bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Brexit’
Authors: González Guayasén Marrero
Published: February 2017

On 23 June 2016, the British people decided to leave the European Union (EU). Although the withdrawal process has not yet started, it is not surprising that some concerns have emerged in relation to the situation of British citizens residing outside the United Kingdom (but within the EU) who do not possess the nationality of another EU Member State, and citizens of the Union residing in the United Kingdom. From ‘the leave date’, British citizens will no longer possess the status of citizens of the Union, and will subsequently become third-country nationals for EU law purposes. Conversely, the United Kingdom will no longer be part of the EU territory and EU citizens can no longer exercise the rights and freedoms conferred to them within the EU. In this scenario, the right to reside in the EU for British citizens and in the United Kingdom for citizens of the Union could become legally uncertain. This contribution departs from the EU law perspective and takes a human rights approach to dealing with the issue of residence rights. It will be argued that residence rights, in an EU context, can be retained by operation of the provisions of the ECHR.
Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial
Authors: Ahmadi Motahareh , Khalili Hossein , Abbasian Ladan , Ghaeli Padideh
Published: February 2017

Background: Several neuropsychiatric adverse effects of efavirenz are known. Preventing these adverse effects may improve patients’ adherence to antiretroviral therapy (ART). Objectives: To evaluate the efficacy and safety of valerian in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients. Method: In this pilot randomized, double-blinded, placebo-controlled, clinical trial, 51 HIV-positive patients who were receiving efavirenz were recruited into the valerian (n = 25) or placebo (n = 26) group. Patients received valerian (530 mg) or placebo nightly 1 hour before sleep for 4 weeks. The neuropsychiatric status (sleep, anxiety, depression, suicidal thought, and psychosis) of patients was assessed at baseline and week 4 using validated questionnaires. Results: Sleep ( P ≤ 0.001) and anxiety ( P = 0.001) significantly improved in the valerian group compared with the placebo group. Dizziness was the most common complaint of patients in first days of the intervention. In the valerian and placebo groups, 92% and 84.6% of patients experienced dizziness, respectively ( P = 0.35). Nausea was the second common adverse effect that 84% and 76.9% of patients in the valerian and placebo groups experienced ( P = 0.39). Conclusion: In the first 4 weeks of ART including efavirenz, valerian significantly improved sleep and anxiety in HIV-positive patients. Valerian may be considered as a potential option in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.
T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population
Authors: Wilson Katharine J. , Surowiec Rachel K. , Johnson Nicholas S. , Lockard Carly A. , Clanton Thomas O. , Ho Charles P.
Published: February 2017

Background:

Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology.

Methods:

Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated.

Results:

The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes.

Conclusion:

Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon.

Clinical Relevance:

This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.
Examining the Relationship Between Children’s ADHD Symptomatology and Inadequate Parenting: The Role of Household Chaos
Authors: Wirth Andrea , Reinelt Tilman , Gawrilow Caterina , Schwenck Christina , Freitag Christine M. , Rauch Wolfgang A.
Published: February 2017

Objective: This study examines the interrelations of parenting practices, emotional climate, and household chaos in families with children with and without ADHD. In particular, indirect pathways from children’s ADHD symptomatology to inadequate parenting and negative emotional climate via household chaos were investigated. Method: Parenting, emotional climate, and household chaos were assessed using questionnaires and a speech sample of parents of 31 children with and 53 without ADHD, aged 7 to 13 years. Results: Group differences were found for certain parenting dimensions, the parent–child relationship, critical comments, and household chaos. While we found significant indirect effects between children’s ADHD and certain parenting dimensions through household chaos, no effects were found for any aspect of emotional climate. Conclusion: Children’s ADHD symptoms translate into inadequate parenting through household chaos, which underlines the need for interventions to improve household organization skills in parents of children with ADHD.
A Numerical Handling of the Boundary Conditions Imposed by the Skull on an Inhomogeneous Diffusion-Reaction Model of Glioblastoma Invasion Into the Brain: Clinical Validation Aspects
Authors: Stamatakos Georgios S , Giatili Stavroula G
Published: February 2017

