Caracterización clínico epidemiológica del infarto agudo del miocardio inferior extendido a ventrículo derecho en Ciego de Ávila / Clinical epidemiological characterization of the lower face acute myocardial infarction extended to the right ventricle in Ciego de Ávila

RESUMEN Fundamento: La cardiopatía isquémica es uno de los principales problemas de salud tanto en países desarrollados como en países en vías de desarrollo, una de las enfermedades que prevalece en el mundo y con mayor mortalidad. Cada año, millones de personas son ingresadas en los servicios de urgencias por motivos de consulta relacionados con el sistema cardiovascular; de estos ingresos, una gran proporción corresponde al infarto agudo de miocardio. Objetivo: Describir las características clínicas epidemiológicas de los pacientes con infarto agudo de miocardio inferior con extensión al ventrículo derecho. Metodología: Se realizó un estudio observacional, descriptivo transversal, en 46 pacientes ingresados en la Sala de Cardiología en el Hospital Provincial General Docente "Dr. Antonio Luaces Iraola", provincia Ciego de Ávila, período julio de 2016 a junio de 2019 y que cumplieron con los criterios establecidos en el estudio. Resultados: En la mayoría de los pacientes los factores de riesgo que predominaron fueron la hipertensión arterial y la diabetes mellitus, en el grupo de edades entre 60 y 69 años del sexo masculino. La forma de presentación más frecuente fue el dolor precordial y la complicación el bloqueo auriculoventricular. Un porcentaje alto de los pacientes recibió terapia trombolítica. Conclusiones: Predominaron los pacientes en edades comprendidas entre 60 y 69 años del sexo masculino y con antecedentes de hipertensión arterial y diabetes mellitus. La complicación más frecuente fue el bloqueo auriculoventricular y su forma de presentación el dolor precordial. Un alto número de pacientes recibieron tratamiento trombolítico.

ABSTRACT Background: Ischemic heart disease is one of the main health problems in both developed and developing countries, one of the most prevalent diseases in the world and with higher mortality. Every year, millions of people are admitted to the emergency services for consulting reasons related to the cardiovascular system; of these admissions, a large proportion corresponds to acute myocardial infarction. Objective: To describe the epidemiological clinical characteristics of patients with lower acute myocardial infarction with extension to the right ventricle. Methodology: An observational, descriptive cross-sectional study was carried out in 46 hospitalized patients in the Cardiology Room at the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola", Ciego de Ávila province, from July 2016 to June 2019 and who had the criteria established in the study. Results: In the majority of patients, the predominant risk factors were hypertension and diabetes mellitus, in the age group between 60 and 69 years of male sex. The most frequent form of presentation was precordial pain and the complication was atrioventricular block. A high percentage of the patients received thrombolytic therapy. Conclusions: Prevailed patients between 60 and 69 years of age, male and with a history of high blood pressure and diabetes mellitus. The most frequent complication was ventricular atrium block and its presentation was precordial pain. A high number of patients received thrombolytic treatment.

The Comparison of Long-term Effect of Botox(R) Injection on Lower Face Contouring after Single Injection and Long-term Repeated Injections by Standardized Photograph Analysis

PURPOSE: A botulinum toxin type A(BoNT-A) injection has been used as a noninvasive management for lower face contouring since 2000. The aim of this study is to compare reduction rate of lower face width for a longtime according to repeated Botox(R) injections on masseter muscles for lower face contouring procedure. METHODS: Forty-five patients were analyzed for single session of Botox(R) injection and 13 patients were evaluated for repeated Botox(R) injections for over two years. Single injection group was tracked regular intervals at 1, 3, 6, 10, 12 months after the injection, and repeated injection group was measured at every injection time. Twenty-five to thirty units of Botox(R) was injected into each masseteric muscle at five to six points at the prominent portions of the mandibular angle. Standardized frontal view of digital photographs were analyzed by Adobe Photoshop(R)(version CS3) to measure an reduction rate of lower face's width. RESULTS: Reduction rate was 3.7%, 6.9%, 6.2%, 4%, 4% at 1, 3, 6, 10, 12 months post injection each other in single injection group. However, more than 8% reduction rate was found in repeated injection group persistently for more than two years. CONCLUSION: This study shows that effective duration of Botox(R) injection for lower face contouring is expected to continue over one year clinically. Moreover, repeated injections maintained lower reduction rate consistently for a long time. Therefore, repeated injections on masseter muscles at regular intervals is the most effective procedure for lower face contouring.

Lower Face-Neck Lift by Periauricular Minimal Invasion & Suspension Suture

To reverse the wrinkling & sagging of the skin on lower face and neck, there are various surgical methods such as suspension suture method, classical cervicofacial lift, SMAS-platysmal facelift, deep-plane facelift and composite facelift. Aging of lower face and neck present not only with sagging skin, but also is aggravated due to loss of elasticity of the SMAS and platysmal muscle. Successful surgical outcome is expected when tugging of the SMAS and platysma is performed with proper skin excision of lower face. Practically, deep-plane facelift methods present more satisfying outcome than the subcutaneous dissection, but takes longer recovery period and higher risk of postoperative complication. The authors would like to present a new method of lower face and neck lift, with periauricular minimally invasive suspension suture method, which does not required hospitalization, and gives higher patient satisfaction. In this study, 30 patients(26 females, 4 males) were operated from December of 2004 to February of 2007. Minimal periauricular subcutaneous dissection was performed. While measuring the sagging of the soft tissue on lower face and neck, suspension suture was performed anchoring platysma muscle from the submandibular slit incision site to the fascia of the mastoid process and stretched SMAS of the lower face was suspended to the fascia of the mastoid process with PDS 3-0 sutures. Most of the patients were satisfied without specific problems. The procedure carries advantages of simple operative method, easier access under intravenous sedation, much lesser risk of hematoma formation or facial nerve injury, shorter recovery period, improvement on the cervicomental angle and jaw line, and minimal postoperative scar.

