By A. Akascha. Stamford International College. 2019.

Solution: Since a family that used fewer than four programs used either one purchase cheap zetia on line, two order zetia mastercard, or three programs cheap zetia 10 mg fast delivery, the answer is the cumulative probability for 3. Solution: To find the answer we make use of the concept of complementary probabili- ties. The set of families that used five or more programs is the complement of the set of families that used fewer than five (that is, four or fewer) programs. In later sections, we study in detail three of these theoretical probability distributions: the binomial, the Poisson, and the normal. Mean and Variance of Discrete Probability Distributions The mean and variance of a discrete probability distribution can easily be found using the formulae below. Solution: m ¼ð1Þð:2088Þþð2Þð:1582Þþð3Þð:1313ÞþÁÁÁþð8Þð:0370Þ¼3:5589 2 2 2 2 s ¼ð1 À 3:5589Þ ð:2088Þþð2 À 3:5589Þ ð:1582Þþð3 À 3:5589Þ ð:1313Þ 2 þÁÁÁþð8 À 3:5589Þ ð:0370Þ¼3:8559 We therefore can conclude that the mean number of programspffiffiffiffiffiffiffiffiffiffiffiffiffiffiutilized was 3. Let the discrete random variable X represent the number of co-occurring addictive substances used by the subjects. The distribution is derived from a process known as a Bernoulli trial, named in honor of the Swiss mathematician James Bernoulli (1654–1705), who made significant contributions in the field of probability, including, in particular, the binomial distribution. When a random process or experiment, called a trial, can result in only one of two mutually exclusive outcomes, such as dead or alive, sick or well, full-term or premature, the trial is called a Bernoulli trial. The Bernoulli Process A sequence of Bernoulli trials forms a Bernoulli process under the following conditions. One of the possibleoutcomesisdenoted (arbitrarily)asa success,and the other isdenoted a failure. The trials are independent; that is, the outcome of any particular trial is not affected by the outcome of any other trial. For example, if we examine all birth records from the North Carolina State Center for Health Statistics (A-3) for the calendar year 2001, we find that 85. With that percentage, we can interpret the probability of a recorded birth in week 37 or later as. If we randomly select five birth records from this population, what is the probability that exactly three of the records will be for full-term births? If we are looking for birth records of premature deliveries, these would be designated successes, and birth records of full-term would be designated failures. It will also be convenient to assign the number 1 to a success (record for a full-term birth) and the number 0 to a failure (record of a premature birth). The process that eventually results in a birth record we consider to be a Bernoulli process. For simplicity, commas, rather than intersection notation, have been used to separate the outcomes of the events in the probability statement. The resulting probability is that of obtaining the specific sequence of outcomes in the order shown. We are not, however, interested in the order of occurrence of records for full-term and premature births but, instead, as has been stated already, the probability of the occurrence of exactly three records of full-term births out of five randomly selected records. Instead of occurring in the sequence shown above (call it sequence number 1), three successes and two failures could occur in any one of the following additional sequences as well: Number Sequence 2 11100 3 10011 4 11010 5 11001 6 10101 7 01110 8 00111 9 01011 10 01101 4. When we draw a single sample of size five from the population specified, we obtain only one sequence of successes and failures. The question now becomes, What is the probability of getting sequence number 1 or sequence number 2. From the addition rule we know that this probability is equal to the sum of the individual probabili- ties. In the present example we need to sum the 10q2p3’s or, equivalently, multiply q2p3 by 10. We may now answer our original question: What is the probability, in a random sample of size 5, drawn from the specified popula- tion, of observing three successes (record of a full-term birth) and two failures (record of a premature birth)? Since in the population, p ¼ :858; q ¼ ð 1 À p 1 À :858 :142 the answer to the question is 2 3 10 :142 :858 ¼ 10 :0202 :6316 :1276 & Large Sample Procedure: Use of Combinations We can easily anticipate that, as the size of the sample increases, listing the number of sequences becomes more and more difficult and tedious. Such a method is provided by means of a counting formula that allows us to determine quickly