bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliable predictors of reduced redundancy test performance: The interaction between lexical bonds and test takers’ depth and breadth of vocabulary knowledge
Authors: Janebi Enayat Mostafa , Babaii Esmat
Published: January 2017

The present study intended to investigate whether test takers’ breadth and depth of vocabulary knowledge can contribute to their efficient use of lexical bonds while restoring damaged texts in reduced redundancy tests. Moreover, the moderating role of general language proficiency was investigated in this interaction. In so doing, Vocabulary Levels Test (VLT), Word Associates Test (WAT), and a series of C-tests with high and low lexical bonds were administered to two groups of 85 upper-intermediate and 50 lower-intermediate EFL learners. Results of multiple regression analyses indicated the following: (a) breadth and depth of vocabulary knowledge played dissimilar roles for test takers with different levels of language proficiency; (b) depth of vocabulary knowledge was a better predictor for high-bond texts; and (c) test takers with higher levels of language proficiency made more efficient use of lexical bonds as contextual cues. The findings point to the necessity of improving learners’ depth of vocabulary knowledge, especially at lower levels of language proficiency where vocabulary knowledge is mostly a matter of size rather than quality.
The scope of the problem
Authors: Taylor Kenneth M
Published: January 2017

Despite refinements in cardiac surgical technique, disorders of haemostasis remain a significant problem, reflecting the effects of cardiopulmonary bypass on blood cell activation and coagulation. Increased understanding of the dangers of blood and blood product transfusion have shifted the goals from blood replacement to blood conservation in cardiac surgery. Two approaches to blood conservation are used: autotransfusion and administration of pharmacological agents. These approaches may be complementary, but the latter approach- preventing or at least modifying the haemostatic disorder- may be preferable. This paper reviews some of the pharmacological agents that have been used in an attempt to conserve blood, including e-aminocaproic acid, desmopressin, prostacyclin, tranexamic acid, dipyridamole, and aprotinin. None of these agents has been able to eliminate the need for blood transfusion in all patients; aprotinin has been successful, however, in eliminating the need for transfusion in some patients and dramatically reducing the need in others.
Agents that modify haemostasis after cardiopulmonary bypass
Authors: Weisel Richard D
Published: January 2017

Reducing the whole body inflammatory response to cardiopulmonary bypass may reduce postoperative bleeding. Dipyridamole decreases platelet activation, deposition, and depletion. Antifibrinolytic agents may further reduce bleeding by reducing fibrinolysis and maintaining platelet function. This review reports the author's experience with dipyridamole and antifibrinolytic agents, membrane and bubble oxygenators, as well as the effects of warm and cold heart surgery.
Use of erythropoietin in open heart surgery
Authors: D'Ambra Michael N
Published: January 2017

Despite widespread efforts to reduce the need for homologous blood transfusion during and after cardiac surgery, most patients still do require transfusions. This may be explained in part by changing demographics (more elderly patients), more patients presenting for repeat operations, and improvements in surgical and anaesthetic technology that allow more complex and invasive procedures. Cardiac surgery-with the obligate haemodilution associated with cardiopulmonary bypass - presents a great challenge in blood conservation. Erythropoietin has a role in the pharmacological therapy of cardiac surgery because cardiopulmonary bypass is associated with endogenous erythropoietin deficiency. This report discusses the mechanisms of endogenous erythropoietin production, the effect of recombinant human erythropoietin therapy, and the role of this drug in specific cardiac surgical procedures and situations.
A review of dysphagia in four cases of motor neurone disease
Authors: Scott Amanda , Heughan Anita
Published: January 2017

Dysphagia is a common and distressing problem in motor neurone disease. This paper examines some of the strategies available for managing patients with dysphagia, and illustrates these with four contrasting case histories. The factors which influence the decision making process in patients with dysphagia are also discussed.
Palliative care and taboos within motor neurone disease
Authors: O'Brien Tony
Published: January 2017

Taboos, whether held by professional carers, patients or families have the capacity to influence a whole range of choices that must be made during the course of any illness. In the case of motor neurone disease, decisions regarding if, when and how to break bad news, the place of care (home, hospital or hospice), the introduction of aids and devices, and, ultimately, choices regarding the place of death, will all be influenced by a range of taboos. If professional carers have major unresolved issues concerning their own mortality, it is unlikely that they will be able to truly stand alongside those who are facing their own imminent death. In discussing taboos, essentially what is of concern is attitudes. A basic change in attitudes is required if we are to stop viewing patients with incurable illness as some kind of medical failure.
Can there be a Progressive Victimology?
Authors: Walklate Sandra
Published: January 2017

This paper is concerned to examine some of the domain assumptions of victimology. In examining these assumptions close attention will be paid to the influence of positivistic thinking on the development of victimology; in particular the notion of objectivity. Some consideration will be given to the recent attempts which have been made to develop the theoretical and empirical work of the discipline and the argument will be developed that only through a re-examination of the domain assumptions of the discipline will such developments succeed. The notion of victimological progress, it will be contended will only be achievable by taking seriously the challenge posed by feminism on the questions of the nature of science and the construction of knowledge.
The Reactions of Prosecutors and Judges to Victim Impact Statements
Authors: Henley Madeline , Davis Robert C. , Smith Barbara E.
Published: January 2017

