Evolución de la técnica follicular unit extraction (FUE) / Evolution of the follicular unit extraction (FUE) technique

El microtrasplante capilar, método FUE, es la cirugía para la recuperación capilar que consta en la extracción de unidades foliculares con punches de distintos diámetros y longitudes, desde una zona llamada dadora, generalmente occipital y/o temporal aunque pueden utilizarse otras partes del cuerpo como barba, tórax, abdomen y pubis, para luego de seleccionarse y conservarse en forma adecuada ser implantadas en la llamada zona receptora. Tanto los avances en la técnica como en el uso de instrumental de última generación generan resultados mejores y más naturales, con una recuperación más rápida y menor daño de sus zonas dadoras.

Hair transplant, FUE method, is surgery for hair recovery that consists of the extraction of follicular units with punches of different diameters and lengths, from an area called the donor; usually occipital and/or temporal; although they can be used on other parts of the body such as beard, thorax, abdomen and pubes. After being appropriately selected and preserved, they are implanted in the so-called receiving area. Both advances in technique and in the use of cutting-edge instruments generate better and more natural results, with faster recovery and less damage to the donor areas

Impact of a Meditation Program on Pulse-Wave Velocity, C-reactive Protein and Quality of life / Impacto de un programa de meditación sobre la velocidad de onda de pulso, la proteína C-reactiva y la calidad de vida

background: Although various studies refer to the effect of meditation on blood pressure (BP), its impact on other cardiovascular clinical variables is unknown. Objective: The aim of this study was to evaluate the effects of a meditation program on pulse wave velocity (PWV), quality of life and ultrasensitive C-reactive protein (us-CRP) in patients with ischemic heart disease or chronic heart failure. Methods: This was a randomized study with two groups of patients: a meditation group (M) and an active control group (AC) with cardiovascular health education, evaluating the difference between initial and final values at 12 weeks of B P, PWV, quality of life (assessed by the SF-36 questionnaire) and us-CRP. results: Thirty-five patients were included in the M group and 35 in the AC group; mean age was 61 years and 80% were men. Both groups had similar baseline characteristics, except for higher number of smokers and triglyceride levels in the M group. At 12 weeks, no significant differences were found for ∆PWV: +0.51 (±1.40) in AC and +0.19 (±1.53) in M (p=0.37). Conversely, ∆SF-36 was +0.79 (±7.58) in AC vs. +5.40 (±9.69) (p=0.03) in M, and ∆us-PCR was +1.17 (±2.9) in AC vs. -0.69 (±0.89) in M (p=0.02). Conclusions: A meditation program did not significantly modify PWV at 12 weeks. However, patients allocated to this intervention improved their quality of life and us-PCR was significantly reduced. Larger studies are required to confirm these findings and explore the mechanisms involved in this improvement.

Diagnostic ability of Physical Examination in aortic Valve stenosis / La capacidad diagnóstica del examen físico en la estenosis valvular aórtica

background: Physical examination is essential to detect aortic stenosis but there is scarce information currently available. Objectives: The goal of this study is to evaluate the diagnostic yield of physical examination, the interobserver agreement of clinical signs, and to establish a score to identify severe aortic stenosis. Methods: One-hundred patients were included in the study. Before echocardiographic evaluation, two cardiologists independently evaluated the clinical signs of the physical examination in aortic stenosis. Sensitivity, specificity, and inter-observer agreement were calculated, and the area under the curve was analyzed to develop a score for predicting severe aortic stenosis. results: The decreased intensity of the first heart sound and the crescendo-decrescendo shape of the murmur had sensitivity >90% and specificity <70%. The specificities of an absent second sound, a murmur that peaks later in systole and the presence of a parvus et tardus pulse were >95%, but the sensitivities were <50%. Inter-observer agreement was good for most criteria, except for murmur shape and intensity. The best area under the curve was achieved by the score composed of heart sounds of decreased or absent intensity, duration of the holosystolic murmur, parvus et tardus carotid pulse and a grade 3-4 systolic murmur. Conclusions: Physical examination findings have low sensitivity but good specificity. Inter-observer agreement of clinical signs of severity was moderately good. Correct identification of patients with severe aortic stenosis can be achieved using a simple score.

