bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Role of Septal Extension versus Columellar Grafts in Modern Rhinoplasty
Authors: Rohrich Rod J. , Durand Paul D. , Dayan Erez
Published: April 2020

Effective control of nasal tip projection and rotation is a key component in modern rhinoplasty. Tip projection is a product of several anatomical factors: length and strength of lower lateral cartilages, the suspensory ligament, fibrous connections to the upper lateral cartilages, and the anterior septal angle. Several cartilage grafts have been described for effectively altering nasal tip projection and rotation. Columellar struts and septal extension grafts are both commonly used in modern rhinoplasty to affect projection and rotation of the nasal tip. Although columellar strut grafts have shown moderate efficacy in maintaining tip projection and unifying the tip complex, their effect on increasing tip projection has been shown to be very limited. In comparison, septal extension grafts have been shown to effectively control tip projection, rotation, and shape by securing the nasal tip to the septum. Varieties of septal extension grafts have been described to support the medial crura and control tip shape, all of which depend on the presence of a stable caudal septum. The type of graft used is dependent on the specific characteristics of the underlying tip structures. The authors’ aim is to provide an updated classification of cartilage grafts for altering nasal tip projection and rotation, and an algorithmic approach for their implementation. Although both columellar struts and septal extension grafts offer the modern rhinoplasty surgeon a way to alter tip projection and rotation, they do vary in efficacy. Understanding which graft to use and in what setting is key in successfully controlling projection, rotation, and shape of the nasal tip.
What Is Driving Paradigm Shifts in Plastic Surgery and Is Cosmetic Surgery Keeping Up?
Authors: Yao-Mei Tang Jasmine , Pawliuk Colleen , Bucevska Marija , Mulpuri Varshita , Arneja Jugpal S.
Published: April 2020

Background:

Cosmetic surgery represents 20 to 30 percent of total plastic surgical volume. The authors hypothesize that with current capitalization and market share, cosmetic surgery should be proportionally represented in scientific innovation.

Methods:

All journals that may contain articles relevant to plastic surgery were selected from the 2016 edition of Journal Citation Reports. The authors identified, reviewed, and analyzed the 100 top-cited plastic surgery clinical articles using the Science Citation Index Expanded (1900 to 2017) as a proxy for innovation.

Results:

The top-100 articles were cited a median of 329.5 times (range, 240 to 1709 times). Sixteen journals were represented, led by Plastic and Reconstructive Surgery (45 percent) and Annals of Surgery (15 percent). Fifty-six percent were reconstructive, 13 percent were breast, 11 percent were pediatric/craniofacial, 11 percent were cosmetic, and 9 percent were hand/peripheral nerve articles. Only 11 percent of articles represented level of evidence I or II, with the majority (79 percent) of articles being level IV. Sixty-seven percent of publications originated from United States. The 11 cosmetic articles originated from different subspecialties: injectables, fillers, and fat grafting (n = 7); contouring (n = 2); facial cosmetic (n = 1); and general cosmetic (n = 1).

Conclusions:

Cosmetic innovation is not keeping up with reconstructive innovation; it is unknown why cosmetic surgery is lacking. The authors offer several speculations as to why there is a gap in cosmetic surgical research and, by proxy, innovation.
The Impact of Race, Age, Gender, Income, and Level of Education on Motivations to Pursue Cosmetic Surgery and Surgeon Selection at an Academic Institution
Authors: Ligh Cassandra A. , Lett Elle , Broach Robyn B. , Enriquez Fabiola A. , Jordan Atasha , Percec Ivona , Serletti Joseph M. , Butler Paris D.
Published: April 2020

Background:

Aesthetic surgery is a personal choice that appeals to a wide population of individuals. The authors investigated how race and ethnicity, age, gender, income, and education level affect patient motivation to pursue cosmetic surgery and selection of a plastic surgeon.

Methods:

One hundred seventy-two consecutive patients from two surgeons (an African American man and a Caucasian woman) completed surveys from 2016 to 2017 that assessed their decision to pursue cosmetic surgery. Univariable cumulative logit models with odds ratios and 95 percent confidence intervals were calculated with the survey data.

Results:

African American patients were more likely to be willing to travel greater than 100 miles for a surgeon who shared the same ethnicity or race, to consider international surgery, to report that social standards did not influence their decision for surgery, and to view the buttocks as the female feature that best defines attractiveness within their race or ethnicity. Patients with incomes over $125,000 and those over the age of 50 years were more likely to seek a surgeon of the same gender, think a same-gender surgeon could provide better results, be influenced by societal standards to pursue surgery, and view the face as the defining attractive female feature within their race or ethnicity. Patients with college or graduate degrees were more likely to believe a gender- and racially concordant surgeon would provide them with better a result and believed societal standards were unrealistic to obtain with diet and exercise.

Conclusions:

Plastic surgeons encounter patients of varying demographics, all of whom have differing perspectives about cosmetic surgery and motivations for its pursuit. Recognizing and defining these differences could enable surgeons to provide a more individualized cosmetic experience and inform future marketing strategies to attract a diverse patient population.
Supplementation with Extracellular Vesicles Derived from Adipose-Derived Stem Cells Increases Fat Graft Survival and Browning in Mice: A Cell-Free Approach to Construct Beige Fat from White Fat Grafting
Authors: Zhu Yuan-zheng , Zhang Jing , Hu Xuan , Wang Zhao-hui , Wu Shu , Yi Yang-yan
Published: April 2020

Background:

Growing evidence has demonstrated that adipose-derived stem cell-derived extracellular vesicles enhance the survival of fat grafts and the browning of white adipose tissue. We evaluated whether supplementation with adipose-derived stem cell-derived extracellular vesicles promotes the survival and browning of fat grafts.

