[Complications of body lifts]. / Complications des body lifts.

Many complications can occur after body lift surgery if the surgeon does not follow the rules. These complications can be general or only local and aesthetic but anyway very difficult to fix. Therefore, the surgeon must know the very efficient ways to avoid them. We will describe more precisely acute anemia, fat necrosis followed with infection and wound dehiscence, violin deformation and finally intergluteal groove lengthening.

Occurrence of pesticides in Dutch drinking water sources.

We determined pesticide occurrence in groundwater and surface water sources used for drinking water production in The Netherlands, using both routine monitoring data from Dutch drinking water companies and by studying the presence of newly authorized pesticides in drinking water sources. An analytical LC-MS/MS method was developed for 24 recently authorized pesticides, selected based on their mobility and persistence, and applied in a Dutch/Belgian ground- and surface water monitoring campaign. 15 of these pesticides were detected, including seven in concentrations above the water quality standard from the Water Framework Directive. Two neonicotinoids were detected in highest concentrations: acetamiprid (1.1 µg/L) and thiamethoxam (0.4 µg/L). The routine monitoring data was collected over 2010-2014 in The Netherlands, covering 408 pesticides and 52 metabolites. 63 pesticides and 6 metabolites were prioritized according to their presence in groundwater, surface water and drinking water. The vast majority of the pesticides in routine monitoring has not been detected or only in low concentrations. Overall, the study shows that pesticides are of major concern in drinking water sources across the Netherlands. In two third of the abstraction areas pesticides and/or metabolites have been detected. In one third of the abstraction areas pesticide and/or metabolites concentration exceeded water quality standards according to the Water Framework Directive. The results emphasize that monitoring should focus on priority pesticides, since the vast majority of the pesticides has a low priority. The occurrence of recently authorized pesticides in drinking water sources demonstrates the importance to keep routine monitoring methods up to date.

Analytical assessment about the simultaneous quantification of releasable pharmaceutical relevant inorganic nanoparticles in tap water and domestic waste water.

For pharmaceutical applications, the use of inorganic engineered nanoparticles is of growing interest while silver (Ag) and gold (Au) are the most relevant elements. A few methods were developed recently but the validation and the application testing were quite limited. Therefore, a routinely suitable multi element method for the identification of nanoparticles of different sizes below 100 nm and elemental composition by applying asymmetric flow field flow fraction (AF4) - inductively coupled plasma mass spectrometry (ICPMS) is developed. A complete validation model of the quantification of releasable pharmaceutical relevant inorganic nanoparticles based on Ag and Au is presented for the most relevant aqueous matrices of tap water and domestic waste water. The samples are originated from locations in the Netherlands and it is of great interest to study the unwanted presence of Ag and Au as nanoparticle residues due to possible health and environmental risks. During method development, instability effects are observed for 60 nm and 70 nm Ag ENPs with different capping agents. These effects are studied more closely in relation to matrix effects. Besides the methodological aspects, the obtained analytical results and relevant performance characteristics (e.g. measuring range, limit of detection, repeatability, reproducibility, trueness, and expanded uncertainty of measurement) are determined and discussed. For the chosen aqueous matrices, the results of the performance characteristics are significantly better for Au ENPs in comparison to Ag ENPs; e.g. repeatability and reproducibility are below 10% for all Au ENPs respectively maximal 27% repeatability for larger Ag ENPs. The method is a promising tool for the simultaneous determination of releasable pharmaceutical relevant inorganic nanoparticles.

Different compositions of pharmaceuticals in Dutch and Belgian rivers explained by consumption patterns and treatment efficiency.

In the current study, 43 pharmaceuticals and 18 transformation products were studied in the river Meuse at the Belgian-Dutch border and four tributaries of the river Meuse in the southern part of the Netherlands. The tributaries originate from Belgian, Dutch and mixed Dutch and Belgian catchments. In total, 23 pharmaceuticals and 13 transformation products were observed in samples of river water collected from these rivers. Observed summed concentrations of pharmaceuticals and transformation products in river water ranged from 3.5 to 37.8 µg/L. Metformin and its transformation product guanylurea contributed with 53 to 80 % to this concentration, illustrating its importance on a mass basis. Data on the flow rate of different rivers and demographics of the catchments enabled us to calculate daily per capita loads of pharmaceuticals and transformation products. These loads were linked to sales data of pharmaceuticals in the catchment. Simple mass balance modelling accounting for human excretion and removal by sewage treatment plants revealed that sales could predict actual loads within a factor of 3 for most pharmaceuticals. Rivers that originated from Belgian and mixed Dutch and Belgian catchments revealed significantly higher per capita loads of pharmaceuticals (16.0 ± 2.3 and 15.7 ± 2.1 mg/inhabitant/day, respectively) than the Dutch catchment (8.7 ± 1.8 mg/inhabitant/day). Furthermore, the guanylurea/metformin ratio was significantly lower in waters originating from Belgium (and France) than in those from the Netherlands, illustrating that sewage treatment in the Belgian catchment is less efficient in transforming metformin into guanylurea. In summary, the current study shows that consumption-based modelling is suitable to predict environmental loads and concentrations. Furthermore, different consumption patterns and wastewater treatment efficiency are clearly reflected in the occurrence and loads of pharmaceuticals in regional rivers.

