Social Media Return on Investment: How Much is it Worth to My Practice?

Abstract

Background

Plastic surgeons are rapidly integrating social media into their practices and recent articles on the subject have exploded in the literature. Although social media is being evaluated as a tool, few have actually been able to quantify the impact of social media on a practice.

Objectives

To quantify the return on investment for social media in a plastic surgery practice.

Methods

The ideal method for this type of study is a new practice, without preexisting clients and with a broad approach to marketing to examine the effects of multiple marketing tools. In this study, we profile a start-up plastic surgery practice in Beverly Hills, Los Angeles.

Results

In this study, we report practice demographics as well as one year of income, broken down by the referral source for each patient. The dollar amount returned was reported for several social media resources and other internet-based marketing tools.

Conclusions

Social media has a relatively high return on investment, and to date this is the first study to transparently quantify the value of social media in plastic surgery.

Exploring the Genetic Role of Capsular Contracture in Three Family Generations With a Case Report and a Literature Review

Capsular contracture (CC) is a well-known complication of augmentation mammaplasty. The mechanism of capsule formation is multifactorial and the risk factors can be broadly categorized as implant-related or surgical technique-dependent.^1,2 In this case report we consider a patient-related factor, that of familial tendency. We review the literature for known genetic markers and consider whether CC may or may not be related to a familial tendency. To our knowledge this is the first description of bilateral CC affecting three successive generations of the same family.

Ustekinumab treatment of pityriasis rubra pilaris: A report of five cases

Abstract

Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skin disease of unknown etiology. Patients refractory to conventional therapies have been treated successfully with biologic drugs such as anti-tumor necrosis factor agents. Recently, a role of the interleukin-23/T-helper 17 axis in PRP has been described. Our objective was to assess the effectiveness of ustekinumab in five patients with adult-onset PRP refractory to conventional therapies. In the present study, four patients had type I and one patient type II adult-onset PRP. They were treated with three s.c. doses of ustekinumab at weeks 0, 4 and 16. Clinical response was evaluated monthly during treatment up to a 15-month follow-up period. All patients promptly showed a decrease in erythema, follicular hyperkeratosis and scaling. After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP. Our results, in addition to previous studies from other groups, suggest that ustekinumab may be a possible first-line treatment for PRP patients refractory to conventional therapies.

Pilomatrixoma proliferante simulando malignidad

Publication date: Available online 27 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): P. García-Montero, J.B. Repiso-Jiménez, I. Fernández-Canedo

Metástasis cutánea de carcinoma de pulmón

Publication date: Available online 27 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): C. Martínez-Morán, B. Echeverría-García, R. Khedaoui, J. Borbujo

A risk adjustment approach to estimating the burden of skin disease in the United States

Direct insurance claims tabulation and risk adjustment statistical methods can be used to estimate health care costs associated with various diseases. In this third manuscript derived from the new national Burden of Skin Disease Report from the American Academy of Dermatology, a risk adjustment method that was based on modeling the average annual costs of individuals with or without specific diseases, and specifically tailored for 24 skin disease categories, was used to estimate the economic burden of skin disease.

Stress and Skin Disease Quality of Life: The Moderating Role of Anxiety Sensitivity Social Concerns

Summary

Background

Stress is an important factor in the onset, exacerbation, and reoccurrence of many skin diseases. Little is known about psychological risk factors that impact the association between stress and dermatologic conditions. One relevant factor that may modulate this link is anxiety sensitivity (AS) social concerns – the propensity to respond fearfully to anxiety-related sensations (e.g., sweating, flushing) due to perceived social consequences (e.g., rejection or humiliation).

Objective

To gain insight into psychological factors affecting skin disease, we examined the moderating role of AS social concerns in the relation between stress and skin disease quality of life (QOL).

Methods

Participants (N = 237; 161 female; M_age= 34.18, SD_age = 9.57) with active skin disease symptoms were recruited online and completed questionnaires assessing stress, AS social concerns, skin disease QOL, and global skin disease symptom severity.

Results

AS social concerns moderated the association between stress and skin-related emotional and social functioning in adults with skin disease. Stress was a significant predictor of the impairment associated with skin disease.

Conclusions

Stress was linked to skin disease-related emotional and functional impairment associated with skin disease among individuals with high AS social concerns. These results highlight the potential for AS reduction interventions to break the vicious cycle of stress and skin disease symptoms and to improve psychosocial well-being in dermatology patients.

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Insufficient generation of Th17 cells in IL-23p19-deficient BALB/c mice protects against progressive cutaneous leishmaniasis

The JAK2/STAT3 pathway is involved in the anti-melanoma effects of atractylenolide I

A systematic review and meta-analysis of utility estimates in melanoma

Summary

We sought to determine pooled estimates of utility-based health-related quality-of-life (HRQOL) (utilities) for people with American Joint Cancer Committee stage I/II, III, IV melanoma for use in economic evaluations.

We performed a systematic review, meta-analysis, and meta-regression of utilities for melanoma patients. HRQOL scores reported with QLQ-C30, SF-36, SF-12, FACT-G, and FACT-M instruments were converted to utilities using published mapping algorithms. Meta-analysis was used to calculate mean utilities. Meta-regression examined the effects of baseline patient and study characteristics.

