bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death
Authors: Wukich Dane K. , Raspovic Katherine M. , Suder Natalie C. 
Published: February 2017

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Levels of Evidence: Level II: Prospective, Case controlled study
Giant Eccrine Acrospiroma: A Case Report and Review of the Literature
Authors: Koçer UðUr , Aksoy Hasan Mete , TiftikcioðLu YiðIt Özer , Ertoy Dilek , Karaaslan Önder 
Published: February 2017

Background Acrospiromas are histologically distinct cutaneous tumours of sweat duct origin and usually measure 1 to 2 cm in size. Objective We describe a patient with a large benign eccrine acrospiroma. Methods Case report and literature review. Results A 50-year-old woman underwent excision of a 5.5×5.0 cm cystic mass located on the left gluteal region, and the resulting defect was closed by a local flap. A diagnosis of benign eccrine acrospiroma was made after histopathological examination. On histological examination, the lesion was characterized by multilobular dermal masses composed of a biphasic cell population. There was no recurrence five months after the operation. Conclusion Although eccrine acrospiromas are usually benign, they can, on rare occasions, undergo malignant transformation. In addition, the clinical appearance of this lesion is not specific and differential diagnosis from other lesions, both benign and malignant, can only be done after the complete removal of the lesion.
Sensitivity and specificity of clinical testing for carpal tunnel syndrome
Authors: Wiesman Irvin M , Novak Christine B , Mackinnon Susan E , Winograd Jonathan M 
Published: February 2017

Objective The present study evaluated the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of carpal tunnel syndrome (CTS). Methods There were 29 carpal tunnel syndrome (CTS) subjects (mean age 48 years) and 30 control subjects (mean age 45 years). The six clinical tests included Tinel's sign, wrist flexion with fingers extended, wrist flexion with fingers flexed, wrist extension, combined wrist extension/median nerve pressure and combined wrist flexion/median nerve pressure. Results The highest sensitivity and highest negative predictive value was found with wrist flexion with pressure (96%) and wrist extension with pressure (94%) at 60 s. The highest specificity was found with wrist flexion with fingers flexed for 30 s (95%). The highest positive predictive values were found with the wrist flexion with fingers flexed test for 30 s (91%) and the wrist extension test for 30 s (90%). Conclusion No one test possesses all the qualities necessary to be the ideal clinical test for the detection of carpal tunnel syndrome.
Unusual complication of radial artery cannulation
Authors: Bengezi Omar A , Dalcin Ariana , Al-Thani Hassan , Bain James R 
Published: February 2017

Currently, radial artery cannulation is the preferred method for con-tinuous hemodynamic monitoring in critically ill patients. Reported complications of radial artery cannulation include infection, digital gangrene, thrombosis, pseudoaneurysm, skin necrosis and median nerve palsy Radial artery catheter fracture is a very rare complication. A review of the English language literature revealed only one reported case. We present an additional case of spontaneous radial artery catheter fracture.
Dimethyl Sulfoxide and Oxidative Stress On Cultures of Human Keratinocytes
Authors: Silva Duarte Ivone Da , Gragnani Alfredo , Ferreira Lydia Masako 
Published: February 2017

Objectives: The aim of the present study was to examine the protective action of the antioxidant dimethyl sulfoxide (DMSO) against the oxidative stress on keratinocyte cultures caused by glucose deprivation and hypoxia, using the concentration of malonyl dialdehyde existing in the cell culture as an indicator of the oxidative stress level. Methods: Eighty flasks with cultured human keratinocytes in a confluent layer were divided into eight groups, including the following: culture medium with and without glucose, culture medium with and without the addition of DMSO, culture medium subjected and not subjected to hypoxia, and culture medium with a combination of these factors. Results and Conclusions: The statistical analysis of the results showed that DMSO proved to be an effective agent against the oxidative stress on cultures of keratinocytes under the experimental conditions studied.
Why Do Free Flap Vessels Thrombose? Lessons Learned From Implantable Doppler Monitoring
Authors: Williams Jason G , French Rodney J , Lalonde Donald H 
Published: February 2017