A single N-acetylgalactosamine residue at threonine 106 modifies the dynamics and structure of interferon α2a around the glycosylation site.

Enzymatic addition of GalNAc to isotopically labeled IFNα2a produced in Escherichia coli yielded the O-linked glycoprotein GalNAcα-[(13)C,(15)N]IFNα2a. The three-dimensional structure of GalNAcα-IFNα2a has been determined in solution by NMR spectroscopy at high resolution. Proton-nitrogen heteronuclear Overhauser enhancement measurements revealed that the addition of a single monosaccharide unit at Thr-106 significantly slowed motions of the glycosylation loop on the nanosecond time scale. Subsequent addition of a Gal unit produced Gal(ß1,3)GalNAcα-[(13)C,(15)N]IFNα2a. This extension resulted in a further decrease in the dynamics of this loop. The methodology used here allowed the first such description of the structure and dynamics of an O-glycoprotein and opens the way to the study of this class of proteins.

Screening and human health risk assessment of pharmaceuticals and their transformation products in Dutch surface waters and drinking water.

Numerous studies describe the presence of pharmaceuticals in the water cycle, while their transformation products are usually not included. In the current study 17 common pharmaceuticals and 9 transformation products were monitored in the Dutch waters, including surface waters, pre-treated surface waters, river bank filtrates, two groundwater samples affected by surface water and drinking waters. In these samples, 12 pharmaceuticals and 7 transformation products were present. Concentrations were generally highest in surface waters, intermediate in treated surface waters and river bank filtrates and lowest or not detected in produced drinking water. However, the concentrations of phenazone and its environmental transformation product AMPH were significantly higher in river bank filtrates, which is likely due to historical contamination. Fairly constant ratios were observed between concentrations of transformation products and parent pharmaceuticals. This might enable prediction of concentrations of transformation products from concentrations of parent pharmaceuticals. The toxicological relevance of the observed pharmaceuticals and transformation products was assessed by deriving (i) a substance specific provisional guideline value (pGLV) and (ii) a group pGLV for groups of related compounds were under the assumption of additivity of effects within each group. A substantial margin exists between the maximum summed concentrations of these compounds present in different water types and the derived (group) pGLVs. Based on the results of this limited screening campaign no adverse health effects of the studied compounds are expected in (sources of) drinking water in the Netherlands. The presence of transformation products with similar pharmacological activities and concentration levels as their parents illustrates the relevance of monitoring transformation products, and including these in risk assessment. More thorough monitoring yielding information on statistical uncertainty and variability in time and space, and research on possible synergistic effects of low concentration mixtures of compounds belonging to similar pharmacological classes require attention.

[French creativity in body contouring surgery]. / La créativité française en chirurgie de la silhouette.

Since the end of (XIX)th century, many French surgeons have contributed in body contouring surgery evolution. In this article, the authors outline the most essential innovations as the invention of inflatable mammary implants by H.-G. Arion or fat remodeling surgery revolutionized with liposuction by Y.-G. Illouz. The authors end with a field, which is undergoing rapid changes: excess skin surgery. Before 2000, this surgery was known for its complications: necrosis, prolonged effusions, bad scarring. It was imperative to innovate since demand is exponential as the worldwide spread of obesity and massive weight loss which results from it.

The concentric medial thigh lift.

Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.

[Outline surgery after massive weight lossing or gastroplasty]. / Chirurgie de la silhouette et gastroplastie.