We identified 33 studies reporting 213 utilities. From meta-analyses, the mean utility for stage I/II melanoma was 0.970 (95%CI: 0.895-0.979); for stage III melanoma was 0.766 (95%CI: 0.699-0.833); for stage III/IV was 0.763 (95%CI: 0.755-0.771) and for stage IV melanoma was 0.764 (95%CI: 0.714-0.813). The difference in utility between stage III and stage IV was not statistically significant (p=0.521). For patients with stage I/II, the utility estimate at time of surgery was 0.772 (95%CI: 0.753-0.790), and from 3-12 months post-surgery, the utility estimate was 0.852 (95%CI: 0.844-0.860). Utility estimates for patients with stage IV melanoma were 0.653 (95%CI: 0.621-0.685) during the first 3 months of treatment and 0.831 (95%CI: 0.808-0.855) from 4-12 months on treatment. For patients with stage IV melanoma treated with chemotherapy, the utility estimate was 0.518 (95%CI: 0.513-0.523), while for those treated with targeted therapy, the utility estimate was 0.834 (95%CI: 0.822-0.846).

These robust, evidence-based estimates of health state utility can be used in economic evaluations of new treatments for patients with early stage or advanced stage melanoma.

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Epidemiology of Staphylococcal Scalded Skin Syndrome in United States Children

Abstract

Background

Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. We sought to describe the incidence, costs, length of stay (LOS), comorbidities, and mortality of SSSS in US children.

Methods

The Nationwide Inpatient Sample 2008-2012 was analyzed, including a 20% sample of US hospitalizations and 589 cases of SSSS.

Results

The annual incidence of SSSS was 7.67 (range: 1.83–11.88) per-million US children, with 45.1 cases per-million US infants age <2 years. In multivariate logistic regression models, SSSS was significantly associated with female sex (adjusted odds ratio [95% confidence interval]:1.12 [1.00–1.25]), age (2-5yr:13.31 [11.82-14.99], 6-10yr:2.93 [2.35–3.66], 11-17yr:0.44 [0.31–0.63]), race/ethnicity (blacks:0.69 [0.58–0.84]), season (winter:2.04 [1.66–2.50], summer:3.47 [2.86–4.22], fall:3.04 [2.49–3.70]), with increasing odds over time (2010-2011:2.28 [2.07–2.51], 2012:2.98 [2.69–3.30]). The geometric mean (95% CI) LOS and cost of hospitalization for patients with vs. without SSSS was 3.2 (3.0-3.4) vs. 2.4 (2.4-2.5) days and $4,624.0 [$4,250.8-$5,030.1] vs. $1,871.7 [$1,782.7-$1,965.1]. Crude inpatient mortality rates were similar for children with vs. without SSSS (0.33% [0.00–0.79%] vs. 0.36% [0.34-0.39%]). SSSS was associated with other infections, including in upper respiratory tract and skin.

Conclusions

SSSS prevalence appears to be increasing over time, and was associated with a number of socio-demographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.

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Job change facilitates healing in a cohort of patients with occupational hand eczema

Abstract

Background

Occupational hand eczema is a frequent and often chronic disease and knowledge of the consequences of change of profession is sparse.

Objectives

To compare severity of hand eczema and health related QoL HR-QoL in patients who after 5 years were still in the same profession and those who were not.

Methods

The study is a register-based cohort study including patients with recognised occupational hand eczema in Denmark in 2010 and 2011. Outcomes were eczema related parameters and Dermatology Life Quality Index (DLQI) obtained from a follow-up questionnaire after 5 years.

Results

A total of 1496 participants were included in the study. More participants who changed or ended profession reported complete healing of hand eczema at follow up, compared to participants still in the same profession (OR=1.62 (1.06-2.47) and OR=2.85 (1.83-4.42), respectively), as well as increased improvement at follow-up (OR=1.91(1.44-2.54) and OR=1.51(1.09-2.10), respectively), while DLQI for participants who changed or ended profession was increased at follow up, (Incidence Rate Ratio (IRR)= 1.12 (0.98-1.28) and IRR= 1.29 (1.11-1.51), respectively). Subgroup analyses of patients with irritant or allergic occupational hand eczema did not differ markedly from this result. Change of work procedures was positively associated with improvement (OR=2.31(1.51-3.54)), and did not markedly influence DLQI.

Conclusion

Change of profession has a beneficial effect on eczema parameters, but a negative effect on HR-QoL, indicated by increased DLQI. Change of work procedures while staying in the same profession positively influenced improvement, with no marked influence on HR-QoL, and should be considered as an alternative to job change.

This article is protected by copyright. All rights reserved.

In vivo Zika virus detection in human skin

Abstract

Zika virus (ZIKAV) a Flavivirus mainly transmitted by Aedes aegypti and Aedes albopictus mosquitoes has been responsible for an extensive epidemic affecting people in more than 56 countries since its emergence in Brazil in 2015 (1). Evidence of the neuroinvasiveness and the tropism of ZIKAV for placenta trophoblasts has turned an infection, originally known for its mildness, into a major world public health concern due to the severity and dissemination of associated disorders (i.e.: congenital Zika syndrome and Guillain Barré syndrome) (2). Despite a commonly short viremia of low intensity the spread of ZIKAV infection is primarily due to vectorial transmission rather than to vertical or sexual transmission which have recently been evidenced (3-5).

