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Infertility Diagnosis and Treatment
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
Our knowledge of the erection and ejaculation processes is far from complete and there are still many controversies.46 Nevertheless it is quite clear that the ultimate mediator of erection is the penile engorgement of blood. Within the penis the three elongated structures the two, corpora cavernosa and the corpus spongiosum are spongy and highly vascularized. Accumulation of blood in these structures is the source of tumescence. It is recognized that vasculogenic and neurogenic factors are responsible for initiating and maintaining the erection. Study of the vascular and neural processes are key to the understanding of the erection and its failure.
Tumescent Anesthesia
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
William B. Henghold, Brent R. Moody
Tumescent anesthesia (TA) is a distinct form of local anesthesia that employs a large volume of fluid (usually normal saline) containing a very dilute concentration of anesthetic (primarily lidocaine) and vasoconstrictor (epinephrine), as well as other additives (notably, sodium bicarbonate). Local anesthesia is defined as the loss of sensation within a confined area without alteration of the patient’s consciousness. Tumescent is derived from the Latin word tumescere, meaning to swell. It is the swelling and resultant firmness of the tissue that both contributes to the regional anesthetic effect and also facilitates the procedure for which it is now most commonly employed, liposuction. TA is local infiltration anesthesia and should not be confused with regional anesthesia as occurs with peripheral nerve blockade.
Surgical Rejuvenation of the Ageing Face
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Gregory S. Dibelius, John M. Hilinski, Dean M. Toriumi
A tumescent liposuction technique is used to harvest the fat for transfer. Tumescent solution containing 20 mL of 1% lidocaine and 1 amp of epinephrine in 1 L of isotonic saline is infiltrated into the subcutaneous fat plane using a blunt-tip cannula. The tumescent solution is permitted to stand for a period of time prior to liposuction to allow for adequate vasoconstriction. Fat is then harvested using a liposuction technique similar to that described above. A 2–3 mm blunt multihole cheese grater type cannula is preferred for the harvest. Careful attention is paid to the plane of harvest to avoid irregular scarring of the dermis or entry into the abdominal cavity. The non-dominant hand continuously palpates the depth of the cannula and controls its movement. The amount of fat required for facial injections is typically well below the volume performed in a standard liposuction procedure, which decreases the morbidity of the technique substantially. Patients should be counselled not to expect a significant aesthetic improvement at the donor site.
Quality of Life, Sexual Functioning and Chronic Disease: A Comparative Study with Portuguese Women without Chronic Disease, and Women with Diabetes Type 1 and 2, and Arterial Hypertension
Published in International Journal of Sexual Health, 2022
Maria Manuela Peixoto, Júlia Lopes, Ana Luísa Rodrigues
DM appears to put women at greater risk for sexual dysfunction (Bak et al., 2018; Bąk et al., 2021; Giraldi & Kristensen, 2010; Mezones-Holguin et al., 2008), as it can impair sexual arousal and, consequently, vaginal lubrication (Enzlin et al., 2003; Mezones-Holguin et al., 2008; Rutherford & Collier, 2005). Given the influence of DM on penile tumescence (Enzlin et al., 1998; Giraldi & Kristensen, 2010; Kizilay et al., 2017; Rutherford & Collier, 2005; Schiavi et al., 1995; Schreiner-Engel et al., 1985), it is possible that it also influences clitoral tumescence. However, the negative physiological influence is more significant in men (Rutherford & Collier, 2005), and less conclusive in women (Kizilay et al., 2017). Different pathophysiological mechanisms such as hyperglycemia (reduced hydration of mucous membranes in the vagina), microvascular damages and neuropathies may impair women’s sexual response (Enzlin, Mathieu, & Demytteanere, 2003; Giraldi & Kristensen, 2010; Rutherford & Collier, 2005; Schreiner-Engel et al., 1985).
Autologous fat transplantation for the treatment of abdominal wall scar adhesions after cesarean section
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sheng-Hong Li, Yin-Di Wu, Yan-Yun Wu, Xuan Liao, Pik-Nga Cheung, Ting Wan, Li-Ling Xiao, Jian-Xing Song, Hai-Ling Huang, Hong-Wei Liu
Approval for autologous fat harvesting and transplantation was obtained from the Institutional Review Board of Medical Science, Jinan University, and written consent was obtained from the study participants. The liposuction sites were located in the lower abdomen, thigh, and knee. The incision for lower abdominal liposuction was made at the inner edge of the umbilicus. Lidocaine (0.125%) was used as a topical infiltrating anesthetic. A no. 11 scalpel was used to make an incision of approximately 3 mm in accordance with the preoperative plan. A no. 20 blunt-side-opening long needle was used to inject the tumescent anesthesia solution (25 ml of 2% lidocaine + 2 mg of adrenaline + 12.5 ml of 8.4% sodium bicarbonate + 1000 ml of normal saline). The amount of tumescent fluid injected depended on the amount of fat required and the range of liposuction. A side-opening liposuction needle with an inner diameter of 3 mm was inserted into the subcutaneous fat layer, a 20 ml syringe was connected, and subcutaneous fat was extracted using the syringe liposuction technique [14,15]. Uniform radioactivity extraction was conducted, and the amount of extracted fat depended on the amount of fat required to fill the subcutaneous tunnels of the scar. The contused tissue around the incision was trimmed, and the skin incision was sutured. The surgical area was bandaged under pressure. The collected fat was statically precipitated and filtered to remove the tumescent anesthetic fluid and was then placed in a 10 ml syringe for use.
Liposuction for large facial involuted infantile hemangiomas in children: clinical evaluation and management strategies
Published in Journal of Dermatological Treatment, 2021
Wei Gao, Yajing Qiu, Yunbo Jin, Xiaoxi Lin
Preoperatively, the incision and facial zones to be corrected by liposuction were marked. After induction with general anesthesia, a traditional tumescent technique was applied. The tumescence (20 ml of 2% lidocaine, 5 ml of epinephrine diluted 1:10,000, and 500 ml of saline solution) was infiltrated into the areas to be liposuctioned subcutaneously via cannulas through a small (1–3 mm) incisions. The total volume infused varied from one case to another, depending on the patient’s age, size, and estimated final aspirate. Proper tumescence will ensure smooth aspiration. Syringe-assisted liposuction with blunt-tipped 2- or 3-mm cannulas was performed in the subcutaneous plane above superficial musculoaponeurotic system (SMAS). The cannula was inserted into the lesion and swept through the zones to be corrected until clinical parameters such as symmetry were achieved (Figure 1, left). During the aspiration, surgeons gently palpated the skin to feel the tip position, while maintaining the depth of the cannula within the subcutaneous plane. To prevent contour irregularities, the cannula moved along a smooth, uniform, and radial pattern. Thus, we can sculpt the face and quantitate the amount of fat removed so that symmetry can be maintained (Figure 2(a,b)).