Day 1 :
Clínica Doctor Mira, Plastic Surgeon, Spain
Time : 09:00 am - 09:35 am
Juan A Mira is a Plastic Surgeon since 1975 from Valencia, Spain. He has published his first work on "Mamaplastia aumentativa via transareoar inferior: 100 casos" (Revista de Cirugía Plástica Iberolatinoamericana), in 2003 his revolutionary innovation in breast prostheses "Anatomic Asymmetric Prosthesis: shaping the breast" (Aesthetic Plastic Surgery) and in 2010 his "Anatomic Bilateral Contour Mammary Prosthesis: ABC”.
Maintaining the shape and position of female breast has been a permanent human desire. Since 5000 years to nowadays we have noticed this evidence. Sir Astley Cooper seemed to offer us a way to follow when he described his remarkable fascia in the middle of the XIX century. Anatomist and surgeons followed what they thought it was responsible for the shape and suspension of the gland. But it was the unjustifiably forgotten, Col. Christine Haycock who demonstrates during her 40 years' experience that neither Copper’s fascia nor breast weight have anything to do with shape and ptosis. This is an important detail that made us think about two important points in breast augmentation: form and permanence. We review the topic, from the first attempts of breast implants until today. We talk briefly about incisions, access, placement and implants. In order to reach conclusions that provoke a technique of simple breast augmentation for every plastic surgeon, always clinically safe and aesthetically pleasing. We consider here our proposed solutions describing a new shape of mammary prosthesis for preventing that aesthetic issue: naturally anatomical and therefore with shape and in pairs, not in units for both breasts, as they have all been developed in the last 60 years.
Complutense University Madrid, Spain
Time : 09:35 am - 10: 05 am
Dr. Ernesto Delgado Cidranes MD. PhD. APMCM. FSNA. FSCTA is an Anesthesiology, Resuscitation and Intensive Care Professor at Complutense University Madrid, Spain. He is the Scientific Director of ISGAR Society (International Society of Urogynecology, Aesthetic and Research), Scientific Chairman of UroGyneTV. Founder and CEO Advanced Pain & Aesthetic Management Center, Madrid. Cheif Editor, Journal of Pain Management and Therapy. Editor for Journal of Anesthesiology and Critical Care. Expert on Advanced Ultrasound and Pelvic Floor Disorders. He’s also an expert in Stem Cells and Regenerative Medicine. AIUM Member, Head Pain Unit, Hospital La Milagrosa. Anesthesiologist & Pain Management at CIMEG, MADRID. Director of International Course “The Art of Lung Ultrasound”. Director for International Certification ISGAR STEM CELLS (Cadaver & Live). Members of Organizing Committee for Pain Medicine at World Series Conferences USA. Anesthesiologist Research Teknon Hospital Barcelona.
A case study was performed by evaluating 23 patients using PET-MRI by implication of neuro inflation in patients with poor response to usual treatments. PET-MRI was performed on all patients. According to the diagnosis of uptake, the therapeutic behaviour to be followed was defined, as well as the comparison with the final result and degree of satisfaction and decrease of the inflammatory focus for the control of persistent chronic pain. The results were satisfactory and definitive in all of the patients and we concluded that PET-MRI in real time is a powerful tool for the resolution of complex patients with chronic pain
Research Institute of Clinical Medicine, European University, Georgia
Keynote: Transnasal sphenopalatine ganglion block for postdural puncture headache treatment after spinal anesthesia – case report
Time : 10:05 am - 10:45 am
Vakhtang Shoshiashvili is specialized in Anesthesiology and has a quite a few experience of regional anesthesia and pain management. He also contributed in treatment of cancer pain conditions. Since, 2013 he is an expert in anesthesia and intensive care at TSMU and Ministry of Health Care and Social Affairs Republic of Georgia. Currently, he is also an Associate Professor at European University and since 2016 is working as an Anesthesiologist at Research Institute of Clinical Medicine Tbilisi, Georgia.
Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design and the technique used also affect the risk. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing and improves with lying down. Conservative therapies such as bed rest, hydration and caffeine are commonly used as prophylaxis and treatment for this condition. We are presenting a case report of PDPH after pilonidal cystectomy. The patient was a 23 years old male, non-smoker has spinal puncture with B. Braun Spinocan 25 G Quincke type needle on the L3-4 level. Five minutes later after injecting of 3.5 ml Marcaine (“Astra Zeneca”) there was an acceptable depth of spinal anesthesia where surgery and anesthesia was done without complication. On second day patient was ambulated at home, no headaches. On third day after surgery patient felt severe postural headache. Hydration and caffeine was not helpful. We decided to relieve this pain condition by the sphenopalatine ganglion block with 2% lidocaine application through the transnasal cotton ended catheter. Pain was relieved immediately. Duration of the application was five minutes. Procedure was repeated for 1 h with interval of three times. PDPH was relieved completely. We are concluding that sphenopalatine ganglion block with transnasal 2% lidocaine application is a simple, effective and safe tool for PDPH treatment which is usable for ambulated patients.
Prince Sultan Military Medical City, Saudi Arabia
Keynote: Victims and culprits of evidence biased and chaotic medicine presented by hemodynamic monitors
Time : 1100 AM - 11.35 AM
Ashraf EL-Molla, M.B., B.Ch., M.Sc., M.D, Consultant Anesthesiologist, Ministry Of Health, Egypt, Cairo. He is interested in airway management, his recent publication “Bridging Bronchus, type six as a new rare case of a bronchial anomaly
Hemodynamic monitoring in critical care setting and perioperative period has been studied for decades and generated a large number of publications. We observed a conceptual shift in philosophy by monitoring static parameters of dynamic, functional and flow directed hemodynamic monitors (HM). We also witnessed the change of hemodynamic monitoring from invasive to minimally invasive and finally non-invasive technologies. In the era of evidence based medicine, it is imperative to realize that the evidence of HM to improve patients’ outcome is either small or, more often non-existent. Apart from the well known limitation related to modern dynamic monitors, none of the cardiac output (COP) monitors available today consistently present with <30% mean percentage error and >92% concordance. Most widely used modern dynamic COP monitors demonstrate a mean percentage error around 40-45% and most devices present with concordance <92%. Despite these disappointing results, it is surprising that a professional discipline such as medicine is able to conduct clinical studies using devices that have been consistently demonstrated inaccuracy and generate positive clinical outcome results. We consider this deviation as evidence bias or chaotic medicine as best or may be evidence corrupted medicine as worst. The reason for lack of evidence is probably related to the fact that human physiology is an incredibly a complex model. The novel hemodynamic devices provide a false sensation of security as those monitors are claimed to be effective to characterize fluid responsiveness which is taken as a sign of hypovolemia. This approach ignores the fact that HM cannot differentiate between absolute hypovolemia induced by blood and fluid loss and surgical stress which releases catecholamine that leads to vasoconstriction and various anaesthetic drugs that produce vasodilatation and relative hypovolemia as well as myocardial depression. We call for transparency in clinical research and a complete review as well as urgent refinement and modification of most of the present monitors not only for better patients’ outcome, but also for us as physicians who accepted what other industries dealing with life and death would clearly consider unacceptable