bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound in Diagnosis of Magnet Dislocation of Cochlear Implants: A Retrospective Study in Patients With Surgical Magnet Repositioning and Preinterventional Ultrasound Examination
Authors: Rupp Robin , Hornung Joachim , Balk Matthias , Hoppe Ulrich , Iro Heinrich , Gostian Antoniu-Oreste 
Published: June 2020

Objective:
To investigate whether ultrasound is a reliable diagnostic tool to identify magnet dislocation in patients with cochlear implant.

Design:
Retrospective analysis.

Setting:
A tertiary referral medical center.

Patients:
Patients with cochlear implant who presented with the suspicion of magnet dislocation between January 1, 2009 and July 31, 2019.

Interventions:
Preinterventional ultrasound with subsequent surgical magnet repositioning.

Main Outcome Measures:
Accuracy of ultrasound in detecting magnet dislocation; intraoperative extent of magnet dislocation.

Results:
Out of the 28 included patients (n = 28 magnets, 36% ♀; 51.6 years [±19.0 yr]) the diagnosis by the preoperative ultrasound was confirmed intraoperatively in 25 patients (89%). In two cases (7%), tissue swelling impeded the determination of the magnet by the preoperative ultrasound. In one case, ultrasound misdiagnosed the magnet as not dislocated. During revision surgery, all 28 magnets were repositioned successfully revealing a predominant partial dislocation (86%) compared with complete magnet dislocation (14%).

Conclusion:
In CI-patients undergoing 1.5 Tesla MRI, partial magnet dislocation occurs much more frequently than complete magnet dislocation. The clinical suspicion of a dislocated cochlear implant magnet can be accurately confirmed by preoperative ultrasound. Thus, preoperative diagnostic ultrasound can be advocated as the diagnostic tool of first choice.
Stories of Lymphoma Survivors in Early Aftercare
Authors: Friesen-Storms Jolanda H. H. M. , Bours Gerrie J. J. W. , Quadvlieg-Delnoy Danny J. L. , Moser Albine , Heijmans José M. J. , van der Weijden Trudy , Beurskens Anna J. H. M. , Jie Kon-Siong G. 
Published: June 2020

Background
Survivors of lymphoma experience multiple challenges after treatment. However, a lack of knowledge of in-depth experiences of lymphoma survivors in early aftercare persists.

Objective
To gain an in-depth understanding of the experiences of lymphoma survivors in early aftercare who have received an aftercare consultation based on evidence-based guideline recommendations, with an advanced practice nurse.

Methods
This study used a narrative design. We recruited lymphoma survivors after a best-practice aftercare consultation with an advanced practice nurse. A total of 22 lymphoma survivors and 9 partners participated. Data were collected through narrative interviews and analyzed according to thematic narrative analysis.

Results
Six themes emerged: living and dealing with health consequences, coping with work and financial challenges, having a positive outlook and dealing with uncertainty, deriving strength from and experiencing tensions in relationships, getting through tough times in life, and receiving support from healthcare professionals.

Conclusions
The stories of lymphoma survivors in early aftercare revealed their experiences of how they coped with a range of challenges in their personal lives. Choosing an aftercare trajectory based on an aftercare consultation that encourages patients to think about their issues, goals, and possible aftercare options may be useful for their transition from treatment to survivorship.

Implications for practice
Survivors’ social support and self-management capabilities are important aspects to be addressed in cancer care. An aftercare consultation involving shared goal setting and care planning may help nurses provide personalized aftercare.
Ki67 Immunohistochemistry Quantification in Breast Carcinoma: A Comparison of Visual Estimation, Counting, and ImmunoRatio
Authors: van den Berg Eunice J. , Duarte Raquel , Dickens Caroline , Joffe Maureen , Mohanlal Reena 
Published: June 2020

Background:
Molecular analysis has shown that breast carcinomas can be classified into several intrinsic subtypes, with implications for management and prognosis. In the majority of pathology laboratories molecular analysis of each case is not possible and immunohistochemistry is used for subtyping. This includes analysis of hormone receptors as well as HER2-neu and Ki67. The methodology for the interpretation of the proliferation index using Ki67 remains an area of uncertainty. We investigated the degree of agreement between different methods of Ki67 interpretation.

