bluuebunny/crossref_metadata_2025 huggingface dataset:
The natural history of type 2 endoleaks after endovascular aneurysm repair justifies conservative management
Authors: Ajalat Mark , Williams Russell , Wilson Samuel E
Published: March 2018

Objective

Management of type 2 endoleaks after endovascular aneurysm repair has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of type 2 endoleaks in order to derive direction in management.

Methods

Patients who had endovascular aneurysm repair at the Veterans Affairs Long Beach were retrospectively identified and computerized tomographic angiography was independently reviewed by a radiologist and a vascular surgeon. Type 2 endoleaks were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates.

Results

Of the 160 patients who had completed required follow-up to date (mean 3 years) after endovascular aneurysm repair, 39 (24.4%) patients were identified as having a type 2 endoleak on computerized tomographic angiography imaging. 6 (15.4%) of these 39 patients required repair due to aneurysm sac growth >1 cm. 2 (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified type 2 endoleak. Spontaneous resolution of type 2 endoleaks occurred in 16 (41.0%) patients. 4 patients (10.3%) had delayed type 2 endoleaks that presented 4, 9, 12, and 23 months after their 30 day post op computed tomography was normal. None of the 4 patients with delayed type 2 endoleaks required reintervention and none had aneurysm sac growth greater than 5 mm.

Conclusions

Overall, we found that 85% of patients who had type 2 endoleaks did not require intervention after a mean follow-up time of 3 years. The association of a type 1 or 3 endoleak with a type 2 endoleak was more likely to require correction due to aneurysm expansion >1 cm, thus type 2 endoleaks associated with another type of endoleak require more aggressive management.
And For Law: Why Space cannot be understood without Law
Authors: Philippopoulos-Mihalopoulos Andreas
Published: March 2018

Doreen Massey, the iconic political geographer, whose book For Space has influenced the way various disciplines understand space, has largely ignored law in her work. In fact, just as most non-legal scholars she replaces law with politics. Here, I read Massey through law, arguing that often, non-legal writing is characterized by a misapprehension of the law. Through an analysis of her arguments against some understandings of space (such as systemic, negative, closed, textual), I mount a critique against the standard understandings of law (as precisely all these things) and suggest instead a lawscaping way of understanding the connection between law and space, as well as issues of spatial justice and responsibility.
A kindergarten-based child health promotion program: the Adapted National Aeronautics and Space Administration (NASA) Mission X for improving physical fitness in South Korea
Authors: Min Jungwon , Kim Gilsook , Lim Hyunjung , Carvajal Nubia A. , Lloyd Charles W. , Wang Youfa
Published: March 2018

Background:

Effective and sustainable intervention programs are needed to promote physical activity (PA) in children.

Objectives:

To adapt the NASA Mission X: Train Like an Astronaut program for use with South Korean children, and to evaluate its feasibility and effectiveness for promoting children’s physical fitness.

Methods:

Children 5 years old ( n = 212) and their parents were recruited from three kindergartens in three cities to participate in a 6-week intervention program in fall 2014. We assessed the children’s PA and related changes, and parental changes in attitude and beliefs, after participation in the intervention.

Results:

Girls reported less PA than boys (40.7 vs. 59.0, p < 0.01). Children with a normal body mass index (BMI) were more likely to be active than underweight children (< 10 percentile) or overweight children (⩾ 85 percentile). After the intervention, about one-half of the children had increased their level of PA (49.4%), increased interest in PA (59.1%) and found psychological need satisfaction in exercise (52.6%). The majority of parents became aware of the necessity of childhood PA (94.2%), their child’s PA capability (64.3%), and the relationship of PA with their children’s self-esteem (79.9%).

