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We believe that this textbook will serve this function buy discount diovan 40 mg on line. Goldman Pier Antonio Bacci Gustavo Leibaschoff Doris Hexsel Frabrizio Angelini PREFACE & xi & REFERENCES 1 diovan 80mg. Social Impact of Cellulite and Its Impact on Quality of Life discount diovan 40mg otc. Definition diovan 160 mg on-line, Clinical Aspects, Associated Conditions, and Differential Diagnosis. Cellulite Characterization by High-Frequency Ultrasound and High-Resolution Magnetic Resonance Imaging. Theory and Working Principles of BeautytekÒ in Cosmetic Medicine................................ Surgical Treatment A: Lipoplasty, Vibro-Assisted Liposuction, Lipofilling, and Ultrasonic Hydroliposuction. Belardi Department of Nuclear Medicine, Privat Hospital Santa Chiara, Florence, Italy Martin Braun Vancouver Laser and Skin Care Center, Vancouver, British Columbia, Canada Maurizio Ceccarelli Rome, Italy Stela Cignachi School of Medicine, Lutheran University of Brazil (ULBRA) of Rio Grande do Sul, Canoas, Rio Grande do Sul, Brazil Taciana de Oliveira Dal’Forno Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil Alberto Di Giuseppe University of Ancona, Ancona, Italy Debora Zechmeister do Prado Doris Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil Valerio Genitoni Universita` di Urbino, Urbino, Italy Mitchel P. Goldman University of California, San Diego, California and La Jolla Spa MD, La Jolla, California, U. Doris Hexsel School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil Camile Luisa Hexsel Internal Medicine, Henry Ford Hospital, Detroit, Michigan, U. Gustavo Leibaschoff University of Buenos Aires School of Medicine, and International Union of Lipoplasty, Buenos Aires, Argentina S. Leonardi Bacci Medical Center, Arezzo, Italy xix xx & CONTRIBUTORS S. Mancini Surgery School, University of Siena, Siena, Italy Rosemari Mazzuco Doris Hexsel Dermatologic Clinic, Porto Alegre, Rio Grande do Sul, Brazil Anju Pabby American Academy of Cosmetic Surgery Fellow Trainee and La Jolla Spa MD, La Jolla, California, U. Bernard Querleux Department of Physics, L’Oreal´ Recherche, Aulnay-sous-bois, France Jaggi Rao American Academy of Cosmetic Surgery Fellow Trainee and La Jolla Spa MD, La Jolla, California, U. Scatolini Department of Nuclear Medicine, Privat Hospital Santa Chiara, Florence, Italy Denise Steiner Mogi das Cruzes University, Mogi das Cruzes, Sao Paulo, Brazil Marlen A. Sulamanidze Moscow, Russia 1 Social Im pact of Cellulite and Its Im pact on Q uality of Life Doris Hexsel School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil Camile Luisa Hexsel Internal Medicine, Henry Ford Hospital, Detroit, Michigan, U. As it is more common to expose the body in certain cultures and in sunny countries such as Brazil, cellulite is of great concern to many women and also represents a problem of great social impact. In today’s globalized culture, physical well-being, including the care taken with appearance, is highly valued. From this perspective, it is very important to evaluate the impact on quality of life (QOL) of such cosmetic problems as cellulite, wrinkles, and aging. The fact that these have an impact on the QOL is indirectly shown by the growing interest in the investigation and treatment of these problems, which until recently were considered to be of minor significance. New studies involving QOL will benefit all those who suffer to a greater or lesser degree from these problems, and will be of great value in assessing the need for new scientific research into the treatment of these problems. Their study revealed that in the 37 different cultures studied, men and women gave greater priority to sexual attraction in the choice of partners than to aspects of personality such as independence, emotional stability, and maturity (1). Dermatological diseases and cosmetic problems significantly affect self-esteem. As the symp- toms are visible, the discomfort and psychoemotional effects are frequently more serious than the physical alterations caused by the disease. Thus, it becomes very important to assess and quantify the emotional and social parameters in these patients in order to understand the dis- ruption that the problem causes in various daily activities. Thiswill facilitate the follow-up and treatment evaluation, and consequently allow for improvements in the QOL of the patients. The great importance given to QOL evaluation in clinical investigation and patient care has led to the development of questionnaires designed for the collection of information from 1 2 & HEXSEL AND HEXSEL patients on the impact of the disease on their everyday lives. This knowledge allows the medi- cal professional to better observe how the disease affects the patients physically, psychologi- cally, and socially, and facilitates the evaluation of the effects on the lives of the patients. In the case of cellulite, the reasons that lead the patient to seek treatment are gener- ally social and, sometimes, also emotional. These may include the embarrassment caused by cellulite in social, affective, and sexual relations as well as the avoidance of normal everyday activities such as visiting a swimming pool or beach, practicing sports, or expos- ing the body during intimacy.