Materials and Methods:
We analyzed 204 breast core biopsies diagnostic of breast carcinoma using visual estimation/eyeballing (EB), ImmunoRatio, and counting by 2 pathologists (CP1 and CP2). The correlation between the different methods and the interobserver agreement between the 2 pathologists was assessed. Specific analysis was also done with respect to classification of cases into low Ki67 groups (using Ki67 values<14% and <20%) since this is critical in classifying tumors into luminal A and luminal B subtypes.

Results:
Correlation between the different methods was best achieved comparing ImmunoRatio and CP1, and worst comparing CP1 and EB. Correlation was better when considering interobserver variability (CP1 vs. CP2). Comparing the number of cases classified as low Ki67 (<14% and <20%) the Cohen κ statistic varied from κ=0.267 to 0.814 with different methods. When limiting the analysis to cases with a Ki67 of 10% to 25% according to any method, there was greater disagreement.

Conclusions:
At the higher and lower Ki67 levels, the correlation between the methods of assessment was acceptable, however, at levels close to the cut-off values for lumial A versus luminal B, several patients would be differently classified by the different methods and therefore potentially receive suboptimal management.
Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging
Authors: Haddock Nicholas T. , Dumestre Danielle O. , Teotia Sumeet S. 
Published: June 2020

Background:
In deep inferior epigastric perforator (DIEP) flap breast reconstruction, many surgeons use preoperative imaging for perforator mapping as a method to plan the operation, reduce operative times, and potentially limit morbidity. This study compared operative times for specific portions of DIEP flap harvest with and without preoperative computed tomographic angiography imaging.

Methods:
Two patient groups undergoing DIEP flap breast reconstruction were studied prospectively. In the experimental group, the harvesting surgeon was blinded to the preoperative computed tomographic angiography scan; in the control group, the harvesting surgeon assessed the scan preoperatively. Times for initial perforator identification, perforator selection, flap harvest time, and total procedure times were compared. Perforator choice was evaluated. Correlation of perforator choice preoperatively and intraoperatively was also performed.

Results:
Times were recorded in 60 DIEP flaps (27 blinded and 33 unblinded). The nonblinded group was more efficient in all categories: time to first perforator identification (28.6 minutes versus 17.8 minutes; p < 0.0001), time to perforator decision-making (23.1 minutes versus 5.6 minutes; p < 0.0001), time to flap harvest (128 minutes versus 80 minutes; p < 0.0001), and total operative time (417 minutes versus 353 minutes; p < 0.001). Perforator location was not different between groups. Blinded intraoperative decisions correlated with preoperative imaging in 74 percent of flaps. More perforators were included in the blinded flaps compared to the nonblinded flaps (2.3 versus 1.4; p < 0.001).

Conclusions:
Use of preoperative computed tomographic angiography leads to decreased operative times, specifically with regard to perforator identification and perforator selection. Without preoperative computed tomographic angiography, surgeons included more perforators in the flaps.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Radiographic Comparison of Superior and Inferior Gluteal Vessels in Jackknife versus Prone Position: A Prospective, Self-Controlled Trial
Authors: Barnes Connor W. , Ford Jonathan M. , Harrington Michael A. , Kedar Rajendra P. , Tran Thanh Q. , Karlnoski Rachel A. , Decker Summer J. , Smith David J. 
Published: June 2020