Methods:

Extracellular vesicles derived from adipose-derived stem cells were injected into fat grafts of C57BL/6 mice once per week until postgraft week 12. The grafts were collected and weighed after postgraft weeks 2, 4, and 12. The histological morphology, neovascularization, and the proportion of M2 macrophages of grafts were evaluated. The ability of extracellular vesicles to promote macrophage polarization and catecholamine secretion was detected. Whether the inducement of browning adipose differentiation is extracellular vesicles or the paracrine effect of M2 macrophages polarized by extracellular vesicles was also verified.

Results:

Grafts treated by extracellular vesicles derived from adipose-derived stem cells showed enhanced beige adipose regeneration with increased neovascularization, M2 macrophage proportion, and norepinephrine secretion at postgraft week 4. Increased retention and decreased fibrosis and necrosis were noted at postgraft week 12. The extracellular vesicles uptake by macrophages promoted M2 type polarization and catecholamine secretion while suppressing M1 type polarization. Of note, browning adipose differentiation with enhanced energy expenditure could be promoted only by the conditioned medium from extracellular vesicle–polarized M2 macrophages but not by extracellular vesicles themselves.

Conclusions:

Supplementation with extracellular vesicles derived from adipose-derived stem cells increases fat graft survival and browning by which extracellular vesicles–polarized M2 macrophages secrete catecholamines to promote beige adipose regeneration.
Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery
Authors: Westenberg Ritsaart F. , Oflazoglu Kamilcan , de Planque Catherine A. , Jupiter Jesse B. , Eberlin Kyle R. , Chen Neal C.
Published: April 2020

Background:

The first aim of this study was to determine the rate of revision carpal tunnel release in five urban hospitals over a period of 14 years. The secondary aim was to assess what demographic, condition-related, and treatment-related factors are associated with revision carpal tunnel release.

Methods:

Between 2002 and 2015, 7464 patients underwent carpal tunnel release. After manually reviewing the medical records, the authors identified 113 patients who underwent revision surgery. Multivariable logistic regression analysis was performed to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including carpal tunnel release performed simultaneously and separately), and type of surgery (open or endoscopic). To gain further insight into these factors, a matched case-control analysis in a 1:3 ratio was performed.

Results:

One hundred thirteen of 7464 patients (1.5 percent) underwent revision carpal tunnel surgery. The median (interquartile range) time to revision surgery was 1.23 years (0.47 to 3.89 years). In multivariable logistic regression analysis, older age, male sex, bilateral carpal tunnel release, and endoscopic carpal tunnel release were independently associated with higher odds for revision surgery. Multivariable conditional logistic regression of the matched case-control cohort showed that smoking and rheumatoid arthritis were independently associated with revision carpal tunnel release. Splint treatment before the initial surgery was independently associated with single carpal tunnel release.

Conclusion:

Endoscopic release, male sex, smoking, rheumatoid arthritis, and undergoing staged or simultaneous bilateral carpal tunnel release are risk factors for revision surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
The Next Frontier of Outcomes Research: Collaborative Quality Initiatives
Authors: Billig Jessica I. , Kotsis Sandra V. , Chung Kevin C. ,   For the Michigan Collaborative Hand Initiative for Quality in Surgery
Published: April 2020

Quality improvement efforts at the federal level have instituted both rewards and penalties as incentives to improve health care quality. However, neither of these methods has shown long-lasting improvements. Furthermore, many programs have focused on decreasing mortality or hospital readmissions, measurements that are not applicable to many surgical fields, including plastic surgery. One model that has been shown to be effective is a collaborative quality initiative that uses a pay-for-participation method whereby participants learn from one another and institute changes to improve patient care. Many of these changes are process measures that are easier to implement and quicker to show improvement than structural or outcome measures. Regional collaborative quality initiatives have been developed in other surgical specialties such as bariatric surgery and urology. Currently, the authors are establishing a new collaborative quality initiative for hand surgery: the Michigan Collaborative Hand Initiative for Quality in Surgery. It is a collaboration of nine sites with the goal of identifying areas that are in need of quality improvement in hand surgery and implementing measures to improve on them. The authors believe that collaborative quality initiatives will promote high-quality care and should be incorporated into the field of plastic surgery.
Unnecessary Interfacility Transfers for Craniomaxillofacial Trauma
Authors: Pontell Matthew E. , Colazo Juan M. , Drolet Brian C.
Published: April 2020

Background:

Patients with craniomaxillofacial injuries are frequently transferred for specialist evaluation. Although transfer guidelines have improved outcomes for trauma care, no standards exist for craniomaxillofacial injuries. As a result, many patients are unnecessarily transferred emergently between facilities, resulting in high costs to patients and the health care system. This study assesses the regional frequency and necessity of transfers for isolated craniomaxillofacial injury.

Methods:

A retrospective review was conducted of all transfers with a diagnosis of “facial trauma” from 2013 to 2018. Using a previously validated framework, emergency interfacility transfers were deemed either necessary or unnecessary.

