Comparison of the syringe and pump aspiration methods of lipoplasty

In our study of six patients who underwent fat aspiration with a syringe on one side and with a pump on the other, there was notably less blood in the fat aspirate from the syringe and less bruising and morbidity in the postoperative period. The only variable in the study for each patient was the method of aspiration.

Outbreak of Brucella melitensis among microbiology laboratory workers in a community hospital

From May to September 1988, eight employees of a microbiology laboratory developed acute brucellosis (attack rate, 31%). Seven of the eight affected employees had clinical illness ranging from a nonspecific, flulike illness to severe hepatitis. Blood cultures obtained from five of the affected employees (63%) were positive for Brucella melitensis, biotype 3. Comparison of cases and controls showed that there were no risk factors besides employment in the laboratory. Based on work locations, assignments, and interviews, it was found that person-to-person, droplet, food-borne, and waterborne spread were unlikely. Our investigation disclosed that 6 weeks before the outbreak began, a frozen brucella isolate from a patient hospitalized 3 years earlier had been thawed and subcultured without the use of a biologic safety cabinet. This clinical isolate was subsequently identified as B. melitensis, biotype 3, identical to the employee isolates. It is presumed that transmission occurred via the airborne route. This outbreak reemphasized that all work on Brucella species, an established biosafety level 3 organism, must be conducted under a biologic safety hood. Furthermore, it might be prudent to perform all clinical "setups" under a safety hood since aerosolization commonly occurs during the initial processing of specimens and the majority of these specimens are from patients with uncertain diagnoses.

Effects of environmental colour on males and females: a red or white or green office

This experiment assessed the effects of a red versus a green versus a white office environment on worker productivity and mood. An equal number of males and females completed a mood questionnaire before and after proofreading in one of the three offices. It was predicted that the subjects in the red office would report more tension and possibly make more errors. However, the subjects in the red office made the fewest errors, while the subjects in the white office made the most errors. Females scored significantly better on the proofreading task, and reported more tension and less vigour than males in the experiment. Subjects who worked in the red office found the colour of their office more distracting than subjects who worked in and rated the white office. The subjects in the white office reported that they would like to work in this environment and considered this colour most appropriate for an office. The authors speculate that a sterile, white environment may not be as conducive to work as is believed.

A mathematical model of retrieval system performance

There have been a number of major evaluations of the performance of retrieval systems against large full text and surrogate (bibliographic) databases. These evaluations have concentrated on the experimental determination of the Precision Ratio, the fraction of retrieved items that are relevant to an information request, and the Recall Ratio, the fraction of the total number of relevant items that were actually retrieved. While these measures have met with general acceptance, they have also generated much controversy. The purpose of this article is to review the results of several of the largest evaluations and to propose a simple model for the performance of such systems that may help explain the relationship between these measures and user behavior.

Clinical manifestations of enterococcal infection

Enterococci are important causes of community-acquired and nosocomial infection. They cause endocarditis, bacteremia, urinary tract infections and neonatal sepsis. As causes of intra-abdominal and pelvic infection, enterococci are more commonly associated with abscess, biliary tract infection, spontaneous bacterial peritonitis, post-operative infection, post-partum endomyometritis and chronic or recurrent infection. As causes of soft tissue infection, enterococci are more commonly identified in burns, decubitus or diabetic foot ulcers, and wounds associated with intestinal surgery. Enterococci are often cultured in association with other pathogens when identified in intra-abdominal, pelvic or skin and soft tissue infection. Enterococcal superinfection after therapy with cephalosporins has been well described, and occurs as a result of the low in vitro activity of cephalosporins against enterococci. The epidemiology of enterococcal infection is complex and includes both endogenous and exogenous acquisition of the organism. Antibiotic resistance is an ever-increasing problem complicating therapy in patients with enterococcal infection.