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Laser treatment of congenital melanocytic nevi: a systematic review

Summary

Recent studies on congenital melanocytic nevi (CMN) indicate a lower risk for melanoma than assumed for many years. As a result, the treatment paradigm in CMN shifted from complete removal to cosmetically acceptable, less invasive treatment options such as laser treatment. Our objective was to systematically review the efficacy and safety of laser therapy for CMN. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. We rated the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-four eligible studies with 434 patients were included, three non-randomised controlled studies and 21 case series (majority of poor quality). Twenty different laser modalities or combinations were evaluated. Overall, the Q-switched laser was used most frequently, although large or giant CMN were generally treated with an ablative laser. Due to heterogeneity between studies, comparison between laser modalities was hampered and statistical analysis was precluded. Lasers in CMN showed rather good results for clearing of hyperpigmentation on the short term, albeit very low quality evidence. Outcome measures varied widely, patient satisfaction was hardly measured and high incidences of scarring, repigmentation and complications were reported. No malignant change was seen. While most studies report short-term improvement of CMN after laser therapy, there is no high quality evidence for the efficacy and safety of laser modalities in CMN on the long term. Future research should focus on well-conducted, and well-reported prospective studies on different laser modalities for CMN, with use of recognised and validated outcome measures.

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Postzygotic mosaïcism and incontinentia pigmenti in male patients:molecular diagnosis yield

Abstract

Incontinentia pigmenti (IP, MIM 308300) is an X-linked dominant genodermatosis caused by the more frequently occurring (80% of cases) deletion mutation Δ 4-10 on IKBKG gene, located on chromosome Xq28. Incontinentia Pigmenti is generally lethal in male fetuses, while heterozygous females survive owing to functional mosaicism.¹ Two potential mechanisms have been proposed to explain the survival of male patients with IP carrying IKBKG mutation: (1) abnormal karyotype, i.e. 47, XXY Klinefelter syndrome; (2) more frequently postzygotic mosaicism for IKBKG mutation.² Detection of postzygotic mosaicism is dependant of tissue sampling localization and percentage of mutated cells in the sample.

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Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

Related Articles

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

Arch Plast Surg. 2017 Oct 26;:

Authors: Huizum MAV, Hage JJ, Oldenburg HA, Hoornweg MJ

Abstract
Background: Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation.
Methods: To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study.
Results: We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site.
Conclusions: In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

PMID: 29069885 [PubMed - as supplied by publisher]

Cheek Lift for Enhancing Anterior Cheek Lift.

Related Articles

Cheek Lift for Enhancing Anterior Cheek Lift.

Arch Plast Surg. 2017 Oct 26;:

Authors: Bellity P, Bellity J

Abstract
Supported by recent literature on the signs of aging of the middle and lower face, our clinical research has documented a loss of volume of the deep structural components of the central face and a progressive descent of the nasolabial fat and the jowl fat, leading to facial fragmentation. The signs that appear around the age of 45 to 50 years are well targeted by the mini-invasive technique described here. We focused on refitting the jowl fat and the nasolabial fat associated with cutaneous tightening. The use of absorbable barbed sutures (Quill) led to significant improvements, enabling the fitting of fat on fat. In the past 4 years, 167 operations were performed using this technique. The clinical results were very satisfactory, yielding a natural effect caused by the mobilization and strong fixation of the nasolabial fat and the jowl fat in the direction opposite to their displacement.

PMID: 29069884 [PubMed - as supplied by publisher]

Multiple Cutaneous Squamous Cell Carcinomas Arising in Several Body Areas Except for the Face.

Related Articles

Multiple Cutaneous Squamous Cell Carcinomas Arising in Several Body Areas Except for the Face.

Arch Plast Surg. 2017 Oct 26;:

Authors: Kim JS, Park YJ, Kim NG, Lee YJ, Choi BH, Lee KS

PMID: 29069883 [PubMed - as supplied by publisher]

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap.

Related Articles

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap.

Arch Plast Surg. 2017 Oct 26;:

Authors: Han JH, Shin HW, Yoon KC, Kim JK

Abstract
When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.

PMID: 29069882 [PubMed - as supplied by publisher]

The Effect of Hyperbaric Oxygen Therapy on a Large Composite Graft in an Ear Amputated by a Human Bite.

Related Articles

The Effect of Hyperbaric Oxygen Therapy on a Large Composite Graft in an Ear Amputated by a Human Bite.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park Y, Cho JY

PMID: 29069881 [PubMed - as supplied by publisher]

Instrumentation in Maxillofacial Surgery: Few Practical Tips.

Related Articles

Instrumentation in Maxillofacial Surgery: Few Practical Tips.

Arch Plast Surg. 2017 Oct 26;:

Authors: Shrotriya R, Puri V

Abstract
When a newly inducted plastic surgery resident embarks on maxillofacial surgery, with drills, screws, plates and burrs, it seems like a new domain altogether. As a new resident, it is truly fascinating as to how such wide variety of bony work is done without scarring over the face. Here we discuss a few practical tips which the author has learned during his surgical sojourn in residency. It is hoped that the readers who are new to maxillofacial surgery, shall find these useful.

PMID: 29069880 [PubMed - as supplied by publisher]

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature.

Related Articles

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature.