Conclusions:

The adapted NASA Mission X program was feasible and effective in promoting PA in kindergarteners, and also improved their parents’ attitude and beliefs about children’s PA in South Korea. This study provided a model for promoting childhood health through child care and educational settings.
Validating a Classroom Perception Instrument for Gifted Students in a University-Based Residential Program
Authors: Wu Jiaxi , Jen Enyi , Gentry Marcia
Published: March 2018

Summer enrichment and residential programs can provide gifted students with positive social interactions and challenging curricula. However, little research has focused on gifted students’ perceptions of the learning environment in such programs. This research project evaluated the psychometric properties and practical applications of the Student Perceptions of Classroom Quality ( SPOCQ) instrument. The two studies used a total sample of 1,492 diverse, gifted students in Grades 5 through 12 who participated in a university-based enrichment residential program from 2010 through 2013. Confirmatory factor analysis results indicated that although the original model was a moderately good fit for the gifted student participants in 2010 to 2011, some items on the SPOCQ were classroom specific and did not apply to residential programs. Therefore, those items were revised and retested, and results showed that the modified model was a better fit for gifted student participants in 2012 to 2013.
Platforms and hyper-choice on the World Wide Web
Authors: Graham Timothy
Published: March 2018

Choice is a sine qua non of contemporary life. From childhood until death, we are faced with an unending series of choices through which we cultivate a sense of self, govern conduct, and shape the future. Nowadays, individuals increasingly experience and enact consumer choice online through web-based platforms such as Yelp.com , TripAdvisor.com and Amazon.com . These platforms not only provide a sprawling array of goods and services to choose from, but also reviews, ratings and ranking devices and systems of classification to navigate this landscape of choice. This paper suggests a radical reconsideration of platform architectures and design features to consider how they reconfigure and respecify choice, ‘choosers’, and choice-making practices. Platforms are not simply cameras that present choice and enable comparisons between different options, but are more akin to engines that govern, drive and expand choice, configuring users within particular discourses, practices and subjectivities. In making sense of the entangled trajectories of consumer choice, platform architectures and Big Data, I suggest that ‘hyper-choice’ emerges as a condition of the contemporary platform-driven web. I examine hyper-choice not only in terms of the relationship between platforms and a growing abundance of choice, but more importantly how platforms reconfigure choice in ways that go beyond and fundamentally challenge existing understandings of what choice is, who and what is involved in producing knowledge about choice, and what it means to be a ‘chooser’.
Perceived Benefits and Challenges of a Risk-Based Approach to Multidisciplinary Chronic Kidney Disease Care: A Qualitative Descriptive Study
Authors: Smekal Michelle D. , Tam-Tham Helen , Finlay Juli , Donald Maoliosa , Benterud Eleanor , Thomas Chandra , Quinn Robert R. , Tam Kin , Manns Braden J. , Tonelli Marcello , Bello Aminu , Tangri Navdeep , Hemmelgarn Brenda R.
Published: March 2018

Background:

The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care.

Objective:

We aimed to describe patient, family, and health care provider’s perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input.

Methods:

We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta. We obtained perspectives from patients and families through focus groups, as well as input from health care providers through interviews and open-ended responses from an online survey. Twelve patients/family members participated in 2 focus groups, 16 health care providers participated in an interview, and 40 health care providers responded to the survey.

Results:

Overall, participants felt that a KFRE-based approach had the potential to improve efficiency of the clinics by targeting care to patients at highest risk of kidney failure; however, they also expressed concerns about the impact of loss of services for lower risk individuals. Participants also articulated concerns about a perceived lack of capacity for adequate CKD patient care in the community. Our implementation strategy was modified as a result of participants’ feedback.

Conclusions:

We identified benefits and challenges to implementation of a risk-based approach to guide care of patients with advanced CKD. Based on these results, our implementation strategy has been modified by removing the category of referral back to primary care alone, and instead having that decision made jointly by nephrologists and patients among low-risk patients.
Topically administered hyaluronic acid in the upper airway: A narrative review
Authors: Pignataro Lorenzo , Marchisio Paola , Ibba Tullio , Torretta Sara
Published: March 2018

Hyaluronic acid plays a role in controlling inflammatory airway processes and mucociliary clearance, and it is also involved in tissue healing and remodelling. Some studies have tested the effectiveness of topically administered hyaluronic acid in patients with upper airway diseases with positive preliminary results. This article describes the use of topically administered hyaluronic acid in patients with otolaryngological disorders. Pertinent studies published between January 2000 and October 2016 were selected by means of a MEDLINE search using the following terms: ‘hyaluronic acid’ and ‘otolaryngology’, ‘otitis’, ‘pharyngitis’, ‘tonsillitis’, ‘rhinitis’, ‘rhinosinusitis’ and ‘nose’. Twelve of the 19 initially identified papers were selected, corresponding to 902 patients as a whole. There is some evidence that topically administered hyaluronic acid is effective or moderately effective in different otolaryngological conditions, as it improves the global subjective and clinical status of patients with inflammation of the nasopharyngeal and oto-tubaric complex, those with rhinitis or rhinosinusitis and those who have undergone nasal and sinonasal surgery. However, these findings should be viewed cautiously as they are based on a limited number of studies, some of which were probably under-powered because of their small patient samples.
Arab ESL Secondary School Students’ Attitude Toward English Spelling and Writing
Authors: Al-Sobhi Bandar , Md Rashid Sabariah , Abdullah Ain Nadzimah
Published: March 2018