A novel explicit triscale reaction-diffusion numerical model of glioblastoma multiforme tumor growth is presented. The model incorporates the handling of Neumann boundary conditions imposed by the cranium and takes into account both the inhomogeneous nature of human brain and the complexity of the skull geometry. The finite-difference time-domain method is adopted. To demonstrate the workflow of a possible clinical validation procedure, a clinical case/scenario is addressed. A good agreement of the in silico calculated value of the doubling time (ie, the time for tumor volume to double) with the value of the same quantity based on tomographic imaging data has been observed. A theoretical exploration suggests that a rough but still quite informative value of the doubling time may be calculated based on a homogeneous brain model. The model could serve as the main component of a continuous mathematics-based glioblastoma oncosimulator aiming at supporting the clinician in the optimal patient-individualized design of treatment using the patient’s multiscale data and experimenting in silico (ie, on the computer).
The poverty of Critical Theory in International Relations: Habermas, Linklater and the failings of cosmopolitan critique
Authors: Schmid Davide
Published: February 2017

Within and outside of the discipline of International Relations, Frankfurt School Critical Theory faces a ‘crisis of critique’ that is affecting its ability to generate analyses and political interventions that are relevant to the present world-historical conjuncture. This article seeks to identify the theoretical origins of this predicament by investigating the meta-theoretical architecture of the prevailing Habermasian framework of critique. I contend that the binary ontology and methodology of society that lies at the heart of the Habermasian paradigm has effected an uncoupling of normative critique from substantive social and political analysis and resulted in a severe weakening of both Critical Theory’s ‘explanatory-diagnostic’ and ‘anticipatory-utopian’ capabilities. Thereafter, I discuss the determinate ways in which these issues have manifested in critical theoretical interventions on international politics by exploring both Habermas’s own writings on the post-national constellation and Andrew Linklater’s theory of cosmopolitanism and the sociology of global morals. Both projects, it is argued, rely on a reductive, functionalist analysis of global political dynamics and express a political perspective that lacks a definite critical content. Ultimately, the article contends that a revitalisation of Critical Theory in International Relations must necessarily involve a clarification of its fundamental categories of analysis and a recovery of the orientation towards totalising critique.
Numerical prediction of tissue dosimetry in respiratory tract using computer simulated person integrated with physiologically based pharmacokinetic–computational fluid dynamics hybrid analysis
Authors: Yoo Sung-Jun , Ito Kazuhide
Published: February 2017

Indoor environmental quality, e.g. air quality and thermal environments, has a potential impact on residents in indoors. Development of a computer simulated person (CSP) for indoor computational fluid dynamics (CFD) simulation can contribute to the improvement of design and prediction method regarding the interaction between indoor air/thermal environmental factors and human responses. In this study, a CSP integrated with a virtual airway was developed and used to estimate inhalation exposure in an indoor environment. The virtual airway is a numerical respiratory tract model for CFD simulation that reproduces detailed geometry from the nasal/oral cavity to the bronchial tubes by way of the trachea. Physiologically based pharmacokinetic (PBPK)-CFD hybrid analysis is also integrated into the CSP. Through the coupled simulation of PBPK-CFD-CSP analysis, inhalation exposure under steady state conditions where formaldehyde was emitted from floor material was analysed and respiratory tissue doses and their distributions of inhaled contaminants are discussed quantitatively.
Assessing Regulation of Reliability of Electricity Supply
Authors: Singh Balbir
Published: February 2017

A review of the current regulation and performance indicates wide variation with respect to reliability of supplies in the electricity systems in Europe. Can the variation in reliability of supply be explained by differences in regulatory frameworks and is it possible to draw any best practice lessons for the future? This paper provides a cross country analysis of reliability of supply performance and regulation in the Nordic electricity market. A correlation between service reliability regulation and reliability performance is observed in the Nordic region however the current evidence is not sufficient to identify best practice. The paper also provides evidence about the resource intensive nature of detailed regulation on the basis of data concerning costs of regulation in the Nordic market. An important limitation of the currently available cross country data related to reliability performance is variation in measurement practices. In the appendix we also provide a brief overview of the reliability metrics issues; information which in our opinion is not readily available in economic publications.
Technical Progress, Market Evolution and the Regulation of the Electronic Communications Sector in the EU
Authors: Richards Paul
Published: February 2017

