Facial aging along the periocular area has led to the development of new non-surgical therapies. The lower periorbital area (LPOA) is a vital region for facial rejuvenation and several procedures have been studied to treat it, especially procedures with dermal fillers for volume rebuilding. This manuscript aims to describe a filling technique with hyaluronic acid (HA) along the superficial layer of the lower periorbital area, presenting its effectiveness and safety. Our assessment was made by autonomous observers with pictures of before and after treatment, rated from 0 (no enhancement) to 100 (maximum enhancement). Patients' self-assessment was also performed using a visual analog scale (VAS) based on a 100-mm ruler affording a 0-100 rating. Thirty patients were enrolled in this study. The autonomous observers' evaluation presented a 78.4 mean improvement rate. Patients' self-assessments after the treatment were 0% reporting no improvement, 6.7% mild improvement, 23.3% moderate improvement, 66.7% great improvement, and 3.3% maximum improvement. Restylane Vital Skinbooster infiltration at the lower periorbital area proved to be a safe treatment. The described technique is also simple to execute, has a low rate of complications, and produces a high satisfaction rate.

data about the manner in which PAM visualizes different tumor types. CONCLUSIONS: Using expert elicitation prior distributions for sensitivity and specificity of PAM were obtained. This evidence could be used in early health economic models to establish cost-effectiveness. However, experts expressed difficulties estimating the performance based on limited data. The expression of uncertainty surrounding their beliefs reflects the infancy of the diagnostic method, however further clinical trials should be commissioned to indicate whether these results are valid. Before that, the use of the elicited priors in health economic models requires careful consideration.OBJECTIVES: A small number of patients with minor head injury deteriorate, resulting in serious injury or death. Clinical features are often used to identify which patients with minor head injury are likely to deteriorate and therefore need CT scanning. To estimate the value of these characteristics for diagnosing intracranial injury (including the need for neurosurgery) in adults, children and infants, a systematic review and meta-analysis of diagnostic accuracy was undertaken. METHODS: Citations were identified through electronic searches of several key databases, including MEDLINE, from inception to March 2010. Cohort studies of patients with minor head injury (Glasgow Coma Score [GCS], 13-15) were selected if they reported data on the diagnostic accuracy of individual clinical characteristics for intracranial or neurosurgical injury. Study selection, quality assessment and data extraction were performed by one reviewer and checked by at least another. Where results allowed, pooled sensitivity, specificity and likelihood ratios were estimated through meta-analysis. RESULTS: Data were extracted from 71 studies (with cohort sizes ranging from 39 to 31694 patients). The most useful clinical characteristics for identifying those with intracranial injury were depressed or basal skull fracture in both adults and children (positive likelihood ratio [PLR], Ͼ10). Other useful characteristics in adults or children included focal neurological deficit, post traumatic seizure (PLR Ͼ5), persistent vomiting, and coagulopathy (PLR 2 to 5). Characteristics that had limited diagnostic value included loss of consciousness and headache in adults and scalp haematoma and scalp laceration in children. Few studies were undertaken in children and even fewer reported data for neurosurgical injuries. CONCLUSIONS: Amongst other characteristics, depressed or basal skull fracture indicated increased risk of intracranial injury and the need for CT scanning in adults and children. Other characteristics, such as headache in adults and scalp laceration of haematoma in children, do not reliably indicate increased risk.

AIMS: To expose a case of acute abdomen due to appendicitis whose diagnosis was difficult and complicated because of the patient's profile and his comorbidities. CASE DESCRIPTION: Male patient, 52 years old, superobese, smoker and with chronic liver disease, complaining of acute abdominal pain in the right hypochondrium, vomiting and low diuresis. Initially with no signs of peritoneal irritation, the patient was medically managed, but presented worsening of clinical status, progressing to shock and cardiac arrest. The investigation by laparotomy found acute appendicitis, collateral circulation and liver cirrhosis. CONCLUSIONS: Acute abdomen has great impact on emergency care and, since it comprises several clinical situations, knowing and suspecting its main causes and its atypical presentations becomes essential, mainly in cases of difficult diagnosis.

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