This paper details the results of two studies that document the reactions of prosecutors and judges to victim impact statements. Criminal justice officials were asked for their views on the principle of introducing victim impact statements into the criminal justice system and were questioned about their experiences with a program to prepare and distribute victim impact statements. Both studies found that most prosecutors and judges support victim impact statements in theory. Yet, when presented with victim impact statements and asked to integrate them into their established routines, a significant proportion of officials resisted in various ways. Explanations for the observed resistance are explored.
What if R2P Was—Truly—Everyone’s Business? Exploring the Individual Responsibility to Protect
Authors: Pison Hindawi Coralie
Published: January 2017

Echoing the call recently made by Ed and Dana Luck and building on a research project triggered several years ago by Siba Grovogui’s postcolonial critique of the concept of responsibility to protect (R2P), this article explores the significance of what may be labeled individual R2P. It argues that acknowledging individual R2P as part of the doctrine not only highlights the role that a heretofore underappreciated layer of actors can and does play to protect individuals from some of the worst crimes. At the theoretical level, it also has the potential to mitigate some of the R2P doctrine’s main ambiguities, while in real life, acknowledging individual R2P does, without exonerating institutional actors from their obvious responsibilities, recognize at the very least the right of people of conscience, worldwide, to take matters in their own hands even in the worst cases of international paralysis.
Housing the Intergenerational Families
Authors: Li William D. H. , Huang Jiou-Wun
Published: January 2017

This study uses recent survey data from the Panel Study of Family Dynamics to examine factors relating to married couples coresiding with parents in Taiwan. We investigate how both factors from parents and married couples influence the continuity of intergenerational coresidence by using longitudinal data. The familiar support to aged parents certainly is a key factor for coresidence. Also, the needs of the married couples are closely related to coresidence, especially the need on housing. The finding indicates that those coresiding young couples in the early family life stages are more likely to keep living in parents’ homes.
“A More Careful Tender Nurse Cannot Be than My Dear Husband”
Authors: Calvert Leanne
Published: January 2017

Childbirth is generally viewed as a female activity, which had little participation from men. Drawing largely on the papers of the Crawford family, this article offers an alternative to the traditional picture of childbirth. It argues that men (as husbands, brothers, and fathers) were not only interested in pregnancy and childbirth, but that they also played an active role in these events. It also explores the roles played by men in domestic medicine and argues that the gendered boundaries of the family were not as fixed as they appear.
A Study of HLA-Linked Genes in a Monosymptomatic Psychotic Disorder in an Indian Bengali Population
Authors: Debnath Monojit , Das Sujit K , Bera Nirmal K , Nayak Chitta R , Chaudhuri Tapas K
Published: January 2017

Objective:

The etiology of delusional disorder is imperfectly understood. Involvement of biological factors has long been suspected. We examined the incidence of class I human leukocyte antigens (HLAs) in patients with delusional disorder to understand the role of HLA genes and explore a possible immunogenetic etiology for delusional disorder.

Methods:

We used a nested case–control study design. Psychiatric reference data were available for 27 500 patients registered between 1998 and 2003. Initially, we enrolled 150 patients with delusional disorder from the India-born Bengali population, using DSM-IV diagnostic criteria. After longitudinal follow-up, 80 patients were found to have only delusional disorder, while the remaining 70 patients represented different illnesses with paranoid symptoms and were excluded. We performed serological typing on all 150 patients and applied the polymerase chain reaction–based high-resolution molecular typing method to the 80 patients with delusional disorder. Eighty healthy donors of the same ethnic background, matched for age, sex, and other socioeconomic variables, formed the control group.

Results:

Some of the HLA alleles were associated with delusional disorder, and the gene HLA-A*03 was found to be significantly more frequent. This gene may influence patients' susceptibility to delusional disorder.

Conclusion:

The study reveals important associations between HLA genes and delusional disorder. This preliminary observation may help our understanding of this disorder's genetic basis.
An Ecologic Study of Parasuicide in Edmonton and Calgary
Authors: Newman Stephen C , Stuart Heather
Published: January 2017

Objective:

From 1986 to 1999, the suicide rate in the Edmonton Regional Health Authority (RHA) was greater than that in the Calgary RHA (mean rate ratio 1.4). We conducted a study to determine whether a similar relation holds for parasuicide, and if so, whether the pattern can be explained at the ecologic level by sociodemographic factors.

Methods:

The Edmonton and Calgary RHAs provided data on emergency department visits for nonfatal intentional self-injury for 1997. We obtained sociodemographic data from the 1996 national census for the Edmonton and Calgary census metropolitan areas (CMAs) from Statistics Canada's public-use files. In each CMA, which is nearly coterminous with the corresponding RHA, we created 10 geographic areas based on average income. We analyzed the data at the ecologic level, using linear regression and multilevel Poisson regression.

