bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketamine-Diazepam Protocol for Intravenous Sedation: The Cosmetic Surgery Hospital Experience
Authors: Quttainah Adel , Carlsen Lloyd , Voice Sandra , Taylor John 
Published: February 2017

Rising hospital costs and operating room scheduling difficulties have influenced plastic surgeons to rely more often on intravenous sedation in office surgical settings. The use of ketamine as an intravenous sedation agent has enjoyed some popularity, but this has been far from universal. Its reputation for producing psychological sequelae such as nightmares, flashbacks and schizophrenic-like reactions have made many anesthesiologists and plastic surgeons reluctant to use this drug. The authors’ experience using a ketamine/diazepam protocol with approximately 11,400 patients since 1971 at the Cosmetic Surgery Hospital in Woodbridge, Ontario is presented. The methodology consists of intravenous diazepam followed with low-dose ketamine (0.5 mg/kg to a maximum of 40 mg) 2 min later. This provides the surgeon with a period of profound amnesia to allow for infiltration of the local anesthetic. It is this local anesthetic delivered during the dissociative state that provides prolonged analgesia throughout the surgery. The patient is maintained throughout the procedure with increments of diazepam and midazolam. This protocol is found to be effective, reliable and reproducible, and the experience of the patient and plastic surgeon has been overwhelmingly favourable.
A Case of Epiphora and Recurrent Basal Cell Carcinoma of the Nasal Tip and Review of Acquired Nasolacrimal System Obstruction
Authors: Parker Wendy Lynne , Lessard Marie-Lucie 
Published: February 2017

A case of a 67-year-old man with recurrent basal cell carcinoma of the nasal tip and an incidental symptom of epiphora (volunteered by the patient) is presented. Epiphora is an abnormal overflow of tears that fail to drain into the inferior nasal meatus via the nasolacrimal system. Within the differential diagnosis of epiphora and nasolacrimal obstruction is neoplasm – primary, secondary or metastatic. On further investigation, including computed tomography imaging, he was subsequently found to have invasive disease extending along the left embryological cleavage plane superiorly to the medial canthal tendon. An excision attempt using Mohs technique by the dermatological surgeon was unsuccessful in adequately clearing the margins, and revealed a diagnosis of morphea-like basal cell cancer. This failure, taken together with the extent of disease identified by computed tomography scan, resulted in significant alteration of the operative approach. The patient underwent extensive tumour extirpation and nasal reconstruction using a forehead flap. The present case alerts surgeons involved in the management of skin cancers to the importance of the anatomical relationship of the nasolacrimal apparatus to embryological soft tissue cleavage planes when dealing with recurrent and aggressive lesions. In addition, it serves as a reminder to inquire about the signs and symptoms associated with nasolacrimal obstruction. Moreover, when preparing for surgical excision of recurrent aggressive basal cell carcinoma, high-quality imaging is essential to tailor the operative plan.
A Methodological Guide to Performing a Cost-Utility Study Comparing Surgical Techniques
Authors: Thoma Achilleas , Haines Ted , Veltri Karen , Goldsmith Charlie H , O'brien Bernie J , Quartly Caroline 
Published: February 2017

Background: When recommending the adoption of a new surgical intervention as opposed to maintaining an old one, surgeons need to consider the opportunity cost, which is the value of the forgone benefits. To inform these decisions, surgeons can use economic analyses of surgical practices. Unfortunately, economic analyses conducted alongside randomized controlled trials in surgery are rare. Objectives: The objective of the present study was to use data from a small randomized controlled trial to illustrate the methodology for a cost-utility analysis comparing two techniques of carpal tunnel release: open release without (‘usual’ technique) and with (‘novel’ technique) ligament reconstruction. Methods: Eighteen eligible patients were entered into this prospective study. Fifteen were followed to six weeks postoperatively. One day preoperatively, and five days, three weeks and six weeks postoperatively, patients completed a self-administered Health Utilities Index Mark 2-3 questionnaire (utilities) and a case report form from which resource utilization (cost) was collected. Utilities were expressed as quality-adjusted life weeks, a fraction of quality-adjusted life years. Results: The mean total cost of the usual technique was lower than the novel technique, and the mean quality-adjusted life week was higher, favouring the usual technique. Indirect costs were four to nine times higher than direct costs in both techniques. Conclusion: The novel technique was more costly and less effective, and fell in the ‘lose-lose’ quadrant of the cost-effectiveness plane; it was rejected in favour of the usual technique. This methodology should be applied when deciding whether to adopt novel surgical techniques in plastic surgery to optimize scarce health care resources.
A Survey of Volunteer Reconstructive Surgery Performed Outside of Canada By Canadian Plastic Surgeons
Authors: Fitzcharles-Bowe Colleen M , Lalonde Donald H 
Published: February 2017

