It was not until many centuries later, in mid-nineteenth and drawing quite a few avatars, when steps were critical to saving surgery, then one of its major areas: pain.

Located now in the XXI century, Dr. Cordero Escobar Idoris Sciences, professor, head of the National Group Teaching and the Office of Anaesthesiology Clinical-Surgical Hospital Hermanos Ameijeiras, Ciudad de La Habana, valued as a “dizzying” Current development of the specialty with the appearance of new drugs, techniques and equipment to respond to major surgery.

Anesthesiology and Reanimation, valued, is a medical specialty that treats patients before, during and after any surgical procedure, and is also responsible for its resuscitation and relief of acute, chronic or cancer. The anesthesiologist is, therefore, the perioperative clinical, in the extreme ages of life, as in pregnancy or the neurosurgical patient.

- Are there, as it were, different anesthetic techniques?

“Yes, the general in which there is loss of consciousness, which includes regional and, in turn, various techniques or under implementation in which the patient is conscious throughout the surgical procedure, but no pain.

- What is your greatest asset? What disadvantage?

“Etymologically, anesthesia means: a, negative particle, and estesia, sensitivity. Therefore, it is the absence of pain perception, and behold its main indication and advantage. Now, more than “handicap” I would say it is a requirement: it must be administered by an anesthesiologist who knows the specialty-specific drugs, anesthesia machines, monitors, concomitant diseases and treatments to prevent or treat complications .

- Who decides, and what are the main reasons for this, the type of anesthesia to be used in an intervention?

The anesthesiologist is the doctor trained to do so and the reasons are obvious. In the preanesthetic consultation determines the patient’s illness and whether these are compensated or not, suggests additional tests or modify treatment, and also determines subsequent behavior.

- Does management always involves risks of anesthesia for the patient?

“Obviously, there are risks inherent to the patient, the surgical procedure and anesthesia itself, which today are minimized by the high qualification of our specialists to ensure a safe anesthesia to our population.

- Now, exemplify a hypertensive patient facing surgery. What care are demanded?

“That these patients maintain their blood pressure controlled from the preoperative and for this the doctor-patient relationship plays an essential role.

- Do the specialists in Anesthesiology with therapeutic arsenal to address, during the operation, at an elevation of blood pressure in patients known as hypertensive or not?

Yes, in all patients, but essentially in hypertensive surgery. Blood pressure was monitored continuously during surgery and, if necessary using various drugs.

- Broadly speaking, what are the main responsibilities of the anesthesiologist as part of the surgical team?

“The primary responsibility of the anesthesiologist is to defend the body from suffering unconscious by anesthesia and surgical aggression and ensure patient safety under anesthesia and postoperative recovery.

- Are there people who are intolerant to anesthesia?

“Yes, of hypersensitivity to some specific medicinal products in our specialty. These patients should be treated before surgery, and describes therefore, as important data in the protocol of anesthesia, drugs to which they are allergic.

credit to: JOSEPH A. DE LA OSA
Source: www.granma.cubaweb.cu/salud/consultas/a/a29.html
image source: www.med.umich.edu/anes/tcpub/glossary/graphics/anesthesia_glossary-78.jpg

This center is the first public health in Madrid that performs this technique, very popular, on the other hand, in American health, where 30% of all skin cancers are treated with this surgery and by which he has undergone several its former presidents, including Ronald Reagan, Bill Clinton and George Bush. And is that the results of this technique exceed those of any other. The cure rate in previously untreated basal cell carcinomas is 98-99%, whereas with traditional methods is achieved in 90-96% of cases. And if playing the tumor, micrographic surgery is even more useful, cures 86-92%, for 50% of other techniques. Another advantage, says Paul Umbert, Sacred Heart University Hospital (Barcelona) and that this surgery practice since 1981, is that “in 95% of cases the procedure is outpatient with local anesthesia.”

