RESUMEN
Several studies have examined the association between childhood physical abuse (CPA) and anxiety disorders with inconsistent results. In order to help clarify this relationship, we investigated the association between CPA and current anxiety disorders while controlling for the following groups of factors: (1) demographics; (2) family background; (3) current socioeconomic status (SES); (4) current stressors; and (5) current mood disorders. Data from the 2005 Canadian Community Health Survey were analyzed. The sample included 12,481 respondents from the Canadian provinces of Manitoba and Saskatchewan. The regional-level response rate was 84%. Fully 7.3% (n = 964) of respondents reported they had been physically abused as a child or adolescent by someone close to them and 4.4% (n = 540) reported they had been diagnosed with an anxiety disorder by a health professional. A significant association between CPA and anxiety disorders was found when controlling for demographic factors, family background, current SES and stressors (OR = 1.61; 95% CI = 1.25, 2.08). The odds of anxiety disorders declined to non-significance when further statistical adjustments were made for current mood disorders. The findings of this research suggest that the relationship between CPA and anxiety may be largely explained by co-morbid mood disorders.
Asunto(s)
Trastornos de Ansiedad/epidemiología , Maltrato a los Niños , Trastornos del Humor/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/etiología , Niño , Comorbilidad , Femenino , Humanos , Masculino , Manitoba/epidemiología , Persona de Mediana Edad , Trastornos del Humor/etiología , Saskatchewan/epidemiología , Adulto JovenAsunto(s)
Cateterismo/métodos , Cateterismo Urinario/métodos , Algoritmos , Falla de Equipo , HumanosAsunto(s)
Lipectomía/instrumentación , Mamoplastia/instrumentación , Adolescente , Adulto , Mama/patología , Femenino , Humanos , HipertrofiaRESUMEN
As we have gained experience with the extended superficial musculoaponeurotic system (SMAS) technique in face lifting, refinements in our procedure have led to increased consistency in results. The important factors that have led to our technical modifications include the following: (1) the significance of the retaining ligaments of the midface, which determine the degree of surgical dissection required for both skin and SMAS in rhytidectomy; (2) the changes in facial shape that occur with aging, secondary to the descent of facial fat; (3) the possibility of modifying facial shape through the repositioning of facial fat in an extended SMAS face lift; (4) the improved longevity of result to be obtained by incorporating Vicryl mesh into SMAS fixation; (5) the artistic nuances of incision design that help to minimize scar perceptibility. Understanding these factors enables surgeons to use the extended SMAS technique successfully with more challenging cases, enhancing facial appearance while minimizing signs that the patient has undergone a surgical procedure.
Asunto(s)
Poliglactina 910 , Ritidoplastia/métodos , Mallas Quirúrgicas , Adulto , Anciano , Estética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Resultado del TratamientoRESUMEN
Dermabrasion remains an effective and reliable resurfacing option for perioral rhytides, acne scars, traumatic facial scars, and rhinophyma. It is inexpensive, portable, and widely available. It is well taught in most plastic surgical training programs and, therefore, does not require expensive secondary training courses. Dermabrasion requires no specialized accessory equipment and poses no fire hazard in the operating room. Extensive literature and clinical experience document its efficacy. Proper patient selection and recognition of planing depth are both essential to successful outcome. Despite the recent popularity of the carbon dioxide laser, dermabrasion should remain a fundamental working skill for all plastic surgeons.
Asunto(s)
Dermabrasión , Acné Vulgar/terapia , Adulto , Anciano , Cicatriz/terapia , Dermabrasión/métodos , Femenino , Humanos , Persona de Mediana Edad , Rinofima/terapia , RitidoplastiaRESUMEN
To delineate the histologic effects of laser resurfacing at photoaged skin, a protocol was designed to biopsy laser test sites in conjunction with adjacent actinically damaged skin at the time of rhytidectomy. Five patients with photodamaged skin underwent resurfacing of the preauricular region to examine the effect of increasing pulse energy and increasing number of passes on depth of dermal penetration. Histologic examination of these specimens showed that the depth of laser injury was dose-dependent. Increasing pulse energy created a deeper wound, and increasing the number of passes similarly produced a larger band of necrosis. Ten patients with photodamaged skin underwent resurfacing of the preauricular region 15 days to 6 months prior to undergoing a rhytidectomy. A comparison of the laser-resurfaced test spot with the adjacent untreated photodamaged skin demonstrated consistent histologic changes to both epidermis and dermis in all specimens examined. Following laser resurfacing, epidermal atrophy and atypia were eliminated, and all specimens exhibited a regeneration of epithelium that was normal in its morphology. Melanocytic hypertrophy and hyperplasia were corrected following treatment, although density and function of epidermal melanocytes appeared normal. All specimens exhibited a substantial amount of neocollagen formation involving both the superficial and middermis following resurfacing. In association with new collagen development within the dermis, there was noted to be a similar degree of proliferation of elastic fibers, as well as a diminution of glycosaminoglycans, which are typically present in actinically damaged elastotic dermis. To determine the effect of laser resurfacing on-black skin, laser test spots were placed in the postauricular region of three black patients. Biopsy of these test sites showed that the histologic effects of laser resurfacing were similar to those observed in Caucasian patients, with complete repopulation of epidermal melanocytes in specimens biopsied 3 months following resurfacing. The histologic effects of laser resurfacing are microscopically similar to those of phenol peeling in terms of the amelioration of photodamage. The distinction between these two treatment methods lies in their apparent effect on epidermal melanocytes, which appear to function normally following laser resurfacing.