Results:

The parasuicide rate in the Edmonton CMA was greater than that in the Calgary CMA (rate ratio 1.3). In both CMAs, the parasuicide rate decreased as average income increased. In the final regression models, the only independent variables were average income, CMA, and their interaction term (linear regression model R2 = 0.82).

Conclusions:

The parasuicide rate in the Edmonton CMA is elevated, compared with that in the Calgary CMA. At the ecologic level, much of the variation in rates can be explained by average income and CMA. The high degree of correlation among the sociodemographic variables suggests that it may not be low income per se that is affecting the parasuicide rate but, rather, the consequences of belonging to a socially disadvantaged stratum of society.
Is Cannabis Use a Contributory Cause of Psychosis?
Authors: Degenhardt Louisa , Hall Wayne
Published: January 2017

Objective:

To assess whether cannabis use in adolescence and young adulthood is a contributory cause of schizophreniform psychosis in that it may precipitate psychosis in vulnerable individuals.

Method:

We reviewed longitudinal studies of adolescents and young adults that examined the relations between self-reported cannabis use and the risk of diagnosis with a psychosis or of reporting psychotic symptoms. We also reviewed studies that controlled for potential confounders, such as other forms of drug use and personal characteristics that predict an increased risk of psychosis. We assessed evidence for the biological plausibility of a contributory causal relation.

Results:

Evidence from 6 longitudinal studies in 5 countries shows that regular cannabis use predicts an increased risk of a schizophrenia diagnosis or of reporting symptoms of psychosis. These relations persisted after controlling for confounding variables, such as personal characteristics and other drug use. The relation did not seem to be a result of cannabis use to self-medicate symptoms of psychosis. A contributory causal relation is biologically plausible because psychotic disorders involve disturbances in the dopamine neurotransmitter systems with which the cannabinoid system interacts, as demonstrated by animal studies and one human provocation study.

Conclusion:

It is most plausible that cannabis use precipitates schizophrenia in individuals who are vulnerable because of a personal or family history of schizophrenia.
What are the Policy Implications of the Evidence on Cannabis and Psychosis?
Authors: Hall Wayne , Degenhardt Louisa
Published: January 2017

Objective:

To explore the implications for mental health services, for health education about the risks of cannabis use, and for public policy toward cannabis use of observational evidence that cannabis use is a contributory cause of psychosis.

Method:

Using comparative analyses of similar evidence for the harmful effects of alcohol, tobacco, and amphetamine use, we considered the relation between observational evidence and action on cannabis. We examined arguments on the grounds of public health prudence for discouraging cannabis use by young individuals. With the assumption that the relation may be causal, we considered recommendations for policy in mental health services, health education, and public policy toward cannabis.

Results:

The observational evidence and biological plausibility of the hypothesis that cannabis is a contributory cause of psychosis is at least as strong as evidence for causal relations between heavy alcohol and amphetamine use and psychosis. On public health grounds, there is a good case for discouraging cannabis use among adolescents and young adults. It remains uncertain how best to discourage use and at whom campaigns to reduce cannabis use should be targeted.

Conclusions:

We should discourage young adults seeking treatment in mental health services from using cannabis and inform them of the probable mental health risks of cannabis use, especially of early and frequent use. We must exercise caution in liberalizing cannabis laws in ways that may increase young individuals' access to cannabis, decrease their age of first use, or increase their frequency of cannabis use. We should consider the feasibility of reducing the availability of high-potency cannabis products.
Going Beyond: An Adventure- and Recreation-Based Group Intervention Promotes Well-Being and Weight Loss in Schizophrenia
Authors: Voruganti Lakshmi NP , Whatham Jeff , Bard Eleanor , Parker Gayle , Babbey Candice , Ryan Janet , Lee Suganya , MacCrimmon Duncan J
Published: January 2017

Objective:

To undertake a preliminary study to assess the feasibility of clinical implementation and evaluate the effectiveness of a novel adventure- and recreation-based group intervention in the rehabilitation of individuals with schizophrenia.

Methods:

In a 2-year, prospective, case–control study, 23 consecutively referred, clinically stabilized schizophrenia patients received the new intervention over an 8-month period; 31 patients on the wait list, considered the control group, received standard clinical care that included some recreational activities. Symptom severity, self-esteem, self-appraised cognitive abilities, and functioning were documented for both groups with standardized rating scales administered at baseline, on completion of treatment, and at 12 months posttreatment.

Results:

Treatment adherence was 97%, and there were no dropouts. Patients in the study group showed marginal improvement in perceived cognitive abilities and on domain-specific functioning measures but experienced a significant improvement in their self-esteem and global functioning ( P < 0.05), as well as a weight loss of over 12 lb. Improvement was sustained over 1 year with further occupational and social gains.