Julián Sánchez Conejo-Mir, Professor of Dermatology, Hospital Virgen del Rocío (Sevilla) and president of the European Society of Micrographic Surgery, explains that this is a “technical and pretty laborious to perform, since it involves removing the tumor in layers . The tumor is processed fresh, with the help of a cryostat. Chop and numbered the pieces to produce a map that maintains the correct orientation of the area removed. Once stained the pieces are analyzed under a microscope, which are located the potential areas with malignant cells. If there are still remnants of the tumor, the whole process is repeated until the previous surgical site is clean. Once tumor-free, dermatologist close the defect made by flaps or grafts. In a single act, has removed the tumor with a high reliability and the defect has been reconstructed.

“Although it may exceed two hours of intervention,” Sanchez continues, “This is a technique that saves money in the public health system, since it avoids reoperation and patient, blind excisions deformities in facial aesthetic areas”. Ideally, explains Juan Ramón Garcés, Dermatology Service, Hospital de Sant Pau (Barcelona), is that any assistance can be made “removal, reading and reconstruction, although in some cases not possible and the last subsequent step is performed. ”

This technique combines dermatology, surgery and histology, as highly specialized demands of the dermatologists or work with pathologists to the correct reading of the tumor, as is the case of Ramón y Cajal. This fact, together can consume many hours of surgery to the total elimination of the tumor are the two main reasons for its poor implementation in public health. In fact, where more is done is in Barcelona, Valencia (Valencian Institute of Oncology), Seville, Madrid and Guadalajara and the centers receive patients from all over Spain. However, thanks to the good health of dermatology in Spain from the Spanish Group for Dermatologic Surgery, Laser and Cutaneous Oncology is hoped that in 10 years this technique is performed on all first-rate Spanish hospitals.

The prostate or prostatectomy surgery is necessary, in the absence of a less aggressive, in the following situations:

1.To restore or improve lost or impaired function is to improve the quality of life
2.To increase the chances of life expectancy

In the first case is when the prostate grows in a way that prevents the normal flow of urine causing urinary retention, urinary incontinence, repeated infections, hydronephrosis, etc. and there is no evidence of cancer. In these cases it may be required transurethral prostatectomy, which is the most frequent surgery. There are other treatment options according the result of the CMP – Prostate

In the second case is when prostate cancer is established, directly or indirectly, and after evaluating all the factors that compromise the results of surgery such as age, tumor size, metastasis, sexual activity, patient preference, ability to get the results expected. Radical prostatectomy, which requires opening the abdomen result in urinary incontinence and impotence.

To get an accurate idea of the need for prostatectomy is the best test CMP – Prostate preceded by the PSA. Digital rectal examination is limited to assessing the consistency and relative size of the back of the prostate that is in contact with the rectum (see chart below).

Prostate surgery has side effects and complications, according to the patient, type of surgery and surgical complications remain the main urinary incontinence and impotence. There are also the complications of any surgery such as bleeding, infection and adverse effects and complications of anesthesia.

Naturally it is essential to an overall assessment of the body before surgery, to determine the benefits they bring surgery and the risk of it. . Remember that the more prevention to be, better get your surgeon.

Surgery for prostate cancer has two techniques: retropubic and perineal radical and, except as a palliative in patients who are very elderly or very sick, while surgery for prostatic hypertrophy is conservative and only is extracted from the prostate, thus side effects will be smaller in the latter.

This distension gives look globulose sometimes also accompanied a fold fat, causes him malaise and outsiders solved slimming diets.

Proper treatment is make anatomical evaluation all structures and think three levels:

• Firstly as is skin if leftover or not skin if has striations not if is distended.
• Secondly as is fat if we excess fat if is distributed one asymmetrically or there Fatty lumps below stomach, flanks waist, etc.
• Y thirdly is muscular wall if muscles are united if there good tone muscular and abdomen shaped hourglass or if muscles are distended and separated we one diastasis recti.