Background: Members of the Canadian Society of Plastic Surgeons have been offering humanitarian services to countries outside of Canada since the 1960s. Objective: To document the extent of voluntary reconstructive services performed by members of the Canadian Society of Plastic Surgeons. Method: A survey was sent to all members of the Canadian Society of Plastic Surgeons asking them to list the extent of their voluntary services. Results: Over 80 Canadian Society of Plastic Surgeons members have performed voluntary reconstructive services with more than 40 organizations in over 60 countries. Conclusion: These voluntary services provide a significant benefit to patients around the world and are rewarding for the surgeons who perform them.
Patterns of Reinnervation and Blood Flow in Split-Skin Grafts
Authors: Juma A , Oudit D , Ellabban M 
Published: February 2017

One of the most important functions of skin is thermoregulation. The alterations in the patterns of blood flow in skin is one of the main physiological processes responsible for thermoregulatory control. The mechanisms governing the thermoregulatory control of cutaneous blood flow are mainly neural and chemical in nature. At present, there is a lack of studies in the literature looking at the relationship between reinnervation and the blood flow pattern of skin grafts. The present study uses Laser Doppler flowmetry and the immunohistochemical stains protein gene product 9.5, calcitonin gene-related peptide and substance P to identify nerve fibres, and antibodies to CD31 and von Willebrand factor to identify endothelial tissues. The aim of the present study was to investigate the patterns of blood flow and nerve tissue regeneration in split-skin grafts up to 15 years following the original procedure. Thirty-two split-skin grafts were studied and these were placed into two groups based on the nature of the bed of excision: group I consisted of patients who underwent tangential excision and split-skin grafting (n=17), and group II consisted of patients with split-skin grafts placed onto fascial beds (n=15). Each subpopulation of patients was further divided into three groups based on the length of time following grafting: one to three years, four to six years and seven to 15 years. These divisions were arbitrarily chosen and called A1, A2 and A3, respectively. In the Laser Doppler flowmetry arm of the study, the grafts were assessed at various stages after heating, cooling and further reheating. The Laser Doppler flowmetry studies showed that, on subjecting the skin grafts in both groups I and II to heating and cooling followed by reheating, the overall response of the blood flow to changes in the temperature was slower. The immunohistochemical analysis showed that in all graft types and graft ages, protein gene product 9.5, calcitonin gene-related peptide and substance P stains demonstrated a relative lack of the presence of nerve fibres in the split-skin grafts compared with the control (‘normal’ skin). However, von Willebrand factor and CD31 immunological staining demonstrated that vessels were present in the split-skin grafts, with no significant difference in size or quantity from the control samples. It was found that the blood flow in the split-skin graft in response to thermal challenge, although present, was slower than that of normal skin, a finding which was independent of the age of the skin graft. It is thought that this was related to a lack of regeneration of nerve fibres and, hence, a deficiency in the neurally mediated reflexes of the blood vessels within the split-skin grafts.
A Double-Blind Randomized Controlled Trial Showing the Analgesic and Anesthetic Properties of Lidocaine E to Be Equivalent to Those of Ropivicaine and Bupivacaine in Carpal Tunnel Release Surgery
Authors: Pressman A , Doumit G , Rosaeg O , Bell M 
Published: February 2017

In a three-phase trial, the anesthetic properties of lidocaine, bupivacaine and ropivicaine were compared in carpal tunnel release surgery. In phase I, two groups of 25 sequential patients were injected with either lidocaine plain 2% or lidocaine 2% with adrenaline 1:100,000 (E), as the local anesthetic for outpatient carpal tunnel release surgery. Subjective injection pain, postoperative pain at 2 h increments and the number of analgesic pills taken were recorded. During the first postoperative hours, outcome measures were superior in the lidocaine E group. In phase II, a double-blind randomized design compared 42 patients injected with either lidocaine E or a combination of lidocaine E and bupivacaine. Postoperative pain scores and analgesic pills taken were compared using nonparametric statistical tests. During the first 4 h there was a slight benefit in the duration of the anesthetic and fewer pain pills were used in the bupivacaine group. Phase III was a randomized double-blind comparison of ropivicaine and lidocaine E 2% in 72 patients. There was a slight decrease in pain scores and fewer analgesic pills required during the first 6 h in the ropivicaine group. Lidocaine plain 2% provided significantly inferior analgesic and anesthetic properties compared with lidocaine E 2%, bupivacaine or ropivicaine. Sequential randomized comparisons between lidocaine E and bupivacaine and ropivicaine showed clinical equivalence. The present study showed lidocaine E 2% to be a satisfactory and comparatively cost-effective anesthetic for outpatient carpal tunnel surgery.
A Midface Swelling in a Child – a Possible Diagnostic Dilemma
Authors: Patel Kuntal , Oudit Deemesh , Ross G , Nicolson Caroline , Howcroft AJ 
Published: February 2017