Conclusion:

In the context of overcoming barriers to providing early intervention for youth and preventing metabolic problems among older adults with schizophrenia, adventure- and recreation-based interventions could play a useful complementary role.
Suicide Cases in New Brunswick from April 2002 to May 2003: The Importance of Better Recognizing Substance and Mood Disorder Comorbidity
Authors: Séguin Monique , Lesage Alain , Chawky Nadia , Guy Andrée , Daigle France , Girard Gina , Turecki Gustavo
Published: January 2017

Objective:

To investigate all suicide cases that occurred in New Brunswick in the 14 months spanning April 1, 2002, to May 31, 2003, to determine 6-month and lifetime prevalence rates of psychopathology in the deceased.

Method:

We used 2 psychological autopsy methods: direct proxy-based interviews and medical chart reviews, together with telephone contacts with informants. Consensus DSM-IV diagnoses were formulated by clinical panels on the basis of the Structured Clinical Interviews I and II for DSM-IV complemented by medical charts.

Results:

Of the 109 suicide deaths identified by the coroner at the time of the study, we were able to investigate 102. At time of death, 65% of the suicide victims had a mood disorder, 59% had a substance-related disorder, and 42% had concurrent mood and substance-related disorders. The lifetime prevalence of substance-related disorders among these suicide victims was 66%. Finally, 52% of the suicide victims presented with a personality disorder; one-half of these were of the cluster B type.

Conclusions:

Although treatment of depression has frequently been recognized as the focal point of clinically based suicide-prevention efforts, our results underscore substance-related disorders as a key dimension of completed suicide. Suicide-prevention programs should be designed to address this problem more directly.
Screening for Mental Health Problems among Patients with Substance Use Disorders: Preliminary Findings on the Validation of a Self-Assessment Instrument
Authors: Castel Saulo , Rush Brian , Kennedy Sidney , Fulton Kari , Toneatto Tony
Published: January 2017

Objectives:

We conducted a preliminary study on the validation of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) among patients seeking treatment for substance use disorders (SUDs).

Method:

We assessed 76 patients with SUDs, using the PDSQ, followed by the Structured Clinical Interview for DSM-IV. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves were calculated.

Results:

Overall, the psychometric properties identified with the PDSQ in patients with SUDs differed from those found in psychiatric outpatient populations. The ROC curves were calculated for major depressive disorder, posttraumatic stress disorder, and panic disorder. The areas under the curves were 0.86 (95%CI, 0.77 to 0.95; P < 0.001), 0.79 (95%CI, 0.68 to 0.90; P < 0.001), and 0.66 (95%CI, 0.51 to 0.82; P = 0.05), respectively.

Conclusion:

The use of the PDSQ to screen for other psychiatric disorders in populations with SUDs is promising but requires larger validation studies to provide data on its psychometric properties and inform the choice of cut-off scores for this population.
Functional Mechanisms of Episodic Memory Impairment in Schizophrenia
Authors: Danion Jean-Marie , Huron Caroline , Vidailhet Pierre , Berna Fabrice
Published: January 2017

Objective:

To achieve a better understanding of the functional mechanisms underlying episodic memory dysfunction in schizophrenia, which is a prerequisite for unravelling schizophrenia's neural correlates in neuroimaging studies and, more generally, for developing an integrated approach to the pathophysiology of schizophrenia. It is also crucial for developing cognitive remediation.

Method:

This paper reviews empirical evidence of episodic memory dysfunction in schizophrenia obtained with reference to various theoretical models of episodic memory.

Results:

All the studies converge to show a significant impairment of the critical feature of episodic memory: conscious recollection. Schizophrenia is also associated with a defect of autobiographical memory. The episodic memory dysfunction results from a predominant failure of strategic processing at encoding, although an impairment of strategic processing at retrieval cannot be ruled out. The possibility that it is not the execution of the encoding strategies that is defective but, rather, their self-initiation by the patients is plausible.

Conclusions:

These findings may explain some behavioural abnormalities associated with schizophrenia, notably, inadequate functional outcomes in everyday life. They may also have implications for cognitive remediation and better social and work functioning of patients with schizophrenia.
Acute Treatment of Bipolar Disorder with Adjunctive Risperidone in Outpatients
Authors: Ghaemi S Nassir , Sachs Gary S , Baldassano Claudia F , Truman Christine J
Published: January 2017

Objective:

To test the hypothesis that, although typical neuroleptics are commonly used in the treatment of bipolar disorder, newer atypical antipsychotic agents, like risperidone, may be more effective and better-tolerated.

Method:

The effectiveness of risperidone was evaluated in 14 outpatients with bipolar disorder, type I, who received risperidone for 6.4 ± 2.7 weeks at 2.75 ± 1.8 mg/day.

Results:

Nine (64%) patients were much improved based on Clinical Global Impression (CGI) scores, and mean Global Assessment of Functioning (GAF) scores improved from 48.2 ± 4.9 to 58.8 ± 7.3 (t = 4.49, P = 0.0006, paired t test). Treatment was well tolerated, and no patient experienced worsening of mood symptoms while receiving risperidone.