Planning surgery we take account also two points, first design a scar allows us extirpate this whole skinfold. Secondly this scar must remain hidden under underwear below swimsuit and for it we we shape it U, lest exit sides, by English.

In women older we assessing whether mons is very more horizontal so that making this surgery and when tightening this zone Verticalic and rejuvenate and also if very prominent and must do her liposuction.

Is important have abdomen vacuum gases therefore preoperatively necessary administer the patient a poor diet gases well medication eliminate these gases.

At surgery we rebuilding three planes: surgery skin remodeling fat sometimes aided or not liposuction and third plication of rectis muscles and reconstruction muscular.

Then makes wound closure suture intradermal order to end marks zip after advise patient having two weeks relative rest before making another activity energetic to muscular wall is firmly remodeled.

With all these measures cosmesis very satisfactory.

Facial implants are one of the most important resources are there in aesthetic medicine today.

They are primarily indicated for the treatment of wrinkles, furrows, scars and all types of skin depressions, facial implants also allow us to increase remodeling and different facial areas such as lips, chin, cheekbones etc ..

This calls for the physician to know the precise aesthetic characteristics and specifications of different substances on the market.
Facial implants can be classified in different ways, we believe that the classification according to the length of material could be of more interest to the patient.

It is very important to make a treatment protocol according to the needs of each patient and, thus, a classification with six groups from low to high complexity. In group 1 patients would only have a slight limp, slight puckering of the brow and a bit pronounced nasolabial folds. In group 6 patients who present a face with many stigmata of aging. For each group established treatment guidelines and lead times and providing calendar and guidelines, ie drawing up its custom protocol.

The hyaluronic acid used mesoplasty with all levels to fill all facial depressions. The grid to fill nasolabial folds and to create columns tension mixed with vitamins. The low density to correct the tear throuht and enriching the periorbital region especially the sense of dark circles without bags. The high density to give more volume to cheekbones and chin.

Tension Columns injected parallel to the malar and temporal region and carry out the lifting effect of the middle third of the face also regenerate the entire subcutaneous tissue and skin.

The mesoplasty uses the application of botulinum toxin (Botox, Vistabel …) to produce a relaxation of the wrinkles and folds and for facial expression Tension Columns are not affected by muscular contractions and to act the right way.

The mesoplasty also makes filling of certain facial areas like the lips or the tail of the eyebrows.

The facial rejuvenation facial structures placed in the correct position correcting sagging and excess skin resected but the skin and subcutaneous tissue are malnourished surgery improves the shape but not the quality of these tissues. It is the mesoplasty which improves the quality of these tissues. The combination of surgical techniques and mesoplasty is the ideal treatment for best results.

With the new technique developed by us, presented at the Congress of the American Society of Aesthetic Surgery and published in the Aesthetic Surgery Journal, “solves this problem, since its design does not involve removal of the skin after the area where the nipple is placed, but the final location of the nipple-areola complex is at the end of the intervention, when the breast is already decreased, facilitating changes in position, thus allowing for better symmetry with the other breast.

This is a triangular shape, being the apex of the triangle, where we will place the nipple in the desired location without any preconditions, on completion of reduction.

The aim of our technique is to make a proper placement of the areola, without tension, making the procedure symmetrically on both sides without being influenced by the design and subsequent removal of the skin that is done with the Lejour technique.

In none of the cases treated with this technique any complication was observed in the nipple-areola complex or asymmetry, as was formerly very good results postoperatively.

Patients implanted with the technique achieves a more satisfactory cosmetic result than with previous techniques and gain a greater symmetry of the breasts with a much more harmonious outcome.

The nasal pyramid is the central and most prominent of the face. The purpose of my technique is correct defects, improve or alter the function and not be noticed operated.