how many subsets of objects can be formed when we use in the subsets different numbers of the objects that make up the set from which the objects are selected. When the order of the objects in a subset is immaterial, the subset is called a combination of objects. When the order of objects in a subset does matter, we refer to the subset as a permutation of objects. Though permutations of objects are often used in probability theory, they will not be used in our current discussion. If a set consists of n objects, and we wish to form a subset of x objects from these n objects, without regard to the order of the objects in the subset, the result is called a combination. For examples, we define a combination as follows when the combination is formed by taking x objects from a set of n objects. The number of combinations of n objects that can be formed by taking x of them at a time is given by n! We then may write the probability of obtaining exactly x successes in n trials as nÀx x x nÀx f ðxÞ¼nC qx p ¼ nCxp q for x ¼ 0; 1; 2;... We use f ðxÞ rather than PðX ¼ xÞ because of its compactness and because of its almost universal use. This follows from the fact that n and p are both x nÀx nonnegative and, hence, nCx; p , and ð1 À pÞ are all nonnegative and, therefore, their product is greater than or equal to zero. This is seen to be true if we recognize that nCxq p is equal to n n n ½ 1 À p p ¼ 1 ¼ 1, the familiar binomial expansion. If the binomial q þ p is expanded, we have n n nÀ1 1 nnÀ 1 nÀ2 2 1 nÀ1 n ð q þ p ¼ q þ nq p þ q p þÁÁÁþnq p þ p 2 If we compare the terms in the expansion, term for term, with the f ðxÞ in Table 4. If a random sample of size 10 is selected from this population, what is the probability that it will contain exactly four mothers who admitted to smoking during pregnancy? Fortunately, probabilities for different values of n, p, and x have been tabulated, so that we need only to consult an appropriate table to obtain the desired probability. That is, the table gives the cumulative probabilities from x ¼ 0 up through some specified positive number of successes. Subtracting the latter from the former gives :9927 À :9600 ¼ :0327, which nearly agrees with our hand calculation (discrepancy due to rounding). Frequently we are interested in determining probabilities, not for specific values of X, but for intervals such as the probability that X is between, say, 5 and 10. If a random sample of 25 people is drawn from this population, use Table B in the Appendix to find the probability that: (a) Five or fewer will be color blind. The probability that six or more are color blind is the complement of the probability that five or fewer are color blind. Solution: We find this by subtracting the probability that X is less than or equal to 5 from the probability that X is less than or equal to 9. We may obtain probabilities from Table B, however, by restating the problem in terms of the probability of a failure, 1 À p, rather than in terms of the probability of a success, p.

Frequency is Reduction in postmaturity is the most important route to higher in neonates who are delivered by cesarean section discount generic zetia uk. As a consequence quality zetia 10 mg, alveoli are full of retained of shoulder and endotracheal suction under laryngoscopic fuid which tends to inhibit gas exchange discount 10 mg zetia. However, it Tachypnea or minimal respiratory distress (usual pre- can be cut down to 30–40% with ventilatory support. Te term refers to severe respiratory distress as a result of persistent elevation in pulmonary resistance due to failure of normal circulatory transition at birth. Diuretic-related: Dyselectrolytemia, osteopenias Treatment Steroid-relasted: Neurologic sequelae It is in the form of only symptomatic measures such as: Beta agonist-related: Enhanced large airway instabil- Monitoring of heart rate, respiratory rate, oxygen ity in infants with tracheomalacia and bronchomalacia. As the retained fuid is absorbed Subglottic stenosis, airway granulomas and pseudopolyps by the lymphatics, respiration shows improvement. Within tend to persist in adolescence, warranting surgical interven- 24–72 hrs, recovery is usually complete. Consequent upon insult to neonate’s lung tissue from baotrauma and oxygen toxicity, there is release of infamma- Clinical Features tory mediators. Tis is followed by increased permeability, Manifestations include respiratory distress on top of other resulting in leakage of water and protein and, later, fbrosis features of sepsis such as feeding difculty, poor activity and cellular hyperplasias. Diagnosis Clinical Features Diagnosis is by and large clinical supported with: Manifestations include