The Paper explains the origin of market-based regulation in the EU and the issues arising from defining economic markets under innovation and network convergence. This market-based approach will remain appropriate for downstream applications such as business connectivity where fixed and wireless platforms are largely complementary but will come under increasing strain for mass market services where rival platforms exist for the delivery of entertainment services. Regulatory approaches such as those based on pre-defined ‘bottlenecks’ have the suggestion of comparative simplicity but in practice do not enable a clear application of proportionate regulation absent an associated market review. In the future more attention will need to be given to the characterisation of downstream markets and a clearer distinction between the requirements of mass market consumers and businesses.
The Fallacies of Network Neutrality Regulation
Authors: Knieps Günter , Zenhäusern Patrick
Published: February 2017

In this paper, historical functionalities of the traditional Internet are contrasted with today's Internet functionalities of the “smart” Internet architecture. It is shown that network neutrality regulation prohibiting congestion management and traffic quality differentiation is contrary to economically founded allocation mechanisms. By regulation of remaining monopolistic bottleneck components within the local loop the transfer of market power from the telecommunications infrastructure into the complementary Internet access service markets can be avoided. Regulation between access service providers and Internet application service providers is not only superfluous but detrimental.
Setting the Regulatory Allowed Rate of Return Using Simulation and Loss Functions – The Case for Standardising Procedures
Authors: Dobbs Ian M.
Published: February 2017

The level set for the allowed rate of return for a regulated firm is a critical input in many regulatory determinations. Regulators typically recognise that the welfare losses that might arise from errors in estimation of the allowed rate of return may not be symmetric, and have often tried to account for this by selecting ‘conservative’ values for some of the key input variables. This paper discusses the drawbacks of these essentially ad hoc procedures, and proposes a more systematic approach to the determination of the allowed rate of return, based on simulation and welfare loss functions. Such an approach could help promote greater consistency in making such determinations across the regulated sector.
The Third European Energy Liberalization Package: Does Functional and Legal Unbundling in the Gas Storage Sector Go Too Far?
Authors: Gao Anton Ming-Zhi
Published: February 2017

The third European gas liberalization package (the 3rd Package) is intended to facilitate access to gas storage through the introduction of functional and legal unbundling in the storage sector. This article will challenge this new regulatory regime from two perspectives. First, this new regime may change the originally coherent regulatory patterns in the 1st and 2nd Gas Directives without taking into account the economic rationales. Second, this new regime will lead to three serious concerns upon implementation, i.e., the cost-effectiveness, clear implementation of the unbundling, and the doctrine of ‘rigid unbundling as a last resort. For the purpose of finding a solution, this article provides three legislative suggestions to the 3rd Package. In spite of these efforts, the issue of the unclear scope of storage subject to the open access regime and to the functional and legal unbundling remains unresolved in the 2nd Gas Directive and 3rd Package. Thus, to facilitate access to storage, it is suggested that the Commission may have to clarify the scope issue first and consider adopting a more direct approach; i.e., it should consider the regulated third party access regime for the storage sector in the 3rd Package instead of the indirect approach of further unbundling.
Risk Acceptance and Regulatory Risk
Authors: Rammerstorfer Margarethe
Published: February 2017

The current debate among policy makers, regulatory analysts, and industry concerns the insufficient investment activities within the area of regulated utilities and emphasises the necessity of analyzing the interdependencies between systematic risk and regulatory activities. This article deals with the different extents of systematic risk under different regulatory regimes. First, it is shown that price cap regulation provides higher systematic risk than incentive regulation or no-regulation. In a second step, the extent of risk aversion of regulated companies is analyzed. It turns out that an unregulated company chooses the investment project with the highest expected return, whereas regulated companies primarily focus on risk prevention.
Tendering Universal Service Obligations in Liberalized Network Industries
Authors: Jaag Christian , Trinkner Urs
Published: February 2017

In the past decades, several countries have introduced reverse auctions for allocating universal service or public mission subsidies in various industries. Examples include urban transport, air transport and telecommunications. Recently, such mechanisms have also been envisioned in liberalized postal markets. Issuing an invitation to tender for obligations in otherwise liberalized markets significantly differs from auctioning off a monopolistic provision of services or goods (“competition for the market”), as is e.g. the case with spectrum auctions in the telecommunications sector. We discuss the rationale for introducing such a regulatory regime as well as conceptual and practical issues concerning its implementation.

