Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

High-Definition Liposculpture: What are the Complications and How to Manage Them?

Background High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients. Methods An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed. Results A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results. Conclusion High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period

Acute compartment syndrome as a complication of cutaneous loxoscelism mainly edematous

El síndrome compartimental agudo (SCA) es el aumento de la presión en un espacio osteofascial cerrado. Esto reduce la presión capilar bajo el nivel necesario para la viabilidad de los tejidos del compartimento. El SCA de mano como complicación de un loxoscelismo cutáneo (LC) de predominio edematoso es muy poco frecuente. Presentamos el caso de una mujer de 22 años que presentó un SCA de la mano secundario a un LC y que requirió tratamiento quirúrgico de urgencia mediante una fasciotomía dorsal y palmar. Palabras clave: Loxoscelismo cutáneo; síndrome compartimental; Loxosceles spp.; araña del rincón; mordedura araña.Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy. Keywords: cutaneous loxoscelism; compartment syndrome; Loxosceles spp; brown recluse spider; spider bite

Variation in the number of metamers of rectus abdominis muscle. A high definition lipoesculture guide Variaciones en el número de metámeros del músculo recto abdominal. Una guía para la lipoescultura de alta definición

© 2018 Sociedad Espanola de Cirugia Plastica Reparadora y Estetica (SECPRE). All rights reserved. Background and Objective. Rectus abdominis muscle usually have 3 tendinous intersections. The aims of high definition abdominal liposculpture is to delineate the musculature. One of its difficulties is to determine by the surface anatomy the number of metamers presents. The aim of this study is to describe the variations in the number of metamers of the rectus abdominis muscle in the Chilean population and determine if there is a pattern that helps to the surgical mark of the abdominis metamers. Methods. Randomized sample of 200 patients who met inclusion criteria: &gt;18 years of age and under 65 years, tomographic study of the abdomen and pelvis with coronal sequence, performed at the Clinical Hospital of the University of Chile between January and May 2017; and exclusion: pathology of the abdominal wall, previous abdominal surgery or inadequate imaging study. Sex, number of tendinous inte

Variation in the number of metamers of rectus abdominis muscle. A high definition lipoesculture guide Variaciones en el número de metámeros del músculo recto abdominal. Una guía para la lipoescultura de alta definición

© 2018 Sociedad Espanola de Cirugia Plastica Reparadora y Estetica (SECPRE). All rights reserved. Background and Objective. Rectus abdominis muscle usually have 3 tendinous intersections. The aims of high definition abdominal liposculpture is to delineate the musculature. One of its difficulties is to determine by the surface anatomy the number of metamers presents. The aim of this study is to describe the variations in the number of metamers of the rectus abdominis muscle in the Chilean population and determine if there is a pattern that helps to the surgical mark of the abdominis metamers. Methods. Randomized sample of 200 patients who met inclusion criteria: &gt;18 years of age and under 65 years, tomographic study of the abdomen and pelvis with coronal sequence, performed at the Clinical Hospital of the University of Chile between January and May 2017; and exclusion: pathology of the abdominal wall, previous abdominal surgery or inadequate imaging study. Sex, number of tendinous inte

Long term quality of life outcomes after body contouring surgery: Phase IV results for the body-QoL (R) Cohort

Background: Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. Objectives: The authors evaluated the effect of BCS on QoL and the durability of this effect over time. Methods: QoL was measured with the Body-QoL (R) instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. Results: Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 +/- 14.1 preoperatively to 85.5 +/- 17.5 short-term postoperatively and to 84.4 +/- 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 +/- 15.6 vs 46.1 +/- 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. Conclusions: QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts

Variaciones en el número de metámeros del músculo recto abdominal. Una guía para la lipoescultura de alta definición

Resumen Introducción y Objetivo: El recto abdominal es un músculo que consta, generalmente, de 3 inserciones tendinosas transversas. La lipoescultura de alta definición apunta a delinear la musculatura abdominal, sin embargo, una de sus dificultades es determinar mediante la anatomía de superficie el número de metámeros presentes. Nos planteamos describir las variaciones en el número de metámeros del músculo recto del abdomen en la población chilena mediante análisis de tomografía computarizada de abdomen y pelvis, así como determinar si existe un patrón para la marcación quirúrgica de los metámeros. Material y Métodos: Empleamos una muestra aleatoria de 200 pacientes que cumplían los criterios de inclusión: mayores de 18 años y menores de 65 años, estudio de tomografía computarizada de abdomen y pelvis con secuencia coronal realizado en el Hospital Clínico de la Universidad de Chile entre enero y mayo del 2017; y de exclusión: patología de la pared abdominal, cirugía abdominal previa, estudio imagenológico inadecuado. Describimos el sexo, número de inserciones tendinosas supra e infraumbilicales, ángulo costal corto, ángulo costal completo, diámetro xifo-umbilical y umbílico-púbico. Analizamos los datos con STATA® v13, considerando un valor estadísticamente significativo de p<0.05 e intervalos de confianza de 95%. Resultados: Del total de paciente, 100 (50%) de los pacientes fueron mujeres. La media de edad fue de 40,9 ± 12.1 años, y 154 pacientes (77%) tenían 3 metámeros. No evidenciamos diferencias significativas entre ambos sexos (p=0.393). Ni en el análisis de la distancia xifo-umbilical (p=0.185) ni de la umbílico-púbica (p=0.327) entre sexos respectivamente. El número de metámeros se encuentra en relación inversa al tamaño de los mismos. La angulación del reborde costal en relación al xifoides es significativamente menor en mujeres (69.4 ± 15.2 frente a 80.2 ± 14.2). Conclusiones: La anatomía más frecuente del músculo recto del abdomen en la población chilena corresponde a 3 metámeros supraumbilicales por cada recto abdominal. Cuanto menor sea la relación entre la distancia xifo-umbilical / distancia xifo-púbica, menor cantidad de metámeros tiene el músculo recto. No fue posible predecir en forma precisa el número de metámeros mediante otra medida antropométrica

The Body-QoL: Measuring Patient Reported Outcomes in Body Contouring Surgery Patients

Artículo de publicación SCOPUSBackground This study aimed to design a new patientreported outcome (PRO) instrument to measure patient satisfaction after body-contouring procedures such as liposculpture, abdominoplasty, body-lift, thigh-lift, and arm-lift. Methods Phase 1a involved an extensive literature review, 16 in-depth patient interviews, and expert focus groups with 5 plastic surgeons to develop a conceptual framework for the outcomes deemed important for body image and preliminary PRO instruments. In phase 1b, the preliminary instrument was tested with a second independent sample of 29 patients with whom simple interviews were additionally performed. In the second sample, scale reliability was calculated. Results In phase 1a, the domains identified for the conceptual framework included clothing and body image, sexual and affective life, self-image and self-esteem, social relationships, and physical symptoms. In phase 1b, the scale internal consistency was 91.5 %. Conclusions When psychometric evaluation is completed, the Body-Shape-Related Quality of Life instrument and its subscales will provide a reliable tool for plastic surgeons, researchers, and patients to use in measuring the impact and effectiveness of body-contouring procedures from the patient’s perspective. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-