tachypnea and respiratory distress. Bronchopulmonary dysplasia is a clinical diagnosis in a preterm infant who received ventilator support and Treatment supplemental oxygen in frst week of life or longer followed by bouts of sepsis and inadequate nutritional intake. For nosocomial infections—cephalosporins plus It includes congenital heart disease, interstitial pneumo- amikacin nia, recurrent aspiration, recurrent pneumonias, sur- Prognosis factant protein defciency, pulmonary lymphangiectasia and Wilson-Mikity syndrome. Alter- body tissues so much and so that the body demands are not natively, chest tube drainage may prove life-saving. Based on cardiac output and fow: Low cardiac output Triggering factors include frequent handling, envi- and high cardiac output ronmental heat, rapid rewarming, vigorous suction, sud- Advanced trauma life support classifcation: den fexion of neck and lung infation (head paradoxical z Class 1: Upto 15% blood loss refex). Te fundamental pathologic defect appears to be z Class 2: 20–25% blood loss z Class 3: 30–35% blood loss an immaturity of the medullary respiratory center which z Class 4: 40–50% blood loss. In addition, systemic manifestations due to involve- the diagnosis and treatment of infection. Besides this syndrome, difcult or traumatic delivery as also Diagnosis premature delivery may also be accompanied by perinatal infections. At times, a perinatal infection may actually It is based on a carefully recorded history and physical manifest after some interval following birth. Treatment Te organisms responsible for postnatal neonatal infec- Aggressive therapeutic approach consists of maintaining tion include E. Alternatively, it may invade the body transfusion, vitamin K, antibiotics, inotropic drugs (digox- through skin or mucosa (usually in the presence of a breach in, dopamine, isoproterenol, dobutamine) and massive or cut). Uncommon causa- Quite a number of factors contribute to uniqueness of tive agents include streptococcus (group A and B), neonatal infections (Box 17. Pseudomonas aeruginosa and herpes virus hominis type Te term intrauterine infection refers to infection 2. Use of silver nitrate drops may also cause conjunctival infammation which manifests within 6–12 hours after acquired in utero. Te term perinatal infection refers to an infection that z Low birth weight/prematurity z Contaminated environments in uterus is acquired just before or during delivery from the mother. Any suggestion of spread of z A check on the entry of individuals harboring infection, including infection is an indication for administering erythromycin carriers, into the nursery z Change in hand-washing solutions and protocols or some antibiotic agent. Te lesions, usually preceded by redness of oral mucosa and tongue are characteristically discrete whitish patches/ spots over the tongue mucosa, gums and lips; extension over to the posterior oropharynx may occur, leading to swallowing difculties. Noma Neonatorum Occasionally, Pseudomonas aeruginosa infection may cause superfcial gangrenous lesions involving nose, lips, mouth, anus, eyelids and scrotum. Delay in instituting proper treatment may lead to involvement Umbilical infection in the newborn is a common problem. Te etiologic factors include poor sanitary conditions and local application of unsterile dressings. It may present as: observation during the frst couple of days, needs only Slight purulent discharge from localized infection of saline irrigation or sulfacetamide drops (10%). Gonococcal ophthalmia is treated with (it is respon- Even septicemia and neonatal tetanus may well be sible for profuse purulent discharge) systemic penicillin regarded as forms of umbilical sepsis. If left untreated therapy (100,000–150,000 units/kg/day in 2 or 3 divided or inadequately treated, localized infection may be doses) and penicillin, gentamicin or chloramphenicol eye accompanied by formation of a pinkish, rounded, drops. Conjunctivitis caused by Chlamydia trichomatis (inclu- Prevention: It lies in aseptic care of the umbilicus, sion blenorrhea) needs treatment with 10% sulfacetamide including its cutting. Treatment: It consists of administering a broad- Pyoderma spectrum antibiotic and local application of triple-dye, Superfcial skin eruptions, usually caused by Staphylococ- gention violet paint or a powder/cream containing cus aureus and albus result from contaminated hands of bactracin and neomycin. No treat- needs cauterization by touching it with silver nitrate or ment other than local application of triple-dye is indicated. Systemic Infections Tese are identical despite varying causative agents 305 and may vary from inapparent or silent to fulminant, Neonatal