Background: Before implantable venous Doppler monitoring, by the time the failing flap was explored, thrombosis had often occurred and therefore the cause of flap flow cessation was often difficult to determine. The Doppler allowed the detection of flow cessation in failing flaps before thrombosis occurred in every case since the authors started using it in 1999. Objectives: To review the authors’ experiences with the implantable venous Doppler. Methods: The authors reviewed 43 free flaps in 40 consecutive patients (1999 to 2002) in which the implantable venous Doppler was used. All cases were performed at the Saint John Regional Hospital, Saint John, New Brunswick, by the senior author. Data were collected from the hospital and office charts. Results: The Doppler detected inadequate blood flow in nine free flaps. In five of the cases, the cause was a kink in the vein. Repositioning the vein to get rid of the kink salvaged all five flaps. In the sixth case, compression of the vein after insetting was detected and successfully corrected. Flow cessation in the seventh case was attributable to arterial vasospasm, which was also salvaged. In the last two cases, the cause was low flow in the flap from the time the vessel clamps were let go. In spite of patent anastomoses, these two flaps were lost because there was not enough flow to sustain them. Conclusion: The implantable venous Doppler has allowed intraoperative detection of free flap vessel flow cessation, identification of the reasons for, and the correction of these prethrombotic states.
Maxillofacial Injuries in Moose-Motor Vehicle Collisions Versus Other High-Speed Motor Vehicle Collisions
Authors: Kim Sharon , Harrop A Robertson 
Published: February 2017

Background Anecdotal experience has suggested that there is a higher frequency of maxillofacial injuries among motor vehicle collisions involving moose. Objectives A retrospective cohort study design was used to investigate the incidence of various injuries resulting from moose-motor vehicle collisions versus other high-speed motor vehicle collisions. Methods A chart review was conducted among patients presenting to a Canadian regional trauma centre during the five-year period from 1996 to 2000. Results Fifty-seven moose-motor vehicle collisions were identified; 121 high-speed collisions were randomly selected as a control group. Demographic, collision and injury data were collected from these charts and statistically analyzed. The general demographic features of the two groups were similar. Moose collisions were typically frontal impact resulting in windshield damage. The overall injury severity was similar in both groups. Likewise, the frequency of intracranial, spinal, thoracic and extremity injuries was similar for both groups. The group involved in collisions with moose, however, was 1.8 times more likely then controls to sustain a maxillofacial injury (P=0.004) and four times more likely to sustain a maxillofacial fracture (P=0.006). Conclusions Occupants of motor vehicles colliding with moose are more likely to sustain maxillofacial injuries than those involved in other types of motor vehicle collisions. It is speculated that this distribution of injuries relates to the mechanism of collision with these large mammals with a high centre of gravity.
Constriction Band Syndrome Occurring in the Setting of in Vitro Fertilization and Advanced Maternal Age
Authors: Rinker Brian , Vasconez Henry C 
Published: February 2017

The debate as to the pathogenesis of constriction band syndrome began with Hippocrates and continues today the exogenous theory attributes the condition to entanglement of the fetus in the amniotic remnants following premature rupture of the amnion, which is in contrast to the endogenous, or genetic, mechanism. A case of constriction band syndrome in the setting of in vitro fertilization, where the child was genetically unrelated to the birth mother, is presented. Constriction band syndrome has been reported following amniocentesis and chorionic villus sampling, but it has not heretofore been presented in the setting of in vitro fertilization. In addition, the present case presents an opportunity to separate maternal from genetic factors and, possibly, shed some light on the etiology of the condition.
‘Optimum Mobility’ Facelift. Part 1 – the Theory
Authors: Fanous Nabil 
Published: February 2017

Traditional rhytidectomy techniques, such as the cutaneous lift, the superficial musculoaponeurotic system lift, the deep plane lift and the subperiosteal lift, are mostly differentiated by their different planes of dissection. As well, many of these techniques consider the complete mobilization of tissues a prerequisite for obtaining a satisfactory result. However, is it true that the result of a rhytidectomy is linked to the choice of the dissection plane? Also, is it true that the adequacy of the surgical mobilization of tissues is vital to the outcome? the present paper discusses the above questions and introduces a factor that is believed to be crucial to the planning and success of a rhytidectomy: facial tissue mobility. The analysis of this mobility is presented and leads to the development of three theories: ‘intrinsic mobility’, ‘surgically induced mobility’ and ‘optimum mobility points’. These theories form the foundation of a rhytidectomy technique termed ‘optimum mobility’ facelift.
Facial paralysis for the plastic surgeon
Authors: Kosins Aaron M , Hurvitz Keith A , Evans Gregory Rd , Wirth Garrett A 
Published: February 2017