Currently, there are many trends that spread open rhinoplasty, lifting the entire skin of the back and severing the columella, and all to see well. We think it is very important to avoid scars on both external and internal columella taking off too much skin. But we agree on the need to look good and we use the endoscopy. We use a finger-mm endoscope, with which we can see a big all we are doing, with little sloughing of skin.

For the removal of the back is necessary to peel off the skin to introduce the necessary instruments and also to see. If we cut the root of the back with a chisel, so that it can enter into the fabric, we must turn down and then went up and gives us the shape of nose slide.

Also if we look good we have to operate off the skin to lift with a separator. When the skin heals is shining and adherent. These two factors make the nose note since it is operated as a slide and glowing skin.

The conservative rhinoplasty endoscopy is an important step in surgery of the nasal pyramid. This technique consists of resecting the back with a file of 2mm., Introduced with a short tunnel without having to take off much skin, only two millimeters. To be able to see well and not allow irregularities, this is possible with very little skin sloughing through the endoscope inserted into one side of the nasal septum. Thus we get the nose is nice and not be noticed operated.

The open rhinoplasty technique used in nose trauma or sequelae of cleft lip.

But in this case we make the resection of glandular tissue, but remodeled this to get a full breast, young and high. The main novelty is that the shape and weight of the breast is not supported by the skin and classical techniques with inverted T scar, if the weight is supported by points are glandular structures that make up the new structure of the breast and chest muscle. This allows the scars to distend and the breast remains in place.

Similarly, we use our technique of location of the nipple at the end of surgery. With the new technique developed by us, presented at the Congress of the American Society of Aesthetic Surgery and published in the Aesthetic Surgery Journal, the design does not involve removal of the skin after the area where the nipple is placed, but the final location of the nipple-areola complex is at the end of the intervention, when the breast is already high, facilitating changes in position, thus allowing for better symmetry with the other breast.

This is a triangular shape before surgery, with the apex of the triangle where we will place the nipple in the desired location without any preconditions, on completion of reduction. The aim of our technique is to make a proper placement of the areola, without tension, making the procedure symmetrically on both sides without being influenced by the design and subsequent removal of the skin that is done with the Lejour technique.

If during the procedure is very empty the breast is associated with the technique of pexia the placement of a rise in the same surgery, using balloons meters that allow us to choose the size of the prosthesis more suitable to each case in particular.

With the three elements, the vertical scar nipple final placement, suturing the pectoralis glandular structures and placement of prostheses increased if necessary, we get very good aesthetic results in breast pexia and lasting results .

Before the surgery we have to fix if overtaking is due to the absence of the fold, we call antihelix, can also be prominent due to the shell, the shell is concave area extending from the flag to the ear canal content. Sometimes the protruding ear is due to two things, the absence of antihelix and a prominent shell.

Once the assessment that is what we have to proceed to surgery.

First draw the antihelix, bending the ear back. Then put a little local anesthesia, if an adult who supports local anestasia or no sedation, if a child who will not support local anesthesia.

Then proceed with a needle with ink, to mark the cartilage where we want it to bend. Following behind the ear remove a small ellipse of skin that includes these points marked. Segidamente weaken this part of cartilage that we want it to bend and form the antihelix.

There are many techniques for this maneuver, Moustarde, Davis, etc. to bend and weaken this cartilage. We have published our technique is to use a 4 mm burr. to bend in a manner consistent antihelix eroding the cartilage and so, when folded, becomes a very natural look. In our experience we have seen that when trying to weaken the cartilage with a scalpel cuts are sometimes too sharp and is not natural that antihelix.

We can also erode the height of the shell to adapt and get this new form. Then with suture material and transparent irreabsorvible are a few points behind the ear to bend. We’ll consider giving the proper tension for the two pavilions are symmetrical.

The patient can do normal life immediately after the operation, although it is useful when you go to sleep for fifteen days, place a strip of hair sport or to maintain the ears in correct position and can not be some wrinkles that we may distort the aesthetic result achieved. Otoplasty