The vertical midface lift. An improved procedure.

We describe a novel procedure for an anatomically-based face lift to correct vertical vectors in the ageing face. It has the advantage of surgical simplicity, minimal tissue removal and minimal risk. It provides an effective readjustment of cheek volume and correction of periorbital hollowness. Natural facial expression is preserved largely because there is no change in the position of the lateral canthus. The cheek is mobilised subperiosteally through a blepharoplasty incision. A second dissection is made via a short temporal incision, to join the infraorbital dissection. A Hagedorn needle is then inserted through a point inferior to the lateral canthus and in line horizontally with the nasal ala. It is passed to the orbital incision, charged with a loop of suture material, and pulled down again to the cheek incision, from where it is pushed back to the orbit to suspend the cheek. The upper border of orbicularis oculi is fixed firmly to the temporalis aponeurosis at the level of the temporal incision. We now frequently use an Endotine Midface device for fixation. Of the first 150 patients, results were excellent or good in 145. This represents a revival of the subperiosteal mask lift, and abandons the use of endoscopic techniques. In spite of its simplicity, the operation involves subperiosteal dissection as well as delicate eyelid surgery that necessitate plastic surgical skill.

Maternal smoking during pregnancy and nicotine and cotinine concentrations in maternal and neonatal hair.

OBJECTIVE: Conflicting data have been reported in the association between maternal smoking and adverse effects during pregnancy and in neonates. Some studies, conducted on a limited number of patients have evaluated maternal consumption and fetal exposure by measuring nicotine and cotinine in the hair. Our aims were to evaluate the relationship among maternal cigarette consumption, fetal smoking exposure and outcome of pregnancy in a population of pregnant women who smoked. DESIGN: Mothers smoking during pregnancy were included at their first prenatal visit and followed prospectively. Maternal data (demographic variables, obstetrical history and cigarette consumption), neonatal data and birth indicators (number of weeks of gestation, type of delivery, weight) were collected. Hair samples from the mothers and the babies were collected at birth. SETTING: The present study was conducted in the Department of Obstetrics of the University Hospital Robert Debré in Paris. POPULATION: A total of 254 women smokers were included in the study and 182 mother/neonate pairs were analyzed after exclusion of 50 babies whose hair samples were inadequate and 22 for various other reasons. METHODS: Nicotine and cotinine concentrations in the maternal and neonatal hair were measured at birth by radio-immunoassay. MAIN OUTCOME MEASURES: Cigarette consumption was based on self reporting and quantified each trimester. It was expressed more precisely during the third trimester by the mean number per cigarette per day. Nicotine and cotinine concentrations in the maternal and neonatal hair at birth were also analysed. RESULTS: Nicotine and cotinine concentrations in maternal hair were associated with cigarette consumption during the third trimester of pregnancy (P < 0.003 and P < 0.01, respectively). In neonates, only cotinine concentrations were associated to maternal cigarette consumption (P < 0.0001). This association remained significant in a multivariate analysis, which included maternal cotinine hair concentrations and the ethnic group. CONCLUSIONS: Our results have shown a strong relationship between maternal cigarette consumption and fetal exposure to smoking measured by cotinine concentrations in neonatal hair. Further studies are required to look for associations between fetal exposure and adverse pregnancy outcome.

Stable correction of antimongoloid deformity of the external canthus.

The antimongoloid deformity comprises inferior dystopia of the lateral canthus. It causes a sad looking appearance, inferior scleral show and laxity of the lower eyelid. Many different procedures have been described to correct this deformity. We believe that a stable and lasting correction can be achieved using a coronal-approach subperiosteal mask-lift, combined with DMAS (Deep Musculo-Aponeurotic System) suspension of a temporo-masseteric anchor-flap (instead of a simple canthoplasty). If bony augmentation of the cheek bones is required, we use an autograft of cartilage of the concha of the ear. While this 'orthomorphic' procedure is primarily applied in esthetic cosmetic surgery, it can also be used to correct deformities in reconstructive surgery.

[Cardiac consequences of adolescent anorexia nervosa]. / Conséquences cardiaques de l'anorexie mentale de l'adolescence.

