Forehead biconvexity enhancement with fat grafting

Background: Frontal biconvexity is a key criterion for an attractive forehead. Fat injection as an effective, safe and reliable method for soft tissue augmentation could be used to enhance forehead contour. We report our experience with combined platelet-rich plasma (PRP) and fat grafting to create or restore frontal biconvexity and to reduce wrinkles. Methods: Fifty-seven females and 4 males (mean age, 40.2 years) underwent the combined PRP and fat injection. Fat mixed with PRP on the ratio of 5:1 was injected in small aliquots in the space between the dermis and underlying frontalis muscle. Patient satisfaction with the cosmetic result was evaluated by a questionnaire using pre- and postoperative photos and a four-point grading scale. Results: All patients who underwent three injection sessions (n = 5) evaluated the esthetic result as excellent. In patients who had two injection sessions (n = 36), 36 evaluated the result as excellent, 50 as good, and the remaining 5 as moderate. In patients who had a single injection session (n = 15), 27 evaluated the result as excellent, 40 as good, and the remaining 5 as moderate. Concerning frontal wrinkles, 25 of 34 (73.5) patients reported good improvement and the remaining 9 (26.5) reported moderate improvement. Conclusion: Fat injection combined with PRP should be considered as an effective tool to improve forehead biconvexity. Level of evidence: Level IV, therapeutic study. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy. Methods: Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (n=31) or 100 mg hydrocortisone in 250 ml normal saline (n=31) before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function. Results: Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95; P<0.01). The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9) mg vs 61.66 (±38.69) mg; P=0.00). The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group. Conclusion: Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects

Marjolin&apos;s ulcer: clinical and pathologic features of 83 cases and review of literature

Abstract Background: Marjolin&apos;s ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. In this article, we will report 83 cases of this disease. Methods: Retrospectively, we retrieved 83 records of patients with cancer arising from chronic skin conditions. Data concerning demography, type of original skin insult, time interval between original lesion and cancer, cancer histology, and lymph node involvement were recorded. Results: The mean age was 55.30 years (range: 21-90). There were 51 males (61.5%) and 32 females (38.5%). Foot was the most prevalent site of primary skin lesion (49.4%) followed by scalp (1