Sepsis (Nns) depending on severity of infection, maturity and birth Sepsis is a serious neonatal problem. Loose motions, abdominal distention, fever or hypo- thermia (latter is more common and more dangerous), Etiopathogenesis failure to gain weight, pallor, jaundice, respiratory dis- Infection may be contracted antenatally, or during or after tress and skin eruptions are other prominent features. Te neonatal occurrence of convulsions, high-pitched cry, blank units must, therefore, have an ongoing review of the listless appearance, bulging anterior fontanel and neck causative organisms and their antibiotic sensitivity pattern retraction should arouse suspicion of its existence. Predisposing factors and etiologic Depending on involvement of various systems, there pathogens are listed in Box 17. One should take advantage of the clinical clues for probable etiologic diagnosis (Table 17. Diferential Predisposing factors and etiologic pathogens diagnosis is from conditions such as hypoglycemia, Box 17. Presence of two or more parameters means Instrumentation a positive sepsis screen. A repeat screen is indicated in Equipment (use of catheters, respirator, resuscitator, feeding case of a negative result after 12 hours; every 48 hours bottles, solutions for cold sterilization, incubator, face masks and white aprons, etc) in ventilated neonates. Grayish-black gangrenous lesions over skin Pseudomonas Handling by medical personnel, including doctors and Peripartum fu-like maternal illness, gastro- Listeria nurses, may. Lumbar puncture is of value if meningitis is sus- Maintenance of optimal body temperature, i. Nasal saline drops to clear nasal block, if any Other useful investigations include chest X-ray, blood Blood transfusion (packed cells) for anemia and shock; sugar, urine for routine and culture and serum bilirubin. In of accompanying meningitis, a third generation case of scleroma, endotoxic shock and meningitis, admini- cephalosporin (cefotaxime) + ampicillin/amikacin stration of hydrocortisone may be considered. Prolonged chemotherapy ampicillin + gentamicin/amikacin and the second line should be supplemented with vitamin K and other vitamin cefatoxime + amikacin. For resistant Staphylococcus, coamoxyclav or Close monitoring, timely institution of appropriate antimi- vancomycin is the best. In nosocomial septicemia (Staph- crobial therapy and intensive supportive care are the key ylococcus, Klebsiella, Pseudomonas), ceftazidime/cefap- factors in survival of the neonates with sepsis.

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In addition buy discount zetia online, in the presence of a bypass tract order zetia 10 mg on line, if A-V nodal reentry is induced with block below the His buy zetia 10 mg free shipping, a preexcited tachycardia can ensue (Fig. The actual frequency of apparent antidromic tachycardia that is due to A-V nodal reentry with passive conduction over a bypass tract is unknown. Proof of A-V nodal reentry as the mechanism of preexcited tachycardias may be difficult. The most clear-cut proof would be demonstration of A-V nodal reentry following spontaneous or drug- induced block in the bypass tract at the same cycle length, with the same H-A interval, and the same retrograde activation sequence as during the preexcited tachycardia (Fig. Other criteria supporting A-V nodal reentry are the induction of A-V nodal reentry by atrial or ventricular extrastimuli with subsequent conduction over the bypass tract owing to His–Purkinje delay or block, with no change in the atrial activation sequence or H-A. A more detailed description of A-V nodal reentry with innocent bystander bypass tract is given later in this section. Approximately 50% of our patients in whom atrial stimulation has induced a preexcited tachycardia have had true antidromic tachycardias. The remainder have had either preexcited tachycardias using multiple bypass tracts or A-V nodal reentry with an innocent bystander bypass tract. In this patient, an anterior paraseptal bypass tract is present during sinus rhythm. Atrial stimulation from the high-right atrium is initiated at a paced cycle length of 400 msec. The first atrial extrastimulus blocks in the right anterior paraseptal bypass tract and conducts over a left lateral bypass tract. Before the next stimulus, retrograde conduction is manifest over the previously blocked right anterior bypass tract. The presence of His potentials during this tachycardia probably represents simultaneous antegrade conduction over P. This is supported by the fact that the fourth atrial extrastimulus terminates the tachycardia by retrograde block in the right anterior bypass tract owing to the premature capture of the