Arch Plast Surg. 2017 Oct 26;:

Authors: Fracol M, Dorfman R, Janes L, Kulkarni S, Bethke K, Hansen N, Kim J

Abstract
We report a case of a 51 year old female with a 25 pack year smoking history who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed right breast cancer. The patient reported herself as a non-smoker despite significant e-cigarette use, with resulting significant mastectomy skin flap necrosis and breast reconstruction failure. Little is known about the physiologic effect of e-cigarettes on wound healing and tissue perfusion. To this end, we provide an updated review of the impact of e-cigarettes on surgical outcomes. PubMed, Ovid MEDLINE, and PRS GO were searched for the terms "e-cigarette", "electronic cigarette", "e-cig", "electronic nicotine delivery system", "vaping", "surgery", "surgical", "peri-operative", "operate", "operative" and "wound healing". Abstract review of all articles was performed. 123 articles returned that contained both variants of e-cigarettes and surgery as keywords. Of those, manual assessment returned three articles which were found to be relevant to e-cigarette use in the surgical patient. No articles were found that compared perioperative complications in e-cigarette versus traditional cigarette users in humans. In conclusion, our case report depicts the potential dangers associated with e-cigarette use in the surgical patient. There is a public misconception that e-cigarettes are healthier than traditional cigarettes and as such their use may go unreported by patients. Early evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, and may have a significant deleterious effect on wound healing.

PMID: 29069879 [PubMed - as supplied by publisher]

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy.

Related Articles

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy.

Arch Plast Surg. 2017 Oct 26;:

Authors: Yun MH, Yoon ES, Lee BI, Park SH

Abstract
Background: Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy.
Methods: A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups.
Results: Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02).
Conclusions: Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

PMID: 29069878 [PubMed - as supplied by publisher]

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Related Articles

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park SH, Kim JH, Lee JW, Jeong HS, Lee DJ, Kim BC, Suh IS

Abstract
Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

PMID: 29069877 [PubMed - as supplied by publisher]

Cleft Lip and Palate Repair Using a Surgical Microscope.

Related Articles

Cleft Lip and Palate Repair Using a Surgical Microscope.

Arch Plast Surg. 2017 Oct 26;:

Authors: Kato M, Watanabe A, Watanabe S, Utsunomiya H, Yokoyama T, Ogishima S

Abstract
Background: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate.
Methods: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed.
Results: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses.
Conclusions: Surgical microscopy was demonstrated to be useful during cleft operations.

PMID: 29069876 [PubMed - as supplied by publisher]

Irritated Subtype of Seborrheic Keratosis in the External Auditory Canal.

Related Articles

Irritated Subtype of Seborrheic Keratosis in the External Auditory Canal.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park JK, Kim KS, Kim SH, Choi J, Yang JY, Lee JJ

PMID: 29069875 [PubMed - as supplied by publisher]

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity.

Related Articles

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity.

Arch Plast Surg. 2017 Oct 26;:

Authors: Hendrickson SA, Wright TC, West EV

PMID: 29069874 [PubMed - as supplied by publisher]

Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction.

Related Articles

Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction.

Arch Plast Surg. 2017 Oct 25;:

Authors: Do SB, Chung CH, Chang YJ, Kim BJ, Rho YS

Abstract
Background: A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula.
Methods: Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation.
Results: A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation.
Conclusions: Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.

PMID: 29067796 [PubMed - as supplied by publisher]

Natural history and clinical outcome of junctional epidermolysis bullosa generalized intermediate due to a LAMA3 mutation

Abstract

Junctional epidermolysis bullosa (JEB) comprises rare autosomal recessive disorders with a broad spectrum of clinical features and severity. The genetic basis involves mutations in genes encoding proteins of the dermal-epidermal junction, primarily laminin 332. This heterotrimeric glycoprotein consists of laminin α3, β3 and γ2 chains, and the majority of mutations in the respective genes (LAMA3, LAMB3, and LAMC2) lead to premature termination codons resulting in severe generalized JEB (previously Herlitz)¹.

This article is protected by copyright. All rights reserved.

Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomised controlled feasibility trial

Abstract

Background

Almost 70% of all leg ulcers have a venous component. Venous leg ulcers (VLU's) are typically painful and heal slowly, resulting in an impaired quality of life (QoL), social isolation and reduced work productivity. Compression therapy offers high healing rates, however, improvements aren't usually sustained. Exercise is a low-cost, low-risk, and effective strategy for improving physical and mental health. However, little is currently known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy in this patient group.

Objectives

To assess the feasibility of a 12-week supervised exercise programme combining aerobic, resistance and flexibility exercises as an adjunct therapy to compression in patients with VLU's.

Methods

This was a two-centre, two-arm, parallel-group, randomised feasibility trial. Thirty-nine patients with venous ulcers were recruited and randomised 1:1 either to exercise (3 sessions per week) and compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow-up and patients' preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year following baseline, with healing rate and time, ulcer recurrence and infection incidents also being documented. Intervention and healthcare utilisation costs were calculated. Qualitative data was collected to assess participants' experiences.

Results

Overall, 72% of the exercise group participants attended all scheduled exercise sessions. No serious adverse events, and only two exercise-related adverse events (e.g., increased ulcer discharge) were reported. Loss to follow-up was 5%. At 12-months median ulcer healing time was lower in the exercise group (13 vs 34.7 weeks). Total NHS costs were calculated as £813.27 for the exercise and £2,298.57 for the control group.

