Calf contouring with endoscopic fascial release, calf implant, and structural fat grafting

Departamentul de Chirurgie Plastică, Spitalul Memorial Ataşehir, Istanbul, Turcia, Departamentul de Chirurgie Plastică, Brown University School of Medicine, Providence, Statele Unite ale Americii, Departamentul de Chirurgie Plastică, Spitalul International Medpark, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Gambele curbe sunt cauza unui stres psihologic pentru femei. După evaluarea aspectului estetic şi formei gambelor, dacă grosimea excesivă este factorul ce contribuie cel mai mult, sunt considerate procedurile de lipoplastie şi reducere musculară. Dacă picioarele sunt zvelte, nu prezintă hipertrofie musculară dar totuşi au o identaţie şi proeminenţă laterală traduse printr-un neajuns estetic, care ar fi opţiunile? Răspunsul la această întrebare este discutat în această lucrare. Material şi metode: Douăzeci şi două de paciente, operate timp de 5 ani (2007-2012), au fost incluse în acest studiu. O tehnică operatorie nouă a fost introdusă în practică. Pentru a obţine rezultate optime această metodă necesită eliberarea endoscopică a fasciei ce acoperă partea medială a muşchilor gambieni cu augmentare simultană cu implanturi gambiene, liposucţie şi grefă structurală de grăsime. Rezultate: Toate pacientele au fost urmărite în perioada postoperatorie pe parcursul unei perioade medii de 31 de luni. Procedura a fost bine tolerată, cu disconfort minim în perioada postoperatorie. Creşterea proximală şi distală în diametru a gambelor a fost măsurată la 6 luni după intervenţie. Modificarea medie a diametrului gambian proximal a constituit 2,16 cm şi 1,77 cm a celui distal. Concluzii: A fost aplicată o metodă nouă endoscopică pentru conturarea gambelor. Tehnica fasciotomiei endoscopice cu implanturi gambiene şi grefă structurală de grăsime pentru îmbunătăţirea estetică a acestei parţi a piciorului este simplă, efectivă, de încredere şi previzibilă pentru conturarea gambelor.Introduction: Curved lower legs cause psychological stress for women. In evaluating the shape, if thickness is the main contributing factor of leg aesthetic, then lipoplasty or calf reducing procedures will be the option. If the legs are slender and have no muscle hypertrophy but still have some indentation or bulges on both sides and lack an aesthetic shape what will be the options? The answer to the question above is discussed in detail in this article. Material and methods: Twenty-two patients, operated over a period of 5 years from 2007 to 2012, were included in the study. A novel technique has been introduced. This method requires release of fascia covering muscles of the inner leg bulge via endoscopic approach and simultaneous calf augmentation with calf implant, liposuction, and structural fat grafting to optimize the results. Results: Patients were followed on a regular basis with a mean follow-up of 31 months. The procedure was well tolerated with minimal discomfort during the postoperative period. Increase in diameter of proximal and distal lower legs was measured at least 6 months after surgery. Mean diameter change of proximal lower legs was 2.16 cm and 1.77 cm in distal lower legs. Conclusions: A novel endoscopic approach for lower leg contouring is discussed. Endoscopic fasciotomy technique with calf implant and structural fat grafting for improved lower leg aesthetics is a simple, effective, reliable, and predictable technique for calf contouring

Nocebo Hyperalgesia in Patients With Fibromyalgia and Healthy Controls:An Experimental Investigation of Conditioning and Extinction Processes at Baseline and 1-Month Follow-up

Nocebo effects are adverse treatment outcomes that are not ascribed to active treatment components. Potentially, their magnitude might be higher in patients with chronic pain compared to healthy controls since patients likely experience treatment failure more frequently. The current study investigated group differences in the induction and extinction of nocebo effects on pressure pain at baseline (N = 69) and 1-month follow-up (N = 56) in female patients with fibromyalgia and matched healthy controls. Nocebo effects were first experimentally induced via classical conditioning combined with instructions on the pain-increasing function of a sham transcutaneous electrical nerve stimulation device, then decreased via extinction. One month later, the same procedures were repeated to explore their stability. Results suggest that nocebo effects were induced in the healthy control group during baseline and follow-up. In the patient group, nocebo effects were only induced during follow-up, without clear group differences. Extinction was only observed during baseline in the healthy control group. Further comparisons of nocebo effects and extinction indicated no significant changes across sessions, possibly suggesting their overall magnitudes were stable over time and across groups. In conclusion, contrary to our expectations, patients with fibromyalgia did not have stronger nocebo hyperalgesia; instead, they might be less responsive to nocebo manipulations than healthy controls. Perspective: The current study is the first to investigate group differences in experimentally manipulated nocebo hyperalgesia between chronic pain and healthy populations at baseline and 1-month follow-up. Since nocebo effects are common in clinical settings, their investigation in different populations is essential to explain and minimize their adverse effects during treatment.</p