Asunto(s)
Terapia por Láser , Ritidoplastia , Envejecimiento de la Piel/patología , Atrofia , Biopsia , Población Negra , Dióxido de Carbono , Recuento de Células , División Celular , Quimioexfoliación , Colágeno/análisis , Fármacos Dermatológicos/uso terapéutico , Tejido Elástico/patología , Epidermis/patología , Epitelio/patología , Cara , Estudios de Seguimiento , Glicosaminoglicanos/análisis , Humanos , Hiperplasia , Hipertrofia , Terapia por Láser/métodos , Melanocitos/patología , Necrosis , Fenoles/uso terapéutico , Regeneración , Piel/patología , Pigmentación de la Piel , Población BlancaRESUMEN
This article describes new trends, techniques, and instrumentation in aesthetic surgery. Advances in our understanding of anatomy and the changes that come about with intrinsic and extrinsic factors are discussed. Specifically, anatomic approaches to rhytidectomy, the preservation of lid shape in blepharoplasty, and CO2 facial resurfacing are highlighted. Body contouring surgical techniques, including minimal scar breast reductions, endoscopic-assisted augmentation mammoplasty, and superficial liposuction, are reviewed.
Asunto(s)
Cirugía Plástica/tendencias , Antihipertensivos/uso terapéutico , Clonidina/uso terapéutico , Estética , Párpados/cirugía , Femenino , Humanos , Terapia por Láser , Lipectomía , Masculino , Mamoplastia , Cuidados Preoperatorios , Ritidoplastia , Cirugía Plástica/métodos , Colgajos QuirúrgicosRESUMEN
BACKGROUND: Although quality of life (QL) and performance status are important outcomes in head and neck (HN) cancer, there is little systematic inclusion of these parameters in treatment trials. METHODS: Rate and recovery of function were evaluated over a 6-month period in 21 laryngeal cancer patients, 7 in each of 3 treatment groups: total laryngectomy (group 1), hemilaryngectomy (group 2), and radiotherapy only (group 3). Assessment included Performance Status Scale for Head and Neck Cancer Patients (PSS-HN: Diet, Speech, and Eating in Public subscales) and the FACT-HN, a multidimensional QL measure. RESULTS: Groups differed in patterns of performance recovery over time in expected directions. Group 1 recovered most slowly, without achieving normal functioning by 6 months; most of group 2 returned to normal functioning by 3 months; group 3 showed little overall dysfunction. There was no difference in overall QL between groups or over time. Performance status was significantly correlated with the FACT head and neck subscale and somewhat with the Physical subscale. In contrast, ability to eat and/or speak was not associated with overall QL nor with any other specific QL dimension (eg, emotional or social well-being). CONCLUSIONS: Results support the sensitivity and applicability of two site-specific performance/QL measures: PSS-HN and FACT-HN. Findings also emphasize the need to employ multidimensional tools to adequately evaluate the nonmedical outcomes in head and neck patients.
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Neoplasias Laríngeas , Calidad de Vida , Anciano , Femenino , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Laringectomía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Oral oltipraz, as a single-dose treatment, was evaluated as a chemopreventive agent in 31 normal subjects. In a subset of subjects, the relationship between plasma oltipraz concentrations and the induction of lymphocyte glutathione (GSH) and glutathione S-transferase (GST) enzyme levels was evaluated. Pharmacokinetic analysis revealed nonlinear disposition of oltipraz with disproportionate 40-fold increase and 9.5-fold decrease in peak plasma concentrations (Cmax) and p.o. clearance, respectively, over the dose range of 100-500 mg. There was no correlation between the oltipraz dose and the absorption rate or the time to reach Cmax. Since oltipraz undergoes extensive metabolism, saturable first-pass elimination could be one of the sources of nonlinearity. Pharmacodynamic evaluation was conducted based on the percentage of elevation of GSH and GST levels over baseline in lymphocytes of subjects receiving 100 mg and 125 mg oltipraz. Induction was observed in both dose groups with a time lag between the maximum concentrations of oltipraz and that of GSH or GST. We also observed a linear correlation between oltipraz Cmax and the corresponding GSH and GST elevations. Subjects with higher Cmax values showed a greater increase over baseline in the GSH and GST levels. Mild toxicities were observed at all dose levels. The most common were flatulence, hunger, fatigue, and headache. These preliminary results indicate that oltipraz may be effective in inducing GSH and GST, an enzyme capable of carcinogen elimination.