It turns out that designing an efficient tender for universal service subsidies in liberalized markets is considerably more difficult than tendering e.g. a monopoly franchise. A first reason is that the cost assessment is more complex in the former case as future competitive market outcomes have to be anticipated; in the case of franchise bidding, at least the number of competitors is given by the tender itself. Hence, revenue effects caused by competitors are easier to calculate. Second, the threat of a winner's moral hazard requires more detailed ex ante regulations. These raise the social cost of universal service provision. Compared to direct designation of universal services with ex post compensation, tendering causes a series of fundamental concerns and trade-offs that make the application of auctions less attractive than in other sectors.
The Dynamic of Competition in Presence of Switching Costs
Authors: Defeuilley Christophe , Mollard Matthieu
Published: February 2017

Theoretical models with switching costs have shown that, in a dynamic game, firms have incentives to adopt two-period strategies. Initially firms will ‘invest’ in markets at an early stage in their development to be able to then ‘harvest’ at a later stage when consumers are locked-in to the supplier they have previously patronized. This article illustrates, based on a case study: the supply of electricity in Great Britain, that this two-period strategy is not always crowned with success. Specifically, certain firms (in this case British Gas) may have difficulties sustaining customer loyalty in the second phase because customers benefit from a ‘learning effect’, which in turn lowers their switching costs. Taking these learning effects into account could enrich the range of situations analyzed in the existing economic literature with respect to the understanding of the impact of switching costs on competition.
Naruc as Network: A Perspective on the U.S. Regulatory Policy Community
Authors: Beecher Janice A.
Published: February 2017

While much has been written about network industries, somewhat less attention has been paid to the policy networks among regulators themselves. Networks serve the collective and individual interests of members through professional socialization, capacity development, and institutionalization. Regulatory networks are particularly valuable if they help address information asymmetry, an inherent strategic advantage of regulated firms. Given potential tradeoffs associated with networking, regulatory networks must be vigilant about protecting institutional integrity. The history and culture of U.S. regulation are inextricably tied to the National Association of Regulatory Utility Commissioners (NARUC). This paper presents an historical and cultural account of ‘NARUC as network’ and offers a perspective for thinking about regulatory policy networks generally.
Future perspectives on nonmedical prescribing
Authors: Stewart Derek , Jebara Tesnime , Cunningham Scott , Awaisu Ahmed , Pallivalapila Abdulrouf , MacLure Katie
Published: February 2017

Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of ‘prescribing’ and the ‘prescribing process’ and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation.
Baclofen overdose mimicking anoxic encephalopathy: a case report and review of the literature
Authors: Miller John J.
Published: February 2017

A patient who has overdosed on baclofen can present with significant neurological symptoms suggestive of a serious brain insult, but with appropriate diagnosis and treatment they often fully recover within 72 h. If the patient had been maintained on chronic baclofen therapy prior to the overdose, one must be watchful for signs of baclofen withdrawal as recovery from the overdose occurs.
Flipping every student? A case study of content-based flipped language classrooms
Authors: Sun Yu-Chih
Published: February 2017

The study aims to explore university-level foreign language learners’ perceptions of the content-based flipped classroom approach and factors influencing their perceptions. The research questions guiding the study are three-fold. (a) What attitudes and perceptions do students have about language and knowledge acquisition in the content-based flipped classroom? (b) What learning processes and strategies do students employ in the process? (c) What themes emerge from the content-based flipped classroom experience? The findings reveal that by humanizing the classroom through rich interaction between students using the flipped classroom concept, students show improvement in communicative skills, confidence, and content knowledge development. However, students differ in their perceptions of its effectiveness due to their varying epistemological beliefs about the certainty of knowledge, authority and the sources of knowledge, what learning really means, and the importance of measurability in learning outcomes.
Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies
Authors: dos Santos Rafael G. , Bouso José Carlos , Hallak Jaime E. C.
Published: February 2017

Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT2A agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.
Sculpturing of the Male Breast
Authors: Rai Kimit
Published: February 2017

During the past decade, more esthetic surgery has been performed on male patients compared with the past. The most common request has been for improvements in the chest, ‘love handles‘ and abdomen. In the youthful male, the musculature, breast tissue and nipple areolar complex are quite tight. As age progresses, laxity of the tissue, skin and musculature becomes a problem. Management of contouring of the male breast depends on the size and shape of the breasts, whether the breasts are glandular or fatty and whether ptosis is present. Surgery aims to reduce fat content, increase skin and subcutaneous tissue contracture, and reposition the tissue in a more anatomical plane. Most of the procedures done by the author have been by ultrasonic liposculpturing. The level of satisfaction has been over 90%. A combination of ultrasound and conservative excision of glandular components can be done. Management of most juvenile breast hypertrophy and enlargement should be discouraged because of incomplete growth of the patient. However, sometimes ultrasound liposuction has a significant role to play in correcting this deformity.
Use of Abdominoplasty Technique and Marlex for Closure of a Major Abdominal Wall Defect
Authors: Morritt An , Lane G , Nishikawa H
Published: February 2017

Surgical resection of extensive primary or secondary abdominal wall tumours leads to major defects requiring reconstruction. The present case report describes the use of Marlex (polypropylene) mesh (CR Bard Inc, USA) with Mitek GII suture anchors (Mitek Products, USA) and an abdominoplasty technique to close a defect involving the entire lower half of the abdominal wall.
Acute carpal tunnel syndrome from a foreign body in the carpal tunnel
Authors: Balakrishnan Chenicheri , Bradt Lisa M , Sylora Roxanne L , Graff Nirutisai
Published: February 2017

A case of acute carpal tunnel syndrome as the result of a foreign body in the carpal tunnel is reported. The diagnosis was based on the patient's symptoms and radiographs. Early recognition and decompression of the carpal tunnel with removal of the foreign body led to a full recovery.
Reston: A Plastic Surgeon's Dream Material
Authors: Thomson Hugh G
Published: February 2017

Reston foam is a polyurethane ether polymer that has many attractive features for use by plastic surgeons. In the present paper, these features are addressed and clinical examples are shown.
Cutaneous myiasis due to Dermatobium hominis in Winnipeg
Authors: Musto David J , Murray Kenneth A
Published: February 2017

Cutaneous myiasis is an uncommon infestation in North America, with most cases arising in travelers who have recently returned from Central and South America. The majority of cases are due to Dermatobium hominis and present with a furunculoid nodule with local inflammation. The case reported is of a 57-year-old woman with cutaneous myiasis contracted in Winnipeg, Manitoba.
Extensor Digitorum Brevis Manus: A Case of Fourth-Compartment Syndrome
Authors: Mahabir Rc , Williamson Js , Williamson Dg , Raber El
Published: February 2017

The presence of an extensor digitorum brevis manus represents a variation of the normal anatomy of the fourth extensor compartment of the wrist. It usually presents as a swelling on the dorsum of the wrist and is often inaccurately diagnosed. An awareness of its existence and of its characteristic appearance on diagnostic imaging studies is the basis for diagnosis. Symptomatic cases require division of the extensor retinaculum or excision of the muscle, depending on subtype, while asymptomatic cases require no intervention.
Reflex Sympathetic Dystrophy Syndrome Associated with Burns of the Upper Extremity
Authors: Balakrishnan Chenicheri , Bradt Lisa M , Rankin David , Pane Thomas A
Published: February 2017

Reflex sympathetic dystrophy syndrome is an ill-defined symptom complex with clinical manifestations of excessive pain, joint stiffness and soft tissue changes. It rarely manifests following burns. Diagnosis is usually made from clinical symptoms and ganglion block. Early diagnosis and institution of conservative management is required to control symptoms and disability.
Endometriosis in the Canal of Nuck: Atypical Manifestations in An Unusual Location
Authors: Cervini Patrick , Wu Louis , Shenker Robert , O'blenes Catherine , Mahoney James
Published: February 2017

