A new hyaluronic acid polymer in the augmentation and restoration of labia majora.

Aesthetic surgery of female external genitalia has gained increasing popularity over the past decade, with reduction of the labia minora (labiaplasty) being the procedure most commonly requested and performed. Female external genitalia lose elasticity and volume with age, but few studies describe the techniques for labia majora augmentation. Currently, very few studies have investigated the effectiveness and safety of labia majora augmentation with hyaluronic acid (HA) injection. This study aims to evaluate the effectiveness and safety of labia majora augmentation with hyaluronic acid filler injection. We retrospectively analyzed 37 patients affected by hypotrophy of the labia majora, treated with HA dermal filler 28mg/ml PEG crosslinked (Neauvia® Intense Rose, Matex Lab, Switzerland) between May 2015 and July 2016. Global evaluation of the aesthetics of the intimate area and clinical data were investigated with VAS (Visual Analogic Scale) ad hoc. Adverse events and complications were recorded. A total of 37 women affected by labia majora hypotrophy were treated with 28mg/ml HA dermal filler. A significant clinical improvement was observed in the score provided by both patients and doctor. Only mild adverse events and complications were recorded. HA hydrogel with a novel crosslinking agent is able to provide a considerable rejuvenation with a simple outpatient procedure and to bring a significant clinical improvement. HA-based filler infiltration treatment in labia majora is repeatable, has virtually no complications, and is reversible.

Bone mineral density and the risk of fracture in patients receiving long-term inhaled steroid therapy for asthma.

To determine whether high-dose or prolonged inhaled steroid therapy for asthma increases a patient's risk of osteoporosis and fracture, we measured bone density in 26 men and 43 women (41 postmenopausal, all of whom had received supplemental estrogen therapy) after treatment with an inhaled steroid for 10.1 +/- 5.5 years and oral prednisone for 10.7 +/- 9.7 years (mean +/- SD). Most had stopped receiving prednisone since commencing the inhaled steroid therapy. We found that bone densities (adjusted for age and sex to yield a z score) were lower in association with higher daily doses of inhaled steroid (p = 0.013 ANCOVA) and with the duration of past prednisone therapy (p = 0.032). Larger cumulative inhaled steroid doses were associated with higher bone densities (p = 0.002) and a reduction in the numbers of patients at risk of fracture. Bone density also increased with the amount of supplemental estrogen therapy (p = 0.058) and, at equivalent levels of inhaled and oral steroid use, women showed higher bone density z scores than did men. Women with a lifetime dose of inhaled steroid greater than 3 gm had normal bone density regardless of the amount of past or current prednisone use or the current dose of inhaled steroid. These data indicate that the daily dose, but not the duration, of inhaled steroid therapy may adversely affect bone density, and that estrogen therapy may offset this bone-depleting effect in postmenopausal women.

An anatomic, radiographic, and biomechanical assessment of extrapedicular screw fixation in the thoracic spine.

This study performed a thorough review of the pertinent thoracic spine anatomy to determine the appropriate landmarks for extrapedicular screw placement and indentified the anatomic structures at risk; assessed the safety and accuracy of the newly proposed screw insertion technique; determined the stability and strength of this new screw position through biomechanical testing; and analyzed the stability of this extrapedicular screw location with respect to bone mineral density of the vertebra.

Eosinophilic granuloma of the lung presenting as a solitary pulmonary nodule.

A symptomless 58 year old man had an eosinophilic granuloma of the lung that presented as a solitary pulmonary nodule rather than the usual diffuse reticulonodular shadow on the chest radiograph. Only one previous case presenting in this way has been described.

Radiologic investigation of low back pain.

Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to billions of dollars annually. The traditional techniques for anatomic visualization have been plain-film radiography and myelography, but they have limitations. The development of computed tomography and magnetic resonance imaging have substantially improved anatomic imaging. However, invasive procedures, such as discography, percutaneous nerve-root blocking and percutaneous facet injection, may be helpful in patients with disabling pain in whom noninvasive methods give negative findings, show abnormalities that do not correlate with the symptoms or identify multiple sites of disease. The invasive procedures are believed by some to be associated with too many complications. We have attempted to clarify the strengths and weaknesses of the currently available methods of investigating low back pain and the indications for their use.

Longitudinal stress fracture of the tibia: case report.

Stress fractures usually present with vague clinical features and delayed radiographic findings. A patient with a longitudinal stress fracture of the tibia is described here. Computed tomographic images, perpendicular to the fracture, were diagnostic while plain radiographs and scintigraphy showed nondiagnostic changes due to an unexpected fracture pattern.

Radiocarpal arthroscopy and arthrography in the diagnosis of ulnar wrist pain.

The purpose of this prospective study was to compare arthroscopy with arthrography in the diagnosis of ulnar wrist pain. Thirty-seven consecutive patients with ulnar wrist pain but normal routine and stress radiographs had dynamic and static radiocarpal arthrograms (R.G.H.) and arthroscopy (J.H.R.) performed. Sixteen arthrograms demonstrated a leak of contrast into the distal radioulnar joint. Arthroscopy demonstrated a perforation of the triangular fibrocartilage complex in all 16. Seven arthrograms demonstrated a leak of contrast into the midcarpal joint. Arthroscopy demonstrated lunotriquetral instability in two and no abnormality in five. Seventeen arthrograms showed no abnormality. Arthroscopy confirmed no abnormality in nine but also demonstrated seven triangular fibrocartilage perforations and one case of isolated lunate chondromalacia. Arthroscopy findings were confirmed in eight patients who underwent a subsequent arthrotomy. Radiocarpal arthroscopy is superior to arthrography in the diagnosis of chronic ulnar wrist pain.

Budd-Chiari syndrome with inferior vena cava obstruction associated with systemic lupus erythematosus.

The Budd-Chiari syndrome is an uncommon condition in which hepatic venous outflow is obstructed by thrombosis of the major hepatic veins. Many of the cases are idiopathic, but it has been described in association with vena caval webs, abdominal trauma, retroperitoneal neoplasms, and hypercoagulable states. A patient with systemic lupus erythematosus (SLE) who developed the Budd-Chiari syndrome with inferior vena cava thrombosis led to a review of the possible association between SLE and the Budd-Chiari syndrome. The therapy of the Budd-Chiari syndrome with associated vena cava thrombosis is also discussed.

Identifying postmenopausal patients at risk of significant bone loss.

Bone loss is a major cause of morbidity in elderly women; however, recent evidence suggests that osteoporosis need not be the inevitable consequence of aging. Family physicians must therefore identify women at risk of osteopenia and initiate treatment aimed at preventing or delaying further reduction in bone mass. To identify patients at risk of osteopenia, radiographic measurements of the radius and second metacarpal were made in 77 postmenopausal women attending a family medical centre; 34 patients were Indian and 43 were Caucasian. Using either the measurement of the radius or the second metacarpal, 75% of the Indian women and 50% of the Caucasian women had demonstrable bone loss. X-ray of either the second metacarpal or radial head can be useful in identifying females with significant reduction in bone mass.