Asunto(s)
Anticarcinógenos/farmacocinética , Glutatión Transferasa/metabolismo , Glutatión/metabolismo , Pirazinas/farmacocinética , Administración Oral , Anticarcinógenos/administración & dosificación , Anticarcinógenos/sangre , Área Bajo la Curva , Disponibilidad Biológica , Inducción Enzimática , Humanos , Linfocitos/metabolismo , Proyectos Piloto , Pirazinas/administración & dosificación , Pirazinas/sangre , Tionas , Tiofenos , Factores de TiempoRESUMEN
The exposed, often desiccated Achilles tendon presents a difficult wound that cannot always be solved with the use of regional tissue. A series of 15 consecutive patients with wounds associated with previous failed repairs (n = 5), radiation (n = 1), trauma (n = 4), pressure sores (n = 3), and burn contractures (n = 2) is presented. Patients with osteomyelitis of the calcaneus were not included. All were covered with free fascial flaps from parietotemporal or forearm donor sites and skin grafts. There were two partial flap losses. Complications were minimal, and all patients were mobilized and ambulating within 2 months. Average follow-up was 4 years. Those with peripheral vascular insufficiency were revascularized prior to free tissue transfer. Vascularized fascia covered with skin grafts provides the treatment of choice for the localized Achilles tendon exposure not exceeding 10.0 cm. Advantages include (1) provision of thin, pliable tissue that permits gliding, (2) minimal bulk, (3) simultaneous donor- and recipient-site dissections, (4) transfer of mobile tissue that can be wrapped around tendon, and (5) early wound coverage and mobilization.
Asunto(s)
Tendón Calcáneo/cirugía , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Adolescente , Adulto , Anciano , Niño , Fasciotomía , Humanos , Persona de Mediana Edad , Colgajos Quirúrgicos/métodosRESUMEN
The objective in rhytidectomy is to rejuvenate and improve facial appearance. To obtain consistent results, facelifting should be approached not just as a tightening or lifting procedure but also as a reconstructive procedure, reversing the anatomic changes that occur in aging. The ability to bring aesthetic harmony back into the aging face requires the blending of surgical technique, anatomic knowledge, and artistic sensitivity to individualize the surgical approach for a given patient. To obtain surgical rejuvenation while minimizing signs of surgical distortion remains the ultimate goal of our facelifting procedures.
Asunto(s)
Ritidoplastia/métodos , Femenino , Humanos , Complicaciones PosoperatoriasRESUMEN
Parchment thin skin is a common problem associated with secondary rhinoplasty. When such skin is present, the underlying osseocartilaginous skeleton often becomes visible. Although many techniques have been used to treat the condition, we have found that an onlay graft of temporalis fascia is a most satisfactory method to cover the underlying osseocartilaginous framework or cartilage grafts. Temporalis fascia grafts have been advocated for this purpose in closed rhinoplasty; however, precise placement of the graft is difficult because the graft rolls. On the other hand, when used in open rhinoplasty, the graft may be placed accurately and secured under direct vision. This paper presents our experience with temporalis fascia grafts in open secondary rhinoplasties. Six female patients ages 31 to 57 underwent open secondary rhinoplasty. Five patients also had autologous cartilage grafts. Our average follow-up was 24 months; the minimum was 1 year, and the longest 7 years. All patients had excellent dorsal contours and osseocartilaginous irregularities were not observed. One patient developed a culture-proven nasal infection that responded successfully to antibiotics without removal of the fascia or cartilage graft, a result unlikely to occur when alloplastic materials are used. Biopsy of the temporalis fascia and cartilage grafts was obtained in one patient 12 months after placement. Microscopic examination confirms the long term viability of both grafted tissues, inasmuch as the temporalis fascia was vascularized and normal chondrocytes were present in the cartilage grafts. In summary, we have found that temporalis fascia grafts are a very satisfactory method for managing thin skin in open secondary rhinoplasty.
Asunto(s)
Fascia/trasplante , Rinoplastia/métodos , Adulto , Femenino , Cabeza , Humanos , Persona de Mediana EdadRESUMEN
The complete response rate of disseminated nonseminomatous germ cell tumors (NSGCT) of the testes with current aggressive chemotherapy and surgical resection of residual disease is between 70 and 80 per cent. Those patients who do not attain complete response tend to have short survivals. A case is presented of a forty-one-year-old white man who has had nearly continuous evidence of metastatic embryonal carcinoma for more than eleven years. Although NSGCTs are characterized by rapid proliferation, early metastasis, high response rate to chemotherapy, and rapid death if uncontrolled, this case demonstrates an indolent form of disease with poor response to chemotherapy and yet prolonged survival in spite of uncontrolled disease. This is the first reported case of indolent metastatic germ cell neoplasm with survival of more than ten years.