Learners’ attitude is considered a key motivational component and an important nonlinguistic factor that influences second-language learning. The primary aim of the current study is to explore Arab secondary school students’ attitudes toward English spelling and writing. To collect the data, a 52-item attitude questionnaire was administered to 70 Arab students studying English as a second language (ESL) in the Saudi School in Malaysia. The questionnaire comprises two scales: (a) attitudes toward English spelling and (b) attitudes toward writing in English that includes four writing purposes: (a) School Use, (b) Social Use, (c) Official Use, and (d) Creativity. The findings of the study revealed that the Arab ESL secondary school students have a high positive attitude toward English spelling and writing. The findings also indicated that the students’ attitude toward the Social Use of English is the highest, whereas their Creativity in writing is the least mean among the four purposes. In addition, the study revealed that there is a significant positive relationship between the students’ attitude toward spelling and writing. The findings suggest that English literature, that is, stories and literary activities, should be integrated in the curriculum to develop the students’ creativity in ESL writing. The study also recommends that other studies may investigate Arab students’ spelling error analysis as well as address other important aspects of writing such as brainstorming, drafting, revising, and editing.
Rigidly Applied Rules? Revisiting Inflexibility in Obsessive Compulsive Disorder Using Multilevel Meta-Analysis
Authors: Fradkin Isaac , Strauss Asher Y. , Pereg Maayan , Huppert Jonathan D.
Published: March 2018

Several recent models of obsessive compulsive disorder (OCD) consider it to be a neurocognitive disorder involving inflexibility and disinhibition. Indeed, previous reviews of neuropsychological functioning in OCD suggested impaired performance in flexibility tasks. The current meta-analysis examines whether the reported differences in flexibility can be explained by general underperformance unrelated to flexibility. In addition, the role of feedback processing in inflexibility is investigated. To this end, we integrated evidence from 75 studies that compared patients with OCD with nonpsychiatric controls on at least one flexibility measure, while applying a novel approach in which task scores measuring flexibility were compared with control scores from the same tasks measuring other confounding processes. The results revealed no evidence for inflexibility in OCD, with patients’ performance most parsimoniously explained by nonspecific factors. These results challenge models stressing inflexibility as an endophenotype of OCD. Methodological implications for reviewing cognitive deficits in psychopathology are discussed.
Article Commentary: Pediatric facial transplantation: Ethical considerations
Authors: Flynn Jennifer , Zlotnik Randi Shaul , Hanson Mark D , Borschel Gregory H , Zuker Ronald
Published: March 2018

Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement.
Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty
Authors: Gutierrez Santiago , Wuesthoff Carolina
Published: March 2018

Background

Steroids have proven to be of some benefit in rhinoplasty edema and ecchymosis when administered at a high and repeated dose.

Objective

To evaluate the effects of single-dose, long-acting intramuscular steroids on postoperative edema and ecchymosis after closed rhinoplasty with osteotomies compared with placebo.

Methods

A randomized, double-blinded, placebo-controlled trial was performed. Fifty-four patients were randomly assigned to two groups: 28 received a single dose of long-acting dexamethasone (mean [± SD] dose 16±4 mg) immediately before anesthetic induction; the remaining 26 received an intramuscular injection of saline solution. The same surgeon performed all surgeries, with patients under general anesthesia. Acetaminophen was the only analgesic used to control postoperative pain. High-resolution digital photographs were taken on postoperative days 1, 3, 7 and 14. Scoring was performed separately for eyelid swelling and ecchymosis by an independent observer using a graded scale (0 to 5) for edema and a scoring system (0 to 13) for ecchymosis.

