Nasal dorsal augmentation with silicone implants

Silicone rubber has been used safely and effectively for facial augmentation for nearly 5 decades in eastern Asia. We have used silicone rubber nasal implants in primary ethnic rhinoplasty and have found consistent and long-lasting results with low complication rates. Silicone dorsal nasal augmentation in primary rhinoplasty avoids donor site morbidity and implant resorption as seen with autogenous implants. Silicone nasal implants have a low extrusion and infection rate. In the appropriate patient with proper placement, silicone nasal implant is nearly the ideal implant material.     

In the cut and thrust of apoptosis, serine proteases come of age

Proteolysis is central to the systematic cellular degradation that occurs during apoptosis. Predominantly, caspases have been studied in this regard. However, increasing evidence suggests that certain serine proteases may also play a significant role in apoptosis. Not only are these serine proteases involved in apoptosis signalling pathways independently, but they may also interact with more classical mediators of apoptosis such as the caspases or Bcl-2 family proteins. Isolation of apoptosis-associated serine proteases and the use of specific inhibitors have helped to shed light on potential pathways in which they are involved. Despite the recent developments in the field, knowledge regarding the role of serine proteases in apoptosis remains limited, but it is clear that investigations are gathering momentum and such studies may herald a new and exciting departure in apoptosis research.     

Life-Threatening Complication During Percutaneous Ablation of Adrenal Gland Metastasis: Takotsubo Syndrome

A rare life-threatening complication during percutaneous cryoablation of an adrenal gland metastasis from a lung carcinoma is reported. The patient presented hypertensive crisis at the beginning of the thawing cycle, followed by electrocardiographic change which necessitated interruption of the procedure and his transfer to the intensive care unit with suspicion of heart infarct. There was a slight increase in cardiac enzyme levels, and ventricular angiography demonstrated transient hypokinesis-dyskinesis of the mid left ventricular segments without apical involvement, while the coronary arteries showed no significant stenosis on coronarography. These findings led to the diagnosis of Takotsubo cardiomyopathy left ventricular dysfunction syndrome. This is the first case of Takotsubo cardiomyopathy occurring as a complication during percutaneous ablation of an adrenal gland tumor.     

Exercise <Superscript>18</Superscript>FDG Imaging for the Detection of CAD: What Are the Clinical Hurdles?

Myocardial perfusion imaging (MPI) has been in clinical use for over 30 years, providing an effective, reliable, and relatively simple tool for diagnosis, risk stratification, and follow-up of patients with suspected or know coronary artery disease (CAD). The unique strength of nuclear imaging is its ability to provide tools for imaging biochemical and metabolic processes, and receptor and transporter functions at molecular and cellular levels in intact organisms under various physiologic conditions. Metabolic imaging using radiolabeled glucose analogues (¹⁸F-fluorodeoxyglucose [¹⁸FDG]) provides a unique ability to image myocardial ischemia directly (“hot spot” imaging) in patients with known or suspected CAD. Exercise ¹⁸FDG imaging can potentially overcome some of the limitations of currently used stress-rest MPI. In this article, we describe recent studies using exercise ¹⁸FDG for imaging myocardial ischemia and its potential use in routine clinical practice.     

A Serious but Rare Complication of Laparoscopic Adjustable Gastric Banding: Bowel Obstruction Due to Caecal Volvulus

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for the treatment of morbid obesity. LAGB complications have declined since its development in the early 1990s. However, LAGB complications are still occurring and can sometimes be serious and life threatening. These complications are related either to the band or to the access port, such as band slippage or tubing disconnection, retrospectively. We report a rare case of bowel obstruction due to caecal volvulus caused by connecting tube used in LAP-BAND system in a bariatric operation, which obstructed a caecal loop, in a female who had undergone LAGB 2 years previously. Diagnosis of bowel obstruction was established with plain abdominal radiograph appearances. Follow-up abdominal computed tomography findings confirmed the diagnosis of caecal obstruction and revealed the underlying cause for this obstruction. Surgery was performed, and intraoperative examination demonstrated that connecting tube of the LAP-BAND system was a main causative factor. We can hypothesize that bowel obstruction secondary to LAGB operation may become frequently diagnosed as more LAGB operations performed worldwide. The emergence of many problems, such as this, can be minimized with enhancement in the development of better surgical materials, proper operative technique, and close postoperative management and follow-up.