Results:

A total of 368 transfers were identified with isolated craniomaxillofacial injuries. Only 27 percent of transfers required admission. Half of transfers were unnecessary, none of which required intervention by the facial trauma service. Of 49.5 percent of necessary transfers, 38 percent required admission for surgery or management of symptoms related to facial injury, 62 percent were discharged from the emergency department, and three patients required emergency surgery.

Conclusions:

Isolated craniomaxillofacial trauma rarely requires emergency surgery; however, transferred patients occasionally require urgent and elective procedures. Unnecessary transfers result in substantial expense to the patient and the health care system, and patients ultimately experience a delay in definitive care. Unnecessary patient evaluation diverts emergency staff and resources, increasing wait times and morbidity for other patients. This study demonstrates an opportunity for transfer guidelines to improve interfacility triage of patients with facial injury.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Computer-Aided Design and Manufacturing Cutting and Drilling Guides with Prebent Titanium Plates Improve Surgical Accuracy of Skeletal Class III Malocclusion
Authors: Li Kehan , Li Jiayang , Du Wen , Xu Chunwei , Ye Bin , Luo En
Published: April 2020

Background:

The aim of this study was to evaluate the effects of the use of computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates for the correction of skeletal class III malocclusion.

Methods:

In this prospective, randomized, controlled clinical trial, 46 patients with skeletal class III malocclusion were randomly assigned into two groups. The patients underwent bimaxillary surgery with computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates (experimental group) or computer-aided design and manufacturing splints (control group). Preoperative and postoperative imaging data were collected and then analyzed using Mimics Research 19.0, Geomagic Studio, and IBM SPSS Version 21.0.

Results:

Deformity evaluation and posttreatment assessment were performed for all patients. The experimental group had fewer postoperative complications. Comparison of the linear and angular differences to facial reference planes revealed more accurate repositioning of the mandible and condyles in the experimental group, although the position of several landmarks still requires small adjustments.

Conclusion:

Computer-aided design and manufacturing cutting and drilling guides with prebent titanium plates effectively corrected skeletal class III malocclusion, providing positional control of segments with reasonable surgical accuracy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Technical Refinements of Vulvar Reconstruction in Gender-Affirming Surgery
Authors: Dy Geolani W. , Kaoutzanis Christodoulos , Zhao Lee , Bluebond-Langner Rachel
Published: April 2020

Penile inversion vaginoplasty involves creation of vulva and a vaginal canal. Few studies describe techniques for creating aesthetic vulvar components, particularly the clitoral hood and labia minora. The authors present their approach to primary vulvoplasty, aiming to achieve the following: (1) labia minora that are well-defined and three-dimensional; (2) labia minora that frame the introitus; (3) sufficient clitoral hooding; (4) a patent introitus that appears closed at rest; and (5) prominent labia majora. In this technique, the labia majora are created by first pulling the superolateral scrotal skin inferiorly and medially toward the perineum. The labia majora incisions may be made laterally, medially, or both laterally and medially, dependent on the amount of penile and scrotal skin available. Initial approximating sutures are placed to anchor the labia inferiorly, and then excess skin is removed medially. The surgeon should avoid excess defatting of the labia majora, which are subject to initial edema and often atrophy with time. The preputial or distal penile shaft skin is used for the clitoral hood and medial aspect of the labia minora, with proximal penile shaft skin used for the lateral surface. The penile skin used for the lateral aspect of the labia minora must be pulled inferomedially toward the perineum, to create a narrow, tapered appearance and avoid effacement of the labia minora. Interrupted horizontal mattress quilting sutures are used to define the labia minora as distinct subunits. By considering homologous structures and anatomical subunits, we are able to create well-defined, aesthetic vulva in trans women and nonbinary individuals.
Constrictive (Obliterative) Bronchiolitis as Presenting Manifestation of Connective Tissue Diseases
Authors: Arcadu Antonella , Ryu Jay H.
Published: April 2020

Background

Constrictive (obliterative) bronchiolitis (CB) is an uncommon form of obstructive lung disease that can occur in patients with identifiable causes including connective tissue diseases (CTDs) as a form of lung involvement. We explored whether CB can be the presenting manifestation of CTD.

Methods

We identified 44 patients with cryptogenic CB and examined the presenting clinical, laboratory, and radiologic features, as well as their clinical course.

Results

The mean age at presentation was 60.5 (SD, 13.8) years and included 38 women (86%); 32 (73%) were never smokers. All patients presented for evaluation of dyspnea, commonly associated with cough. An obstructive pattern on pulmonary function testing was demonstrated in 86% of patients. On chest high-resolution computed tomography, nearly all patients manifested a mosaic attenuation pattern with air trapping on expiratory views, characteristic of CB. Bronchoscopic lung biopsy (n = 10) was usually nondiagnostic (90%), whereas all 5 surgical lung biopsies yielded evidence of CB. Serologic testing for CTD was positive in 19 patients (43%) and most commonly included antinuclear antibody, rheumatoid factor, and anti–cyclic citrullinated antibodies. Seven of these patients with positive serologic results were eventually diagnosed to have CTD. Connective tissue diseases included rheumatoid arthritis in 4 patients, Sjögren syndrome in 2, and undifferentiated CTD in 1 patient.