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and bot-ulinum toxin injection, but these are beyond the scope of the present paper.
Pilomatricoma: Experience of the Hospital for Sick Children
Authors: Cypel Tatiana Karine Simon , Vijayasekaran Vijith , Somers Gino R , Zuker Ronald Melvin 
Published: February 2017

Background Pilomatricoma (calcifying epithelioma of Malherbe) is a common skin neoplasm in the pediatric population that is often misdiagnosed as other skin conditions or tumours. Objectives The objective of the present retrospective study was to review the clinical and histopathological presentation of this neoplasm in children. Methods The records of the pathology department at The Hospital for Sick Children, Toronto, Ontario, were searched for all cases of pilomatricoma between 2001 and 2006. The records of these patients were reviewed to determine sex, age, location and size of the tumour, pathological features and recurrence rate. All patients underwent surgical excision of the lesions. Results A total of 93 lesions in 85 patients were identified. The median age was 8.7 years. Of the 85 patients diagnosed with pilomatricoma, 44 (52%) were female. In all cases, the initial presentation was an asymptomatic, slow growing, superficial hard mass with bluish discolouration. The most common sites of occurrence were the face (48%), neck (21%) and upper limbs (18%). The size of the surgical specimens collected ranged from 0.1 cm to 2.6 cm. The diagnosis was confirmed by histopathological examination in all cases. Ghost cells and basaloid cells were described in most of the cases (83%). There were no recurrences in this series. Conclusions This entity should be considered with other benign or malignant conditions in the clinical differential diagnosis of solitary firm skin nodules, especially those on the face, neck and upper limbs. The diagnosis can generally be made by clinical examination. The treatment of choice is surgical excision, and the recurrence rate is very low.
Predicting Breast Reduction Weight Using the Mass of Breast Ptosis
Authors: Murray John D , Elwood Eric T , Barrick Rebecca , Feng Jack 
Published: February 2017

Background The preoperative prediction of therapeutic breast reduction weights, to achieve both relief of breast weight symptoms and yet achieve excellent breast shape, remains a challenge. Objectives To design a simple clinical method to preoperatively predict and quantify therapeutic breast reduction weights. Methods In 31 women who underwent therapeutic bilateral reduction mammaplasty, the mass of the hypertrophic breast hanging below the inframammary fold was preoperatively weighed and then compared with the mass of the reduction specimen. Thirty patients underwent breast reduction using a superomedial nipple-areolar pedicle. Postoperative breast weight-related symptoms and breast shape findings were then noted. Statistical analysis relied on mean, SD, sample size, Mann-Whitney test for medians, Levene's test for variances and regression analysis. Results The average clinical follow-up was 160 days, with all patients achieving satisfactory breast size and shape from both the patient and surgeon's perspectives. All patients reported improvement of back pain, shoulder pain and lower neck pain. Two breasts developed delayed healing of the lateral skin flap, necessitating debridement and reclosure, followed by uneventful ongoing healing. There was no significant difference in preoperative ptotic breast mass and resectional breast mass (all P>0.05). Conclusions Simple preoperative weighing of the ptotic portion of the hypertrophic breast can serve as a goal for the reduction weight, while creating pleasing breast proportions and improving breast weight-related symptoms. Preoperative quantification of the ptotic breast mass may guide the reduction technique and assist insurance precertification efforts.
A Comparison of the Superficial Inferior Epigastric Artery Flap and Deep Inferior Epigastric Perforator Flap in Postmastectomy Reconstruction: A Cost-Effectiveness Analysis
Authors: Thoma Achilleas , Jansen Leigh , Sprague Sheila , Duku Eric 
Published: February 2017