Results

No statistically significant differences in terms of age, sex or amount of bleeding during surgery were found between the two groups. No statistically significant difference was observed in the decrease of both ecchymosis and edema between placebo and high-dose, long-acting dexamethasone. A statistically significant difference in operation time was found, favouring the steroid group. No severe complications were observed due to steroid use.

Discussion

Osteotomies are basically a form of (controlled) trauma, with considerable disruption of the abundant blood vessels in this facial region and, therefore, are associated with with undesirable effects. A recent meta-analysis failed to show benefits of the use of steroids after postoperative day 3. Only a trend toward reduction in edema and ecchymosis with the use of long-acting steroids compared with placebo was demonstrated in the present study.

Conclusion

There was no benefit in administering single-dose, long-acting steroids in patients undergoing closed rhinoplasty with osteotomies.
Biomechanical analysis of the FlatWire Figure 8 sternal fixation device
Authors: Wilson Ryan M , Ghareeb Paul A , Mcclellan W Thomas , Boustany Ashley N
Published: March 2018

Objective

To determine whether the FlatWire Figure 8 sternal fixation device (Penn United, USA) is mechanically superior to the current standard in sternotomy closure.

Description

Unstable sternal closure using traditional steel-wire cerclage can increase postoperative pain, bony cut-through and wound dehiscence. The authors present the Figure 8 sternal fixation device to minimize these complications. Biomechanical properties of the device were compared with conventional steel wire sternal repair.

Evaluation

Using two constructs of both FlatWire and steel wire, pull-to-failure, Hertzian contact and cut-through were compared. Samples were tested to 500,000 cycles or failure. Cyclic comparisons were performed using log-rank t tests and Student's t tests for cut-through analysis. FlatWires were found to have superior biomechanical properties in all categories tested.

Conclusion

The FlatWire provides superior biomechanical properties compared with conventional steel wire, which may lead to reduced sternal wound complications.
Current biopsy practices for suspected melanoma: A survey of family physicians in Southwestern Ontario
Authors: Lutz Kristina , Hayward Victoria , Joseph Mariamma , Wong Eric , Temple-Oberle Claire
Published: March 2018

Background

Family physicians (FPs) have an opportunity to diagnose pigmented lesions early with a timely biopsy.

Objective

To assess current biopsy practices used by FPs in diagnosing melanoma.

Methods

A computer-generated random sample of 200 practicing FPs from large and small communities in Southwestern Ontario was identified from the College of Physicians and Surgeons of Ontario physician directory. Paper-based surveys exploring practice setting, basic melanoma knowledge, biopsy practices and referral wait times were mailed using a modified Dillman protocol.

Results

The response rate was 50% and respondents reflected the demographic characteristics of FPs nationwide as per the National Physician Survey. Knowledge testing revealed reasonable mean (± SD) scores (3.2±1.03 of 5). Twenty percent of respondents would always perform an excisional biopsy of skin lesions suspicious for melanoma. The remaining 80% would avoid an excisional biopsy in an aesthetically sensitive area and if there was risk of failure to close the defect primarily, among other reasons. If an excisional biopsy were not performed, one-half of respondents would perform an incisional biopsy (eg, punch biopsy). In large communities, 24% of patients were not seen by a surgeon within six months when referred without a tissue biopsy, leading to delayed diagnosis.

Discussion

Educating and supporting FPs to perform incisional biopsies in cases for which excisional biopsies are inappropriate should result in earlier diagnosis of melanoma.

Conclusion

FPs appropriately recognize that excisional biopsies are ideal in melanoma management and one-half will move on to an incisional biopsy when excision is not appropriate.
Three-dimensional remodelling to determine best fit for hemihamate autograft arthroplasty
Authors: Shih Jessica , Podolsky Dale , Binhammer Paul
Published: March 2018

Objective

To determine the best fit of a hamate osteochondral graft to reconstruct a palmar defect of a middle phalanx articular fracture using three-dimensional remodelling.

Methods

The proximal middle phalanx and distal hamate articular surfaces of 10 cadaveric right hands were scanned using a three-dimensional laser scanner. A defect was marked on the middle phalanx digital image to simulate a 50% palmar lip fracture. A hemihamate autograft surgical procedure was simulated by aligning the middle phalanx and hamate digital articular surfaces. In addition to the second digit measurements, the midpoint distances of the central ridge of proximal articular surface of the middle phalanx digital image for digits 3, 4 and 5 were recorded for reference value, as well as the offset distances for the long and small finger.