The canal of Nuck is an embryological remnant of the processus vaginalis and has been described as a site for endometriosis seeding. Endometriosis localized to the canal of Nuck is exceedingly rare with three cases reported. The case of a 31-year-old woman with an endometrioma in the canal of Nuck, made diagnostically challenging by atypical imaging and clinical findings, is described.
Absence of Capsular Contracture in 319 Consecutive Augmentation Mammaplasties: Dependent Drains As A-Possible-Factor
Authors: Fanous Nabil , Salem Iman , Tawilé Carolyne , Bassas Ae
Published: February 2017

Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.
Primary Unilateral and Bilateral Cleft Lip and Nose in An Older Population
Authors: Rai Kimit
Published: February 2017

A one-stage procedure to reconstruct complete and incomplete unilateral/bilateral cleft lip and nose deformities is presented. Emphasis was made on closure of the lip muscles, correction of the nostril floor, correction of the alveolar cleft as well as reconstruction of the nose through an intranasal approach, with a supported suture technique for nasal correction. No dental or orthodontic treatment was available or performed in this older population. Emphasis was on primary closure of the muscles, using the rotation advancement principle. The repair that was performed was near anatomical, reconstructing the labial sulcus, the nostril floor, the alveolar cleft and the nasal deformity all in one stage. There was a high level of satisfaction both from the patient's and surgeon's point of view.
A New Agent for Flap Survival – Hippophae Rhamnoides L. (Sea Buckthorn): An Experimental Study in Rats
Authors: Emsen Ilteris Murat
Published: February 2017

Hippophae rhamnoides L. (sea buckthorn) is a member of the Elaeagnaceae family, and is a temperate bush native to Europe and Asia. The antioxidant activity of H rhamnoides L. has been shown in vitro cell culture and animal studies. Different fractions of H rhamnoides L. fruits inhibit 2,2-azobis-(2,4 dimethylvaleronitrile) and ascorbate iron-induced lipid peroxidations in vitro. H rhamnoides L., as well as vitamin E, decrease the malondialdehyde content in hyperlipidemic rabbit serum-cultured smooth muscle cells. The aim of the present study was to investigate, in a rat model, the potential effect of H rhamnoides L. on survival of random pattern skin flaps. for this purpose, 30 Wistar Albino rats were used, and a McFarlane-type caudally based skin flap was created on the dorsum of the rat (2.5 cm × 8 cm). Rats were divided into three groups: one control (group A) and two treatment groups (groups B and C). H rhamnoides L. was administered orally to the experimental groups: group B received a single 15 mg/kg dose per day and group C received 15 mg/kg twice per day. The areas and lengths of flap necrosis were measured in each group. The extent of necrotic flap areas were evaluated as length and area of total flap area, and differences were studied by Student's t tests. The areas and lengths of necrosis of skin flaps decreased depending on H rhamnoides L., but viability of the flaps treated with 15 mg/kg/day was not significantly different from the control group. The rats receiving H rhamnoides L. 15 mg/kg twice per day had the highest flap survival rate (P<0.001). In conclusion, H rhamnoides L. may have a dose-dependent effect to increase flap survival in random skin flaps.
Scrotal and Penile Reconstruction Using the Vacuum-Assisted Closure Device
Authors: Snyder Ned , Gould Lisa J
Published: February 2017

Fournier's gangrene is a necrotizing, soft tissue infection that spreads along the deep external fascial planes of the perineum, scrotum (or vagina), penis, thighs and lower abdomen. Due to the rapid progression of the disease, patients are frequently left with a large integumentary deficit. Treatment of the skin defect has been described in a multitude of ways including split-thickness skin grafting, burying the testes in the thighs, thigh flaps and a variety of myocutaneous and fasciocutaneous flaps. Many of the previously described techniques have worked well for smaller defects and for closure of wounds but fall short of aesthetic reconstruction of sexual organs. Described here is a technique using split-thickness skin grafts, with foam dressings as the bolster. This was performed using the vacuum-assisted closure device (Kinetic Concepts Inc, USA). This technique creates a natural appearing scrotum that holds the testes away from the body, in a physiological manner, and surfaces the penis with a natural appearance, in a functional manner. The technique results in nearly 100% graft take and greatly decreases length of hospital stay.
‘Optimum Mobility’ Facelift. Part 2 – the Technique
Authors: Fanous Nabil , Karsan Naznin , Zakhary Kristina , Tawile Carolyne
Published: February 2017

In the first of this two-part article on the ‘optimum mobility’ facelift, facial tissue mobility was analyzed, and three theories or mechanisms emerged: ‘intrinsic mobility’, ‘surgically induced mobility’ and ‘optimum mobility points’.