Cardiac complications are common in adolescent anorexia nervosa and are the cause of a third of deaths. Some workers have reported prolongation of the QT interval and cases of sudden death in these patients. The aim of this study was two-fold: to assess the cardiac complications of anorexic adolescents and to determine the outcome after renutrition in the hospital setting. This was a prospective study of 48 consecutive cases (45 girls) with an average age of 14 +/- 2 years, admitted to the paedopsychiatric unit and fulfilling the DSM-IV criteria of anorexia nervosa. The digitised ECG, Holter ECG and echocardiography were recorded before and after renutrition. Anorexia nervosa was severe with a body mass index < 14 in 2/3 of cases. Over 2/3 of patients had bradycardia with a heart rate < 50/min in half the cases but normal chronotropic function on Holter monitoring. Prolongation of the QTc interval was demonstrated (QTc > 440 ms in 11/44 cases). Echocardiographic abnormalities, in particular left ventricular dysfunction (24/46) and pericardial effusion (12/46) were reversible after renutrition. There were no clinical or biological predictive factors for the occurrence of cardiac complications on admission. The authors confirm that cardiac complications of anorexia nervosa are common, usually benign and always reversible after renutrition in hospital. Therefore, most electrical abnormalities normalise with the heart rate and echocardiographic abnormalities with improvement of conditions of load.

Notched T waves on Holter recordings enhance detection of patients with LQt2 (HERG) mutations.

BACKGROUND: The 2 genes KCNQ1 (LQT1) and HERG (LQT2), encoding cardiac potassium channels, are the most common cause of the dominant long-QT syndrome (LQTS). In addition to QT-interval prolongation, notched T waves have been proposed as a phenotypic marker of LQTS patients. METHODS AND RESULTS: The T-wave morphology of carriers of mutations in KCNQ1 (n=133) or HERG (n=57) and of 100 control subjects was analyzed from Holter ECG recordings. Averaged T-wave templates were obtained at different cycle lengths, and potential notched T waves were classified as grade 1 (G1) in case of a bulge at or below the horizontal, whatever the amplitude, and as grade 2 (G2) in case of a protuberance above the horizontal. The highest grade obtained from a template defined the notch category of the subject. T-wave morphology was normal in the majority of LQT1 and control subjects compared with LQT2 (92%, 96%, and 19%, respectively, P:<0.001). G1 notches were relatively more frequent in LQT2 (18% versus 8% [LQT1] and 4% [control], P:<0.01), and G2 notches were seen exclusively in LQT2 (63%). Predictors for G2 were young age, missense mutations, and core domain mutations in HERG. CONCLUSIONS: This study provides novel evidence that Holter recording analysis is superior to the 12-lead ECG in detecting G1 and G2 T-wave notches. These repolarization abnormalities are more indicative of LQT2 versus LQT1, with G2 notches being most specific and often reflecting HERG core domain missense mutations.

Macronutrient energy intake and adiposity in non obese prepubertal children aged 5-11 y (the Fleurbaix Laventie Ville Santé Study).

OBJECTIVE: To investigate associations between adiposity indices and food intake in nonobese prepubertal free-living children. SUBJECTS: Five-hundred and one children, 280 boys and 221 girls aged 5-11 y in two little towns in northern France. DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: Height and weight, four skinfolds (biceps, triceps, subscapular, suprailiac), waist and hip girths, were measured. Sum of skinfolds (SSF), body mass index (BMI), and relative weight (RW) were calculated. Energy intake (EI), percentage of energy intake ascribed to carbohydrates (%EIC), complex carbohydrates (%EICC), fats (%EIF), saturated fats (%EISF) and proteins (%EIP) were assessed by a single 24 h record. Basal metabolic rate (BMRI was estimated according to Schofield's equations. Obese (RW > or = 120%), and underreporting children according to Goldberg's and Black's equations were excluded. RESULTS: In multiple linear regressions analyses performed with hierarchical mixed models, adiposity indices were significantly and inversely associated in girls with %EIC (all P-values < 0.02), and positively with %EIF (all P-values < 0.05, waist girth and BMI excepted). Similar but non-significant trends were observed in boys. The relationships were not linear, and thresholds close to current dietary recommendations were highlighted. When %EIF was low, a lower percentage of energy intake ascribed to %EISF was associated with thinness. These associations remained after the exclusion of children who had an EI/BMR > or = 1.50. CONCLUSIONS: In nonobese prepubertal children aged 5-11 y, a high %EIC, close to dietary recommendations (> or = 55%), was associated with thinness. A high %EIF, over the upper dietary recommendation (< or = 35%), was associated with a greater adiposity thickness. There was no further increase in adiposity beyond this threshold. Reasons for the absence of a linear relationship pattern between adiposity and macronutrient intake remain to be determined.