Results

The mean midpoint distance for the index finger was 2.96 mm (95% CI 2.71 mm to 3.21 mm). The mean angle of offset was 20.09° (95% CI 15.54° to 24.64°). The mean graft offset distance was prominent by 1.23 mm (95% CI 0.57 mm to 1.89 mm). The reference values for the third, fourth and fifth middle phalange midpoint distances were 3.26 mm (95% CI 3.09 mm to 3.43 mm), 3.13 mm (95% CI 2.93 mm to 3.33 mm) and 2.48 mm (95% CI 2.33 mm to 2.63 mm), respectively. The offset distances for digits 3 and 5 were 1.24 mm (95% CI 0.48 mm to 2.00 mm) and 1.08 mm (95% CI 0.48 mm to 1.68 mm), respectively.

Conclusions

The present study provides information about best fit for placing a hamate autograft for the hemihamate arthroplasty procedure. In this model, the hamate graft must be offset to recreate the curvature of the middle phalanx.
Do plastic surgery division heads and program directors have the necessary tools to provide effective leadership?
Authors: Arneja JS , Mcinnes CW , Carr NJ , Lennox P , Hill M , Petersen R , Woodward K , Skarlicki D
Published: March 2018

Background

Effective leadership is imperative in a changing health care landscape driven by increasing expectations in a setting of rising fiscal pressures. Because evidence suggests that leadership abilities are not simply innate but, rather, effective leadership can be learned, it is prudent for plastic surgeons to evaluate the training and challenges of their leaders because there may be opportunities for further growth and support.

Objective

To investigate the practice profiles, education/training, responsibilities and challenges of leaders within academic plastic surgery.

Methods

Following research ethics board approval, an anonymous online survey was sent to division heads and program directors from all university-affiliated plastic surgery divisions in Canada. Survey themes included demographics, education/training, job responsibilities and challenges.

Results

A response rate of 74% was achieved. The majority of respondents were male (94%), promoted to their current position at a mean age of 48 years, did not have a leadership-focused degree (88%), directly manage 30 people (14 staff, 16 faculty) and were not provided with a job description (65%). Respondents worked an average of 65 h per week, of which 18% was devoted to their leadership role, 59% clinically and the remainder on teaching and research. A discrepancy existed between time spent on their leadership role (18%) and related compensation (10%). Time management (47%) and managing conflict (24%) were described as the greatest leadership challenges by respondents.

Conclusions

Several gaps were identified among leaders in plastic surgery including predominance of male sex, limitations in formal leadership training and requisite skill set, as well as compensation and human resources management (emotional intelligence). Leadership and managerial skills are key core competencies, not only for trainees, but certainly for those in a position of leadership. The present study provides evidence that academic departments, universities and medical centres may benefit by re-evaluating how they train, promote and support their leaders in plastic surgery.
Intraoperative tissue expansion in the surgical correction of craniosynostosis
Authors: Doshier Laura J , Fowler Daniel , Mcewan Thomas , Baker C Lynette , Muzaffar Arshad R
Published: March 2018

Background

Wound healing complications can occur after calvarial vault expansion due to tension on the scalp flaps.

Objectives

To compare wound healing outcomes in patients with craniosynostosis undergoing calvarial vault expansion with and without intraoperative tissue expansion of the scalp.

Methods

The present analysis was an institutional review board-approved, retrospective cohort study involving 40 consecutive patients at the University of Missouri Hospitals and Clinics (Columbia, Missouri, USA) who underwent calvarial vault expansion for nonsyndromic craniosynostosis between June 1, 2009 and June 30, 2012. Patients were divided into two sequential cohorts: the first 20 underwent calvarial vault expansion without intraoperative tissue expansion; the second 20 underwent calvarial vault expansion with intraoperative tissue expansion. The main outcome measures included presence or absence of wound healing complications (persistent scabbing or slow-healing wounds, hardware exposure, need for operative wound revision or healed but widened scars), with documented postoperative follow-up of at least three months. The primary end point was the presence of a well-healed scar; the secondary end point was the need for an operative revision.

Results

Patients in the intraoperative tissue expansion group had a higher percentage of well-healed scars (73.6%) than those in the nonexpansion group (42.1%) (P=0.0487). This difference was primarily due to scar widening in the nonexpansion group.

