Preauricular incision outlining during a face-lift: a step-by-step description.

UNLABELLED: The data on the proper way to establish the preauricular incision (PAI) line and manage skin tension during lifting are limited. Undoubtedly, proper tissue handling represents a true challenge during a lifting procedure and is a crucial step in avoiding disfiguration. The authors describe their approach to PAI demarcation and local skin tension management performed in 165 cases since 2007. LEVEL OF EVIDENCE V: This journal requires that 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 at www.springer.com/00266.

Endoscopic saphenous vein harvesting: initial experience and learning curve.

BACKGROUND: Saphenous vein remains an elective conduit for up to 85% of coronary bypass operations. It is obtained through one or numerous skin incisions, with a reported morbidity varying from 5% to 25%. The endoscopic vein harvesting (EVH) technique was developed to minimize this morbidity and to improve clinical outcomes. The aim of this study was to review the feasibility of this method, its learning curve, and changing results in a group without previous experience in this procedure. METHODS: Between July 1998 and October 1999, 179 patients for coronary artery bypass grafting underwent EVH (Vasoview Guidant, USA "double access" and Uniport), by two operators. Results were reported based on time of harvesting, length of conduits, technical details, and clinical outcomes, and divided into six groups of 30 consecutive patients each. RESULTS: Patient demographics were as follows: 86.03% were male, aged 64.3+/-9.12 years (range, 43 to 92 years), with diabetes mellitus in 28.49%, obesity in 18.43%, and vascular disease in 11.17%. The EVH method was limited to the thigh in 77.65% of cases and extended to the leg in 22.35%. Patients received an average of 2.45+/-0.58 incisions and obtained conduits had a mean length of 34.96+/-9.65 cm (range, 15 to 70 cm). The number of venous bypasses per patient was 1.30+/-0.59. Mean time of EVH was 47.24+/-19.84 minutes (range, 15 to 120), with a length-time index of 0.85+/-0.36. Primary success was achieved in 95.54%, with crossover to open technique in 4.46%. General morbidity was 8.9%, with hematoma in 1.11%, skin necrosis in 1.11%, infection in 6.7%, and readmission in 1.11%. CONCLUSIONS: Endoscopic vein harvesting is a feasible and reproducible method, with a typical learning curve, acceptable morbidity, and unquestionable benefits for coronary artery bypass graft patients.

[Vasodilators in isolated human radial arteries]. / Vasodilatadores en arterias radiales humanas aisladas.

This paper was designed to evaluate the effectivity of several vasodilators, applied topically, to attenuate the hyperreactivity of radial arteries (RA) implanted as aorto-coronary bypass. Remnant segments of the RA were obtained from 20 operations, and each of the segments was divided into 4 rings. The rings were incubated for 30 minutes in control conditions (n = 20) or in presence of 30 microM of Diltiazem (DILT, n = 6), 30 microM of mibefradil (MIBE, n = 4) or a mixture of 30 microM of verapamil + 30 microM of nitroglycerin (VP-NTG, n = 6). A subsequent exposure to KCl 80 mM (in absence of vasodilators) evoked a sustained contraction in control rings, which was attenuated by 35 +/- 9% by DILT, 48 +/- 13% by VP-NTG and by 69 +/- 20% by MIBE (p < 0.05). Preincubation with vasodilators also attenuated the rate and intensity of rhythmic contractions of the RA. In rings that were cold-stored during 24 hs and then restimulated with KCl 80 mM the depressing effect was still evident: DILT 53 +/- 6%, VP-NTG 46 +/- 14% and MIBE 61 +/- 9% (p < 0.05). The effect of MIBE was more intense and persistent than that of DILT or VP-NTG, even at concentrations eliciting a similar initial depression of contraction. It is concluded that the exposure to vasodilators during a period equivalent to the duration of the surgical preparation of the RA produces an attenuation of the arterial reactivity that might provide an additional protection against RA spasm during the immediate postoperative period.

