring the development of significant fibrosis, is not essential. Being obese is an independent risk factor for liver damage and could contribute to liver fibrosis either alone or in association with other insulting factors. The identification of obese patients with septal fibrosis/cirrhosis, at surgery, is of considerable interest in clinical practice, mainly under the aspect of prognosis and liability.

Otoplasty: a comparison of techniques for antihelical defects treatment.

BACKGROUND: Prominauris, the most common malformative defect of the external ear, is dependent on a combination of elementary defects mainly affecting the antihelix and the concha. Transection versus cartilage weakening results in antihelix treatment are discussed. METHODS: In this study, 104 ears with antihelical defects were treated in 63 consecutive patients: the 33 patients (53 ears) in group A, received a transection-based treatment, whereas the 30 patients (51 ears) in group B, underwent cartilage weakening and suture. All the patients were treated using a posterior access. The aesthetic results were evaluated by an independent well-trained plastic surgeon. RESULTS: No differences were found in correction degree and stability between the two methods, but cartilage weakening techniques provided a smoother and more natural curvature. CONCLUSIONS: Cartilage weakening techniques can lead to better aesthetic results, primarily because of a softer and more natural ear curvature.

Augmentation mammaplasty of teardrop-shaped breasts using round prostheses.

A new submuscular-subglandular technique to correct teardrop-shaped breasts using round prostheses is presented. In this technique the prostheses are only partially covered by muscle. The muscle is also divided to enhance the projection at the nipple level without the need for anatomical prostheses. A series of 911 implanted prostheses is presented and the results are discussed with regard to both visual and tactile aspects, as well as the dynamic appearance. The complication rates are surprisingly comparable to those of totally submuscular implant techniques. This perhaps suggests that the coverage provided by the divided muscle is sufficient to minimize the contact between the implant and the gland, often considered the primary cause of the higher capsular contracture rates found in techniques using subglandular locations.

Aesthetic breast reconstruction.

Breast reconstruction is fully justified only from an aesthetic perspective. A reconstructed breast, therefore, should be as aesthetically natural and similar to the contralateral one as possible, even if this means reproducing some little defects. The breast's profile (projection, ptosis, sulcus location, and superficial unevenness), symmetry, areola, and nipple are the characterizing aesthetic factors. The authors present their experience in prosthetic breast reconstruction seen with an aesthetic eye and an artistic touch, illustrating personal tips and technical adjustments: use of anatomical prostheses, pectoralis muscle treatment, sulcus stabilization or reconstruction, superficial irregularities correction, and nipple-areola complex reconstruction. Results are evaluated by both the surgeon and the patient using a score system, validating the method.