Summary:
Mortality after gluteal augmentation with fat transfer techniques is extremely high. Placement of fat subcutaneously versus in the gluteal musculature, or both, is considerably debated. The purpose of this study was to radiographically show the anatomical difference in live subjects in different procedural positions: the flexed or “jackknife” versus prone position. A total of 10 women underwent computed tomographic scanning of the pelvis with venous phase run-off in both the jackknife and prone positions. A computed tomography–specialized radiologist then reviewed images and measured distances from the inferior and superior gluteal veins to the skin and muscle. Three-dimensional imaging and analysis were also performed. Measurements were significantly shorter with respect to distance from skin to muscle, skin to vessel, and vessel to muscle observed from inferior and superior gluteal veins in the jackknife versus the prone position. Three-dimensional modeling showed a significant reduction in the volume and inferior and superior gluteal vein diameters when in the jackknife position. When placed in the jackknife position for gluteal augmentation with fat transfer, extreme caution should be taken with the injecting cannula, as the underlying muscle is only 2 to 3 cm deep. Three-dimensional analysis showed narrowed and reduced volume of gluteal vasculature when in the jackknife position; this is a possible indication of torsion or stretch on the vessel around the pelvic rim that could cause vein avulsion injury from the pressurized fat within the piriform space.
Facial Asymmetry in Unilateral Condylar Hyperplasia: Comparing Treatment for Active versus Burnt-Out Disease
Authors: Maniskas Seija , Ly Catherine L. , Parsaei Yassmin , Bruckman Karl C. , Steinbacher Derek M. 
Published: June 2020

Background:Facial asymmetry caused by unilateral condylar hyperplasia requires treatment to address facial and occlusal imbalances. There is no definitive evidence to suggest that a single intervention strategy (during either active condylar overgrowth or the burnt-out phase) results in better/more symmetric correction. This study sought to quantify preoperative and postoperative facial asymmetry in unilateral condylar hyperplasia patients comparing treatment for active versus burnt-out disease.Methods:Preoperative and postoperative three-dimensional photographs were obtained. Images were compared to those of unaffected controls as a standard for normal facial symmetry. Facial asymmetry was assessed using root-mean-square deviation. Pairedttests were performed to compare the root-mean-square deviations of preoperative and postoperative images between the unilateral condylar hyperplasia groups and against controls.Results:Forty patients were included (11 active, nine burnt-out, and 20 controls) and 60 three-dimensional images were evaluated. Preoperatively, patients in the burnt-out group had worse asymmetry than those with active unilateral condylar hyperplasia (p= 0.011). Both groups demonstrated significantly improved symmetry postoperatively (active,p= 0.0069; burnt-out,p= 1.74E-4). However, burnt-out patients remained with some residual asymmetry (p= 4.75E-4), whereas their active counterparts showed no significant difference compared to unaffected controls (p= 0.089).Conclusions:Patients with end-stage unilateral condylar hyperplasia have more severe facial asymmetry that is more difficult to normalize compared to earlier intervention during active unilateral condylar hyperplasia. These findings suggest that, if possible, corrective intervention is preferable during active unilateral condylar hyperplasia.CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.
Litigation in Hand Surgery: A 30-Year Review
Authors: Sasor Sarah E. , Chung Kevin C. 
Published: June 2020

Background:
Although hand surgery is generally safe and effective, some patients experience complications or poor outcomes prompting them to seek compensation. This study reviews malpractice claims in hand surgery using a national data set to assess reasons for litigation and identify predictors of outcome.

Methods:
The Westlaw database was queried for cases related to hand surgery and medical malpractice between 1989 and 2018. Jury verdicts and settlements were reviewed for relevance, and variables including plaintiff and defendant demographics, diagnosis, alleged reason for malpractice, verdicts, and payouts were recorded.