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The primary goal of a bone graft material is to stabilize the periodontal defect buy 160mg diovan with visa, while promoting recovery of native bone cheap diovan 80mg visa. Engineering porosity into the degradable construct enhances cellular ingrowth and osteointegration within bone graft substitutes [28 buy generic diovan 40mg online,30–32] discount diovan 40mg with visa. Average pore sizes on the order of 150 to 500 m are desired for optimal bone cell ingrowth [33,34]. Bony ingrowth enables integration of the synthetic material within host tissue and promotes replace- ment of the degrading material with native bone. Porosity and mechanical properties of PPF composites as a function of material formulation were optimized for treatment of maxillofacial and mandibular defects. Formulation of the PPF-based bone graft substitutes enables easy application to osseous defects. Mixing of PPF and crosslinkers creates a putty that may be applied to defect sites and cured in situ. Viscosity of the resultant mixture permits injection through needles as small as 16 gauge. The set time of the material ranges from 1 to 10 min, during which time the material expands to fill void spaces and may be molded or placed by the surgeon. The crosslinking reaction is not highly exothermic, with temperatures between 37 and 40 C measured within the curing graft substitute. Highly exothermic reactions, such as those observed in PMMA bone cements, have been associated with local tissue necrosis. The PPF-based bone graft substitute approaches peak mechanical properties 18–24 h after application. Developing porosity of the cured graft substitute has been used to promote osteointegration and incorporation of the synthetic material. Engineered porosity of PPF-based bone graft substi- tutes has been created prior to implantation via a porogen leaching process. Controlled pore sizes are prepared by leaching porogen materials (either gelatin microspheres or salt particles like sodium chloride) from crosslinked PPF scaffolds [31,36]. Porous PPF scaffolds have also been produced using calcium carbonate and tricalcium phosphate as porogen fillers. These techniques are useful in engineering porosity in the scaffold as a function of particulate size and solubility. Generation of pores during the curing process was used as a method to induce immediate porosity and expansion of the graft substitute in situ. The addition of effervescent agents to the formulation controls expansion of the test material during curing. Expansion enables the material to intimately fill the defect site and creates pores that encourage tissue ingrowth. Porosity of the cured PPF composites was analyzed by scanning electron microscopy (SEM) (Fig. Tuning the concentration of effervescent agents—sodium bicarbonate (SB) and citric acid (CA)—effec- tively controls the porosity of the cured test material yielding average pore sizes ranging from 50 to 500 m. Porosity of the bone graft substitute promotes osteointegration and new bone formation within the graft substitute. Porosity of the PPF-based bone graft substitute affects the mechanical integrity of the material. Compressive mechanical properties were determined for highly porous, photocross- linked PPF scaffolds. Porosities greater than 80%, as produced by salt leaching, yielded a compressive strength of 0. The highly porous scaffolds had mechanical properties less than the average value for cancellous bone. Flexural properties of nonporous PPF and beta-tricalcium phosphate composite cylinders were evaluated using four-point bending.