ventricles over the left-sided pathway (in the absence of a His deflection) and anterograde concealment into the right-sided pathway. Diamonds, antidromic tachycardia (n = 4) or preexcited tachycardia using multiple bypass tracts. In our experience, “classic” antidromic tachycardias using a single A-V bypass tract can also be initiated by ventricular P. In this instance, retrograde block in the bypass tract must occur and retrograde conduction proceeds only over the normal A-V conduction system. This is manifested by a prolonged V-H-A activation sequence, which subsequently initiates the tachycardia with antegrade conduction down the bypass tract and repetitive retrograde conduction up the normal pathway (Fig. This mechanism is most likely to occur in patients with an antegrade conducting only pathway or one with poor retrograde conduction. The V-A and, more specifically, H-A times in “classic” antidromic tachycardia are longer than in typical A-V nodal reentry with an innocent bystander bypass tract. As noted earlier, we have never observed H-A intervals ≤60 msec in true antidromic tachycardia, whereas one sees such H-A intervals in the majority of A-V nodal tachycardias. The value of the difference in H-A intervals during ventricular pacing and the tachycardia has been discussed earlier (see Figs. The failure to advance the “A” is consistent with A-V nodal reentry with an innocent bystander accessory pathway. This is consistent with true antidromic tachycardia or a preexcited tachycardia using a second bypass tract for the retrograde limb. A and B: Retrograde conduction occurs over the His–Purkinje system A-V node during right ventricular pacing at 400 msec. The third A-V nodal echo does not conduct, owing to simultaneous A and V activation. We have documented A-V nodal reentry as the mechanism of 13 of 56 cases of preexcited tachycardias, unrelated to atrial tachyarrhythmias which I have studied over the last 40 years. The diagnosis of A-V nodal reentry as the mechanism of the tachycardia primarily depended on the persistence of typical A-V nodal reentry with and without activation over a bypass tract. In six cases, this was due to block in the bypass tract by antiarrhythmic agents with persistence of a tachycardia with an identical H-A interval and P. In addition, the initiation of A-V nodal reentry and subsequent preexcited tachycardia with 1:2 conduction in response to an atrial premature beat, as demonstrated in Figure 10-29, provides supportive evidence of bystander bypass tract. Other indirect evidence supporting A-V nodal reentry follows: (a) the demonstration that the H-A interval during ventricular pacing, either in sinus rhythm or, preferably, during entrainment of the preexcited tachycardia, exceeds the H-A interval during the tachycardia (Fig. A: The preexcited tachycardia with antegrade conduction over a left lateral bypass tract. Note the identical H-A interval and retrograde activation sequence in the narrow and preexcited tachycardia. The V-H and H-A delays following S3 are enough to allow the atrial impulse to return to the ventricle over a left posterior bypass tract and to initiate antidromic tachycardia. All our patients with A-V nodal reentry demonstrated shorter H-A intervals during the preexcited tachycardia than during ventricular pacing at similar rates. Even if this unlikely event occurred, the H-A interval of that preexcited complex would necessarily exceed that during the rest of the tachycardia. While on resumption of the preexcited tachycardia the H-A is 35 msec with an identical actual activation sequence. B: When the coupling interval is reduced to 290 msec, the increased V-H is associated with retrograde conduction up a fast A-V nodal pathway, which turns around to conduct down the slow pathway and simultaneously activate the atria. Atrial activation reaches a left lateral bypass tract, through which it conducts antegradely to the ventricle before the impulse reaches the His bundle over the slow pathway. Note the H-A interval on the initiating complex is longer than the H-A interval during the tachycardia despite the fact that the H1-H2 interval exceeds the cycle length of the tachycardia. Cycle length alterations dependent on changing V-H intervals – thereby demonstrating requisite participation of 41 the His-Purkinje system in the tachycardia circuit – are not uncommon in true antidromic tachycardias. We never saw this phenomenon in any of our patients with A-V nodal reentry and innocent bystander bypass tracts. Documentation of A-V nodal reentry as the underlying mechanism of a preexcited tachycardia is of critical importance in planning ablative therapy to cure the arrhythmia. As noted above the