Purpose To perform a cost-effectiveness analysis comparing the superficial inferior epigastric artery (SIEA) and deep inferior epigastric perforator (DIEP) flaps in postmastectomy reconstruction. Methods A decision analytic model with seven clinically important health outcomes (health states) was used, incorporating the Ontario Ministry of Health's perspective. Direct medical costs were estimated from a university-based hospital. The utilities of each health state converted into quality-adjusted life years (QALYs) were obtained from previously published data. Health state probabilities were computed from a systematic literature review. Analyses yielded SIEA and DIEP expected costs and QALYs allowing calculation of the incremental cost-utility ratio (ICUR). One-way sensitivity analyses were conducted under five plausible scenarios, assessing result robustness. Results Five SIEA and 27 DIEP studies were identified. The baseline SIEA expected cost was slightly higher than that for the DIEP ($16,107 versus $16,095), with slightly higher QALYs (33.14 years versus 32.98 years), giving an ICUR of $77/QALY. Taking into account conversions from SIEA to DIEP, the ICUR increased to $4,480/QALY. Sensitivity analysis gave ICURs ranging from $2,614/QALY to ‘dominant’, all consistent with the adoption of the SIEA over the DIEP. Conclusion The best available evidence suggests the SIEA is a cost-effective procedure. However, given the high SIEA to DIEP conversion rates and small marginal differences in cost and effectiveness, the ICUR may be sensitive to minor changes in costs or QALYs. The ‘truth’ can only be obtained from a randomized, controlled trial comparing both techniques side by side, simultaneously capturing the costs of the competing interventions.
Predicting the Results of Rhinoplasty Before Surgery: Easy Noses Versus Difficult Noses
Authors: Fanous Nabil , Brousseau Valérie Julie , Karsan Naznin , Fanous Amanda 
Published: February 2017

A major problem for many rhinoplastic surgeons is the ability to predict, before surgery, the difficulty of the procedure (whether the rhinoplasties will be technically easy or technically difficult to perform) and the success rate of the result (whether the rhinoplasty will likely give good results or poor ones). The present paper outlines a systematic approach to nasal analysis, allowing the surgeon to consistently estimate, before surgery, the degree of technical difficulty of each rhinoplasty, as well as predicting its future result in terms of patient satisfaction. This preoperative evaluation is based on the analysis of the skin texture and the osteocartilagenous framework on lateral and frontal views. It allows for the nose to be classified as green (easy), yellow (moderate) or red (difficult), depending on two factors: The degree of surgical difficulty and the expected patient's satisfaction with the result. The essence of the present paper is to introduce a simple, systematic approach to assist the novice rhinoplastic surgeon to assess the complexity, the risks and the expected outcome of a rhinoplasty in the preoperative period, rather than postoperatively.
Empirical Antibiotics Use in Soft Tissue Infections
Authors: Shortt Rodger , Thoma Achilleas 
Published: February 2017

Purpose Various antibiotics are available to treat soft-tissue infections. However, it is unclear if the empirical antibiotic is always appropriate or the most economical. Objective To determine the percentage of empirically treated wounds susceptible to the antibiotic therapy prescribed, and to determine the percentage of wounds treated with the most economical antibiotic therapy. Methods A retrospective chart review was performed on all charts with a diagnosis of ‘soft-tissue infection’ between January 1, 2005, and June 30, 2005, at St Joseph's Hospital, Hamilton, Ontario. Eligible charts were identified using the medical diagnosis coding system. The following diagnoses (including subheadings) were included: cellulitis, lymphangitis, abscess, carbuncle or furuncle. The following was extracted: patient demographics; soft-tissue diagnosis; name, dose and duration of antibiotics used; culture results; and Gram-stain results. A comparison between the empirical antibiotic prescribed and the microbiology result was made. An assessment was performed on the cost of the initial empirical antibiotic treatment compared with less-expensive effective alternatives. Results For soft-tissue infections with positive culture growth, empirical antibiotic treatment was appropriate in all abscess cases, 50% of ulcer cases and 83% of cellulitis cases. for cellulitis patients receiving a single empirical antibiotic, it was appropriate in 89% of cases. Only 42% of culture-positive patients were treated with the most economical regimen, multiple antibiotics being the most common fault. Conclusions To be most economical, a single empirical antibiotic should be used to treat cellulitis. Culture results should be used to guide any antibiotic changes.