A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Comparison Between Lipofilling and a Nonabsorbable Filler for Facial Wasting Rehabilitation in HIV-Positive Patients

Background: Several treatments have been described for facial wasting rehabilitation in HIV-positive patients. In this article, we compare lipofilling and a nonabsorbable filler for facial wasting rehabilitation induced by antiretroviral therapy in HIV-positive patients. Methods: This study was conducted as a clinical prospective study. Twenty-three HIV-positive patients affected by facial wasting were treated for facial rehabilitation, between January 2007 and December 2008, at the Head and Neck Department of the II University of Naples. They were divided into 2 groups; the first group was treated with lipofilling (group A), and the second one with the injection of a nonabsorbable filler, Aquamid reconstruction (Contura International A/S, Soeborg, Denmark) (group B). All the patients were HIV-positive, they had been receiving antiretroviral therapy for several years (1.8-6.7 years, 3.2 years on average) and showed clinical signs of facial lipoatrophy. Group A was composed of 14 patients (9 men, 5 women; mean age, 43.7 years), all presenting facial wasting and lipohypertrophied areas of the body. Group B was composed of 9 male patients, 7 presenting only facial wasting, and 2 presenting lipohypertrophied areas of the body (mean age, 44.8 years). Clinical efficacy was assessed independently by the investigator and the patient, 3 months, 6 months, and 1 year after baseline. The main assessment was made by the investigator using the Global Aesthetic Improvement Scale (GAIS) 1 year after baseline; secondary assessment using the GAIS was made by the investigator and the patient 6 months after baseline. Results: There were no major complications. No infections or other complications were observed. According to GAIS ratings, group A (lipofilling) obtained significantly higher ratings than did group B (nonabsorbable filler) after baseline (P < 0.05). Conclusions: We can treat HIV-related lipodistrophy more extensively with lipofilling because, after harvesting the fat graft, other body contouring procedures also can be performed; there is a better aesthetic outcome in facial rehabilitation performed with lipofilling, probably due to the possibility to fill deeper than with nonabsorbable fillers

An Adipocitolitic Aqueous Micro-Gelatinous Solution for Buffalo Hump Deformity Reduction

Buffalo hump is a manifestation of HIV related lipodistrophy, it is characterized by an enlargment of dorsocervical fat pad and is distressing for patients. Surgical correction until a few years ago was the only option for treatment, however in last years non surgical corrections was carried out with minimally invasive techniques. Authors report this case that describe a longer follow up of an already published study were this deformity was treated with the injection of an adipocitolitic aqueous micro-gelatinous solution and during all the follow up no relapse was observed

The Outcome of Primary Subglandular Breast Augmentation Using Tumescent Local Anesthesia.

BACKGROUND: Tumescent local anesthesia (TLA) technique to obtain regional anesthesia and vasoconstriction of the skin and subcutaneous tissues is routinely adopted for several plastic surgery procedures. Here, we describe the use of TLA in primary subglandular breast augmentation. This series evaluates advantages and disadvantages of TLA in elective augmentation breast surgery as well as patients' response to this procedure. METHODS: Between December 2008 and November 2011, 150 patients underwent bilateral primary subglandular breast augmentation under TLA and conscious sedation in the presence of a board-certified anesthesiologist. Midazolam 0.05 mg/kg IV and ranitidine 100 mg IV were given as premedication. Tumescent local anesthesia was composed of 25 mL of lidocaine 2%, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% NS. The solution was delivered between the pectoral fascia and the mammary gland via a spinal needle. After infiltration, 45 minutes were allowed before surgery for local anesthetic effects to take place. RESULTS: The mean age of the patients was 34.3 years. The average amount of tumescent solution infiltrated was 1150 mL, with a maximal dose of 17 mg/kg of lidocaine used. Operating time was 45 minutes and recovery room time averaged 125 minutes. Minor complications were found in a total of 9 (5.3%) patients, with no main surgery-related complications such as hematoma or seroma formation. CONCLUSIONS: Breast augmentation under TLA and conscious sedation proved to be safe in the presence of a board-certified anesthesiologist and when performed with meticulous surgical technique

A modified alar cinch suture technique

Widening of the alar base following total maxillary osteotomy is a well-known phenomenon. This change in the nasal morphology can compromise the facial aesthetics of the patient. Alar cinching through the vestibular incision used for maxillary osteotomy appears to be a simple and convenient means to narrow the alar base. We present a modified alar base cinch suturing technique and compare it with the published techniques in the literature. © 2009 Springer-Verlag

Microsurgical anastomosis with the 'PCA' technique.

BACKGROUND: In this study, we introduce a new microvascular anastomosis technique called 'PCA' (Posterior wall first--Continuous interrupted--Airborne). The conventional microvascular anastomosis (CI), with single interrupted stitches, requires a long time to be completed, as each suture must be tied before starting the following stitch. Surgeons are often searching to reduce microsurgery time, particularly when there are multiple vessels to be anastomosed or when there is a prerequisite for the ischemia time to be quick. METHODS: The authors conducted a comparative study of PCA and CI on 40 Wistar-albino rats. The femoral arteries and veins of each rat were used, resulting in a total of 160 vessels, with a diameter of 0.8 to 1mm. The rats were divided into two groups. Patency rates were compared between the two groups, using the chi-square test. The times required to perform the anastomosis were compared using the Student's t test. A p value<0.001 was considered significant. RESULTS: The mean time required for microvascular anastomosis of the femoral arteries was 22 minutes (mins) and 46 seconds (secs) in the PCA group, and 28 mins and 50 secs in the CI group. The mean time required for microvascular anastomosis of veins was 19 mins and 20 secs in the PCA group, and 23 mins and 36 secs in the CI group. CONCLUSION: The combination of the three different techniques (posterior wall first, continuous-interrupted, and airborne), used for the microvascular anastomosis, is safe, secure, and time-saving. The advantages of this combined method are the benefits of a single stitch, the increased speed of a continuous suture, and the reduced time of tying. The PCA technique may be helpful to selected clinical situations, due to a reduction in microsurgical time, as in such cases of multiple digital replantations, multiple "in chain" free flaps, vein grafts, and high metabolic free flaps, such as the intestine free microvascular transfer