Conclusions

Nearly one-half of patients with cryptogenic CB manifest positive CTD serology, and some of these patients have CTD not previously diagnosed. These results suggest that CB can be the presenting manifestation of a CTD.
Association of Dickkopf-1 Polymorphisms With Radiological Damage and Periodontal Disease in Patients With Early Rheumatoid Arthritis
Authors: Cardona-Rincón Alex Dario , Acevedo-Godoy Mónica Alexandra , Bello-Gualtero Juan Manuel , Valle-Oñate Rafael , Chalem-Choueka Philippe , Perdomo Sandra Janeth , Miyared Arias-Arias Angela , Chila-Moreno Lorena , Bautista-Molano Wilson , Romero-Sánchez Consuelo
Published: April 2020

Background

Rheumatoid arthritis (RA) is a systemic autoimmune disease that increased bone resorption. Periodontal disease (PD) is an associated risk factor of RA. Studies suggest an association between bone markers such as the dickkopf-related protein 1 (DKK-1) and progression of radiological damage. We aimed to evaluate the marker DKK-1, its polymorphisms in patients with early rheumatoid arthritis (eRA), and its association with rheumatic, radiological, and periodontal variables.

Methods

This is a cross-sectional study. Samples were obtained from 63 patients with eRA. Radiographs of hands and feet were evaluated by Sharp–van der Heijde score (SHS) and Simple Erosion Narrowing Score (SENS). Serum DKK-1 levels and high-resolution fusion analysis was used for polymorphisms (rs1896368, rs1896367, rs1528873). Bivariate analyses were performed.

Results

Individuals heterozygous for rs1896367 had more frequent erosions (p = 0.026) and joint space narrowing (p = 0.005) in the feet, higher SHS (p = 0.016), and higher SENS (p ≤ 0.001). Patients homozygous for rs1896368 had less frequent joint space narrowing in hands and feet as assessed by SHS and less presence of erosions by SENS (odds ratio, 0.04; 95% confidence interval, 0.00–0.93; p < 0.05). The presence of PD was associated with the homozygous of rs1896367 (p = 0.009) and the heterozygous of rs1896368 (p = 0.033).

Conclusions

Polymorphism rs1896367 seems to be associated with greater radiological compromise; rs1896368 confers protection against bone damage in Colombian eRA patients.
The Influence of Hand Dominance on the Degree of Deformities in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy
Authors: Loureiro Galvão Verena , Ferreira Vasconcelos dos Santos Daiane , Santiago Mittermayer B.
Published: April 2020

Background/Objective

Joint deformities in Jaccoud arthropathy (JA), associated with systemic lupus erythematosus (SLE), can lead to a reduction in articular function and an impaired quality of life. There is controversy in the literature as to whether hand dominance contributes to deformities observed in rheumatoid arthritis and other forms of rheumatism. The purpose of this study was to assess whether hand dominance has any influence on the degree of deformity or joint range of motion in patients with JA associated with SLE.

Methods

This was a pilot cross-sectional study of 22 female patients (mean age, 46.18 ± 12.61 years) with both SLE and JA. Each patient's hand grip and hand and wrist joint range of motion were assessed by the same examiner. The Wilcoxon test was used to compare the median values of the angles and muscular strength found between the sides.

Results

All the study participants were right-side dominant. The median muscle strength of the right and left hands was 13.25 kilogram-force (KgF) (range, 7.00–18.00 KgF) and 10.50 KgF (range, 7.50–17.25 KgF), respectively. Both the fingers of the right and left hands had a median ulnar drift of 10.00°; however, their ranges differed (right, 4.50° to 20.00°; left: 0.00° to 15.50°). No statistically significant differences were found in the extension angulation of the proximal interphalangeal joints or the flexion of the distal interphalangeal joints of the second to fifth fingers, between the dominant and nondominant hands.

Conclusions

Hand dominance does not seem to influence the degree of JA deformities in patients with SLE.
18F-PSMA 1007 Uptake in a Man With Metastatic Breast Cancer
Authors: Marafi Fahad , Sasikumar Arun , Alfeeli Mahamoud , Thuruthel Sanjay
Published: April 2020

A 72-year-old man, who is known with a case of metastatic carcinoma of the breast, was referred for 18F-PMSA 1007 PET/CT with clinical suspicion of synchronous prostate cancer. 18F-PSMA 1007 PET/CT scan detected no abnormal tracer concentrating lesion in the prostate gland; however, abnormal tracer concentration was noted in soft tissue lesions in left breast, metastatic lymph nodes, and skeletal lesions. Compared with 18F-FDG PET/CT, more bone lesions were detected on 18F-PSMA 1007 imaging. The findings of our case open the possibility of imaging metastatic breast cancer with 18F-PSMA 1007 in men.
68Ga-FAPI PET/CT in Assessment of Liver Nodules in a Cirrhotic Patient
Authors: Zhao Liang , Gu Jianwei , Fu Kaili , Lin Qin , Chen Haojun
Published: April 2020

68Ga-FAPI PET/CT was performed in a 56-year-old cirrhotic patient with multiple liver nodules, which were suspected of hepatocellular carcinoma by contrast-enhanced magnetic resonance but were not visualized by 18F-FDG PET/CT. Increased 68Ga-FAPI liver uptake was observed in this cirrhotic patient. However, the nodules had no pathological 68Ga-FAPI uptake and were clearly visualized due to the low activity compared with surrounding liver parenchyma. The 68Ga-FAPI PET/CT features, suggestive of benign nodules, have been later confirmed by histopathological examination. This case suggested that 68Ga-FAPI PET/CT may be useful in the differentiation between benign nodules and hepatocellular carcinoma in the patient with liver cirrhosis.
Obscured Meckel’s Diverticulum by the Urinary Bladder
Authors: Pirayesh Elahe
Published: April 2020