The silhouette surgery in case of obesity or after gastroplasty and massive weight loss is near the usual outline surgery. However, many differences shall be well-known: more and more cases appear and demand is rapidly growing. The main demand for surgery is aesthetical improvement. The development of gastroplasty has greatly increased the demand of this outline surgery. At the beginning of gastroplasty, plastic surgeons sent pathological obeses to the first "gastroplastician" visceral surgeons. Now, after massive weight loss (over 60 kg), general health is improved, but aesthetical aspect is often worsened; so the patients turn back to the plastic surgeons. The therapeutical program associated combined surgeries, for example: breast plasty and abdominoplasty performed during the same procedure or important and multilocular lipoaspirations. Large skin excess and persisting over weight influence surgical procedure. A strict preoperative planning is mandatory to obtain safe, quick and satisfying result. Preoperative informations concerning results and postoperative evolution (like, for example, the possibility of blood transfusion, infection and scars em leader ) are very important. Usually, five procedures will be necessary over a 3 or 4-years period of time: abdominoplasty, body-lifting, arm and thigh-lifting, breast surgery for ptosis, hyper- or hypotrophia of the chest, lipoaspirations and, in a few cases, face lifting em leader. We describe this so particular outline surgery, its techniques and usual evolution.

Remodeling bodylift with high lateral tension.

Body lifts are surgical procedures that are infrequently performed because the length of operating time increases the risk to the patient as well as the likelihood of surgeon fatigue. The other drawback of body lifts is the long incision line. However in our experience, these incisions are well accepted if they are well placed and if the results of body change is significant. The goal of this paper is to show how operating time can be shortened and the scar be correctly positioned by using precise preoperative markings. In addition to high superior tension abdominoplasty, the two innovations of this type of body lift are the dermal fat flap and the suspension of tissue in the trochanteric and buttock regions. Meticulous hemostasis limited undermining, and the closure of dead space are factors that produce a more reliable procedure, both in terms of postoperative problems and the final results.

High superior tension abdominoplasty.

Although abdominoplasty has always been a routine operation, demands for it are constantly increasing for diverse reasons. For one, stomach reduction practiced by digestive surgeons is becoming a regular procedure. Massive weight loss induced by this surgery leads to a demand for abdominoplasty with increased risks of a difficult postoperative period and complications. In addition, more and more patients are looking for an improvement of a moderate cutaneous excess following pregnancy. In this case, standard abdominoplasty technique does not permit a sufficient skin resection and the surgeon must perform a vertical below umbilical scar and an insufficient epigastrium tension. Finally, a hematic or lymphatic collection is obviously undesirable and can lead to an aesthetic disaster. For these reasons, surgeons, more than ever, need a reliable technique that adapts to those different situations.

The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap.

This paper describes the use of a new island flap based on the submental artery. Previously described cervical flaps have inherent problems ranging from limited mobility to unacceptable donor-site scars, to unpredictable outcomes. The flap design and technique were studied on 20 fresh cadavers and 8 patients who underwent radical neck dissections. The flap was then used successfully for reconstruction of orofacial defects in 8 patients. The flap has a long (up to 8 cm), reliable pedicle, and cutaneous dimensions can reach up to 7 x 18 cm. It can be used as a cutaneous, musculofascial (cervicofascial and platysma), or osteocutaneous flap. This flap has an excellent skin color match and a wide arc of rotation, and can extend to the whole homolateral face, except for a part of the forehead and the whole oral cavity. The anatomy, the technique, and clinical experiences are presented.

[Role of osteocutaneous external brachial flap in the treatment of composite loss of substance of the mandible]. / Place du lambeau ostéo-cutané brachial externe dans le traitement des pertes de substance composites de la mandibule.

The authors report on their research begun in 1987 on this flap and its uses in reconstruction of composite defects of the horizontal and symphysical parts of the mandible, regardless of the cause of the loss. For treatment of average sized defects (less than 7 centimeters), it is reliable flap, easy to remove and to model by osteotomies, giving a thin skin mobile with bone and the removal of which results in only moderate development of scar tissue at the donor site.

[Malignant fibrous histiocytoma of the maxillary sinus. Clinical and therapeutic aspects]. / Histiocytome fibreux malin du sinus maxillaire. Aspects cliniques et thérapeutiques.

Malignant fibrous histiocytomas, or MFH, have been individualized only since the last two decades. These sarcomas which usually develop from soft tissues are no longer considered rare, except in some of their facial sinus localizations. Two chapters will be particularly developed: the paramount significance of anatomopathological investigations owing to the difficulty in establishing the diagnosis, since MFHs may be mistaken for benign processes; the treatment which is, generally speaking, the same as for bone sarcomas.