Psychological considerations in the elderly cosmetic surgery candidate

The mean age of Americans is increasing, and more and more Americans are living longer and more productively. It follows, therefore, that an increasing number of elderly patients will be seen by the cosmetic surgeon. These patients are often in the surgeon's office to negate or erase the physical effects of old age, which serve as social cues expressing inadequacy and inability. The plastic surgeon can "turn back the clock" as it relates to physical appearance for these patients; however, not every patient seen by the surgeon is an ideal candidate for surgery. Normally, the surgeon is used to dealing with the physical possibilities of surgical procedures and how they relate to surgical results, but what about the mental health of the elderly patient? In this article we seek to help the plastic surgeon identify the elderly patient who poses potential problems in the preoperative and postoperative periods because of inadequate or unstable mental health.

Comparison of membrane filtration and Autoanalysis Colilert presence-absence techniques for analysis of total coliforms and Escherichia coli in drinking water samples

Over a 4-month period, 950 samples of treated drinking water were analyzed for total coliforms (TC) and Escherichia coli by both membrane filtration (MF) and Autoanalysis Colilert presence-absence (AC) techniques. The two tests agreed 97% of the time on the basis of presumptive TC results and 98.5% of the time on the basis of verified TC results. Samples which produced disagreement between the two tests were most often TC positive by MF and TC negative by AC. E. coli was recovered four times: twice by MF only, and twice by AC only but without the diagnostic fluorescence reaction. In two samples, E. coli could not be isolated from fluorescence-positive AC tests. On the basis of these results, the AC test was implemented as the routine analytical procedure for TC but not for E. coli.

Combination of facial rejuvenation and lipoplasty of the torso

Older women seeking facial rejuvenation often exhibit another sign of middle age--the accumulation of subcutaneous fat in the torso. In the author's practice a total body evaluation approach is used. It is often suggested that the patient combine facial rejuvenation with lipoplasty of the torso if the patient is a good surgical candidate and the procedures can be performed jointly in less than six hours. The advantages are many, including a single convalescent period, decreased costs, and very high patient satisfaction with the degree of makeover in one session.

Psychological considerations in lipoplasty: the problematic or "special care" patient

Plastic surgeons are not able to handpick every patient. They can only, in reality, screen, evaluate, and accept or reject those patients who appear in their practice. Thus, the patient population is already delimited by several demographical and socioeconomic factors. Lipoplasty specialists see a further smaller group within this defined subset of all surgical patients. The group seeking lipoplasty may contain a disproportionately large number of patients with self-concept disorders, whose obsessional emphasis on the physical component of self can present preoperative and postoperative problems to surgeons. This article is designed to help surgeons evaluate their patient population before surgery and to uncover problem or rather "special care" patients.

The use of high-dose lidocaine in wetting solutions for lipoplasty

The use of lidocaine as a local anesthetic has been limited to 7 mg/kg. The authors question whether amounts of lidocaine greater than the recommended dosage may be safely used in the patient undergoing lipoplasty of the torso and knees. Six patients were used as a sample and a wetting solution of 750 mg or 1,000 mg of a .25% lidocaine solution containing 1:400,000 epinephrine was injected into the surgical site. The ratios of milligrams of lidocaine to kilograms of body weight varied from 9.1 to 13.8. Serum lidocaine levels were measured at frequent intervals. Because of many factors, including poor vascularity of subcutaneous fat, vasoconstrictive effect of epinephrine, and aspiration of a portion of the lidocaine, blood levels of lidocaine in the patients never exceeded 1.0 microgram%. We conclude that lidocaine, 9 to 14 mg/kg, results in peak serum lidocaine levels of only 0.5 to 0.8 microgram%.

Lipoplasty of the iliac crest and lateral femorals

The iliac crest and the lateral femoral areas represent the most commonly requested sites for improvement in the lipoplasty surgeon's practice. I have presented a brief discussion of nomenclature, for the sake of establishing common anatomic ground, and have described the procedure as it has evolved in my hands. It is my hope that in this way, I may provide a way to promote better understanding and improve results in these sites.

Early experience of aspirative lipoplasty of the abdomen

The author evaluates his early 2 1/2-year experience with closed aspirative lipoplasty, first introduced in the United States by Illouz. Although his experience with the technique during this period has resulted in good to excellent overall results, the abdomen, however, seems to have inherent problems unique to this area of the torso. He provides the reader with an understanding of these problems and methods to correct them.