We describe a case of a 5-year-old boy with a history of intermittent melena underwent 99mTcO4
− scintigraphy. On dynamic images, no abnormal activity was noted. After voiding and also in the lateral view, the focus of activity was noted in the superior and anterior aspect of the urinary bladder, compatible with a Meckel's diverticulum, which was confirmed pathologically as well.
Primary Central Nervous System Lymphoma With Diffuse Neurolymphomatosis Involving Multiple Cranial and Spinal Nerve Roots
Authors: Singh Shashank Shekhar , Mittal Bhagwant Rai , Kumar Rajender , Singh Harmandeep , Balaini Neeraj , Goyal Manoj
Published: April 2020

Primary central nervous system lymphoma is an extranodal lymphoma originating in the brain, spinal cord, and leptomeninges, which rarely spreads outside the nervous system. Neurolymphomatosis is the term used to describe lymphomatous involvement of the cranial nerves (except optic nerve) and peripheral nerve roots or plexus. We report a case of a 23-year-old man presented with progressive weakness of all 4 limbs. 18F-FDG PET/CT revealed FDG-avid thickening along the multiple cranial nerve roots, spinal nerve roots, and brain parenchymal lesion. Core biopsy from the peripheral nerve root demonstrated the lymphomatous involvement.
Intraosseous Medullary Fat Necrosis on 99mTc-MDP Bone Scan of Patient With Acute Pancreatitis
Authors: Tupalli Avinash , Angamuthu Meivel , Prashanth Arun , Singh Roma , Kumar Rakesh
Published: April 2020

Pancreatic disease can be associated with polyarthritis and panniculitis in a small number of patients, and this triad constitutes PPP syndrome. Early diagnosis is critical as it has high morbidity and mortality. Panniculitis can occur in fat present anywhere in the body. Involvement of fat in bone marrow is relatively uncommon, and radiologic imaging shows osteolytic lesions involving long bones. Here we present a case of acute pancreatitis, referred to our department for evaluation of severe joint pain and multiple bone pain. 99mTc-MDP scan with SPECT/CT has been done, which showed medullary expansion with heterogenous tracer uptake, that is, moth-eaten appearance.
Radiation Recall Myositis Detected With 18F-FDG PET/CT After a Treatment of Cervical Cancer
Authors: Lemay Joanie , Bouchard Myriam , Rousseau Étienne
Published: April 2020

A 34-year-old woman, after being treated for cervical cancer, presented with severe pain in the inguinal and the upper abdominal region with restriction in range of motion of the trunk 71 days after radiation therapy and 19 days after receiving adjuvant gemcitabine and cisplatin chemotherapy. The 18F-FDG PET/CT showed complete response to cancer treatment, but also revealed a localized inflammatory process that was delimited by radiation fields rather than anatomical structures, suggesting a radiation recall phenomenon.
Hepatic Vascular Malformation Mimics PSMA-Positive Prostate Cancer Metastasis
Authors: Hoberück Sebastian , Driesnack Sebastian , Seppelt Danilo , Michler Enrico , Hölscher Tobias , Kotzerke Jörg
Published: April 2020

An 80-year-old man developed high-risk prostate cancer after 7 years of active surveillance. For staging and treatment planning, a 68Ga-PSMA PET/MRI was performed. Besides the PSMA-positive primary tumor and a solitary bone metastasis in the fifth thoracic vertebral body, an intensive intrahepatic PSMA expression (SUVmax, 16.3) was suspicious for a liver metastasis. The results of a previously performed contrast-enhanced CT, a consecutively performed contrast-enhanced ultrasound, and a follow-up PSMA PET/CT after 4 months with a stable lesion during androgen deprivation lead to the diagnosis of a vascular malformation metabolically mimicking a hepatic metastasis of the prostate tumor.
Renal Medullary Carcinoma on Dual-Time Point FDG PET/CT Imaging
Authors: Hou Guozhu , Jiang Yuanyuan , Wang Jing , Li Fang , Cheng Wuying
Published: April 2020

Renal medullary carcinoma is a rare and highly aggressive tumor seen almost exclusively in young individuals of African descent with sickle cell disease. Here, we describe a case of a 29-year-old man, who did not have sickle cell disease, with pathologically confirmed renal medullary carcinoma using dual-time FDG PET/CT.
Therapy Control in a Patient With an Inflammatory Abdominal Aneurysm
Authors: Husmann Lars , Huellner Martin W. , Hasse Barbara
Published: April 2020

We present a case of inflammatory abdominal arterial aneurysms, which demonstrates the potential usefulness of PET/CT with 18F-FDG in long-term monitoring of this disease, but also demonstrates potential pitfalls in abdominal arterial aneurysm imaging with PET/CT. Imaging may be challenged as the initial presentation prior to therapy may mimic an infected aneurysm. Follow-up images may be mistaken for vascular graft infection or persistent disease.
Primary Pancreatic Yolk Sac Tumor Presenting as Diffusely Enlarged Pancreas in Initial 18F-FDG PET/CT
Authors: Sui Huimin , Zhu Zhaohui , Li Zheng , Luo Yaping
Published: April 2020