A lump on the midface of a child can pose as a diagnostic dilemma. There is a wide variety of possible differential diagnoses, ranging from simple benign conditions such as a sebaceous cyst, dermoid cyst, lipoma, neuroma and neurofibroma, to potentially devastating conditions such as odontogenic myxoma. A case of a child in which the formulation of a definite diagnosis was clinically and histologically challenging is presented.
The Effectiveness of Sodium Tetradecyl Sulfate in the Treatment of Wrist Ganglia
Authors: Ajekigbe Lawrence , Stothard John 
Published: February 2017

Background Ganglia are the most common benign soft tissue tumours of the hand. Although benign, a significant number of patients with wrist ganglia consult with their general practitioners, and ultimately the hand surgeon, complaining of pain. A great number of patients are concerned about the cosmetic appearance, and an equally significant number genuinely believe that the ganglion is a cancer. There are several management options resulting in varying degrees of success. These include observation only, surgical excision, aspiration only, aspiration with injection of methylprednisolone, and aspiration with injection of methylprednisolone and hyaluronidase. Objective The main objective was to investigate the effectiveness and safety of sodium tetradecyl sulfate as a sclerosing agent after aspiration of wrist ganglia. Methods Initial data were collected prospectively during a period of 48 months. Following this, patients were sent a postal survey at least two years after they had received treatment to access the levels of recurrence and persistent complications. Results In the short term, 90% of the patients achieved complete resolution after one episode of aspiration and injection. However, there was only a 65% cure rate after two to five years. Complications were few and not significant. Conclusion Sodium tetradecyl sulfate is an effective sclerosing agent after aspiration of wrist ganglia with an excellent short-term efficacy and a long-term cure rate comparable to that of surgical excision.
Carboxy-Methyl-Cellulose Hydrogel-Filled Breast Implants – An Ideal Alternative? a Report of Five Years’ Experience with This Device
Authors: Brunner Christina A , Gröner Reinhard W 
Published: February 2017

The controversy over the potential health risks from exposure to silicone gel from breast implants has led to extensive research to improve the safety of silicone gel-filled implants. In addition, there has been simultaneous research directed toward the development of alternative filling materials, with the goal of a breast implant that would minimize health risks and maximize cosmetic attributes. In the present study, experience with a filler material that has textural characteristics similar to that of silicone gel, but which is biodegradable and can therefore be eliminated by the body in case of implant failure, is reported. Since February 2000, the authors have been monitoring carboxy-methyl-cellulose (CMC) hydrogel breast implants as participants in a prospective clinical trial. CMC hydrogel is a biodegradable, nontoxic, nonmutagenic and viscoelastic gel, which has been in clinical use since 1984 and has been available as the Monobloc breast implant since 1994. for the present study, 122 patients who underwent surgery between February 2000 and February 2005 were evaluated. It was determined that CMC hydrogel implants have a higher radiotranslucency than silicone gel, and the integrity of this device was easy to prove by clinical examination. In case of rupture, the implant can be replaced immediately; it is easily inserted and can be placed through a small incision because of its highly elastic shell. The complication rate was very low, and the patients were highly satisfied. In terms of safety, the implant is comparable with saline, and its consistency is comparable with that of silicone gel.
Facial Fractures – Association with Ocular Injuries: A 13-Year Review of One Practice in a Tertiary Care Centre
Authors: Nagase Daniel Y , Courtemanche Douglas J , Peters Daniel A 
Published: February 2017

Background The incidence of ocular injury associated with facial fractures has been reported to be between 0.8% and 30%. Objective Because of this wide range of incidences, a system to stratify the risk of ocular injury by type of facial fracture was sought. Methods The present study reviewed 266 patients with facial fractures to determine the risk factors for ocular injury. The anatomy of each facial fracture was classified using an orbit-centred approach according to the number of orbital walls fractured. Patients were then grouped using this classification system. Charts documenting follow-up for each patient over a minimum of one year were examined and initial emergency room presentations of patients with subsequent visual impairment were recorded. Results The incidence of severe visual impairment and blindness was 4.5% overall. Although all facial fractures (including isolated fractures of the mandible) had a notable incidence of ocular injury, an increased number of orbital wall fractures were correlated with an increased incidence of permanent visual disability. One of 147 (0.68%) patients without an orbital wall fracture sustained permanent severe ocular injury or blindness, while 13.5% (five of 37) of three-wall orbital fracture patients and 25% (four of 16) of four-wall orbital fracture patients sustained the same injury. Conclusions The risk of ocular injury in complex facial fractures can be stratified by the degree of orbital wall involvement. However, because all patients with persistent visual impairment had ocular findings on initial examination, it is proposed that oculovisual testing is a more sensitive indicator of lasting ocular injuries than the type of facial fracture.
Secondary Alveolar Bone Grafting: An Outcome Analysis
Authors: Murthy Ananth S , Lehman James A 
Published: February 2017