Dissatisfaction among women with "thunder thighs" undergoing closed aspirative lipoplasty

In our practice, we have uncovered a small series of female patients with "thunder thighs" who were dissatisfied with results of closed aspirative lipoplasty. The common problem appears to be unrealistic expectations. These patients expected a change in body habitus. This article reiterates the need for careful patient selection and preoperative information of what the procedure can and cannot accomplish.

Chemical evolution of the citric acid cycle: sunlight photolysis of alpha-ketoglutaric acid

Sunlight photolysis of alpha-ketoglutaric acid produces succinic acid as a major product. Other higher molecular weight products are identified by GC-MS analysis. These results provide further support for the important role of succinic acid in chemical evolution.

Cardiac output during exercise in patients with COPD

Cardiac output response was examined to determine its relationship to exercise and arterial hypoxia, pulmonary hemodynamics, and the clinical/lung mechanics profile of patients with chronic obstructive pulmonary disease (COPD). Twenty patients with COPD were examined on the treadmill at rest and during steady state exercise at the highest workload comfortably tolerable to the subjects (60-70% VO2 max). In eight patients, the exercise cardiac output was less than 80% of predicted, while in the remainder (n = 12), the cardiac output response was normal (greater than 80% of predicted). It was concluded that hyperinflation and severe expiratory airflow limitation may be important determinants of the low exercise cardiac output response in some patients with COPD.

Arterial oxygenation and oxygen transport during exercise in patients with chronic obstructive pulmonary disease

Twenty patients with chronic obstructive pulmonary disease (COPD) walked on the treadmill until symptoms limited further exercise. Ventilation, pulmonary gas exchange, arterial and mixed venous blood gas and haemodynamic variables were measured during steady state. It was not possible to predict from any resting cardiopulmonary variables (including static lung function tests) which patients would develop a decline in arterial PO2. In spite of variable PvO2 values at symptom-limited exercise, a good correlation was obtained between arterial haemoglobin saturation with oxygen and the venous admixture fraction. The directional change in PaO2, however, did not always follow that of the total oxygen transport to the tissues as gauged by either the PvO2 or the efficiency of oxygen delivery (oxygen flux/oxygen consumption) when expressed as a percentage of the value predicted for the level of exertion. This was due to the variable and unpredictable response of the cardiac output on exercise. It is concluded that there is a need to assess each patient individually both at rest and on exercise when evaluating arterial oxygenation and oxygen transport. The pattern of exercise-induced change in these oxygen indices is not predictable from resting data and they may even follow opposite directional trends.

Lipoplasty: treatment for gynecomastia

Excision of moderate to large amounts of adipose tissue in male breasts has been unsatisfactory because of frequent complications and unacceptable cosmetic results. Essentially, one deformity was traded for another. Lipoplasty (blunt suction lipectomy) provides a new means to acquire a better contour without a need for incisions outside the areola with reduced morbidity and complications. The operative technique is discussed in detail and a representative result shown.

Ventilation during steady-state exercise in patients with chronic obstructive pulmonary disease. A preliminary study

In this preliminary study 20 patients with chronic obstructive pulmonary disease (COPD) walked on the treadmill until symptoms limited further exercise. When minute volume exceeded 60% of the predicted maximum breathing capacity the arterial carbon dioxide partial pressure was frequently low, thus indicating hyperventilation; the arterial oxygen partial pressure also declined on exercise. In only 2 patients was there alveolar hypoventilation. Although other factors may be operative, the hyperventilation in some patients with COPD may be induced by an exertional decline in alveolar oxygen partial pressure. In 4 patients the exercise tidal volume exceeded the resting inspiratory capacity, indicating a decline in functional residual capacity and increased work of breathing. It is concluded that there is a need further to assess patients with COPD in respect of the association between exertional dyspnoea, alveolar ventilation and lung mechanics.

Lipoplasty of the torso in patients over fifty

This article describes the author's experience in performing lipoplasty in patients over 50 years of age. Historically, emphasis was placed on selection of patients for this procedure who were under age 40 years. However, the author's experience with 20 patients over 50 indicates extremely high patient satisfaction. Subsequent skin excision was required in only 10% of the patients. The author concludes that many patients over 50 have good skin elasticity and represent satisfactory candidates for lipoplasty. Age alone should not exclude these patients.