Yolk sac tumor is a rare and highly malignant germ cell tumor. We report a case of yolk sac tumor primarily in the pancreas in a 32-year-old man. He presented with pancreatitis at presentation with significantly increased serum alpha-fetoprotein (AFP). 18F-FDG PET/CT revealed diffuse enlargement of the pancreas in the neck, body, and tail portion with homogeneously increased FDG uptake, similar to the change of pancreatitis. The lesion progressively developed to a huge pancreatic mass in the follow-up images, and endoscopic ultrasonography-guided aspiration biopsy of the pancreatic mass confirmed the diagnosis of yolk sac tumor.
Increased Prostate-Specific Membrane Antigen Uptake in Neurofibromatosis
Authors: Wang Yingwei , Zeng Cheng , Liu Huipan , Chen Yue , Zhang Wei
Published: April 2020

A 51-year-old man with 30-year neurofibromatosis and 2-month elevated prostate-specific antigen and back pain underwent a 68Ga–prostate-specific membrane antigen (PSMA) PET/CT scan for possible prostate cancer. Prostate-specific membrane antigen PET/CT imaging showed no abnormal uptake of the prostate. However, in addition to PSMA uptake in his left lung, thorax, and right ilium, which was confirmed being a lung squamous cell carcinoma by a lung biopsy, widespread uptake was also observed in his skin fibroma lesions. This case demonstrates that benign neurofibromatosis could have uptake of PSMA.
Nasal Tip Rotation by Exclusive Superficial Musculoaponeurotic System Deep Medial Ligament Management
Authors: Giacomini Pier Giorgio , Boccieri Armando , Moretti Antonio , Rosati Valentina , Flora Barbara , Di Girolamo Stefano
Published: April 2020

The nasal tip constitutes the mobile portion of the nose, in direct contraposition to the pyramid that is a fixed structure. Its configuration, position, and shape are derived mainly from the outline and from the thickness of the wing cartilages, important elements of the nasal tip, that together with skin and subcutaneous tissue can deeply influence the configuration and dynamics of this section of the nose as well. In reshaping the nasal tip, 2 fundamental concepts must be considered: projection and rotation; these may be modified, acting on the nasal cartilaginous framework and/or on the superficial nasal fibromuscular structure (SMAS). The aims of this study are to evaluate the nasal tip changes in terms of rotation and projection obtained just acting on superficial muscle aponeurotic deep medial layer without performing any dissection or modification of the nasal tip framework, and to try to explain these possible changes according to the SMAS structure rearrangements only. Twenty-one patients (18 female and 3 male) were subjected to closed rhinoplasty, without tip cartilage dissection/modification. Preoperative and postoperative tip rotation angle, nasolabial angle, and tip projection were measured. The only tip procedure performed was the resection of the SMAS deep medial layer. Our results show significant rotation of the nasal tip and no statistically significant tip deprojection.
Complications of Wise-Pattern Compared With Vertical Scar Mastopexy/Breast Reduction in Oncoplastic Breast-Conserving Surgery
Authors: Schaverien Mark V. , Deigni Olivier A. , Adamson Karri A. , Robb Geoffrey L. , Kuerer Henry , Smith Benjamin D. , Garvey Patrick B. , Hassid Victor J. , Villa Mark T. , Baumann Donald P.
Published: April 2020

Background

Oncoplastic breast-conserving surgery (OBCS) is most commonly performed using established or modified mastopexy/breast reduction techniques. Although the comparative complication profiles of Wise-pattern mastopexy/breast reduction techniques compared with vertical scar techniques are well understood, outcomes in the setting of OBCS are unknown.

Methods

A retrospective study was conducted of all patients that underwent OBCS using mastopexy/breast reduction techniques at a single center over a 6-year period. Patients who underwent Wise-pattern techniques were compared with those who underwent vertical scar techniques. Demographic, treatment, and outcomes data were collected. Descriptive statistics were used, and multivariate analysis was performed to evaluate the relationship between these multiple variables and complications.

Results

Of 413 eligible patients, 278 patients (67.3%) received a Wise-pattern technique and 135 (32.7%) underwent a vertical scar technique. The overall complication rate was significantly higher in the Wise-pattern than in the vertical scar group (30.6% vs 18.5%, respectively; P = 0.012), as was the major complication rate (11.9% vs 4.4%; P = 0.011) including need for additional surgery for complications (6.8% vs 1.5%; P = 0.029). Complications resulted in a delay to any adjuvant therapy in 20 patients (4.8%); however, the difference between the groups was not significant (6.1% for Wise pattern vs 2.2% for vertical scar; P = 0.098). In a multivariable logistic model, use of a Wise-pattern technique (odds ratio, 0.37 [95% confidence interval, 0.14–0.99]; P = 0.049) was a significant predictor of major complications.

Conclusions

The Wise-pattern mastopexy/breast reduction OBCS technique was associated with a significantly higher complication and major complication rate than vertical scar techniques. The findings should be considered during choice of surgical technique in oncoplastic breast conservation.
Inframammary Fold Incision Can Reduce Skin Flap Necrosis in Immediate Breast Reconstruction With Implant and Conjoined Fascial Flap
Authors: Kim Ji Hun , Chun Yong Soon , Park Heung Kyu , Kim Sun Eung , Kim Yang Woo , Cheon Young Woo
Published: April 2020

Background

Immediate breast reconstruction with implant (IBRI) can produce good aesthetic results after nipple-sparing mastectomy (NSM). Various surgical incisions can be used for NSM. The purpose of this study is to compare outcomes of using an IBRI with dual-coverage fascial flap after NSM with an inframammary fold (IMF) or a radial (Rd) incision.