In this second part, these three theories are applied to a rhytidectomy procedure termed ‘optimum mobility’ facelift. Before surgery, ‘optimum mobility points’ are marked on the skin. During surgery, the subcutaneous dissection is kept to a minimum by carrying it out precisely to these ‘optimum mobility points’. The facial tissues, with their skin and superficial musculoaponeurotic system attachments intact, are then mobilized laterally using the ‘intrinsic mobility’ phenomenon, and this mobilization fixed in place using mattress sutures.

The ‘optimum mobility’ facelift is an efficient rhytidectomy technique that has a thoughtful, precise plan, a low complication rate, a fast recovery and very satisfactory results.
Femoral Nerve Palsy As a Complication of Anterior Iliac Crest Bone Harvest: Report of Two Cases and Review of the Literature
Authors: Kargel Jennifer , Dimas Vanessa , Tanaka Wayne , Robertson O Bailey , Coy J Michael M , Gotcher Jack , Chang Peter
Published: February 2017

There are many documented neurological complications of anterior iliac crest bone harvest. Until now, these have included injuries to the iliohypogastric, subcostal and lateral femoral cutaneous nerves. Femoral nerve palsy as a direct surgical complication of anterior iliac crest bone harvest has never been cited in any surgical literature, although it has been reported in deep pelvic and abdominal surgeries in which improper retraction and/or prolonged hyperextension of the hip may have caused a nerve compression syndrome. In addition, surgical patients on antithrombolytic therapy have experienced hemorrhage within the iliacus and iliopsoas muscles, resulting in hematoma and secondary femoral nerve compression. The classic motor and sensory deficits reported in femoral nerve palsies are reduced or absent patellar reflex, weak hip flexion, quadriceps muscle weakness, and anesthesia of the anterior thigh and medial aspect of the leg. Two cases of femoral nerve palsy with different etiologies are presented.
Angiomyxoma diagnosed in a man presenting for abdominal lipectomy
Authors: Andres Lewis A , Mishra Mithilesh J
Published: February 2017

Aggressive angiomyxoma is a rare tumour that is locally infiltrative but nonmetastasizing. It occurs nearly exclusively in adult women of childbearing age and almost always arises in the perineum and pelvic area. A case of angiomyxoma occurring in a middle-aged, morbidly obese man is reported. The clinical presentation was one of progressing scrotal edema and enlargement with subsequent development of scrotal abscesses, requiring several incisions and drainages as well as oral and intravenous antibiotics. His symptoms and body habitus left him in a significantly debilitated state, prompting him to seek treatment for his conditions. He initially presented for abdominal lipectomy. However, due to the chronic scrotal infections and enlargement, scrotectomy was recommended before any other surgical procedures. A scrotectomy was performed by the urology service. Pathological diagnosis of the excised tumour was an aggressive angiomyxoma. Given the rarity of this tumour, especially in males, the proper diagnosis and treatment of angiomyxoma is still being investigated. With this in mind, the physical signs and symptoms that characterize this condition are presented and treatment options are reviewed.
Atypical fibroxanthoma in a young woman: An unusual case presentation
Authors: Melendez Mark M , Xu Xiaoti , Mcclain Steve A , Huang Su-I Daniel
Published: February 2017

Atypical fibroxanthoma (AFX) is an uncommon neoplasm, identified as a spindle cell tumour that is generally found in elderly patients on sun-exposed areas. The majority of cases of AFX are benign, and metastasis is a rare phenomenon. The first case in the literature of AFX is described in a young woman with no previous risk factors who presented with a three-month history of an enlarging nodule of the left nasal alar. Excision showed the lesion to be composed of hyperchromatic, pleomorphic, vacuolated spindle cells and multinucleated giant cells. The tumour cells stained positive for macrophage-histiocyte antigen alpha1-antitrypsin, neurokinin-1, CD68 and alpha1-antichymotrypsin. The present case report highlights the importance of correct diagnosis for AFX with adequate excision and by considering the histopathology and immunohisto-chemistry of its clinical differential diagnosis.
Composite tissue allotransplantation of the face: Decision analysis model
Authors: Cugno Sabrina , Sprague Sheila , Duku Eric , Thoma Achilleas
Published: February 2017

Background

Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure.