The creation of new rotation arc to the rat latissimus dorsi musculo-cutaneous flap with delay procedures

BACKGROUND: Latissimus dorsi musculocutaneous flap is one of the most frequently performed reconstructive techniques in surgery. Latissimus dorsi muscle has two arcs of rotation. It is classified as type V muscle. This muscle can be elevated on the thoracodorsal artery to cover large defects in the anterior chest and also, the muscle can be elevated on the segmental vessels to cover midline defects posteriorly. The aim of this study was to create a new arc of rotation on a vertical axis for the muscle and investigate effectiveness of vascular and chemical delays on the latissimus dorsi muscle flap with an inferior pedicle in an experimental rat model. We hypothesized that the latissimus dorsi muscle would be based on inferior pedicle by delay procedures. METHODS: We tested two different types of delay: vascular and combination of vascular and chemical. We also tried to determine how many days of "delay" can elicit beneficial effects of vascular and combination delays in an inferior pedicled latissimus dorsi musculocutaneous flap. To accomplish this, 48 male Sprague-Dawley rats were randomly subjected to vascular or combination delay (vascular and chemical). In addition, one ear of each rat was assigned into a delay procedure and the other ear was used as a control. Results were evaluated macroscopically, and micro-angiography and histological examinations were also performed. As a result, there was a significant difference in viable flap areas between vascular delay alone and control groups (p < 0.05). RESULTS: The higher rate of flap viability was obtained in seven-day vascular delay alone. However, there was no significant difference in the viability between seven-day vascular delay and five-day vascular delay (p < 0.05), so the earliest time when the flap viability could be obtained was at five days. The rate of flap viability was significantly higher in the vascular delay combined with chemical delay than the control group (p < 0.05). CONCLUSION: The combination of vascular and chemical delays increased the rate of viability. Nevertheless, there was no significant difference between vascular delay alone and combination of vascular and chemical delays. Chemical delay did not significantly decrease the delay period. Better histological and microangiographical results were achieved in delay groups compared to control groups. We concluded that the arch of the latissimus dorsi musculocutaneous flap can be changed and the flap can be used for various purposes with the delay procedures

The determination of total protein, total soluble carbohydrate and pigment contents of some macroalgae collected from Gemlik-Karacaali (Bursa) and Erdek-Ormanli (Balikesir) in the Sea of Marmara, Turkey

In this study, 12 taxa from the Chlorophyta, Phaeophyta and Rhodophyta were collected from different depths at Gemlik-Karacaali and Erdek-Ormanlı. A total of 175 specimens from these divisions were used to determine Total Protein (TP), Total Soluble Carbohydrate (TSCH) and Chlorophyll a (Chl a), Chlorophyll b (Chl b), Chlorophyll c (Chl c), total carotenoid (Car) contents and Chl b/Chl a, Chl c/Chl a, Car/Chl a, Car/Chl b, Car/Chl c ratios. TP, TSCH and pigment contents varied significantly with respect to the algal taxa, stations and depth distribution. In addition, individual differences were important in all of the measured parameters. The maximum TP contents (0.94%–31.03%) were determined in some of the Rhodophyta. In some green seaweeds belonging to the genus Ulva L., the TP content was determined between 2.9%–28.1%. Lower TP contents were determined in Cystoseira barbata (Good) C. Agardh (1.1%–4.3%). In contrast to TP contents, TSCH values were very low; maximum TSCH were determined in Ulva species, as were protein contents. In conclusion, the variations in TP, TSCH and pigment in 12 taxa of macroalgae were analysed according to station, depth, and environment

CAD techniques for the electromagnetic design of monolithic millimetre-wave integrated circuits

It is well known that mm-waves have an important role to play in the rapid expansion of mobile and personal communications, mmic technology is an important factor since it can provide a means of mass producing the user terminal rf subsystems. Millimetre-wave integrated circuits do not yet however offer the high packing density and functionality which is now possible for lower frequency applications where lumped elements are used. This problem is influenced most of all by the extreme modelling difficulties encountered at frequencies above 30 GHz. This paper reviews the current state-of-the-art for cad techniques used in mmic design. It describes some limitations of the standard Smarttm library approach and looks at the application of commercial electromagnetic simulators in the design of both microstrip and cpw circuits