Abstract Background and objective. Mastopexy combined with implants that we present with the denomination Regulated technique, aims to simultaneously treat the volume and position of the breast, using silicone gel implants, thus achieving the increase and lifting of the breast in a single surgical time, through a systematization of steps. Methods. We describe this systematization based on 5 main rules, and present an study in patients who consulted for hypotrophy, inconsistent breast tissue and breast ptosis with or without massive weight loss, carried out in patients who attended the Plastic and Postbariatric Surgery Unit (Caracas, Venezuela) during the period 2009-2019. Results. Mastopexy was performed by Regulated technique in 481 patients between 19 and 61 years old; 37.63% (n=181) had postbariatric condition, 23.91% (n=115) were primary surgeries, 56.13% (n=270) secondary surgeries; 84.62% (n=407) underwent mastopexy with the superior pedicle technique, being the most frequently used in patients without post-bariatric condition (54%), and mastopexy with the inferior pedicle technique was the least used, only in (2.49%) (n=12), and mostly in patients with post-bariatric condition (83.33%). Regarding the skin pattern, minimal scars were made in 84% (n=404) and inverted T in 16% (n=77). Round silicone implants with a volume range of 400 to 500 cc were used in 62.37% (n=300). Complications occurred with an incidence of 14.34% (n=69), the most frequent being: fat liquefaction (3.95%), cellulite (3.53%) and seroma (3.11%), only requiring revision surgery in 3 cases. Conclusions. The step by step of the Regulated technique offers the surgeon a practical guide to effectively perform the combination of mastopexy with the use of breast implants, with a low rate of complications demonstrated by our clinical series.

Resumen Introducción y objetivo. La mastopexia combinada con implantes que presentamos bajo la denominación Técnica reglada, tiene como finalidad el tratamiento en forma simultánea del volumen y posición de la mama usando implantes de gel de silicona, logrando así el aumento y levantamiento de la mama en un solo tiempo quirúrgico, mediante una sistematización en pasos. Material y método. Describimos esta sistematización basada en 5 reglas fundamentales y presentamos un estudio sobre pacientes que consultaron por hipotrofia, tejido mamario inconsistente y ptosis mamaria con o sin pérdida masiva de peso, en la Unidad de Cirugía Plástica y Posbariátrica de Caracas, Venezuela, entre 2009 y 2019. Resultados. Practicamos mastopexia por Técnica reglada en 481 pacientes entre 19 y 61 años de edad, en las que el 37.63% (n=181) presentaban condición postbariátrica, 23.91% (n=115) fueron cirugías primarias y 56.13% (n=270) cirugías secundarias. En el 84.62% (n=407) realizamos mastopexia con técnica de pedículo superior, que fue la más frecuentemente utilizada en pacientes sin condición postbariátrica (54%); la mastopexia con técnica de pedículo inferior fue la menos utilizada, en el 2.49% (n=12), y mayormente en pacientes con condición postbariátrica (83.33%). En cuanto al patrón de piel, realizamos cicatrices mínimas en el 84% (n=404) y T invertida en el 16% (n=77). Empleamos implantes de silicona redondos con un rango de volumen de 400 a 500 cc en el 62.37% (n=300). Las complicaciones se dieron en el 14.34% (n=69), siendo las más frecuentes: licuefacción grasa (3.95 %), celulitis (3.53%) y seroma (3.11%), con cirugía de revisión en 3 casos. Conclusiones. El paso a paso de la Técnica reglada ofrece al cirujano una guía práctica para realizar en forma efectiva la combinación de mastopexia con el uso de implantes mamarios, con bajo índice de complicaciones demostrado a través de nuestra casuística.

