BACKGROUND:Technology-assisted liposuction, like lipolaser, endolaser, and ultrasound-assisted liposuction, has surged in popularity. However, with increased adoption, complications have been reported. This study aims to evaluate these devices' efficacy in lipolysis and skin tightening, critically assess associated complications, and explore preventive measures. METHODS:A literature review was conducted using the MEDLINE and LILACS databases to identify studies on lipolaser, endolaser, and technology-assisted liposuction. Inclusion criteria focused on studies related to complications associated with these devices. Articles unrelated to complications with these devices or written in non-English languages were excluded. Additionally, we report a case series of 10 patients treated for scars resulting from these procedures, detailing the management of these complications. RESULTS:88 studies met the inclusion criteria. The most common complications were skin burns, seromas, hematomas, infections, and scars. The studies reviewed are heterogeneous, with varying methodologies, sample sizes, and follow-up periods. Therefore, there is no substantial evidence to indicate that technology-assisted liposuction is superior to traditional liposuction methods, nor are there clear benefits of using endolaser for skin tightening. While the various types of scarring observed in our series showed significant improvement, these scars will persist as lifelong sequelae. CONCLUSIONS:Technology-assisted liposuction can be associated with complications and enduring consequences. Therefore, it is crucial to alert and prepare healthcare professionals who engage with these technologies to manage these complications effectively. Given the limitations of this study, further research is needed to determine whether these technologies provide essential advantages and to ensure their safety. LEVEL OF EVIDENCE IV:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
The Monro-Kellie doctrine, introduced in the late 18th century, was a groundbreaking concept aimed at explaining the interactions between intracranial volume components. It has since become a cornerstone of brain physiology, now recognized as intracranial dynamics. Initially, the doctrine focused on physiological observations of the three incompressible components of the cranial vault: brain tissue, blood, and cerebrospinal fluid (CSF). Over the centuries, advancements in neuroscience and medical technology have deepened our understanding of intracranial pressure (ICP) regulation, its pathophysiological implications and its role in neurological disorders. This revisitation of the Monro-Kellie doctrine examines how impairments in cerebrovascular autoregulation, brain compartmentalization and the glymphatic system interact in severely brain-injured patients, calling for new management strategies when facing these critical situations. Additionally, it reinforces the need for a holistic monitoring approach to improve early diagnostics and intervention. The evolution of ICP assessment has significantly shaped the management of brain trauma, spontaneous bleeding, ischemic stroke, and hydrocephalus. With the introduction of innovative tools such as brain ultrasound, automated pupillometry and noninvasive pressure waveform monitoring, ICP management is shifting toward more accessible and continuous evaluation strategies. This review explores how blending historical principles with cutting-edge innovations is transforming neuromonitoring and enhancing patient outcomes in critical care.
BACKGROUND:Historically, breast reconstruction was performed by plastic surgeons. The Brazilian Society of Mastology (SBM) implemented initiatives to improve breast surgeons' training in oncoplastic techniques; however, the current proportion of surgeons performing these techniques remained unknown. This study aimed to determine the proportion of Brazilian breast surgeons performing oncoplastic surgery, their previous training, the complexity of procedures performed, and factors influencing adoption of techniques. METHODS:In this survey, a structured questionnaire was sent to all SBM-affiliated breast surgeons between July and December 2023. Outcome proportions were estimated using binomial distribution. Adjusted proportion ratios (aPR) were calculated using robust Poisson regression. RESULTS:A 60.2% valid response rate was achieved (n = 1059/1759). Almost half of the respondents performed oncoplastic surgery, with most being young (< 40 years) (aPR: 1.66; 1.31-1.10; p < 0.001), male (aPR: 1.39; 1.22-1.59; p < 0.001), southern residents (aPR: 1.39; 1.18-1.63; p < 0.001), with a specialist degree in breast disease (aPR: 1.19; 1.00-1.42; p < 0.004), primarily trained in general surgery (aPR: 1.32; 1.16-1.51; p < 0.001) and secondarily in breast surgery (aPR: 1.41; 1.08-1.85; p = 0.01), and performing > 100 surgeries/year (aPR: 1.72; 1.49-1.99; p < 0.001). The techniques most commonly mastered were simple displacement (88.7%), therapeutic mammoplasty or contralateral symmetrization (96.4%), reconstruction with implants or tissue expanders (93.6%), extreme oncoplasty (81%), skin- and nipple-sparing (99%) or skin-reducing mastectomy (84.2%), and thoracoabdominal flaps (71.7%). CONCLUSIONS:A high proportion of Brazilian mastologists perform oncoplastic surgery. These findings provide key insights to further enhance training and improve outcomes.
Neurological manifestations associated with COVID-19 remain partially described, mainly in low- and middle-income countries where diagnostic tools are limited. To address this, we assembled medical centers in Brazil with the goal of describing neurological syndromes associated with COVID-19 during the first wave of the pandemic. From June 1st, 2020 to June 1st, 2021, non-consecutive adult patients with new onset of six neurological syndromes up to 60 days after confirmed COVID-19 were included. Data were compiled from four tertiary centers and compared with general local COVID-19 data, as well as with a previous cohort focused on vascular syndrome. 197 patients were included, presenting with vascular syndromes (81), encephalopathy (68), encephalitis (19), Guillain-Barré syndrome (13), other neuropathies (12), and myelitis (4). The incidence curve of neurocovid mirrored that of COVID-19. Neurological syndromes were present regardless of COVID-19 severity. The median time from COVID-19 to onset of neurological symptoms was 14 days, suggesting a post-infectious immune-mediated mechanism. Patients were 10 times more likely to die (χ2 (1) = 356.55, p < 0.01, OR = 10.89) and 38 times more likely to be hospitalized than other COVID-19 patients (χ2 (1) = 1167.9, p < 0.01, OR = 38.22). Those developing vascular syndromes patients were 3 times more likely to require ICU (χ2 (1) = 37.12, p < 0.01, OR = 3.78) and 4 times more likely to die (χ2 (1) = 58.808, p < 0.01, OR = 4.73) than patients with vascular syndromes due to different etiologies. Our study corroborates the association of neurological syndromes with COVID-19. The incidence correlated with local waves of COVID-19, and patients with neurocovid exhibited a higher susceptibility to adverse outcomes compared to other COVID-19 patients. Among all neurological syndromes, vascular syndromes were the most common, and their severity surpassed that of vascular syndromes not attributed to COVID-19.
