Infraorbital Hyaluronic Acid Filler: Common Aesthetic Side Effects with Treatment and Prevention Options

Background Infraorbital hollows can give a fatigued or aged appearance which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects from this treatment are very common. While some patients are clear surgical candidates vs. filler candidates, in real-world practice, many, if not most patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs. benefit profile. Objectives Common aesthetic side effects from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment. Method The authors’ experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short and long-term follow ups over eight years is leveraged to provide detailed guidance. Results Recommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially). Conclusion For nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in management of side effects to increase patient satisfaction with their treatment and aesthetic outcome.

Heimlich Valve as an Ambulation Management of Persistent Pneumothorax or Fluidopneumothorax

Pneumothorax or fluidopneumothorax is a critical condition when there is some air or/and fluid in the plural cavity. The symptoms may include shortness of breath, chest pain, blue discoloration of the skin or lips, increased heart rate, and loss of consciousness. Pleural cavity drainage is management therapy with the concept of Water Seal Drainage (WSD), which requires a long hospital stay. Heimlich valve is a non-return valve that allows fluid and air to exit the thoracic cavity (on inspiration) and prevents fluid and air from re-entering (during expiration). Heimlich valve is a viable, inexpensive, convenient, safe, effective, and efficient alternative in the management of ambulation of patients requiring prolonged pleural cavity drainage. The use of Heimlich valve is an alternative option for patients with persistent pneumothorax or fluidopneumothorax. It can shorten the time of treatment in the hospital, lowering treatment costs, and minimize the presence of nosocomial infections. Relative contraindications include fluidopneumothorax with massive pleural effusion or empyema. The risks and complications are dislodgement or improper reattachment, leaking valve, adhesion, and blockage, thus becoming tension pneumothorax or pleural cavity infection. Currently the latest innovation also improves the patient’s convenience, like Thoracic Vent, Pneumostat, or Mini Mobile Dry Seal Drain.

Single Instillation of Hypertonic Saline Immediately Following Transurethral Resection of Bladder Tumor for Recurrence Prevention –A Phase I Study

BACKGROUND: Urologic guidelines recommend perioperative instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) to decrease tumor recurrence, yet implementation of this recommendation is partial due to associated morbidity. Hypertonic saline destroys cells by osmotic dehydration and might present a safer alternative. OBJECTIVE: To evaluate the safety of 3% hypertonic saline (Hypersal) intravesical instillation following TURBT in rats and in humans. METHODS: In 8 rats whose bladders were electrically injured, intravesical blue-dyed Hypersal was administered. We measured serum sodium levels before and after instillation and pathologically evaluated their pelvic cavity for signs of inflammation or blue discoloration. Twenty-four patients were recruited to the human trial (NIH-NCT04147182), 15 comprised the interventional and 10 the control group (one patient crossed over). Hypersal was given postoperatively. Serum sodium was measured before, 1 hour and 12–24 hours after instillation. Adverse effects were documented and compared between the groups. RESULTS: In rats, average sodium levels were 140.0 mEq/L and 140.3 mEq/L before and following instillation, respectively. Necropsy revealed no signs of inflammation or blue discoloration. In humans the average plasma sodium levels were 138.6 mEq∖L, 138.8 mEq∖L and 137.7 mEq∖L before, 1 hour and 12–24 hours after instillation, respectively. During the postoperative follow-up there was one case of fever. A month after the surgery, dysuria was reported by 5 patients while urgency and hematuria were reported by one patient each. The most severe adverse events were grade 2 on the Clavien-Dindo scale. Adverse events were similar in the control group. CONCLUSIONS: Hypersal instillation is safe and tolerable immediately after TURBT.

The Suitability of Methylene Blue Discoloration (MB Method) to Investigate the Fe0/MnO2 System

The typical time-dependent decrease of the iron corrosion rate is often difficult to consider while designing Fe0-based remediation systems. One of the most promising approaches is the amendment with manganese dioxide (Fe0/MnO2 system). The resulting system is a very complex one where characterization is challenging. The present communication uses methylene blue discoloration (MB method) to characterize the Fe0/MnO2 system. Shaken batch experiments (75 rpm) for 7 days were used. The initial MB concentration was 10 mg L−1 with the following mass loading: [MnO2] = 2.3 g L−1, [sand] = 45 g L−1, and 0 < [Fe0] (g L−1) ≤ 45. The following systems where investigated: Fe0, MnO2, sand, Fe0/MnO2, Fe0/sand, and Fe0/MnO2/sand. Results demonstrated that MB discoloration is influenced by the diffusive transport of MB from the solution to the aggregates at the bottom of the test-tubes. Results confirm the complexity of the Fe0/MnO2/sand system, while establishing that both MnO2 and sand improve the efficiency of Fe0/H2O systems in the long-term. The mechanisms of water decontamination by amending Fe0-based systems with MnO2 is demonstrated by the MB method.

The Blue Man: Pediatric Diseases with Implications for Adulthood

Blue discoloration of the skin and cartilage, or ochronosis, is a rare physical examination finding. Here are two cases of childhood onset ochronosis, one exogenous and one endogenous in etiology.