The BRAINSTEM AND CEREBELLUM: DORSAL cerebellum is located beneath a thick sheath of the (PHOTOGRAPHIC) VIEW meninges discount 40mg diovan otc, the tentorium cerebelli 80 mg diovan visa, inferior to the occipital lobe of the hemispheres (see Figure 17 and Figure 30) discount diovan 80mg with amex, in This specimen of the brainstem and diencephalon purchase diovan 40mg on line, with the posterior cranial fossa of the skull. The third ventricle, the ventricle part of the motor system, influencing posture, gait, and of the diencephalon, separates the thalamus of one side voluntary movements (discussed in more detail in Section from that of the other (see Figure OA and Figure 20A; B). Its function is to facilitate the performance of move- also Figure 17 and Figure 21, where the brain is separated ments by coordinating the action of the various participat- down the midline in the midsagittal plane). This is often spoken of simply as alon is to be discussed with Figure 11. Although it is rather difficult Additional structures of the brainstem are seen from to explain in words what the cerebellum does in motor this perspective: control, damage to the cerebellum leads to quite dramatic alterations in ordinary movements (discussed with Figure • The dorsal part of the midbrain is seen to have 57). Lesions of the cerebellum result in the decomposition four elevations, named the superior and inferior of the activity, or fractionation of movement, so that the colliculi (see also Figure 10). The upper ones action is no longer smooth and coordinated. Certain cer- are the superior colliculi, and they are func- ebellar lesions also produce a tremor, which is seen when tionally part of the visual system, a center for performing voluntary acts, better known as an intention visual reflexes (see Figure 41C and Figure tremor. The lower ones are the inferior colliculi, Anatomically, the cerebellum can be described by and these are relay nuclei in the auditory path- looking at its appearance in a number of ways. These colliculi form the cerebellum in situ has an upper or superior surface, as “tectum,” a term often used; a less frequently seen in this photograph, and a lower or inferior surface used term for these colliculi is the quadrigem- (shown in the next illustration). The pineal, a glandular structure, known as the vermis. The lateral portions are called the hangs down from the back of the diencephalon cerebellar hemispheres. Sulci separate the folia, and some of the deeper sulci • Although not quite in view in this illustration, are termed fissures. The primary fissure is located on the the trochlear nerves (CN IV) emerge posteriorly superior surface of the cerebellum, which is the view seen at the lower level of the midbrain, below the in this photograph. The horizontal fissure is located at inferior colliculi (see Figure 10). Using these sulci and fissures, the cerebellar cortex has This view also shows the back edge of the cerebral pedun- traditionally been divided into a number of different lobes, cle, the most anterior structure of the midbrain (see Figure but many (most) of these do not have a distinctive func- 6 and Figure 7). The pathway for discriminative touch sensation, BRAINSTEM 6 called the gracilis tract (or fasciculus) continues up the posterior aspect of the spinal cord and synapses in the nucleus of the same name; the pathway then continues up BRAINSTEM AND CEREBELLUM: DORSAL to the cerebral cortex. Beside it is another nucleus for a similar pathway with the same func- This is a photograph of the same specimen as Figure 9A, tion, the nucleus cuneatus (see Figure 10). These nuclei but the specimen is tilted to reveal the inferior aspect of will be discussed with the brainstem cross-sections in the cerebellum and the posterior aspect of the medulla. The medulla ends and the The posterior aspect of the pons is still covered by the spinal cord begins where the C1 nerve roots emerge. The posterior aspect of the The cerebellar lobules adjacent to the medulla are midbrain can no longer be seen. The upper end of the known as the tonsils of the cerebellum (see ventral view thalamus is still in view. The tonsils are found just The horizontal fissure of the cerebellum is now clearly inside the foramen magnum of the skull. The vermis of the cerebellum is clearly seen between the hemispheres. Just below the vermis is an Should there be an increase in the mass of tissue occupy- opening into a space — the space is the fourth ventricle ing the posterior cranial fossa (e. This would and Figure 21) The opening is between the ventricle and force the cerebellar tonsils into the foramen magnum, the subarachnoid space outside the brain (discussed with thereby compressing the medulla. The compression, if Figure 21); the name of the opening is the Foramen of severe, may lead to a compromising of function of the Magendie. The complete syndrome is known as tonsillar herni- men is the medulla, its posterior or dorsal aspect. This is a life-threatening situation that significant structure seen here is a small elevation, repre- may cause cardiac or respiratory arrest. Both can be seen in the ventral view of the BRAINSTEM 7 brainstem (see Figure 7). Details of the information car- ried in these pathways will be outlined when the functional aspects of the cerebellum are studied with the motor sys- BRAINSTEM: DORSAL VIEW — CEREBELLUM tems (see Figure 55).

