Aesthetic Breast Surgery Under Cold Tumescent Anesthesia: Feasibility and Safety in Outpatient Clinic
Throughout the last decade, aesthetic breast surgery has enormously spread in the outpatient clinic setting where plastic surgeons perform the vast majority of procedures under local anesthesia as day-case operations. The “tumescent anesthesia” is defined as the injection of a dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into subcutaneous tissue until it becomes firm and tense, which is “tumescent.” The “cold tumescent anesthesia” (CTA) derives from Klein's solution with the introduction of a new concept, which is the low temperature (4°C) of the injected solution. This novelty adds further anesthetic and hemostatic power to the well-known benefits of tumescent anesthesia. The authors report their experience with CTA in the last 15 years in the setting of aesthetic breast surgery, describing in detail the anesthesia protocol, surgical outcomes, and patient satisfaction. A total of 1541 patients were operated on during the study period and were included in this retrospective analysis. The types of breast procedures were breast augmentation in 762 cases (49.4%), mastopexy with implants in 123 patients (8.0%), mastopexy without implants in 452 cases (29.3%), and breast reduction in 204 cases (13.3%). Patient mean age was 42.8 years (range, 18–67 years). The mean operating time was 37 ± 32 minutes for breast augmentation, 78 ± 24 minutes for mastopexy with implants, 58 ± 18 ...
CONCLUSIONS: In patients requiring surgery during vvECMO therapy with perioperative transfusion of two or more PRBCs preoperative fibrinogen levels were significantly reduced compared to patients with transfusion of less than two PRBCs. No other analyzed lab value showed any predictive qualities in terms of bleeding. PMID: 31630509 [PubMed - as supplied by publisher]
This article compares the two devices to provide guidance on the selection and use of these monitoring systems. Their second-generation assays, TEG 6S and ROTEM Sigma, are also discussed. PMID: 31630507 [PubMed - as supplied by publisher]
Delayed ischemic neurological deficit (DIND) is a major driver of adverse outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), defining an unmet need for therapeutic development. Cell-free hemoglobin that is released from erythrocytes into the cerebrospinal fluid (CSF) is suggested to cause vasoconstriction and neuronal toxicity, and correlates with the occurrence of DIND. Cell-free hemoglobin in the CSF of patients with aSAH disrupted dilatory NO signaling ex vivo in cerebral arteries, which shifted vascular tone balance from dilation to constriction. We found that selective removal of hemoglobin from pati...
A 63-year-old woman initially presented to a local urologist with a 9-month history of hematuria/vaginal bleeding followed by urinary retention. Computed tomographic imaging demonstrated a markedly distended urinary bladder with moderate bilateral hydronephrosis. Cystoscopy revealed no evidence of bladder tumor or urethral abnormality, and recurrent urinary tract infection was suspected. The patient developed worsened vaginal bleeding over a 6-month period, and anterior vaginal fullness was then appreciated on examination; she required a permanent indwelling catheter.
This clear cell carcinoma may have arisen in the urethra or the anterior vagina.1 Primary urethral adenocarcinomas are very rare, but when they occur, the most common histology is clear cell carcinoma, probably of M üllerian origin and often associated with a urethral diverticulum. The symptom of prolonged vaginal bleeding, the physical examination placing the bulk of the tumor in the vagina, and the negative cystoscopy suggest that this tumor may have originated in the vagina.
Conclusions: Female gender, increasing age, American Society of Anesthesiology classification, operative time, or a history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, or a bleeding disorder are risk factors for prolonged hospitalization following total shoulder arthroplasty. Level of Evidence: Level III.
ConclusionIn office hysteroscopic mechanical myomectomy with MyoSure® morcellator of submucosal fibromas was a highly effective therapy for women, at three years of follow-up. It appears to give satisfactory long-term results with a low recurrence rate and without significant complications.
Publication date: Available online 22 October 2019Source: Indian Heart JournalAuthor(s): Sunny Goel, Shanti Patel, Elina Zakin, Ravi Teja Pasam, Joseph Gotesman, Bilal Ahmad Malik, Sergey Ayzenberg, Robert Frankel, Jacob ShaniAbstractObjectivesTo compare safety and efficacy of Patent Foramen Ovale (PFO) closure compared with medical therapy in patients with cryptogenic stroke (CS)BackgroundThe role of PFO closure in preventing recurrent stroke in patients with prior CS has been controversial.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at ...
ConclusionsThe study is designed to identify a TxA dose with maximal efficacy and minimal complications. We hypothesize that the high dose has superior efficacy and non-inferior safety to the low dose.
CONCLUSIONS: ERCP is safe and useful in the management of biliary complications after liver transplantation. Early onset of complications is associated with better results. Some patients will need repeated procedures to obtain a good clinical response. PMID: 31633375 [PubMed - as supplied by publisher]