Abstract Background and Objective: A common complication after abdominoplasty in patients with massive weight loss is seroma formation. This condition could change the traditional parameters to remove drainage systems. Our objective are to determine if the post-bariatric condition is a factor that decreases the absorption capacity of fluid in the body surface in dermolipectomy, to know the relationship between the dissected area with the amount of surface drainage, to consider if the average of drainage in 24 hours may be the highest standard for removing the drain, and to describe the biochemical parameters related to the volume of the drainage Methods: We conduct a prospective, longitudinal, descriptive and clinical study with a sample consisted on 30 post-bariatric patients who underwent abdominal dermolipectomy. The intraoperative dissection area was measured and the volume of drainage registered until its removal. Results: The mean age was 38.9 + 10.9 years with 83.3% female The average body mass index was 27.85 + 5.49 kg/m2. The average area of dissection was 582.983 + 173.90 cm2. Drain removal was conducted between 9 and 10 postoperative days. The daily volume obtained by drainage was 72.12 + 24.19 ml. Conclusions: The postbariatric condition of the patients, with large areas of dissection in abdominal dermolipectomies, is related to greater production of fluid in the postoperative period, which is the reason why the parameters that are commonly used for drain removal must be changed.

Resumen Antecedentes y Objetivo: En los pacientes con pérdida masiva de peso, la formación de seroma tras dermolipectomía abdominal es una complicación frecuente. Nos planteamos describir el manejo del drenaje aspirativo en estos pacientes considerando los factores predisponentes para la formación de seroma, y determinar si el área de disección de la dermolipectomía abdominal en pacientes postbariátricos, y su condición metabólica aumenta el volumen obtenido a través de los drenajes aspirativos, así como el tiempo hasta la retirada de los mismos. Material y Método: Realizamos un estudio clínico observacional, descriptivo, prospectivo, de corte longitudinal. La muestra consistió en 30 pacientes a los que se les realizó dermolipectomía abdominal postbariátrica, se midió el área de disección intraoperatoria y se registró el volumen del gasto del drenaje hasta su retirada. Resultados: El 83.3% de los pacientes fueron mujeres, con edad meda de 38.9 + 10.9 años e índice de masa corporal de 27.85 + 5.49 kg/m2. El promedio del área de disección fue de 582.983 + 173.90 cm2, mientras que el volumen diario obtenido por el drenaje fue de 72.12 + 24.19 ml. Retiramos el drenaje con mayor frecuencia entre los días 9 y 10 de postoperatorio. Conclusiones: La condición postbariátrica, con gran área de disección en la dermolipectomía abdominal, está relacionada con una mayor producción de líquido en el postoperatorio, por lo cual se deben cambiar los parámetros comúnmente empleados para la retirada de los drenajes.

Road-killed wild animals have been for years used for surveillance of vectors of zoonotic pathogens and may offer new opportunities for eco-epidemiological studies. In the current study, fungal infection was evaluated by PCR and nested-PCR in tissue samples collected from 19 road-killed wild animals. The necropsies were carried out and samples were collected for DNA extraction. Results, using PCR with a panfungal primer and nested PCR with specific primers, indicated that some animals are naturally infected with Amauroascus aureus, Metarhizium anisopliae, Aspergillus flavus, Aspergillus oryzae, Emmonsia parva, Paracoccidioides brasiliensis or Pichia stipitis. The approach employed herein proved useful for detecting the environmental occurrence of several fungi, as well as determining natural reservoirs in wild animals and facilitating the understanding of host-pathogen relationships.

