González-Ulloa's Manifesto on aesthetic surgery

The realization that the proper development of aesthetic surgery was hindered by a bias against such practice by departmental heads and editors of medical journals led Dr. Mario González-Ulloa from Mexico to formulate a "Manifesto" on this speciality in the 1960s. This Manifesto has been of utmost importance to our speciality because it served to disseminate responsible opinion concerning aesthetic surgery among specialists. Although the bare text of the Manifesto was published in 1966, its content has so far been lost to future generations of plastic surgeons. Because its place in the history of aesthetic plastic surgery needs to be acknowledged, González-Ulloa's Manifesto is presented and discussed here.     

Chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer patients: is it time for additional evidence?

In this letter I propose the name "Proliferative Multifocal Leukoplakia" with the goal of reducing under-diagnosis of this disease, improve the early diagnosis, try to make an early therapy and control, and prevent its malignant transformation.     

Will cardiac surgery improve my quality of life?

Background. The intention of this study is to analyse the correlation between a visual analogue scale (VAS) and the most common preoperative comorbidity and cardiac variables in patients undergoing elective cardiac surgery. This VAS is simple, easy to register and can be used as a global measurement of quality of life (QOL). Methods. Preoperative assessment of QOL in 1351 patients, 979 men and 372 women, with a mean age of 64.5±10.5 (18-88), undergoing elective cardiac surgery between January 2003 and December 2005. QOL was measured by the EuroQol questionnaire. Results. The mean VAS was 58.7±20.9, range 3 to 100. Univariate analysis showed a difference for sex (p=0.000), and NYHA (p=0.009) between patients with an isolated CABG and those with a combined revascularisation (p=0.05). Stepwise logistic regression analysis identified female gender (p=0.00), NYHA (p=0.00) and valve disease (p=0.03) as independent variables for a low QOL. The correlation between NYHA and QOL was low (r=-0.09, p=0.003). Conclusion. The clinical consequence is that using this simple VAS we can identify patients with a good QOL. If these patients present for high-risk surgery, with a better quality of life as primary indication, more extended counselling regarding their QOL is recommended. (Neth Heart J 2007; 15:51-4.)     

Coronary artery surgery: are women discriminated against?

OBJECTIVE--To determine whether the sex differences in access to cardiac surgery observed in the United States exist in the United Kingdom. DESIGN--Retrospective analysis of routinely collected data. SETTING--South West Thames and North West Thames regional health authorities. SUBJECTS--8564 patients discharged from hospital with a principal diagnosis of coronary heart disease in 1987-8 in South West Thames region and 15243 discharges in North West Thames region in 1990-1. MAIN OUTCOME MEASURES--Performance of angiography or coronary artery bypass surgery. RESULTS--In all age groups and among patients with a principal diagnosis of either angina or chronic ischaemia men were significantly more likely than women to undergo revascularisation in both regions. Using multiple logistic regression to control for potential clinical and demographic confounders, the male to female odds ratio for revascularisation among all cases was 1.59 (95% confidence interval 1.25 to 2.03) in South West Thames region and 1.47 (1.32 to 1.63) in North West Thames region. CONCLUSION--There appears to be a systematic difference in the treatment received by men and women in the United Kingdom. The reasons for this are uncertain.