Conclusion:

This open series suggests risperidone is beneficial in the treatment of outpatients with bipolar disorder.
Potential for Community Relocation among Residents of Alberta's Psychiatric Facilities: A Needs Assessment
Authors: Holley Heather L , Jeffers Betty , Hodges Phyllis
Published: January 2017

Objective:

To identify the proportion of residents in Alberta's psychiatric hospitals who would be relocatable to community-based alternatives to care if appropriate programs were made available.

Methods:

A survey of a representative sample of residents in all psychiatric hospitals and care centres was undertaken, excluding patients in specialized programs for forensic psychiatry, brain injury, and substance abuse.

Results:

Findings indicate that 11% of institutionalized patients could be considered good candidates for relocation to community-based alternative care. A further 35% were considered to have potential for relocation provided an intensive and complex array of services was first made available.

Conclusion:

Results support a phased-in approach to hospital downsizing and the need for considerable transitional funding. Because hospital downsizing is unlikely to save dollars, at least in the short term, reforms must remain guided by humanitarian motivations to improve quality of life for persons with severe and persistent mental illnesses.
Efficacy and Tolerability of Moclobemide in Comparison with Placebo, Tricyclic Antidepressants, and Selective Serotonin Reuptake Inhibitors in Elderly Depressed Patients: A Clinical Overview
Authors: Amrein Roman , Stabl Max , Henauer Stephan , Affolter Eva , Jonkanski Iris
Published: January 2017

Objective:

To review the efficacy and safety of moclobemide in comparison with TCAs(for our purposes, “TCAs” will represent tricyclic and tetracyclic antidepressants, including maprotilin and mianserin) and selective serotonin reuptake inhibitors (SSRIs) in elderly depressed patients.

Methods:

The efficacy data reviewed were obtained from the following sources: 1) results of published studies in the elderly; 2) data on patients aged ≥ 60 years extracted from all available controlled trials in adults (≥ 18 years) in which moclobemide was compared with TCAs or SSRIs; and 3) the adverse events were extracted for patients aged ≥ 60 years from the safety data base of all available comparative short-term studies with moclobemide versus TCAs, SSRIs, or placebo and of long-term studies with moclobemide.

Results:

The data show that moclobemide is an effective antidepressant in depressed patients aged ≥ 60 years. The response rate to moclobemide was 50% to 55% in this population. Moclobemide was more effective than placebo and was of similar efficacy to the TCAs and the more recently introduced SSRIs. The tolerability of moclobemide was rated as “very good” or “good” in almost 90% of these patients, which was better than the tolerability of TCAs and similar to that of SSRIs. Patients without any adverse events were more frequently found in the moclobemide group than in those treated with TCAs (P < 0.01) or SSRIs (P < 0.01). Adverse events of the anticholinergic type were more frequent with TCAs than with moclobemide (P < 0.001), and nausea was found 3 times more frequently with SSRIs than with moclobemide (P < 0.01).

Conclusions:

Moclobemide is an effective and well-tolerated antidepressant for the treatment of elderly depressed patients.
What Are Dual Process Models? Implications for Cultural Analysis in Sociology
Authors: Lizardo Omar , Mowry Robert , Sepulvado Brandon , Stoltz Dustin S. , Taylor Marshall A. , Van Ness Justin , Wood Michael
Published: January 2017

In this paper we introduce the idea of the dual process framework (DPF), an interdisciplinary approach to the study of learning, memory, thinking, and action. Departing from the successful reception of Vaisey (2009), we suggest that intradisciplinary debates in sociology regarding the merits of “dual process” formulations can benefit from a better understanding of the theoretical foundations of these models in cognitive and social psychology. We argue that the key is to distinguish the general DPF from more specific applications to particular domains, which we refer to as dual process models (DPMs). We show how different DPMs can be applied to a variety of analytically distinct issues of interest to cultural sociologists beyond specific issues related to morality, such as culture in learning, culture in memory, culture in thinking, and culture in acting processes. We close by outlining the implications of our argument for relevant work in cultural sociology.
Management of Facial Asymmetry
Authors: Urban Scott D. , Waite Peter D.
Published: January 2017

Introduction:

When satisfactory correction of facial deformities and asymmetries are unobtainable by dental orthopedics alone, maxillomandibular surgery or double-jaw surgery is often indicated. As orthognathic surgery has been refined, it has become evident that some problems are beyond treatment in a single jaw. The purpose of this study was to present a review of the literature on the etiology, clinical assessment procedures, radiographic diagnostic techniques, and surgical treatments for mandibular and facial asymmetry. A photographic case report is also presented.

Materials and Methods:

Literature review and case report.

Results:

The indications for bimaxillary surgery are severe deformities untreatable in one jaw, deformities of both jaws, unfavorable movement prone to relapse, and complex 3D movements where single-jaw surgery would be a functional/cosmetic compromise.