Conclusions

The present study demonstrated that the use of intraoperative tissue expansion in patients with nonsyndromic craniosynostosis who underwent calvarial vault expansion resulted in a greater likelihood of a well-healed incision with a lower rate of poor scarring.
Influence of patient age on capsular contracture after aesthetic breast augmentation
Authors: Zeplin Philip H , Fracs Niamph Corduff
Published: March 2018

The influence of age on capsular contracture rates remains unclear. Most studies have only investigated early capsule development and not whether a link between age at primary surgery and the later development of capsular fibrosis exists. To clarify whether patient age impacts the development of late capsular fibrosis, the authors conducted a retrospective case study involving 43 patients who presented for surgical revision of capsular contracture (Baker grade ≥III) between four and 40 years after primary breast augmentation. Possible correlations between age and implant placement were analyzed. Late presentation of capsular fibrosis occurred a mean of 15.6 years after primary augmentation, with a slightly negative, but not significant, correlation between age at primary operation and duration of implant placement. Patients <40 years of age underwent an operative revision after a mean of 18.9 years, while patients ≥40 years of age needed an operative revision a mean of 11.9 years after primary breast augmentation (P=0.0368). The results suggest that with advancing age, the average time to develop capsular fibrosis is significantly shorter in individuals who develop capsular contracture. As more data are collected, appropriate advice can be provided to patients regarding factors that influence the long-term outcomes of breast augmentation.
Review: Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature
Authors: Chin Brian , Cheung Kevin , Farhangkhoee Hana , Thoma Achilleas
Published: March 2018

Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas.
Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution
Authors: Monsivais Sharon E , Roehl Kendall R , Mahabir Raman C
Published: March 2018

Background

In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions.

Objective

To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data.

Methods

Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room.

Results

The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55).

Conclusion

In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.
The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: A preliminary study
Authors: Egea-Guerrero Juan J , Martínez-Fernández Carmen , Rodríguez-Rodríguez Ana , Bohórquez-López Angélica , Vilches-Arenas Angel , Pacheco-Sánchez María , Guerrero Juan M , Murillo-Cabezas Francisco
Published: March 2018

Objective

To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury.

Methods

The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis.

Results

A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003).

Conclusion

These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.
Should ‘smart phones’ be used for patient photography?
Authors: Chan Natalie , Charette Jacob , Dumestre Danielle O , Fraulin Frankie Og
Published: March 2018

Background

Within the field of plastic surgery, clinical photography is an essential tool. ‘Smart phones’ are increasingly being used for photography in medical settings.

Objective

To determine the prevalence of smart phone use for clinical photography among plastic surgeons and plastic surgery residents in Canada.

Methods

In 2014, a survey was distributed to all members of the Canadian Society of Plastic Surgeons. The questions encompassed four main categories: smart phone use for clinical photos; storage of photos; consent process; and privacy issues. The survey participation rate was 27% (147 of 545) with 103 surgeons and 44 residents. In total, 89.1% (131 of 147) of respondents have taken photographs of patients using smart phones and 57% (74 of 130) store these photos on their phones. In addition, 73% (74 of 102) of respondents store these photos among personal photos. The majority of respondents (75% [106 of 142]) believe obtaining verbal consent before taking clinical photographs is sufficient to ensure privacy is respected. Written consent is not commonly obtained, but 83% (116 of 140) would obtain it, if it could be done more efficiently. Twenty-six percent (31 of 119) of respondents have accidentally shown a clinical photograph on their phone to friends or family. A smart phone application that incorporates a written consent process, and allows photos to be immediately stored externally, is perceived by 59% (83 of 140) to be a possible way to address these issues.

Conclusion

Smart phones are commonly used to obtain clinical photographs in plastic surgery. There are issues around consent process, storage of photos and privacy that need to be addressed.
Is antibiotic prophylaxis in breast augmentation necessary? A prospective study
Authors: Keramidas E , Lymperopoulos Ns , Rodopoulou S
Published: March 2018

Background

The role of prophylactic antibiotics in breast augmentation remains controversial. However, the majority of surgeons are administering antibiotics.

Objective

To investigate the effect of antibiotic(s) use in the incidence of infection and capsular contracture following breast augmentation.