Objective To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate. Design A surgeon's experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre. Outcome Measure Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take. Results In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting. Conclusions The iliac crest is a good donor site with excellent results and minimal morbidity.
Diagnosis of Finger Flexor Pulley Injury in Rock Climbers: A Systematic Review
Authors: El-Sheikh Yasser , Wong Ivan , Farrokhyar Forough , Thoma Achilleas 
Published: February 2017

Background Closed injury to the finger flexor pulley system is found frequently in rock climbers. There are no evidence-based published guidelines on the diagnosis and treatment of these injuries. Objectives The present systematic review was undertaken to answer the following questions: what are the most commonly recommended diagnostic criteria for finger flexor pulley injury in rock climbers; and, based on the available evidence, what is the best diagnostic test for these injuries? Methods Four electronic databases were searched using specific key terms, with limits set for language and date. Two reviewers independently identified potentially relevant titles based on inclusion criteria. Inter-reviewer variability was assessed using the Kappa statistic. The scientific quality of articles was assessed using validated scales. Results Of the 93 articles identified, 29 were included in the present analysis. The inter-rater agreement for selection of potentially relevant titles was 88% (kappa=0.74). The most commonly cited diagnostic criterion for closed finger pulley injury was clinical bowstringing of the flexor tendons over the volar aspect of the proximal interphalangeal joint. However, the best study of diagnostic accuracy for these injuries supports the use of dynamic ultrasound. Conclusions Dynamic ultrasound is recommended for the diagnosis of closed finger pulley injuries in rock climbers. The prevailing notion that these injuries can be diagnosed by testing for clinical bowstringing is not supported by evidence.
The Epidemiology of Cutaneous Malignant Melanoma in Nova Scotia
Authors: Howlett Andrew L , Dewar Ron AD , Morris Steven F 
Published: February 2017

Background Since 1993, the annual increase in cutaneous malignant melanoma (MM) incidence has been one of the highest for all cancers registered in Canada, with the leading rate in Nova Scotia (NS). The purpose of the present study was to document the pathological and epidemiological data on MM cases found in NS. Patients and Methods All MM cases identified by the Nova Scotia Cancer Registry from January 1998 to December 2002 were evaluated. The five-year survival outlook, by major prognostic factors, was also determined. In addition, the annual incidence and mortality rates from 1972 to 2002 were computed. Results Between 1998 and 2002, 925 MM cases were recorded. The age-standardized incidence rate for males and females in this period was 19.2 and 16.1 per 100,000 respectively. Men 65 years of age or older had the highest age-specific rate. The most common MM had a Breslow's depth of less than 1.0 mm (61.9%) and was Clark's level II (34.9%). There was no significant seasonal variation noted in the time of diagnosis. Survival analyses indicated that sex, age, tumour location and thickness were significant independent predictors. Despite the increase in incidence, there have only been modest changes in the annual mortality rate. Conclusion The incidence of MM in NS increases with age, and is nearly double for men 65 years of age or older, compared with women in the same age group. Thin melanomas on the extremities of young females have the best prognosis in NS, which is similar to other parts of the world. Incidence appears to be unrelated to season. Public health interventions are necessary to reduce the burden of this disease.
A bilobed groin flap for coverage of traumatic injury to both the volar and dorsal hand surfaces
Authors: Brooks Trevor M , Jarman Abdulaziz T , Olson Jaret L 
Published: February 2017

Background There are many methods available for coverage of both the volar and dorsal hand surfaces in traumatic injury. All of these surgical procedures allow for ample coverage of the defect, but have the major drawback of needing multiple donor sites. In the present report, a case of a complex crush injury to the hand in which both volar and dorsal surfaces received traumatic injury is presented. A bilobed groin flap pedicled on the superficial circumflex iliac artery was fashioned to cover the entire defect. Like many other described flaps, the bilobed groin flap resulted in a favourable functional and cosmetic result for the patient, but with the unique advantage of requiring a single donor site. Methods A bipedicled groin flap was raised from distal to proximal, and the flaps inset onto both the dorsal and volar hand defects. Results The patient regained adequate function of his hand, and was able to return to work full-time as a manual labourer. Conclusion The bilobed groin flap appears to be a valuable option for covering complex hand injuries involving both the volar and dorsal surfaces of the hand.