Results:
Four hundred thirty relevant claims were identified. Distal radius fractures (21 percent), carpal tunnel syndrome (14 percent), and tendon lacerations (6 percent) were the most common diagnoses. Alleged reasons for malpractice included failure to diagnose/treat (34 percent), surgical negligence (29 percent), and improper procedure/treatment (19 percent). Thirty-six cases (8 percent) resolved in settlement for a mean payout of $551,957. A plaintiff verdict was reached in 98 cases (25 percent of trials), with a mean payout of $832,258. The remaining 296 cases (75 percent of trials) resulted in defendant verdicts (no payout). Plaintiff age, plaintiff sex, defendant sex, and defendant degree had no impact on trial outcome. Cases involving surgeons without subspecialty certification in hand surgery were significantly more likely to result in plaintiff verdicts (27 percent versus 7 percent with hand subspecialization; p = 0.003).

Conclusions:
This study reviews malpractice claims in hand surgery over the past 30 years. Providing timely diagnoses, managing expectations, and reducing procedural error may decrease the risk of litigation.
Free Lateral Forearm Flap in Head and Neck Reconstruction: An Attractive Alternative to the Radial Forearm Flap
Authors: Shuck John , Chang Edward I. , Mericli Alexander F. , Gross Neil D. , Hanasono Matthew M. , Garvey Patrick B. , Yu Peirong , Largo Rene D. 
Published: June 2020

Summary:
The lateral forearm flap—a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery—is an attractive alternative to the radial forearm flap. The authors hypothesized that it is safe and effective for head and neck reconstruction. They conducted a retrospective review of all lateral forearm flap reconstructions performed between 2016 and 2018. Patient demographics, defect characteristics, adjuvant therapies, and postoperative complications were recorded. Swallowing and diet were assessed in patients undergoing intraoral reconstruction. The Disabilities of the Arm, Shoulder and Hand questionnaire was completed prospectively preoperatively and postoperatively. Flap and pedicle dimensions were recorded. Twenty-five lateral forearm flap reconstructions were performed; 23 were for intraoral defects. There were no partial or complete flap losses, one venous thrombosis, and one hematoma requiring reoperation. Preoperative and postoperative Disabilities of the Arm, Shoulder and Hand questionnaire scores were equivalent (p = 0.78). In the intraoral cohort, 22 patients (96 percent) resumed an oral diet following reconstruction. The average pedicle length was 11.8 cm (range, 9 to 16 cm); skin paddle length and width were 6.6 cm (range, 4 to 12 cm) and 4.7 cm (range, 4 to 12 cm), respectively; arterial diameter was 1.5 mm (range, 1.4 to 2.5 mm); and venous diameter was 2.8 mm (range, 2.4 to 3.6 mm). All donor sites were closed primarily; one superficial dehiscence was reported. In summary, the authors found that the free lateral forearm flap provided an excellent alternative to the radial forearm flap in head and neck reconstruction. It is a thin, pliable fasciocutaneous flap with excellent pedicle length, and the donor site can be closed primarily with minimal morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome
Authors: Dengler Jana , Dolen Utku , Patterson Jennifer M. M. , Davidge Kristen M. , Kahn Lorna C. , Yee Andrew , Mackinnon Susan E. 
Published: June 2020

Background:
The supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer offers a viable option to enhance recovery of intrinsic function following ulnar nerve injury. However, in the setting of chronic ulnar nerve compression where the timing of onset of axonal loss is unclear, there is a deficit in the literature on outcomes after supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer.

Methods:
A retrospective study of patients who underwent supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer for severe cubital tunnel syndrome over a 5-year period was performed. The primary outcomes were improvement in first dorsal interosseous Medical Research Council grade at final follow-up and time to reinnervation. Change in key pinch strength; grip strength; and Disabilities of the Arm, Shoulder and Hand questionnaire scores were also evaluated using paired t tests and Wilcoxon signed rank tests.

Results:
Forty-two patients with severe cubital tunnel syndrome were included in this study. Other than age, there were no significant clinical or diagnostic variables that were predictive of failure. There was no threshold of compound muscle action potential amplitude below which supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer was unsuccessful.