mere presence of an H-A interval of <70 msec should suggest A-V nodal tachycardia. The term antidromic tachycardia should be reserved for tachycardias that use an A-V bypass tract antegradely and the normal A-V conducting system retrogradely. The difficulty in recording clear retrograde or antegrade His potentials during atrial or ventricular stimulation in the presence of preexcitation makes establishment of the exact initiating and sustaining mechanisms of preexcited tachycardias difficult to ascertain. Nevertheless, in our experience, ∼23% of preexcited tachycardias are due to A-V nodal reentry with an innocent bystander bypass tract. In addition, many (almost 40%) of our patients with spontaneous reentrant preexcited tachycardias incorporating a bypass tract as the anterior limb have multiple bypass tracts (concealed or manifest), whether or not they are used as the retrograde limb. This is in concordance with the 32 40 incidence of multiple bypass tracts reported by Gallagher et al. Retrograde conduction proceeds with marked V-H-A delay to initiate a preexcited tachycardia. B: A-V nodal reentry (block in the fast and conduction down the slow pathway is shown) with 1:2 conduction.

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To calculate the excess skin to be removed purchase 10mg zetia visa, the thigh is To better identify the medial surface to be aspirated with positioned more medially buy 10mg zetia visa, and the apex of the vertical inci- greater intensity buy cheapest zetia, once the patient is positioned with the sion must touch the end of the adductor muscle fascia at point thighs in a vertical position, the excess tissue of the median a, where it is sutured with a provisional stitch (Fig. The landmark thread is extended from a to b and a verti- respectively in apical and medial directions. The projection cal, anterior line is demarcated, which corresponds to the of the landmark thread fixed at point a should be extended projection of the thread on the skin. Following the same pro- without tension until the beginning of the inguinal sulcus cess, a posteroanterior rotation is performed and another ver- incision first, then the gluteal sulcus, marking on the flaps the tical, posterior line traced. In this way, a triangular area is line of resection of excess skin in the proximal region of the outlined with the base facing the sulcus, which corresponds thigh. The excess is resected and the margins sutured with to the area where the thickness of the subcutaneous tissue provisional 3-0 silk stitches, taking care to rotate the skin of must be reduced by liposuction, fading out toward the two the thigh in both anteromedial and posteromedial directions, external lines that delimit the triangular area. Its correction involves an procedure enables the correction of the alteration of the added period of surgery with vertical incision on the line ab, medial aspect of the thigh in its upper third (Fig. This will also result of the region, preventing skin displacement from the crural in a scar on the medial region of the thigh, which usually region toward the anterior region, which would give an tends to become hypertrophic in its evolution up to the third unnatural “upward-stretching” appearance of the inner por- month. The anterior flap is rotated This phase of surgery must be performed before fixing the posteriorly and the posterior one rotated in an anterior direc- flaps. The projection of the thread extending from point a to After the resection of the proximal skin excess, in cases point b defines the line of resection of the two flaps, and of diffuse cutaneous flaccidity and obese thighs, and after positions the scars in a linear and symmetrical manner the medial liposuction already described, skin excess in the (Fig. Superficial incision along the line In flaccid thighs this results in an increase in general skin ab, from a to b is performed, for a length that must be as firmness without significant reduction in volume (Fig. In serious In obesity, where the goal is the reduction of circumfer- cases, it can extend to the knee. Two subdermal flaps, ante- ence, the thickness of the flap of the previously lipoaspirated rior and posterior, are then packaged. One at a time, these median region permits reduction of the perimeter with the 460 F. One means of assessment is to make the patient spread the legs while keeping the feet parallel, until the inner thighs touch each other. Measure the distance between the knees in the pre- and postoperative phases b Medial Dermolipectomy of the Thigh 461 Fig. Pre- and postoperatively at 6 months in anterior view (a) and medial view at 3 months with symmetrical scars (b) c d 462 F. If