Methods

We retrospectively reviewed the records of 88 women who underwent IBRI with dual-coverage fascial flap from March 2015 to June 2018. Inframammary fold incision was used in 19 patients (22 breasts) and Rd incision in 69 patients (75 breasts). In the dual-coverage method, acellular dermal matrix covered the inferomedial quadrant of the breast, and conjoined fascial flap covered the remaining inferolateral quadrant. Patient-reported satisfaction was assessed using the Breast-Q questionnaire, and plastic surgeons assessed aesthetic postoperative scores.

Results

Complications and reoperation rates of 2 incisions were as follows: skin flap necrosis rate showed significant difference between 2 groups (IMF, 0.0% [0/22]; Rd, 16.0% [12/75]; P < 0.05). The other complication rates, hematoma, seroma, infection, capsular contracture, and total reoperations showed no significant difference. Postoperative Breast-Q scores were higher in the IMF group (331.9 ± 10.1) than in the Rd group (311.4 ± 11.0; P < 0.05), indicating higher satisfactory rate in the IMF group than in the Rd group. Surgeon-reported scores for breast symmetry, contour, and scar appearance were also higher in the IMF group (P < 0.05).

Conclusions

Immediate breast reconstruction with implant with dual-coverage fascial flap after NSM with IMF incision was associated with a lower rate of postoperative skin flap necrosis and improved patient satisfaction, compared with Rd incision. Inframammary fold incisions were associated with improved scar and breast appearance.
Oberg-Manske-Tonkin Classification of Congenital Upper Extremity Anomalies
Authors: Uzun Hakan , Özdemir Fethiye Damla Menkü , Üstün Galip Gencay , Sakarya Ahmet Hamdi , Bitik Ozan , Aksu Ali Emre
Published: April 2020

Purpose

Although the Oberg-Manske-Tonkin (OMT) classification has been recommended by the International Federation of Societies for Surgery of the Hand owing to some insufficiencies of the Swanson classification system, it has not achieved a universal adoption by hand surgeons. In this study, we hypothesize that the OMT classification can be used easily to classify congenital upper extremity anomalies. We also aim to make epidemiological analysis of congenital upper extremity anomalies with the OMT classification and to compare the applicability of the OMT and the Swanson classifications.

Methods

We retrospectively analyzed 711 patients and 833 extremities operated on between 2012 and 2017. Photographs, plain x-rays, and brief medical histories of the patients were evaluated by 4 plastic surgeons. Two independent evaluations were made by each surgeon in 1-month interval using these classification systems.

Results

Total number of upper extremity anomalies recorded was 1050. Of the 711 patients operated on, 122 had bilateral anomalies. The anomalies were identified in 833 extremities because many extremities had more than a single diagnosis. We were able to classify all of the anomalies within the OMT classification. The OMT classification gives better reliability results compared with the Swanson classification according to intrarater and interrater reliabilities.

Conclusions

Compared with the Swanson classification system based on phenotypic evaluation of the extremity, the OMT classification system is easier to apply and the association of the anomaly with the embryologic origin during evaluation is possible. We believe that multiple studies from different centers will boost the international acceptance of the OMT classification.
Recidivism rates following firearm injury as determined by a collaborative hospital and law enforcement database
Authors: Marshall William Aaron , Egger Michael E. , Pike Annabelle , Bozeman Matthew C. , Franklin Glen A. , Nash Nicholas A. , Smith Jason W. , Richardson J. David , Harbrecht Brian G. , Benns Matthew V. , Miller Keith R.
Published: April 2020

BACKGROUND

Recidivism is a key outcome measure for injury prevention programs. Firearm injury recidivism rates are difficult to determine because of poor longitudinal follow-up and incomplete, disparate databases. Reported recidivism rates from trauma registries are 2% to 3%. We created a collaborative database merging law enforcement, emergency department, and inpatient trauma registry data to more accurately determine rates of recidivism in patients presenting to our trauma center following firearm injury.

METHODS

A collaborative database for Jefferson County, Kentucky, was constructed to include violent firearm injuries encountered by the trauma center or law enforcement from 2008 to 2019. Iterative deterministic data linkage was used to create the database and eliminate redundancies. From patients with at least one hospital encounter, raw recidivism rates were calculated by dividing the number of patients injured at least twice by the total number of patients. Cox proportional hazard models were used to evaluate risk factors for recidivism. The cumulative incidence of recidivism over time was estimated using a Kaplan-Meier survival model.

RESULTS

There were 2, 363 assault-type firearm injuries with at least 1 hospital encounter, approximately 9% of which did not survive their initial encounter. The collaborative database demonstrated raw recidivism rates for assault-type firearm injuries of 9.5% compared with 2.5% from the trauma registry alone. Risk factors were young age, male sex, and African American race. The predicted incidence of recidivism was 3.6%, 5.6%, 11.4%, and 15.8% at 1, 2, 5, and 10 years, respectively.

CONCLUSION

Both hospital and law enforcement data are critical for determining reinjury rates in patients treated at trauma centers. Recidivism rates following violent firearm injury are four times higher using a collaborative database compared with the inpatient trauma registry alone. Predicted incidence of recidivism at 10 years was at least 16% for all patients, with high-risk subgroups experiencing rates as high as 26%.