Methods

From September 2004 to November 2010, 180 patients underwent primary bilateral breast augmentation. They were prospectively divided into two equal groups: in group A (n=90), no antibiotics were given and, in group B (n=90), only one intravenous dose of cephalosporin was administered during the induction of general anesthesia. Preoperative data included age, body mass index, smoking status, medical history and implant volume. All operations were performed by the same surgeon using the same surgical technique and implant type. No drains were used. Operative data included operative time and estimated blood loss. Patients were evaluated for complications such as infection, hematoma and capsular contracture. The study concluded when all of the patients underwent the one-year follow-up. The Student's t test was used to analyze the results.

Results

All patients completed the study and both groups had similar demographic data. No differences in operative data were observed. The mean operative time was 35 min and the mean blood loss was found to be minimal. In group A, no implant infections were reported, while a wound infection that occurred was treated successfully with oral antibiotics. In group B, no implant or wound infection was noticed. No capsular contractures or hematomas were observed.

Conclusions

The number of patients who underwent primary breast augmentation without antibiotics (n=90) was insufficient to draw any definitive conclusions. However, the present prospective study demonstrated that prophylactic use of antibiotics in breast augmentation had no significant effect on infection and capsular contracture rates. Further randomized clinical trials, in combination with guidelines from aesthetic plastic surgery societies, appear to be warranted.
Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media
Authors: Fraser S. J. , Al Youha S. , Rasmussen P. J. , Williams J. G.
Published: March 2018

Background:

Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students’ knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions.

Methods:

To assess medical students’ knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions.

Results:

As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery.

Conclusion:

Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum.
Aggressive Combined Medical and Surgical Management of Mucormycosis Results in Disease Eradication in 2 Pediatric Patients
Authors: Augustine Haley F. M. , White Colin , Bain James
Published: March 2018

Rhinocerebral mucormycosis is an acute, rapidly fatal, fungal infection, classically involving the nasal mucosa and paranasal sinuses. It is an aggressive, opportunistic infection that frequently progresses to involve the orbit and cerebrum. Cerebral extension in immunocompromised patients is almost universally fatal. There are limited data on mucormycosis in pediatric immunocompromised patients in the literature, with only few reports on rhinocerebral involvement. The immunocompromised patients described in this report presented with suspected periorbital and nasal cellulitis, progressing rapidly to necrotic changes in nasal tissue and oral palatal mucosa. In these patients, the surgical resection of mucormycosis-infected tissue followed by flap reconstruction combined with medical treatment effectively treated the infection, allowed for the rapid resumption of chemotherapy and dramatically improved the quality of life for both the patient and their family.
The Keystone Flap—A Case Series Demonstrating Practical Design, Use, and Applications
Authors: Pripotnev Stahs , White Colin
Published: March 2018

Introduction:

The keystone design perforator island flap is a trapezoidal-shaped random perforator island flap with many advantages over primary closure, skin grafting, and other local flaps for soft tissue reconstruction commonly encountered with cancer excisions.

Methods:

This case series of 39 keystone flaps in 37 patients reviews the practical design, use, and applications of the flap while highlighting certain important considerations. Keystone flaps were designed as in the original description, with a minor modification in the lower extremity where a higher flap to defect width ratio was used.

Results:

Defects varying in size from 6 to 63 cm2 were reconstructed in 23 males and 14 females ranging in age from 49 to 89. In all 39 cases, there were 2 minor complications of partial flap dehiscence and no major complications such as partial or complete flap loss.

Conclusion:

The keystone flap is a versatile and reliable flap with applications almost anywhere on the body. A higher ratio of flap width to defect width up to 1:3 is more appropriate for the lower extremity where tension is higher.
Evaluation of Secondary and Late Secondary Alveolar Bone Grafting on 66 Unilateral Cleft Lip and Palate Patients
Authors: Mahajan Ravi , Ghildiyal Harish , Khasgiwala Ankit , Muthukrishnan Gogulnathan , kahlon Sukhdeep
Published: March 2018

Objective:

The aim of this retrospective study was to evaluate the outcomes of secondary alveolar bone grafting and late secondary alveolar bone grafting in 66 unilateral cleft lip and palate patients.