Conclusions

Our findings support the feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures. The next step will be the design and implementation of an appropriately-powered, multi-centre trial.

This article is protected by copyright. All rights reserved.

Intraoperative detection of inferior vena caval tumor thrombus extending from metastatic lymph node of renal cell carcinoma using ultrasonography

Abstract

A 67-year-old man consulted our department with gross hematuria. Computed tomography (CT) revealed a huge renal tumor with a paracaval metastatic lymph node (mLN). Right total nephrectomy was planned for the renal tumor diagnosed as renal cell carcinoma preoperatively. Just before the resection of the renal vein and artery, intraoperative ultrasonography revealed an inferior vena caval tumor thrombus (IVCTT) extending from the mLN. Ultrasonography clearly and dynamically demonstrated a rhythmic flapping movement of the IVCTT with blood flow in the inferior vena cava. Following right radical nephrectomy, IVCTT resection with the vessel wall was performed to reduce the risk of pulmonary tumor thrombus. Histopathological diagnosis of the renal tumor was clear cell renal cell carcinoma, and the resected IVCTT was confirmed histopathologically as tumor involvement from the mLN of the renal cell carcinoma. Intraoperative ultrasonography can detect IVCTT extending from the mLN, whereas CT cannot.

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

Related Articles

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer.

Arch Plast Surg. 2017 Oct 26;:

Authors: Huizum MAV, Hage JJ, Oldenburg HA, Hoornweg MJ

Abstract
Background: Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation.
Methods: To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study.
Results: We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site.
Conclusions: In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

PMID: 29069885 [PubMed - as supplied by publisher]

Cheek Lift for Enhancing Anterior Cheek Lift.

Related Articles

Cheek Lift for Enhancing Anterior Cheek Lift.

Arch Plast Surg. 2017 Oct 26;:

Authors: Bellity P, Bellity J

Abstract
Supported by recent literature on the signs of aging of the middle and lower face, our clinical research has documented a loss of volume of the deep structural components of the central face and a progressive descent of the nasolabial fat and the jowl fat, leading to facial fragmentation. The signs that appear around the age of 45 to 50 years are well targeted by the mini-invasive technique described here. We focused on refitting the jowl fat and the nasolabial fat associated with cutaneous tightening. The use of absorbable barbed sutures (Quill) led to significant improvements, enabling the fitting of fat on fat. In the past 4 years, 167 operations were performed using this technique. The clinical results were very satisfactory, yielding a natural effect caused by the mobilization and strong fixation of the nasolabial fat and the jowl fat in the direction opposite to their displacement.

PMID: 29069884 [PubMed - as supplied by publisher]

Multiple Cutaneous Squamous Cell Carcinomas Arising in Several Body Areas Except for the Face.

Related Articles

Multiple Cutaneous Squamous Cell Carcinomas Arising in Several Body Areas Except for the Face.

Arch Plast Surg. 2017 Oct 26;:

Authors: Kim JS, Park YJ, Kim NG, Lee YJ, Choi BH, Lee KS

PMID: 29069883 [PubMed - as supplied by publisher]

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap.

Related Articles

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap.

Arch Plast Surg. 2017 Oct 26;:

Authors: Han JH, Shin HW, Yoon KC, Kim JK

Abstract
When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.

PMID: 29069882 [PubMed - as supplied by publisher]

The Effect of Hyperbaric Oxygen Therapy on a Large Composite Graft in an Ear Amputated by a Human Bite.

Related Articles

The Effect of Hyperbaric Oxygen Therapy on a Large Composite Graft in an Ear Amputated by a Human Bite.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park Y, Cho JY

PMID: 29069881 [PubMed - as supplied by publisher]

Instrumentation in Maxillofacial Surgery: Few Practical Tips.

Related Articles

Instrumentation in Maxillofacial Surgery: Few Practical Tips.

Arch Plast Surg. 2017 Oct 26;:

Authors: Shrotriya R, Puri V

Abstract
When a newly inducted plastic surgery resident embarks on maxillofacial surgery, with drills, screws, plates and burrs, it seems like a new domain altogether. As a new resident, it is truly fascinating as to how such wide variety of bony work is done without scarring over the face. Here we discuss a few practical tips which the author has learned during his surgical sojourn in residency. It is hoped that the readers who are new to maxillofacial surgery, shall find these useful.

PMID: 29069880 [PubMed - as supplied by publisher]

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature.

Related Articles

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature.

Arch Plast Surg. 2017 Oct 26;:

Authors: Fracol M, Dorfman R, Janes L, Kulkarni S, Bethke K, Hansen N, Kim J

Abstract
We report a case of a 51 year old female with a 25 pack year smoking history who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed right breast cancer. The patient reported herself as a non-smoker despite significant e-cigarette use, with resulting significant mastectomy skin flap necrosis and breast reconstruction failure. Little is known about the physiologic effect of e-cigarettes on wound healing and tissue perfusion. To this end, we provide an updated review of the impact of e-cigarettes on surgical outcomes. PubMed, Ovid MEDLINE, and PRS GO were searched for the terms "e-cigarette", "electronic cigarette", "e-cig", "electronic nicotine delivery system", "vaping", "surgery", "surgical", "peri-operative", "operate", "operative" and "wound healing". Abstract review of all articles was performed. 123 articles returned that contained both variants of e-cigarettes and surgery as keywords. Of those, manual assessment returned three articles which were found to be relevant to e-cigarette use in the surgical patient. No articles were found that compared perioperative complications in e-cigarette versus traditional cigarette users in humans. In conclusion, our case report depicts the potential dangers associated with e-cigarette use in the surgical patient. There is a public misconception that e-cigarettes are healthier than traditional cigarettes and as such their use may go unreported by patients. Early evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, and may have a significant deleterious effect on wound healing.