Conclusions:

The most important aspects of maxillomandibular surgery are not the surgery itself but understanding the indications and the treatment plan, and maintaining stable reference during surgery. Combining osteotomies of the maxilla and mandible is complicated and perhaps associated with increased morbidity. However, when indicated, the combined osteotomy offers more surgical options and better results without functional or cosmetic compromises than single-jaw osteotomy.
Male Breast Liposuction Today: Hypertumescent Power Liposculpting—A 700-Case Retrospective Study
Authors: Schafer Jeffry B. , Shane Ron
Published: January 2017

Introduction:

Many men (∼36–40%) have some form of breast enlargement or swelling, called gynecomastia. The condition may make these men self-conscious about the feminine appearance of their chests in public. Classic removal, with direct excision of the glandular tissue and fat, has been the treatment for gynecomastia in the past. The purpose of this retrospective surgical review and discussion is to compare various treatment modalities for gynecomastia that have been used in our practice over time, and then to present a protocol for the procedure that is the most successful in terms of highest patient satisfaction and lowest revision rate.

Materials and Methods:

A retrospective surgical review of 700 gynecomastia liposuction treatment regimes, including open and closed techniques employing liposuction with manual, ultrasonic, power, and rotary cannulas is presented.

Results:

Comparisons of various treatment modalities used by the authors in over 700 cases demonstrate the advantage of hypertumescent infiltration of the dense tissue of the male breast before liposculpture. The aesthetic result is more satisfactory for several reasons: (1) scarring is minimal, (2) neurovascular damage to the delicate areola or surrounding tissue is avoided, (3) the surgeon is allowed to sculpt the tissue rather than just remove it, and (4) a more “normal” looking chest without the periareolar scar is created.

Discussion:

Many men with gynecomastia need diet, exercise, and counseling. We have found that many of these men have high levels of free estrogen accompanied by total testosterone under 300 ng/dL. This endocrine pathological scenario is exacerbated by obesity. If the patients continue to be overweight after treatment, their upper torsos will gradually become feminized again. Thus, our patients are encouraged to follow a high-protein and low-fat diet with caloric restriction and to vigorously exercise so that their results will last.

Conclusions:

Surgical treatment can successfully treat gynecomastia in male patients and leave very little scarring. Postoperative diet and exercise will also dramatically improve patients' appearance and self-esteem.
Comparison of Autologous Platelet-Rich Plasma with Bone Dust versus Platelet-Rich Plasma Alone and Bone Dust Alone in a Rabbit Model
Authors: Williams Troy C. , Kelly Christopher , Bello Gustavo , Silberberg Boris , Moreira Andrea , Bradford Melinda
Published: January 2017

Introduction:

When reconstructing bony defects created secondary to tumor excision or remodeling, there exists a need to increase the rate of bone graft acceptance and the degree of development. In our study we intend to show that platelet-rich plasma can be used in craniofacial defects to increase graft densities.

Methods and Materials:

Twenty-seven New Zealand white rabbits were used as specimens in which cranial osteotomies were performed to create a critical size defect that was then repaired with several combinations of substances. Either the bone dust from the defect, bone dust plus autologous platelet-rich plasma, or autologous plateletrich plasma alone was placed into the graft site. Each specimen was evaluated by DEXA Scan as well as histologic examination.

Results:

All 27 specimens survived and remained infection free. Thus, the results showed that the combination of platelet-rich plasma and bone dust allowed for superior bone mineral density and prevention of bone reabsorption.
Radiesse for Aesthetic Soft Tissue Augmentation
Authors: Cuevas Silvia , Rivas Maria Patricia , Amini Sadegh , Weiss Eduardo
Published: January 2017

Introduction:

Calcium hydroxyapatite (CaHa; also spelled “hydroxylapatite”) is the main mineral component of bone, calcified cartilage, and teeth. It has been used since the 1970s in many specialties, including orthopedics, urology, otolaryngology, maxillofacial surgery, and radiology, as a bioactive implant that promotes chemical attachment of the soft tissue to its surface. In 2001, Radiance FN (now Radiesse) was introduced as a CaHa-based product and approved by the US Food and Drug Administration (FDA) as a radiographic tissue marker, for soft tissue vocal fold augmentation, and for implants in maxillofacial defects. Currently, it is also used outside the United States and off-label in the United States for facial soft tissue augmentation. Microspheres of CaHa are suspended in a mixture of water, glycerin, and carboxymethylcellulose gel that provides a scaffold for tissue infiltration. Once injected, the gel is degraded and the CaHa infiltrates the surrounding cells. CaHa is nonirritating, and the carrier gel components are classified as safe by the FDA. Although a great variety of fillers are currently on the market, CaHa (Radiesse) has demonstrated the longest duration in tissue without any reports of antigenicity, migration, or granuloma formation. In this study, we report our experience with CaHa (Radiesse) for aesthetic soft tissue augmentation.

Materials and Methods:

A total of 139 patients were treated over an 18-month period at 2 private offices in Argentina and the United States. Exclusion criteria included previous use of permanent tissue fillers in the treatment area. Patients with previous use of hyaluronic acid fillers in the treatment area (up to 1 year prior to the study) were allowed to participate in the study. Radiesse was injected from 1-mL prefilled syringes with 27½-gauge needles in different areas such as nasolabial folds, lips, marionettes lines, cheeks, and cellulite dimples. Patient satisfaction and adverse effects were assessed by both physicians and patients during the procedure and during follow-up visits up to 1 year later.