liposuction to the medial region is not per- formed, the flaps should be resected at full thickness to obtain a circumferential reduction. The incision in these cases could affect the superficial venous circulation in its most distal part. The saphenous vein, directed toward the b knee, thus becomes more medial and superficial, with the risk that it can be inadvertently included in the tissue to be removed and resected. It is sufficient to ensure that it is wrapped by a layer of subcutaneous tissue, thus keeping intact the venous and lymphatic circulation. Dissection of the subcutaneous tissue of the labia majora at the prefascial level is performed, from the pubic tubercle to the ischial ramus (Fig. When at the height of point “a” excess skin is formed (raised with forceps), its correction involves vertical incision on the line “ab” 2. With the same procedure, we then fix the anchored to the periosteum with no risk to other structures. At the level of the flap, position of scars and maintains the original height of the labia the needle must “pinch” the dermis at a distance of approxi- majora. The In cases where the correction includes the medial region author uses 4-0 monofilament. The sulcus skin must be sutured with eversion the same time do not hinder normal swelling. The bladder catheter and dressings of the Antibiotic and fibrinolytic anti-inflammatory therapy is sulcus must be removed the day after surgery and the wounds prescribed. Vertical dressings must be removed on the 5th serious gynecological repercussions, including irritation and postoperative day. To reduce the tendency to hypertrophy of inflammation, repeatedly in the event of a gaping vagina. In this type of interven- not recommended, but rather some type of loose underwear tion, the positioning of the incision line of the sulcus, the for a period as long as possible, even up to 3 months. The four worn for about a month, day and night, taking care not to phases in the planning described earlier, if performed care- push down the flaps when undressing. In addition, age after the 7th postoperative day in cases with vertical this technique can be used for the correction of secondary scars and in all cases where liposuction has been involved. Specific complications are more frequent and increase when The purpose of the following consent form is to provide associated with liposuction and other body-contouring oper- the patient, in addition to the preoperative information given ations. Following the previously described planning, the spe- by the surgeon, clarifications concerning the characteristics cific complications of the immediate postoperative period and risks associated with thigh-lift surgery. This can be resolved with daily medica- Redundancy or laxity of the inner thighs can be corrected tion. This operation, called thigh lift, is aimed at of the scar, leading to the distortion of the labia majora with removing the excess skin of the region of the inner thigh. Large scars from the inguinal sulcus (groin) to the gluteal fold of the buttock remain. The stitches of the sulcus • Do not resume sexual activity before 3 weeks have passed. The operation is necessar- boxers for the longest period possible, even up to 3 months. Overnight stays • For at least 3 weeks wear elastic stockings if prescribed, (usually 1), frequency of medication, and the removal of even during the night. For 3 months, satisfactory from the earliest stages, although scar readjust- avoid fully spreading or stretching the legs. Extra assistance can be useful, In addition, the operation was illustrated in detail by the though not essential. In some cases, the scars can migrate below the inguinal sulcus (groin), thus becoming visible outside the panty line. In the post-operative period, tension will be felt especially • Do not consume food or drink from midnight. In rare cases, edema may persist in cases of more severe corrections or when associated with general liposuction. And his/her employees to perform on me the surgical pro- Ann Plast Surg 17:176–183 cedure …………………………………. Hoffman S, Simon B (1975) Experiences with Pitanguy method of I know that I will have to undergo an correction of trochanteric lipodystrophy. Cir Plast Ibero- Dr……………………………………………………… Latinoam 7:275 and his colleagues to change operative and postoperative 7. Regnault P, Daniel R (1984) Secondary thigh-buttock deformities after classical techniques. Clin Plast Surg techniques and strategy according to their expertise and 11:505–516 necessity. Delerm A, Girotteau Y (1973) Cruro-femoro-gluteal or circumglu- I agree to follow the medical and physical therapy that teal plasty.

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