Study Design

The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed.

Results

Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years.

Conclusions

The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.
Patient Satisfaction Following Nipple Reconstruction Incorporating Autologous Costal Cartilage
Authors: Lipa Joan E , Addison Patrick D , Neligan Peter C
Published: February 2017

Background

Nipple-areolar reconstruction completes postmastectomy breast reconstruction. Many techniques for nipple reconstruction have been described, and each has their advocates and critics. One of the frequent failings of most designs is loss of nipple projection with time.

Objectives

To determine the effect of including autologous costal cartilage on patient satisfaction with their nipple reconstruction.

Methods

Sixty-eight patients were identified who had undergone fishtail flap nipple reconstruction following autologous free flap breast reconstruction between 1990 and 2004. Qualitative questionnaires, using Likert scales, were sent to each patient to specifically assess their satisfaction with their nipple reconstruction.

Results

Of 26 respondents (mean ± SEM follow-up period 3.7±3.6 years), 13 had undergone nipple reconstruction incorporating costal cartilage banked at the time of initial breast reconstruction, and the other 13 had no cartilage in their nipple reconstructions. While both groups would opt for nipple reconstruction again, patients with cartilage grafts incorporated into their reconstructions had overall satisfaction ratings 1.92 grades higher on average (not significant, P=0.12) than those without. This difference increased to 3.2 grades when the satisfaction of the patient's partner was taken into account (P<0.05). Improved satisfaction corresponded to higher scores for volume, consistency, texture, and particularly for projection and contour of the nipple (P<0.05). Although nipple morphology changed over time, there was a trend toward improved stability in the cartilage group.

Conclusions

Patient satisfaction with nipple reconstruction can be improved by incorporating costal cartilage beneath the skin flaps. Superior contour and projection are sustained over time.
Closure of Orocutanous Fistula Using a Pedicled Expanded Deltopectoral Flap
Authors: Balakrishnan Chenicheri , Narasimhan Kailash , Gursel Tolga , Jackson Ollie , Schaffner Adam
Published: February 2017

Orocutaneous fistulas are associated with considerable morbidity. Closures of these fistulas are a challenge to the reconstructing surgeon. The aim of treatment is to provide healthy tissue to repair both the oral and cutaneous defects. The use of an expanded pedicled deltopectoral flap for the closure of an orocutaneous fistula in a patient who has undergone bilateral neck dissection and radiation is reported.
Posterior Interosseous Nerve Palsy Caused By Lipoma: A Case Report
Authors: Murphy Amanda , Williams Jason
Published: February 2017

Lipomas are benign soft tissue neoplasms that occur commonly in subcutaneous tissue. In rare instances they can occur in deeper planes. When occurring in the proximal forearm they can compress the posterior interosseous branch of the radial nerve resulting in an insidious onset of weakness of digital extensor muscles. A case of posterior interosseous nerve palsy from lipoma in a 58-year-old man in presented.
A Review of Pain Pumps in Plastic Surgery
Authors: J Chandran Geethan , H Lalonde Donald
Published: February 2017

Continuous infusions of local anesthetics for postoperative analgesia have been used for several years by numerous surgical subspecialties. Plastic surgery has only recently embraced these pain pumps, most of which have been used in breast and abdominal surgery. Many different pain pump systems are available. They have been used in many studies and have been found to be effective in improving postoperative analgesia, decreasing narcotic use, and decreasing nausea and vomiting. They have little associated morbidity and systemic toxicity. However, the efficacy of these pain pumps in various areas of plastic surgery need to be studied in well-designed prospective clinical trials. The present paper reviews the current status of the available evidence, usefulness and limitations of the use of pain pumps in plastic surgery.