Materials and Methods:

The total patients were 66 unilateral cleft lip and palate patients, out of which 19 patients underwent secondary alveolar bone grafting and 47 patients underwent late secondary alveolar bone grafting. Autogenous anterior iliac crest cancellous bone graft was harvested and used for grafting the alveolar clefts. Radiographic assessment based on Enemark’s scoring according to the marginal bone levels was done on the intraoral periapical radiographs taken 6 months after performing the surgery.

Results:

Twelve (63%) out of the 19 patients on whom secondary alveolar bone grafting was done achieved score 1 (optimal marginal bone levels), whereas only 12 (25%) out of the 47 patients achieved score 1 amongst the late secondary alveolar bone graftings. Overall results showed, probability, P = .034 (statistically significant).

Conclusion:

This study reaffirmed the fact that alveolar bone grafting when done in preadolescent age group (secondary alveolar bone grafting) gives better results in terms of marginal bony consolidation and maintaining the continuity of the alveolar arch, but the late presentation (late secondary alveolar bone grafting) should not be the refusal criteria for performing the alveolar bone grafting. Although the latter patients may not be rewarded in terms of bony consolidation as much as the preadolescent patients the potential of successful surgery in them still exists in terms of providing a platform for the dental implant placement, improvement in the soft tissue symmetry and aesthetics of the face.
Effectiveness and Complications of Improved Liposuction–Curettage Through Mini-Incisions for the Treatment of Axillary Osmidrosis
Authors: Yang Hu , Xu Gang , Huang Chun-Lan , Xia Ying , Wang Xiao-Wei , Chen Qiang , Wang Shou-Jie , Zhang Li-Yun , Tan Wei-Qiang
Published: March 2018

Background:

Liposuction–curettage (LC) is a popular and effective surgical method for the treatment of axillary bromhidrosis (AB). However, residual malodour and skin necrosis often appear after this type of surgery. We investigated the efficacy and complications of 4 methods of LC.

Methods:

A total of 280 patients with AB comprised the study cohort, of which 228 were followed up. We carried out 4 methods of modified tumescent LC through mini-incisions and provided a questionnaire for evaluation of surgical outcome. Evaluations were malodour elimination, scarring, reduced growth of hair, and complications. Mean follow-up was 15 months.

Results:

The study involved 449 axillae. In patients with LC in the final phase of improvement (programmed and well-organized LC, skin pinching to wrap up the cannula, LC to the skin around 2 surgical incisions, and cotton balls packed in gauze and an elastic set for post-operative management), excellent elimination of malodor was observed in 141 (89.81%) of 157 axillae. Only 4 (2.55%) cases encountered a small area of skin necrosis, and 28 (17.83%) had local damage to the epidermis.

Conclusion:

These data suggest that LC with a final phase of improvement through mini-incisions is effective for AB treatment.
Linburg-Comstock: Is Overuse an Etiological Factor?
Authors: Bulut Tugrul , Tahta Mesut , Ozturk Tahir , Zengin Eyup Cagatay , Ozcan Cem , Sener Muhittin
Published: March 2018

Background:

Linburg-Comstock anomaly is typically defined as a tenosynovial interconnection between flexor pollicis longus and flexor digitorum profundus tendon of the second finger. There are several studies stating that the current anomaly is congenital or acquired. The aim of this study is to reveal whether overuse, which is mostly reported as an acquired etiologic factor, effective in development of the current anomaly.

Methods:

Three hundred thirteen medical secretaries who work with computer keyboard at least 6 hours a day were defined as study group. Three hundred twenty-three volunteers without jobs who necessitate continuous and repetitive hand and finger activities were defined as control group. All individuals were examined by an orthopaedic surgeon. Additionally, cases with Linburg-Comstock anomaly were evaluated in respect of forearm pain and subjective findings of carpal tunnel syndrome.

Results:

Linburg-Comstock anomaly was determined in 27.8% cases of medical secretary group and in 32.2% of healthy control group. In medical secretaries with Linburg-Comstock anomaly, 25.3% had forearm pain and 5.7% had findings of carpal tunnel syndrome. In control group with Linburg-Comstock anomaly, 21.2% had forearm pain and 13.5% had findings of carpal tunnel syndrome. No relationship was found between overuse of the hand and Linburg-Comstock anomaly and the symptoms accompanying the anomaly.

Conclusions:

The current study reveals that overuse is not an etiologic factor in Linburg-Comstock anomaly existence and related symptoms. We think that the current anomaly develops on congenital basis rather than acquired factors.