Results:

Minimal pain, erythema, edema, and bruising were noted during and immediately after the procedure. All of the patients treated were satisfied with their results after one visit. There were no long-term adverse effects during the study period or on follow-up visits. Evaluation of 75% of the patients 1 year after treatment revealed persistence of filling effects.

Discussion:

CaHa used for aesthetic soft tissue augmentation yields immediate clinical results with high patient satisfaction.
Evaluation and Result of Reduction Labioplasty
Authors: Rezai Allen , Jansson Per-Erik
Published: January 2017

Introduction:

Hypertrophy and variation in the size of labia minora has long been recognized as a problem that can be bothersome for aesthetic, functional and psychosocial reasons. In the past labia minora reduction was usually performed by simple and straight resection of the protuberant segment and oversewing the edge. This paper presents a comparison of our results with each procedure.

Materials and Methods:

From March 1997 to February 2005, 100 women from 17 to 45 years old underwent reduction labioplasty. We performed w-shaped resections with interdigitated suturing in 50 cases and de-epithelialized reduction labioplasty in 50 cases.

Results:

Patients in both groups had minimal discomfort postoperatively and at 6 months reported improvement of their original problems with chronic irritation, inadequate hygiene, and sexual intercourse. Twenty-three patients underwent treatment of hypertrophic labia minora with excellent results and minimal postoperative discomfort. Three patients suffered from postoperative infection but were successfully treated with antibiotics. In group A, 5 patients were not satisfied with the appearance of the edge of the labia minora, and in 8 patients, it took up to 2 years for sensation to be restored to the labia minor.

Conclusion:

The deepithelialized reduction labioplasty gives the patient more satisfaction both in the appearance of the edge of the labia minora and the neurovascular preservations of the labia.
An Innovative Device for Fractional CO2 Laser Resurfacing: A Preliminary Clinical Study
Authors: Cassuto Daniel A. , Sadick Neil S. , Scrimali Luca , Siragò Paolo
Published: January 2017

Background and Objective:

Use of CO2 laser resurfacing is a powerful tool for the treatment of several skin conditions, such as fine and coarse wrinkles, scars of various origin, uneven pigmentation, and dilated pores. Some major drawbacks have progressively limited its use: the need for effective anesthesia, the downtime associated with treatment, the risk of hyperpigmentation and scarring, the need for intensive postoperative care, the long-lasting erythema, and the need to avoid sun exposure for extended periods. Fractional laser resurfacing with a 1540-nm laser can avoid some of these disadvantages, but pain and cost still serve as barriers. A new CO2 laser system with a fractional modality added to a traditional though potentially very rapid scanner was tested as a tool for skin rejuvenation. It can perform traditional and fractional resurfacing at depths ranging from 20 to 500 μm and treating 20%, 40%, or 100% of the scanned area.

Materials and Methods:

A series of 24 consecutive patients (Fitzpatrick skin types II–IV) were treated with one pass of the aforementioned fractional CO2 laser (18 faces, 2 necks, 8 hands). No anesthesia was used. The power used was between 8 and 15 W, with SX index values of 4 to 8, according to patient tolerance. SX index indicates pulse width: the shorter the pulse the higher the SX index value. Postoperative management included a thermal water-based cream and makeup provided free of charge. Digital clinical macrophotography was used to assess the results and a subjective pain and satisfaction evaluation was also done.

Results:

All patients showed improvement in skin texture and color after one treatment. Undesired postoperative effects were immediate erythema, and swelling that subsided within 24 hours. Fine pinpoint microcrusting occurred in all cases, but it resolved within 1 week on the face and 10 days on the other body areas. The treatment was well tolerated. With makeup it looked like a tan. No long-term side effects were observed after 6 months of follow-up.

Conclusions:

The evaluated system is an effective and safe tool for skin rejuvenation by fractional laser resurfacing.
Novel Management of Wound Dehiscence: Case Study
Authors: Michelson David N.
Published: January 2017

Introduction:

Wound healing is a long and complex process, and can be affected by many different preexisting health conditions and complications. Postoperative surgical wound dehiscence is a serious complication wherein a surgical wound does not close or heal properly. The decision was made to take a novel approach to treating a patient who presented with this complication by pursuing a course of PRO QR Powder, a topical powder wound dressing (Biolife, LLC, Sarasota, Fla) and 10% acetic acid solution.

Materials and Methods:

A 28-year-old woman suffering from postsurgical wound dehiscence in her axilla was treated with PRO QR Powder, an alternative treatment method. The treatment duration was 10 weeks, with the patient returning at 2-week intervals for assessment.

Results:

Over a 10-week period, the wound showed progress and was completely healed at the end of treatment with no further complications.