Analgesia en procedimientos fotorrefractivos. Una comparación entre gotas, escudos de colágeno y lentes de contacto desechables / Analgesy in photorefractive procedure. A comparison betwen drops, collagen shields and disposable contac lens

Propósito: Comparar los diferentes métodos de uso del Ketorolac para obtener analgesia postoperatoria en pacientes operados con el procedimiento de PRK (por sus siglas en inglés) para miopía. Materiales y métodos: En este estudio prospectivo se incluyó a un grupo de 45 pacientes de forma aleatoria en tres grupos de tratamiento: Grupo A: Gotas cada 2 horas y parche. Grupo B: Lente de contacto blando impregnado. Grupo C: Escudos de colágeno empapados. Se diseñó un formulario de evaluación y se pidió a los pacientes que contestaran por sí mismos en relación con sus sintomatologías en intervalos de 4, 8, 12, 24 y 48 horas. Se realizó evaluación por el observador a las 24 y 48 horas. Resultados: Para todos los grupos el intervalo donde se experimentó el nivel de dolor más alto fue entre las 8 y las 12 horas. Unicamente en el grupo A, el nivel de dolor medio fue severo. Los grupos B y C mostraron dolor medio y moderado respectivamente. Otras molestias fueron experimentadas, principalmente en los grupos A y C, de los cuales el principal fue sensación de cuerpo extraño. Conclusiones: Los lentes de contacto (escudos de colágeno o desechables) empapados con ketorolac y con gotas cada dos horas con el mismo analgésico, parece ser el mejor tratamiento para controlar el dolor postoperatorio en pacientes a quienes se les practicó queratectomía fotorrefractiva (PRK).

Trends in the prevalence of obesity in the French adult population between 1980 and 1991.

OBJECTIVE: To determine changes in the prevalences of overweight and obesity between 1980 and 1991 in French adults. DESIGN: Two cross-sectional studies were performed in 1980 and 1991 by the French National Institute of Statistics and Economics Studies in representative samples of the non-institutionalized French population using a similar random sampling of households from the last available national population census. Overweight and obesity were defined, based on reported height and weight, by a body mass index (BMI)> or = 25 kg/m2 and > or = 30 kg/m2, respectively. As age and socio-economic class (SEC) distributions changed between 1980 and 1991, results were compared before and after a direct age class and SEC standardization of the 1991 data, according to the 1980 population distribution. SUBJECTS: 6792 men and 7150 women in 1980, 7250 men and 7856 women in 1991, aged at least 20y, about 1/2500th of the French non-institutionalized adult population. RESULTS: In women, between 1980 and 1991, there were slight increases in the prevalences of obesity (from 6.3% to 7.0%, P<0.08) and of overweight (26.8% and 27.5%, not statistically significant NS). These increases were most pronounced in women aged 20-29y (obesity: 1.4-2.1%, P<0.15; overweight: 8.0-11.5%, P<0.01). In men, the corresponding prevalences were 6.4% and 6.5%, (NS), and 39.4% and 40.8% (NS). After standardization, the increases in the prevalences of obesity and overweight were even higher between 1980 and 1991 in women (the standardized prevalences in 1991 were respectively: 7.8% and 28.9%), but were unchanged in men. CONCLUSIONS: There were slight overall increases in the prevalences of overweight and obesity between 1980 and 1991 in both genders, which were most pronounced among young women. Changes in the age and SEC distribution in the French population have limited the increase in the prevalences of overweight and obesity in women. These results, based on reported data, may underestimate the prevalences of overweight and obesity and their increase. Nevertheless, the prevalences of reported obesity are similar to those of other European countries, such as Sweden and The Netherlands, and lower than in the UK, USA and Canada.

Ultrasonically assisted lipectomy in aesthetic breast surgery.

A case report of a young patient with marked asymmetry treated successfully with ultrasonically assisted lipectomy with a good functional cosmetic result, undetectable scars, and mammographic control and showing no ill-effect on the breast parenchyma is presented. Further studies and follow-up are needed to confirm the value and advisability of using ultrasonic energy in the female breast.

Subperiosteal facelifting: complications and the dissatisfied patient.

As endoscopic subperiosteal lifting of the upper face is explored, it may significantly limit the indications for the open approach. However, this report is based on our combined large experience and long follow-up in open bicoronal subperiosteal lifting. The combined experience of four surgeons in four countries with an open subperiosteal approach to lifting of the upper face in 545 patients is described. The complications of the procedure, both common and rare, and techniques to avoid untoward effects are discussed. Reasons for patient dissatisfaction are addressed. Based on their evaluation of results and complications of the surgery over a 6-year period (1986-1992), we conclude that subperiosteal lifting is an effective, reliable, reproducible, and safe operation.

[Breast reconstruction by abdominis musculocutaneous flap].

Breast reconstruction was carried out with rectus abdominis musculocutaneous flap on 7 women (8 breasts) with defect of breast, and perfect result was obtained on all the patients. The flap which was normally excised in an abdominal lipectomy was used to cover the defect of breast. The rectus abdominis of the flap was used to fill the reconstractive breast and to carry the vascularization from the internal mammary artery. The advantages of the method are as follow: (1) the waist-line is reduced by closing the musculoaponeurtic defect; (2) The scar of the donor area is well hidden by the abdominoplasty; (3) The breast reconstruction need not use an implant. The disadvantage is a risk of postoperative herniation if the suture tears.