PMID: 29069879 [PubMed - as supplied by publisher]

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy.

Related Articles

The Effect of Low-Dose Nitroglycerin Ointment on Skin Flap Necrosis in Breast Reconstruction after Skin-Sparing or Nipple-Sparing Mastectomy.

Arch Plast Surg. 2017 Oct 26;:

Authors: Yun MH, Yoon ES, Lee BI, Park SH

Abstract
Background: Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy.
Methods: A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups.
Results: Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02).
Conclusions: Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

PMID: 29069878 [PubMed - as supplied by publisher]

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Related Articles

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park SH, Kim JH, Lee JW, Jeong HS, Lee DJ, Kim BC, Suh IS

Abstract
Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

PMID: 29069877 [PubMed - as supplied by publisher]

Cleft Lip and Palate Repair Using a Surgical Microscope.

Related Articles

Cleft Lip and Palate Repair Using a Surgical Microscope.

Arch Plast Surg. 2017 Oct 26;:

Authors: Kato M, Watanabe A, Watanabe S, Utsunomiya H, Yokoyama T, Ogishima S

Abstract
Background: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate.
Methods: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed.
Results: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses.
Conclusions: Surgical microscopy was demonstrated to be useful during cleft operations.

PMID: 29069876 [PubMed - as supplied by publisher]

Irritated Subtype of Seborrheic Keratosis in the External Auditory Canal.

Related Articles

Irritated Subtype of Seborrheic Keratosis in the External Auditory Canal.

Arch Plast Surg. 2017 Oct 26;:

Authors: Park JK, Kim KS, Kim SH, Choi J, Yang JY, Lee JJ

PMID: 29069875 [PubMed - as supplied by publisher]

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity.

Related Articles

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity.

Arch Plast Surg. 2017 Oct 26;:

Authors: Hendrickson SA, Wright TC, West EV

PMID: 29069874 [PubMed - as supplied by publisher]

Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction.

Related Articles

Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction.

Arch Plast Surg. 2017 Oct 25;:

Authors: Do SB, Chung CH, Chang YJ, Kim BJ, Rho YS

Abstract
Background: A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula.
Methods: Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation.
Results: A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation.
Conclusions: Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.

PMID: 29067796 [PubMed - as supplied by publisher]

Correction: Radioembolisation mit Yttrium-90-Mikrosphären

Zusammenfassung

Hintergrund

Die selektive interne Radiotherapie ist eine innovative endovaskuläre minimalinvasive Therapie zur Behandlung von primären Leberneoplasien und Lebermetastasen.

Ziel

Es erfolgt eine Beschreibung der Technik und Anwendungsgebiete.

Ergebnisse

Die selektive interne Radiotherapie (SIRT) stellt inzwischen eine wichtige Säule in der Erst- und Zweitlinientherapie beim Cholangio- und hepatozellulären Karzinom dar. Bei Lebermetastasen kommt die Radioembolisation (⁹⁰Y-RE) meist zum Einsatz, wenn die Metastasierung unter Chemotherapie progredient ist und sich auf die Leber beschränkt („liver only") oder dominant („liver dominant") ist. Diese Therapieindikation wird vereinzelt auch als Salvage-Situation oder chemorefraktäre Situation bezeichnet.

Schlussfolgerung

Die Evidenzlage für die SIRT wird durch neuere Studien deutlich verbessert. Inzwischen findet die SIRT als alternatives Therapiekonzept für die Behandlung von Leberneoplasien Einzug in die onkologischen Leitlinien.

Fehlerhafte Primärdiagnostik beim Mammakarzinom

Proteomics in asthma: the clinicians were right after all, were not they?

Clinical disease phenotypes with underlying information of molecular and biological signatures for the same, is a prerequisite for improving medical care and developing more effective, stratified management st...

What are the clinically important outcome measures in the surgical management of nasal obstruction?

Abstract

Objectives

to assess the correlation between the Nasal Obstruction Symptom Evaluation (NOSE) scale and peak nasal inspiratory flow (PNIF) measurement, and to determine which outcome variable correlates with patient satisfaction and thereby, successful surgical outcome.

Design

Prospective case series.

Setting

Rhinology practice in a tertiary referral centre (Liverpool, U.K).

Participants

Patients having surgery (septoplasty, turbinoplasty) for nasal obstruction.

Main outcome measures

NOSE, PNIF, 5-point Likert scale (weighted from "very satisfied" to "not at all satisfied") and a 10 cm visual analogue scale (0 = not at all satisfied, 10 = very satisfied).