Clinical and Functional Outcome of Percutaneous alcohol septal ablation in Obstructive Hypertrophic Cardiomyopathy / Resultados clínicos y funcionales de la ablación septal percutánea con alcohol en la miocardiopatía hipertrófica obstructiva

background: Percutaneous septal ablation is a therapeutic option for patients with obstructive hypertrophic cardiomyopathy refrac-tory to optimal medical therapy. However, results of initial persistence and long-term safety are still controversial. Objectives: The aim of this study was to report percutaneous alcohol septal ablation technique, clinical and functional outcome, cardiovascular events and its impact on long-term follow-up. Methods: A total of 23 patients were included in the study. Functional class (FC), left ventricular outflow tract gradient before and after the procedure and long-term cardiovascular events were evaluated. results: Median follow-up was 52 months (IR 33-72). All patients were in FC III or IV prior to the procedure, under maximum tolerated medical therapy. The procedure was successful in 91% of cases, with 85% of patients currently in FC I and 15% in FC II. Baseline left ventricular outflow tract gradient decreased from 75 mmHg (95% CI 51-89) to 25 mmHg (95% CI 10-37) (p <0.003) and with Valsalva maneuver from 118 mmHg (95% CI 88-152) to 38 mmHg (95% CI 16-69) (p <0.0002), persisting in the long-term follow-up. During hospitalization, two patients presented with complete atrioventricular block requiring permanent pacemaker implantation. No cardiovascular deaths occurred during follow up. Conclusions: Alcohol septal ablation is a promising option for the treatment of a selected population with hypertrophic obstructive cardiomyopathy, generating sustained clinical and functional improvement with low incidence of events in the long-term follow up.

Extração de unidades foliculares: transplante capilar sem cicatriz linear / Follicular unit extraction: hair transplant without linear scar

Introdução: A técnica de extração de unidades foliculares (FUE, do inglês follicular unit extraction), de um a três folículos capilares, dispensa a necessidade de ressecção da área doadora na região occipitotemporal e de outros envolvimentos táticos e técnicos para transformar o material adquirido nessas unidades. Estas são obtidas diretamente, sendo extraídas por meio de pequenos cilindros ocos (punches), com diâmetro variando de 0,8 mm a 1mm, mediante incisão circular ao redor de cada unidade folicular no couro cabeludo e, subsequente, extração. Método: Foram avaliados e acompanhados, durante 24 meses, 77 pacientes submetidos a transplante de unidades foliculares, aplicado na correção de áreas de alopecia dos mais diversos tipos (androgênica, em cicatrizes de áreas pilosas, transplantes em supercílios, em pequenas áreas de calvície). Destes, 12 eram do sexo feminino e 65 do masculino, com idades que variavam de 19 a 65 anos; sete pacientes foram operados para correção de cicatrizes inestéticas e alargadas, decorrentes de transplantes capilares anteriores, realizados por técnicas convencionais. Os cuidados transoperatórios na manipulação das unidades foliculares são mais acurados, dada a sutileza de suas estruturas. Resultados: Apesar do tempo cirúrgico aumentado, não existe cicatriz linear e as áreas doadoras são menos visíveis e totalmente camufláveis pelos cabelos adjacentes no período de 3 a 5 dias de pós-operatório, mesmo com os cabelos raspados. Conclusão: O método exige maiores cuidados quanto aos procedimentos táticos e técnicos de manipulação e à obtenção das unidades foliculares.

Introduction: Follicular unit extraction (FUE), which involves harvesting a follicular unit containing between one and three hair follicles, prevents the need for donor area resection in the occipitotemporal region for hair transplantation. This method also avoids the need to dissect the material acquired into follicular units. In this method, the follicular units are directly obtained and extracted using small hollow cylinders (punches) with a diameter of 0.8­1 mm through a circular incision around each follicular unit on the scalp. Method: Over 24 months, we evaluated 77 patients with various forms of alopecia (including androgenic and scarring hair loss, eyebrow loss, and small bald areas) who underwent follicular unit transplant. Twelve patients were women and 65 men, with ages ranging from 19 to 65 years. Seven patients underwent the procedure to correct unsightly and extended scars caused by previous hair transplants performed by conventional techniques. This method requires greater intraoperative care in handling the follicular units to avoid damaging them. Results: Although the surgical time was increased, no linear scarring was observed, and the donor areas were less visible due to being masked by adjacent hairs from 3 to 5 days after surgery. This was the case even with shaved hair. Conclusion: Although this procedure requires greater care in handling and obtaining follicular units, FUE enables hair transplants without a linear scar. As such, this method has many clinical indications.