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D R Nevarre

Publications and source records attributed to D R Nevarre.

11 recordsLinked to original sources
PubMed1999

Retrobulbar hematoma and blepharoplasty.

Retrobulbar hematoma leading to visual impairment is a rare but serious complication associated with elective blepharoplasty. A review of the literature addressing etiology, prevention, and management is presented. Removal of anterior orbital fat associated with traction and rupture of vessels within posterior orbital fat is currently most strongly supported as the cause of retrobulbar hematoma after blepharoplasty. Optic nerve ischemia is identified as the likely cause of visual impairment. Specific recommendations for avoidance and management of acute retrobulbar hematoma are offered. Recent background animal and human research is summarized.

Animals↗
PubMed1999

Suction-assisted lipectomy for lipodystrophy syndromes attributed to HIV-protease inhibitor use.

The addition of HIV-protease inhibitors to the arsenal of therapies for the treatment of HIV infection has resulted in significant suppression of viral load such that HIV-positive individuals experience reduced morbidity and extended life expectancy. Recently, a number of syndromes have been described involving abnormal fat distribution that may be associated with prolonged HIV-protease inhibitor therapy. These syndromes include hypertrophy of the cervicodorsal fat pad ("buffalo hump"); a tendency toward increased central adiposity ("protease paunch"); adiposity in the submental, mandibular, and lateral cheek regions of the face; and hypertrophy of adipose tissue in the breast in women. A peripheral lipodystrophy, or fat-wasting, in the extremities and face (particularly the malar and nasolabial fold regions) has also been observed. As these patients live longer and healthier lives, many are beginning to seek surgical correction of the disfigurements. In this regard, we present a review of the literature regarding these recently described syndromes to familiarize plastic and reconstructive surgeons with the unique deformities encountered in this ever-increasing patient population. We also present our results with suction-assisted lipectomy for treatment of these deformities. Physical findings, pathogenesis, and surgical management are discussed.

Adult↗
PubMed1998

The effects of hyaluronidase on the efficacy and on the pain of administration of 1% lidocaine.

Despite current clinical practice, there is no objective evidence to demonstrate the efficacy or pain on injection when hyaluronidase is added to lidocaine as an anesthetic combination for local anesthesia. To evaluate the usefulness of hyaluronidase added to lidocaine in affecting pain on injection and effectiveness of local anesthesia, a prospective, randomized, double blind study comparing 1% lidocaine preparations with and without hyaluronidase (15 U/cc) was conducted. A paired experiment was done with each subject receiving both treatments. Solutions of these local anesthetics were prepared. A 0.5-cc intradermal injection of each was administered to the dorsum of the nondominant hand of 25 volunteers. After showing study participants a standard pain with a peripheral nerve stimulator, pain of anesthetic infiltration was rated by the subject using a visual analog scale. The amount of tissue deformation on injection was assessed. The area of anesthetized skin surrounding each injection was measured at 1/2, 1, 2 1/2, 4 1/2, 8, and 12 minutes after injection. The area of anesthesia achieved by 1% lidocaine infiltration can be significantly enhanced by the addition of hyaluronidase at a concentration of 15 U/cc (p = 0.0003). This raises the pH of the anesthetic to a slightly more physiologic level (6.33 versus 6.20) and makes the pH closer to the pK of the lidocaine. In addition, the hyaluronidase additive significantly decreases the amount of tissue distortion (p < 0.0001) without decreasing the efficacy of anesthetic action (p = 0.01). However, adding hyaluronidase to 1% lidocaine significantly increased the pain on injection (p = 0.0002). The injections of small amounts of hyaluronidase-containing solutions in this experiment did not produce any visible effects at 5 to 7 days after injection; however, the effect of hyaluronidase upon wound healing was not studied.

Adolescent↗
PubMed1997

Supraclavicular approach to subclavian catheterization: review of the literature and results of 178 attempts by the same operator.

Over a period of 15 months, 178 consecutive attempts at supraclavicular catheterization of the subclavian veins were performed by the same operator. There were 42 additional central lines inserted during this period, which were placed via other methods as specified by the attending physicians. Results of the supraclavicular approach are presented and are believed to be the largest reported series of supraclavicular line insertions by one operator. Forty-five of the supraclavicular lines were placed after failed attempts by other emergency room and surgical physicians. Five were inserted in patients that were in hypovolemic shock, and three were placed in morbidly obese patients weighing 800, 400, and 335 pounds. Of the 178 attempts, there was only one significant complication: a left-sided pneumothorax on the 21st attempt in an emphysematous patient. The vein was successfully accessed in 177 cases with only two instances of inability to thread the catheter and one instance of malposition. Overall, there was satisfactory placement in 97.8% of attempts with a significant complication rate of 0.56%. This paper intends to describe the details of subclavian venipuncture by the supraclavicular technique, and, because of the high degree of reliability and safety of this technique in experienced hands, to recommend it as an excellent alternative for central venous access --especially in difficult cases.

Catheterization↗