Um modelo isolado de coração de porco perfundido com sangue foi adaptado para o uso de fósforo 31 ressonância nuclear magnética (31 pRNM) em estudos de espectroscopia do metabolismo cardíaco durante cardioplegia sangüínea contínua e normotérmica (CSCN). O experimento foi dividido em dois grupos: Grupo I (n=5): os corações foram submetidos a 1 hora de CSCN. Grupo II (n=5): um período de 20 minutos de isquemia normotérmica durante o período de 1 hora de CSCN 17. A função do ventrículo esquerdo (VE) foi avaliada, com o coração batendo, utilizando um balão intraventricular, antes do período de parada cardioplégica e a seguir, quando o coração foi novamente perfundido com sangue normokalêmico. Durante todo o protocolo, análise espectroscópica do metabolismo cardíaco foi obtida utilizando-se 4.7 T/30cm Bruker TM Biospec 31 p RNM com uma resolução de 2 minutos para cada resultado. Ao final dos experimentos biópsias miocárdicas foram obtidas para análise de ATP e fosfocreatina (PCr) utilizando cromatografia liqüida de alta "performance" (HPLC). Não houve perda significante de ATP e PCr durante o período de parada cardioplégica com CSCN (Grupo I). Contudo, no Grupo II, a análise espectroscópica demonstrou perda completa de PCr após 14 ± 2 minutos durante a isquemia normotérmica acompanhada de aumento de fosfato inorgânico (Pi) e diminuição do pH intracelular. Quando reperfundido com CSCN, PCr, pH e Pi retornaram aos valores normais em 3 minutos. A função do VE avaliada através da elastância sistólica final foi mantida em 100 ± 10% dos valores obtidos antes da parada cardioplégica no Grupo I. No Grupo II, a função do VE foi de 88 ± 7% (p<0,05) dos valores precedentes à parada cardioplégica. Os resultados das biópsias do miocárdio demonstraram manutenção dos níveis normais de ATP (24 ± 3 µmol/g dry weight) e PCr (55 ± 14 µmol/g dry weight) no Grupo I, porém no Grupo II, apesar dos níveis normais de PCr após a reperfusão, os níveis de ATP diminuíram para 21 ± 3 µmol/g dry weight ao final do experimento. Este experimento demonstrou que o metabolismo cardíaco deteriorou após 14 minutos de isquemia normotérmica com conseqüente diminuição da função do VE (Grupo II). Porém, quando a cardioplegia sangüínea contínua e normotérmica foi utilizada sem interrupções (Grupo I) o metabolismo cardíaco e a função de VE foram preservadas, sugerindo que essa é a maneira ideal para se proteger o coração durante cirurgia cardíaca.

An isolated, blood perfused pig heart model was adapted for metabolic studies using 31 P NMR spectroscopy during continuous normothermic blood cardioplegia (CNBC). The experiment comprised two groups: In Group I (n=5) the hearts were subjected to 1 hour of CNBC. In Group II (n=5) a 20 min period of ischemia was introduced in the middle of the period of CNBC. Left ventricular function was assessed, in the beating heart, prior to the period of CNBC and after 60 min of cardioplegia, using an intra-ventricular balloon. During the entire period of the experiment, spectra were obtained using a 4.7 T/30 cm bore BrukerTM Biospec 31P NMR spectrometer with 2 min of resolution. At the end of the experiments myocardial biopsies were taken for ATP and phosphocreatine (PCr) analyses using high performance liquid chromatography (HPLC). ATP and PCr were maintained after the period of cardioplegic arrest (Group I). However the Group II, complete loss of PCr was shown after 14 ± 2 min of normothermic ischemia, followed by an increase of inorganic phophate (Pi) and decrease of intracellular pH. Following reperfusion after CNBC, PCr, pH and Pi returned normal values in 3 min. Left ventricular function, assessed by end-systolic elastance, was maintained at 100±10% of control in Group I. In the Group II, left ventricular function was 88 ± 7% (p<0.05) of the control. HPLC analyses of the myocardial biopsies showed normal values for Group I, ATP (24 ± 3 µmol/g dry weight) and PCr (55 ± 14 µmol/g dry weight), but in Group II, despite normal levels of PCr after reperfusion, the ATP levels decreased to 21 ± 3 µmol/g dry weight at the end of the experiments. These results showed that cardiac metabolism was seriously compromised after 14 min of normothermic ischemia and left ventricular function had decreased (Group II). However in Group I, in which CNBC was used without interruptions, function and metabolism were preserved, suggesting this is the ideal technique to protect the heart during cardiac surgery.