LEVEL OF EVIDENCE

Epidemiological, level III.
Emerging hemorrhage control and resuscitation strategies in trauma: Endovascular to extracorporeal
Authors: Manning James E. , Rasmussen Todd E. , Tisherman Samuel A. , Cannon Jeremy W.
Published: April 2020

This article reviews four emerging endovascular hemorrhage control and extracorporeal perfusion techniques for management of trauma patients with profound hemorrhagic shock including hemorrhage-induced traumatic cardiac arrest: resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, extracorporeal life support, and emergency preservation and resuscitation. The preclinical and clinical studies underpinning each of these techniques are summarized. We also present an integrated conceptual framework for how these emerging technologies may be used in the future care of trauma patients in both resource-rich and austere environments.
Cone-beam computed tomography for trauma
Authors: Gupta Saurabh , Martinson James R. , Ricaurte Daniel , Scalea Thomas M. , Morrison Jonathan J.
Published: April 2020

Radiographic imaging is critical in helping guide treatment of critically injured patients. Cone-beam computed tomography is an axial imaging technique available from fixed imaging systems found in hybrid operating rooms. It can be used to provide focused studies of specific anatomical regions, where patients cannot undergo conventional multidetector computed tomography. This includes non–contrast-enhanced evaluation of the intracranial contents and vascular imaging throughout the body. There are a number of advantages and disadvantages to cone-beam computed tomography, but these are not widely discussed within the trauma literature. This narrative review article presents the initial practical experience of this novel imaging modality.

LEVEL OF EVIDENCE

Review article, level III.
Resuscitative endovascular balloon occlusion of the aorta for thoracic trauma: A translational swine study
Authors: Glaser Jacob J. , Neidert Leslie E. , Morgan Clifford G. , Brenner Megan , Stigall Kyle S. , Cardin Sylvain
Published: April 2020

Noncompressible torso hemorrhage in trauma is particularly lethal. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has the potential to stabilize these patients, but currently is contraindicated for major thoracic bleeding. The goal of this study was to evaluate the effect of REBOA on the hemodynamic and metabolic profile as well as its effect on early survival in a porcine model of thoracic hemorrhage and shock.

METHODS

Forty-eight male Yorkshire swine (60–80 kg) underwent 30% hemorrhage and were randomized to three thoracic injuries, with and without zone 1 REBOA occlusion: pulmonary parenchymal injury, thoracic venous injury, or subclavian artery injury. Following hemorrhage, thoracic injuries were induced (time of major thoracic injury) and allowed to bleed freely. The REBOA groups had zone 1 occlusion after the thoracic injury, with deflation at the end of prehospital. All groups had whole blood resuscitation at the end of prehospital and were euthanized at end of the hospital care phase. Survival, total blood loss, mean arterial pressure, end-tidal CO2, and arterial blood gas parameters were analyzed. Statistical significance was determined by t tests and two-way repeated-measures analysis of variance.

RESULTS

The use of REBOA improved the hemodynamics in all three injury patterns, with no differences observed in the outcomes of short-term survival and thoracic blood loss between the REBOA and non-REBOA groups. All groups showed equivalent changes in markers of shock (pH, HCO3, and base excess) prior to resuscitation.

CONCLUSION

In this animal study of hemorrhage and major thoracic bleeding, the addition of zone 1 REBOA did not significantly affect short-term survival or blood loss, while providing hemodynamic stabilization. Therefore, in noncompressible thoracic bleeding, without immediate surgical capability, long-term outcomes may be improved with REBOA, and thoracic hemorrhage should not be considered contraindications to REBOA use.
Closing the gap in care of blunt solid organ injury in children
Authors: Yung Nicholas , Solomon Daniel , Schuster Kevin , Christison-Lagay Emily
Published: April 2020

INTRODUCTION

Cross-sectional data of pediatric blunt solid organ injury demonstrates higher rates of nonoperative management and shorter lengths of stay (LOSs) in pediatric trauma centers (PTCs) versus adult trauma centers (ATCs) or dual trauma centers (DTCs). Recent iterations of guidelines (McVay 2008, J Pediatr Surg 2008;43(6):1072-1076 J Trauma Acute Care Surg 2015;79(4):683–693) have emphasized physiologic parameters rather than injury grade in clinical decision making, improving resource allocation and decreasing LOS. We sought to evaluate how these guidelines have influenced care.

METHODS

The National Trauma Data Bank (2007–2016) was queried for isolated spleen and liver injuries in patients younger than 19 years. Linear regression, odds ratio (OR), and χ2 test were used to determine significance between operative intervention or LOS among different trauma center types and grade of injury.

RESULT

A total of 55,036 blunt spleen or liver injuries were identified. Although operative rates decreased in ATCs over time (p = 0.037), patients treated at ATCs or DTCs continued to demonstrate higher ORs of operative intervention (OR, 4.43 and 2.88, respectively) compared with PTCs. Mean LOS decreased by 1.52 (p < 0.001), 0.49 (p = 0.26), and 1.31 (p = 0.05) days at ATC, DTC, and PTC to 6.43, 6.68, and 5.16 days. Improvement in LOS for ATCs was distributed across injury Grades I, II, and IV, while there was no correlation among PTCs for injury grade.

CONCLUSION

Despite more than a decade of guidelines in pediatric solid organ injury supporting nonoperative management and accelerated discharge pathways based on physiologic parameters, rates of operative intervention remain much higher in ATCs versus PTCs, and all centers appear to fall short of consensus guidelines for discharge.

LEVEL OF EVIDENCE

Care management study, level IV.