Conclusions:

This case showed that a treatment approach using PRO QR Powder was safe and effective when treating this type of wound.
The Umbilical Locator: Bringing Simplicity to Surgery
Authors: Forouzanpour Fardad , Karmali Hasni
Published: January 2017

Introduction:

The purpose of this article is to introduce the Umbilical Locator and demonstrate how it simplifies umbilical transposition in abdominal surgeries in both the cosmetic and reconstructive fields.

Materials and Methods:

The Umbilical Locator is a new device that was designed and patented by one of the authors (F.F.) to help surgeons who are performing umbilical translocation during abdominal surgeries. The Umbilical Locator is safe, disposable, sterilizable, made of a nonlatex plastic, and can be used with any surgical method preferred by the surgeon. It was designed specifically for use in abdominoplasties. It was developed, manufactured, and marketed for sale by Innovative Med Inc, Irvine, California.

Results:

To date, the Umbilical Locator has been used exclusively by one of the authors (F.F.), with excellent results. He has used this innovative device in 20 recent abdominoplasties, with no resultant umbilical slough or ischemia. Furthermore, there have been no complications noted with positioning, anchoring, or removal of the device.

Discussion:

In abdominoplasty, an aesthetic and natural appearance of the umbilicus is a key factor to the end result. The Umbilical Locator can be used with any surgical method to create the umbilicus. The purpose of the product is only to help locate the position of the umbilicus on the skin. The surgeon is allowed to use the incision or surgical method of his or her choice on top of the umbilicus after the skin has been redraped prior to excision to precisely locate the umbilicus.

Conclusions:

These preliminary data provide promising evidence for the continued and future use of the Umbilical Locator as a more reliable and accurate method of umbilical localization in abdominoplasty than prior techniques, such as the use of a spinal needle to pinpoint the location of the umbilicus. The Umbilical Locator has the potential to decrease the incidence of deformities, wound tension, and resulting ischemia, and to reduce umbilical hypertrophic scarring. What has been to date a technically imprecise, unsophisticated phase of an abdominoplasty has now been simplified and refined using the Umbilical Locator.
The Use of Integra Artificial Dermis for Keloid Scars
Authors: Leventhal Douglas D. , Pribitkin Edmund A.
Published: January 2017

Introduction:

Keloid scars are notoriously difficult lesions to treat, and at the present time, there is no universally effective therapy. Numerous theories have been put forth regarding keloid formation, but the pathophysiologic mechanism remains a mystery. One hypothesis is that keloids are formed as a result of underlying skin tension. Numerous grafts have been used to decrease skin tension after keloid excision, but recurrence rates typically remain high.

Materials and Methods:

This prospective, nonrandomized clinical intervention study examined the results of Integra artificial dermis grafting in preventing keloid recurrence in patients who presented to an academic otolaryngology/facial plastic surgery office.

Results:

Two patients underwent the procedure, but because of the high recurrence rate and the poor cosmetic outcome, the study was terminated early. All patients had signs of recurrence by the 3-month follow-up visit. One patient served as her own control and had earlier and more severe recurrence at the site where the Integra was used.

Discussion:

Integra artificial dermis grafting fails to prevent keloid recurrence following excision. This study suggests that increased skin tension may not play an integral role in keloid formation.
Surgical Removal of Lipoma by Lipo-Suction Surgery
Authors: Dolsky Richard L. , Asken Saul , Nguyen Abram
Published: January 2017

This report describes a new method of removing medium-to large-sized lipomas through a 0.5-cm incision using the techniques of lipo-suction surgery which was introduced in the United States in 1982 by French surgeons. Our series of six cases in which large-sized lipomas had been extracted showed satisfactory results with minimal incisional scars or evidence of recurrence during the follow-up period ranging from 6 to 14 months.
Autologous Fat Transplantation: Micro and Macro Techniques
Authors: Asken Saul
Published: January 2017

Autologous fat transplantation has been performed for almost a century. Only recently, however, has the fat removed by suction been used for correcting certain skin defects as well as for cosmetic enhancement. This paper presents the clinical indications for such a procedure as well as different methods of harvesting the fat intended for transplantation. New techniques and instrumentation intended to facilitate the extraction and injection of fat and make it as atraumatic as possible are described and illustrated. Although survival of the transplanted fat varies, depending on many factors, and has not been fully documented, this procedure is a new and exciting addition to the cosmetic surgeon's armamentarium.
Pitfalls and Pearls of Extensive Scalp-Lifting
Authors: Brandy Dominic A.
Published: January 2017

Extensive scalp-lifting is a new, revolutionary method to treat male pattern baldness. As discussed in previous articles by the author, there are many great benefits of this technique; however, there are also certain pitfalls that must be clearly avoided. This article discusses these pitfalls and describes helpful pearls to eliminate these problems.
The Tumescent Technique for Lipo-Suction Surgery
Authors: Klein Jeffrey A.
Published: January 2017

The tumescent technique of lipo-suction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to lipo-suction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in lipo-suction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine-induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness.

Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the lipo-suction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia.

Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits lipo-suction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 μg/ml 1 hour after completion of the infiltration.