Combined Approach for Rejuvenation of the Lower Third of the Face and the Neck in the Male Patient

Most men develop deep crease in the nasolabial area and visible redundant tissue in the anterior neck with aging. The ideal operation for those patients seeking facial rejuvenation because of prominent nasolabial folds and neck soft-tissue laxity is the cervicofacial rhytidectomy. If the patient doesn't wish to have a conventional face/neck lift under general anesthesia, a combined approach based on summation of partially effective modalities is a good option. We present our experience with combined subcutaneous neck lift, platysmaplasty, mentoplasty, and platysma graft in the treatment of the lower third of the face and the neck, and obtained good results without complications using this comprehensive approach. In terms of morbidity, the procedure left inconspicuous scars. The platysma grafts remained in place and were not palpable and/or perceptible after insertion. Finally, postoperative recovery occurred uneventfully and no patients presented complications or the need for complementary treatment modalities. The incorporation of this innovative technique will provide us with more choices for addressing this controversial issue with a combined approach. The combination of proven methods may have better results than each one alone. It is a simple, safe, and inexpensive procedure that leaves no visible scars and has long-term adequate outcome. In conclusion, the presented procedure offers an additional technique of rejuvenating the lower third of the face and the neck with excellent results in the male patients.

The Change of the Maximal Bite-force after Botulinum Toxin A Injection for Lower Face Contouring

The temporary effects of muscle atrophy, followed by chemodenervation due to acetylcholine blockade at the neuromuscular junction by botulinum toxin type A(BTX-A) were mainly used for the treatment of hypertrophied muscle. In the treatment of masseter hypertrophy or cosmetic contouring of the lower face with injection of botulinum toxin type A, these muscle atrophy causes the change of the bite-force inevitably. Although several reports about the histological change of muscle, ultrasound and computerized tomography measurement studies of the change of muscle thickness in the treatment of masseter hypertrophy with injection of BTX-A have become available recently, it is necessary to study further the change of the bite-force and the relationship between the bite-force and clinical effects after the botulinum toxin A injection. The aim of this study was to evaluate the change of maximal bite-forces after botulinum toxin type A injections for treating the contouring of the lower face. Botulinum toxin type A(BTXA(R), Lanzhou, China) of 25U per side was carried out in 7 subjects. The change of maximal bite-forces was evaluated at pre-injection and 2 week, 4 week, 8 week, 12 week post-injections using bite- force measuring machine(MPM-3000, Japan). There were statistically significant differences between pre-injection and 2 week, 4 week, 8 week post-injections(p<0.05). However, there was no significant difference between pre-injection and 12 week post-injection. In conclusion, the change of maximal bite-forces after BTX-A injections according to the period was similar to the histological change of the muscle. The clinical effects last more longer than maximal bite force. Therefore, it is necessary to evaluate further these difference with more larger samples and the relationship between the change of maximal bite force and clinical effects.

Aesthetic and Functional Reconstruction of the Postburn Contracture in the Lower Face and Neck Area using Free Radial Forearm Flap

Often, the burn injury has produced deformities both of the facial contour and the facial cover. The hypertrophic burn scar contracture of the lower face and neck is problematic because it distress the patients, functionally and esthetically. In the correction of the lower face and neck deformities, we should focus our attention not only on the restoration of the normal form and function, but also on the achievement of more beautiful appearance. When there was no available skin adjacent to the deformed area, we reconstructed the deformities with free radial forearm flap. So we can restore the deformed face to near normal shape and get good skin quality with these flaps. There were no remarkable complications after surgeory in all cases. To get better outcome of surgery, we have to consider some points. 1) The release and resurfacing of the neck contracture should be carried out in advance. 2) The lowest margin of the flap should be limited, to at least one-finger breadth above the hyoid bone because low setting of the flap deteriorates the cervicomental angle. 3) Adhesion between the flap dermis and the defect bed may be necessary for reconstruction of dumbbell shaped lower lip subunit. Flaps did not look completely normal, but those were compatible with adjacent skin. We could have an adequate functional resurfacing and optimal esthetic outcomes while minimizing recurrent contracture.

Facial form analysis of the lower and middle face in young Korean women

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.

Facial form analysis of the lower and middle face in young Korean women

Nowadays facial skeletal contouring which have developed in craniofacial surgery, acquired popularity in aesthetic surgery. On planning aesthetic surgery, patient's desire must be considered first but it seems to be essential to have an objective standard of facial form. Anthropometric analysis, cephalometric analysis, and photogrammetric analysis were developed for this purpose but with a limitation in three dimensional analysis. Barnett and Whitaker(1986) developed a simple three dimensional analytic system of middle and lower face and reported average values and standard deviations for young Caucasian women. We performed the same analysis for age matched young Korean women and found some difference between young Caucasian women and young Korean women as follows; 1. Young Korean women's middle and lower face is wider than young Caucasian women's face in horizontal dimension. 2. Young Korean women's middle and lower face is shorter than young Caucasian women's face in anterior-posterior dimension. 3. The difference in vertical dimension between the two groups is minimal. 4. In angular relationship, young Korean women's anterior and inferior angles are larger than young Caucasian women's angles. These findings are coincident with other author's observations that Oriental face is wider and rounder than Caucasian face and Orientals have more prominent malar area and mandible angle. For Korean people, with many needs for aesthetic correction of prominent zygoma and mandible angle, this three dimensional analytic system will be useful in planning surgery and research for middle and lower face deformities.