Conclusions:
This study provides the first cohort of outcomes following supercharge end-to-side anterior interosseous nerve–to–ulnar motor nerve transfer in chronic ulnar compression neuropathy alone and underscores the importance of appropriate patient selection. Prospective cohort studies and randomized controlled trials with standardized outcome measures are required.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Central Mound Pedicle: A Safe and Effective Technique for Reduction Mammaplasty
Authors: DeLong Michael R. , Chang Irene , Farajzadeh Matt , Nahabet Edward H. , Roostaeian Jason , Festekjian Jaco , Rough James , Da Lio Andrew L. 
Published: June 2020

Background:
The central mound technique offers a relatively less common approach for breast reduction. This study evaluated the expected safety and efficacy outcomes using this technique in a large patient series.

Methods:
A retrospective review of all patients undergoing central mound breast reduction at the authors’ institution between June of 1999 and November of 2018 was performed. Both bilateral macromastia and unilateral symmetrizing reduction patients were included but evaluated separately for some outcomes. Patient demographics and comorbidities, operative details, postoperative adverse events, and BREAST-Q scores were recorded. Associations between preoperative variables and outcomes were assessed with chi-square tests, Wilcoxon tests, and Kendall tau-b correlations.

Results:
A total of 325 patients were identified for inclusion (227 bilateral and 98 unilateral; 552 breasts). The average patient age was 46 years, and the average body mass index was 27.4 kg/m2. Among the bilateral macromastia patients, the average operative time was 3 hours 34 minutes, and average breast tissue removed was 533 g (right breast) and 560 g (left breast). Among all patients, average follow-up was 169 days. On a per-breast basis for all patients, the following complication rates were observed: seroma, 0.2 percent; hematoma, 1.1 percent; dehiscence, 2.9 percent; infection, 1.5 percent; hypertrophic scar, 4.6 percent; nipple necrosis, 0.4 percent; fat necrosis, 0.9 percent; and skin flap necrosis, 1.7 percent. Using the BREAST-Q Reduction/Mastopexy questions on a Likert scale ranging from 1 to 5, restricted to the bilateral macromastia patient population, all scores improved with statistical significance.

Conclusion:
The central mound pedicle is a safe and effective approach for reduction mammaplasty for both bilateral macromastia patients and unilateral symmetrizing operations.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Lipoabdominoplasty with Anatomical Definition
Authors: Saldanha Osvaldo , Ordenes Andrés I. , Goyeneche Carlos , Cánchica Andrés F. , Saldanha Filho Osvaldo , Bonetto Saldanha Cristianna , Menegazzo Marcos Ricardo , Gonzalez Cação Eugênio 
Published: June 2020

Background:
In the past two decades, lipoabdominoplasty has increased in popularity worldwide, presenting low rates of complications and morbidity when the proper surgical steps are followed. The authors present an update of the lipoabdominoplasty technique with the addition of an abdominal definition and standardized steps for its safe execution, an initial personal experience with the procedure that improves the aesthetic results.

Methods:
Anatomical limits are described for preoperative markings for selective liposuction with abdominal definition. Specific areas of the abdomen are presented to differentiate the areas for an intense or moderate liposuction and the areas for superficial and deep liposuction for anatomical definition. The principles of traditional lipoabdominoplasty are also described and maintained. The initial experiences with 128 patients undergoing the technique are included.

Results:
One hundred twenty-eight patients were operated on by the senior author (O.S.) from 2016 to 2019 using the described technique. One patient presented with a seroma (0.8 percent), and two had a small skin epitheliolysis (1.5 percent). No other major complications were observed. It is the senior author’s opinion that the obtained aesthetic results from the lipoabdominoplasty with definition are superior to those of the traditional technique, as it enhances the natural contour of the abdomen.

Conclusions:
Lipoabdominoplasty with anatomical definition has improved the aesthetic results of traditional lipoabdominoplasty without compromising the safety of that technique. More natural results along the abdominal contour that avoid a completely flat abdomen have been observed by most patients. This approach is safe and reproducible, with low complication rates, and it effectively enhances body contour.