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Madrid: Editorial Médica contact area in the patellofemoral joint and on strain in Panamericana diovan 40mg visa, 1995 generic diovan 80 mg otc. Sanchis-Alfonso diovan 80mg otc, V purchase diovan 160mg fast delivery, E Roselló-Sastre, and V Martinez- Annual Meeting of the International Patellofemoral Study SanJuan. Pathogenesis of anterior knee pain syndrome Group, Napa Valley, San Francisco, CA, September 1999. Sanchis-Alfonso, V, A Subías-López, C Monteagudo- 1971; 53-A: 749–758. Estudio biomecánico de los created after patellar tendon autograft harvesting: impactos en los saltos. A long-term histological evaluation in the lamb model. Patellar dislocation has Knee Surg Sports Traumatol Arthrosc 1999; 7: 340–348. Lateral release and and tangential views in patients and healthy controls. Articular hypermobility and chondral Biomech 1994; 10: 222–236. Biomechanical considerations in patellofemoral joint 40. Open lateral retinacular lengthening com- joint surgery. J Bone Joint Surg 1997; 79-A: ment des subluxations récidivantes de la rotule. Pathophysiology of overuse injuries in the 8: 372–382. Experimental analysis of Therapy: Physical Therapy of the Knee, 2nd ed. New quadriceps muscle force and patellofemoral joint reac- York: Churchill Livingstone, 1995, pp. Saunders, 1994, ankle stabilization and the effect on performance. Clin on patellofemoral joint stress during normal and fast Sports Med 1999; 18: 379–387. Usefulness of computed tomogra- osteotomy for patellofemoral instability. Am J Knee phy in evaluating the patellofemoral joint before and Surg 1997; 10: 221–227. Fithian and Eiki Nomura Abstract tainty is justified. Perhaps we’ve been missing Acute patellar dislocation is a common injury something. In the past 10 years, patellofemoral instability and anterior knee research has begun to focus on the injuries asso- pain, there was until recently little attention ciated with acute patellar dislocation, and the given to the structures that are injured during specific contributions the injured structures patellar dislocation, and the contributions these make to patellar stability in intact knees. The injured structures make in controlling patellar implication is that injury to specific structures motion in the intact knee. Since the early 1990s, may have important consequences in convert- some investigators have focused on the individ- ing a previously asymptomatic, though perhaps ual components of the knee extensor mecha- abnormal, patellofemoral joint into one that is nism that limit lateral patellar motion. These studies have vivo studies of the surgical pathology36-43 and been intended to improve the precision of sur- magnetic resonance (MR) imaging studies36,41-44 gical treatment for patellar instability, and their have reported the pathoanatomy of the primary results are driving refinements in our surgical dislocation with specific attention to injuries indications as well as technique. The Introduction importance of these lines of research is that they Patellar dislocation can lead to disabling seque- have focused attention on (1) the pathological lae such as pain and recurrent instability, par- anatomy of the initial dislocation event, and (2) ticularly in young athletes. This represents a novel prevention of recurrent patellar instability after approach to the clinical problem of the unstable the initial dislocation. The purpose of this article is to bring appropriate treatment. Widespread reports of the results and implications of this body of mixed results9,13,19-27 or outright failure11,12 research into perspective within the context of of surgical treatment suggest that such uncer- the prevailing literature on patellar dislocation.

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