Results

Forty-five (15 female) had complete datasets available for analysis. The mean pre-operative NOSE score was 78.4 (standard deviation, SD 14.8) and improved significantly to 23.0 (SD 19.1) post-operatively. A similar trend was observed where the mean pre-operative PNIF improved significantly by 40% from 91.8L/min (SD 28.2) to 139.9 (SD 27.9) following surgery. The mean improvement in NOSE score of the overall study cohort was 55.4 (SD 22.3) while the mean improvement in PNIF was 48.0 (SD 31.1). Although no correlation was observed between pre- and post-operative NOSE and PNIF, a significant (p = 0.01) but weak positive correlation (r = 0.39) was observed between the magnitude of change in NOSE and PNIF. The mean change in NOSE score of patients who were "very satisfied" with their nasal operation was 64.0 (SD 18.5), significantly higher compared to 39.2 (SD 17.9) in patients who were "satisfied".

Conclusions

Patients who rate being either "satisfied" or "very satisfied" demonstrated significant improvement in NOSE and PNIF following their nasal surgery; the magnitude being twice the calculated minimal clinically important difference.

This article is protected by copyright. All rights reserved.

Auditory display as feedback for a novel eye-tracking system for sterile operating room interaction

Abstract

Purpose

The growing number of technical systems in the operating room has increased attention on developing touchless interaction methods for sterile conditions. However, touchless interaction paradigms lack the tactile feedback found in common input devices such as mice and keyboards. We propose a novel touchless eye-tracking interaction system with auditory display as a feedback method for completing typical operating room tasks. Auditory display provides feedback concerning the selected input into the eye-tracking system as well as a confirmation of the system response.

Methods

An eye-tracking system with a novel auditory display using both earcons and parameter-mapping sonification was developed to allow touchless interaction for six typical scrub nurse tasks. An evaluation with novice participants compared auditory display with visual display with respect to reaction time and a series of subjective measures.

Results

When using auditory display to substitute for the lost tactile feedback during eye-tracking interaction, participants exhibit reduced reaction time compared to using visual-only display. In addition, the auditory feedback led to lower subjective workload and higher usefulness and system acceptance ratings.

Conclusion

Due to the absence of tactile feedback for eye-tracking and other touchless interaction methods, auditory display is shown to be a useful and necessary addition to new interaction concepts for the sterile operating room, reducing reaction times while improving subjective measures, including usefulness, user satisfaction, and cognitive workload.

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Spontaneous Involution (Regression) of a Solitary Cutaneous Myofibroma in an adult patient: Case Report

Abstract:

Myofibromas are unusual benign tumors most commonly seen in infant children. Clinical involution of the tumor often occurs within the first few years of life. Solitary cutaneous myofibroma is the synonymous adult counterpart of infantile myofibromatosis. Although solitary myofibromas have been reported in patients of all ages, only the infantile variant is believed to regress spontaneously. There are only a few case reports of adolescent and young adult patients with regressing solitary lesions that have been described in the literature to date.¹

We report a 71-year-old male with spontaneous regression of solitary cutaneous myofibroma. The residual lesion was excised and to date has not recurred. This report describes the historical, clinical, and histopathological features of adult myofibromas and a novel manifestation that may guide future clinical considerations when approaching solitary tumors with regressive features.

Antibiotic treatment disrupts bacterial communities in the colon and rectum of SIV-infected macaques

Abstract

Antibiotic therapies are known to disrupt gastrointestinal (GI) bacterial communities. HIV and pathogenic simian immunodeficiency virus (SIV) infections have also been associated with disrupted GI bacterial communities. We administered a combination antibiotic therapy to six SIV-infected rhesus macaques (RM) and collected colon biopsies, stool samples, and rectal swabs before and after antibiotics, and evaluated the bacterial communities at each sample site using high-throughput 16S rRNA gene sequencing. The colon mucosa and stool samples displayed different bacterial communities, while the rectal swabs showed a mixture of the mucosal and stool-associated bacteria. Antibiotics disrupted the native bacterial communities at each sample site. The colon mucosa showed depleted abundances of the dominant Helicobacteraceae, while we found depleted abundances of the dominant Ruminococcaceae sp. in the stool. The rectal swabs showed similar trends as the colon mucosa, but were more variable. After the antibiotic treatment, there were increased abundances of similar taxa of facultative anaerobic bacteria, including Lactobacillaceae and Enterobacteriaceae at each sample site.

Reconstruction par lambeau de Taylor après amputation abdomino-périnéale : à propos de 68 cas