Vasodilatadores en arterias radiales humanas aisladas. / [Vasodilators in isolated human radial arteries]

This paper was designed to evaluate the effectivity of several vasodilators, applied topically, to attenuate the hyperreactivity of radial arteries (RA) implanted as aorto-coronary bypass. Remnant segments of the RA were obtained from 20 operations, and each of the segments was divided into 4 rings. The rings were incubated for 30 minutes in control conditions (n = 20) or in presence of 30 microM of Diltiazem (DILT, n = 6), 30 microM of mibefradil (MIBE, n = 4) or a mixture of 30 microM of verapamil + 30 microM of nitroglycerin (VP-NTG, n = 6). A subsequent exposure to KCl 80 mM (in absence of vasodilators) evoked a sustained contraction in control rings, which was attenuated by 35 +/- 9

by DILT, 48 +/- 13

by VP-NTG and by 69 +/- 20

by MIBE (p < 0.05). Preincubation with vasodilators also attenuated the rate and intensity of rhythmic contractions of the RA. In rings that were cold-stored during 24 hs and then restimulated with KCl 80 mM the depressing effect was still evident: DILT 53 +/- 6

, VP-NTG 46 +/- 14

and MIBE 61 +/- 9

(p < 0.05). The effect of MIBE was more intense and persistent than that of DILT or VP-NTG, even at concentrations eliciting a similar initial depression of contraction. It is concluded that the exposure to vasodilators during a period equivalent to the duration of the surgical preparation of the RA produces an attenuation of the arterial reactivity that might provide an additional protection against RA spasm during the immediate postoperative period.

Apendicitis aguda: diagnóstico ecográfico / Acute appendicitis: abdominal ultrasound diagnosis

Entre 1993 y 1995 se realizaron ecografías en 37 pacientes con sospecha clínica de apendicitis aguda y apendicectomizados. Dieciseis pacientes (43 por ciento) del sexo masculino y 21 (57 por ciento) del sexo femenino. Con una sensibilidad del 90 por ciento y una especificidad del 94 la ecografía abdominal es un método complementario accesible, rápido e inofensivo. Se obtuvieron 14 casos (13 por ciento) de laparotomías innecesarias según resultados histopatológicos. El estudio ecográfico es una buena alternativa en búsqueda de un diagnóstico certero. Se investiga la literatura

Apendicitis aguda: diagnóstico ecográfico / Acute appendicitis: abdominal ultrasound diagnosis

Entre 1993 y 1995 se realizaron ecografías en 37 pacientes con sospecha clínica de apendicitis aguda y apendicectomizados. Dieciseis pacientes (43 por ciento) del sexo masculino y 21 (57 por ciento) del sexo femenino. Con una sensibilidad del 90 por ciento y una especificidad del 94 la ecografía abdominal es un método complementario accesible, rápido e inofensivo. Se obtuvieron 14 casos (13 por ciento) de laparotomías innecesarias según resultados histopatológicos. El estudio ecográfico es una buena alternativa en búsqueda de un diagnóstico certero. Se investiga la literatura (AU)

Experience with moderate intensity anticoagulation and aspirin after mechanical valve replacement. A retrospective, non-randomized study.

A selected group of patients who underwent valve replacement were analyzed to evaluate the feasibility, effectiveness and safety of combined treatment with moderate intensity anticoagulation plus aspirin. One hundred ninety-six patients who received a total of 204 mechanical valve prostheses between 1985 and 1991 were selected according to rigid criteria. The prostheses included 124 valves of caged ball design, 62 St. Jude valves and 18 others. The follow up of the whole population was 581.8 patient years, with an average of 2.97 patient years, and was complete by the definition criteria. All patients received moderate intensity anticoagulation with acenocoumarol (target International Normalized Ratio 2.5 to 3.5) and daily aspirin (100 mg or 325 mg). The incidence of thromboembolic events for the whole group was 3.26% per patient year, but only 1.6% in patients "compliant" with treatment. Preoperative embolism and non-compliance with treatment had a strong correlation with postoperative thromboembolism. The INR values had a strong correlation with both thromboembolic and hemorrhagic events. The incidence of serious hemorrhagic events was 4.12% patient years although only two cases (0.34%/pty) were fatal (cerebral hemorrhages). There was no difference in hemorrhagic incidence between patients receiving either 325 mg or 100 mg daily. A low incidence of thromboembolic complications was attained with the use of combined antithrombotic and antiplatelet therapy, even in the first generation caged ball type prostheses. However, the combination of moderate intensity anticoagulation with either 325 mg or 100 mg aspirin was associated with a risk of bleeding similar to high intensity anticoagulation alone. The risk of bleeding appeared to be greater in the presence of gastric pathology, and the combination of anticoagulants and aspirin should be avoided in patients with these conditions.