Functional applications of suction-assisted lipectomy: a new treatment for old disorders

Ever since the introduction of suction-assisted lipectomy in the United States in 1981, the technique has been applied to an increasing number of disorders of the subcutaneous tissues. Indeed, suction-assisted lipectomy has evolved into the method of choice in the treatment of certain pathological entities. While the extraction of lipomas is the most common functional application, suction-assisted lipectomy has also been used successfully to treat such conditions as gynecomastia, axillary hyperhidrosis, benign symmetric lipomatosis (Madelung's disease), congenital body asymmetry, congenital or acquired lymphedema, flap defatting, traumatic or postoperative hematomas, and fat necrosis. We have successfully treated patients presenting with the above disorders. No morbidities or mortalities were encountered in our series of 18 patients. The final results were considered favorable by the majority of patients. Acceptance by the patients of this treatment modality was extremely high because of the smaller incisions required, the exactness in contouring, the simple and minimal postoperative care needed, and the ease with which the procedure can be repeated to refine the results. A comprehensive review of the literature is presented along with our own patient management and long-term results.

A direct effect of the hematocrit on blood glucose: Evidence from hypoxia- and erythropoietin-treated mice

Blood glucose is lower in mountain dwellers living under low partial oxygen pressure. We show that obese mice maintained under hypoxia exhibit a delayed but distinct decrease in blood glucose with improved insulin sensitivity, which is independent of changes in body weight. This effect of hypoxia is mediated by erythropoiesis and is a direct result of the rising hematocrit, which could be due to erythrocytes acting as carriers of glucose units in the blood. Glucose lowering by the red cell mass is evidenced by a prompt decrease in glycemia in mice receiving a blood transfusion. Furthermore, life under hypoxia as well as treatment with erythropoietin reduce glycemia also in mice expressing the erythropoietin receptor exclusively in hematopoietic cells, which contrasts with previous assumptions attributing metabolic actions of erythropoietin to direct action on nonhematopoietic tissues. Our results provide a rationale for associations between hematocrit and blood glucose in humans under anti-anemic therapy, polycythemia, smoking, and high-altitude exposure.

[Thyroid dysfunction: interactions between genetic and environmental conditions]

Thyroid dysfunction (TD) is a very common entity in clinical practice nowadays. Prevalence may be underestimated because of the limitations of epidemiological studies. There are mainly genetic and environmental factors that interact on thyroid function. Genetic factors are extensively described in literature but molecular advance on the field may change older classifications based on B-cell or T-cell mediated disorders. The dominant pattern of inheritance makes family predisposition a relevant question in patient medical history but clinical research show that immune system is not enough to cause overt dysfunction. The role of environmental factors generates debate on medical literature. Some classic factors as iodine intake are well characterized but others as fetal microhimerism or new antineoplastic agents are less known. A review of medical literature on thyroid dysfunction has been performed and genetic and environmental factors are described in this article.