Publication date: Available online 26 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): D. Boccara, K. SerroR, J. Lefevre, M. Mimoun, M. Chaouat
IntroductionLa cicatrisation après amputation abdomino-périnéale est souvent difficile notamment chez les patients ayant bénéficié d'une radiothérapie. La reconstruction vaginale est également un enjeu important pour les femmes ayant bénéficié de cette chirurgie. Nous décrivons et analysons ici notre série de reconstructions périnéales par lambeau de Taylor modifié.Matériel et méthodeEntre 2010 et 2016, 68 (52 femmes, 16 hommes) patients ont bénéficié d'une reconstruction par lambeau musculocutané de grand droit de l'abdomen à pédicule inférieur et à palette oblique dans les suites d'un cancer du canal anal (53), d'adénocarcinome du bas rectum (9) ou d'autres tumeurs malignes du périnée.RésultatsÀ distance de l'intervention, tous les patients ont cicatrisé avec une médiane à 30jours. Le taux de reprises chirurgicales était de 11,7 % dont 1 pour éventration. Les principales causes de retard de cicatrisation étaient les désunions cicatricielles, les abcès et les nécroses partielles. Aucun lambeau n'a ainsi été déposé. La durée moyenne d'hospitalisation était de 23,7jours.ConclusionLa reconstruction des pertes de substance périnéales post-amputation abdomino-périnéale a été grandement améliorée et fiabilisé par la réalisation de lambeaux de Taylor modifiés. Elle permet une cicatrisation complète et rapide avec un faible comorbidité.PurposesHealing after abdomino-perineal resection is often difficult, especially in patients who have undergone radiation therapy. Vaginal reconstruction is also an important issue for the women who undergo this surgery. We describe and analyze here our series of perineal reconstructions with modified Taylor flaps. Between 2010 and 2016, 68 patients (52 women, 16 men) with cancer of the anal canal (53), adenocarcinoma of the lower rectum (9), or other malignant neoplasms of the perineum underwent reconstruction with a rectus abdominis myocutaneous (RAM) flap with an inferior pedicle and an oblique skin paddle.ResultsThis review of records showed that all patients healed, with a median of 30 days. The reoperation rate was 11.7% including 1 for eventration. The principal causes for delayed healing were scar dehiscence, abscess, and partial necrosis. No flap required removal, however. The mean duration of hospitalization was 23.7 days.ConclusionModified Taylor flaps substantially improved the reconstruction of defects resulting from abdomino-perineal resection. They enabled complete and rapid healing with low comorbidity.

The inframammary skin-sparing mastectomy technique

Publication date: Available online 16 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): G.-T. Lam, J.-G. Feron, P. Mallon, A. Roulot, B. Couturaud
Skin-sparing mastectomy and immediate implant-based breast reconstruction is technically a challenging procedures for women with large, ptotic breasts. This is usually performed using the Wise pattern incision resulting in an inverted T scar, which is associated with postoperative complications. The other challenge is obtaining adequate coverage of the prosthesis. We describe a technique that avoids the inverted T scar and provides a single horizontal scar with a double dermo-muscular layer coverage of the prosthesis.

Utilisation du vert d’indocyanine en chirurgie sénologique et reconstruction mammaire

Publication date: Available online 26 October 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): S. Struk, J.-F. Honart, Q. Qassemyar, N. Leymarie, B. Sarfati, H. Alkhashnam, C. Mazouni, F. Rimareix, F. Kolb
Le vert d'indocyanine est un colorant soluble dans l'eau, à élimination hépatique et excrétion biliaire. Illuminé par une source laser infrarouge, le vert d'indocyanine émet une lumière fluorescente dans le spectre du proche-infrarouge qui est invisible à l'œil nu mais qui peut être visualisée à l'aide d'une caméra proche-infrarouge. Lorsqu'il est injecté en intraveineux, il peut être utilisé comme marqueur de la perfusion cutanée. Injecté en sous-cutané, il permet de cartographier le réseau lymphatique. En chirurgie sénologique et en reconstruction mammaire, il est utilisé pour repérer le ganglion sentinelle chez les patientes atteintes d'un cancer du sein, pour évaluer la perfusion des lambeaux cutanés de mastectomie, pour évaluer la perfusion des lambeaux libres utilisés en reconstruction mammaire autologue et dans la prise en charge du lymphœdème secondaires des membres. Le vert d'indocyanine pourrait être enfin utilisé pour guider l'excision des tumeurs non palpables du sein.The Indocyanine green (ICG) is a soluble dye that is eliminated by the liver and excreted in bile. When illuminated by an near-infrared light, the ICG emits fluorescence in the near-infrared spectrum, which can be captured by a near-infrared camera-handled device. In case of intravenous injection, ICG may be used as a marker of skin perfusion. In case of interstitial injection, it may be useful for lymphatic network mapping. In oncological and reconstructive breast surgery, ICG is used for sentinel lymph node identification, to predict mastectomy skin flap necrosis, to assess the perfusion of free flaps in autologous reconstruction and for diagnosis and treatment of upper limb secondary lymphedema. Intraoperative indocyanine green fluorescence might also be used to guide the excision of nonpalpable breast cancer.

Editorial Board

Publication date: October 2017
Source:Annales de Chirurgie Plastique Esthétique, Volume 62, Issue 5

Editorial board

Publication date: November 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 11

Calendrier

Publication date: November 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 11

Journées dermatologiques de Paris 2017

Publication date: Available online 26 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Delaporte

Dermatose neutrophilique du dos des mains après une griffure de lapin

Publication date: Available online 16 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Cariou, L. Tisseau, L. Darrieux, G. Safa, N. Ropars

Lipœdème du cuir chevelu

Publication date: Available online 16 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): L. Chaplain, P. Moguelet, A. Barbaud, P. Senet
IntroductionLe lipœdème du cuir chevelu, alopéciant ou non alopéciant, est une entité mal connue et rarement rapportée. Elle a été décrite pour la première fois en 1935 par Cornbleet. Il s'agit d'une augmentation de l'épaisseur du tissu sous-cutané du cuir chevelu, responsable d'un empâtement global de celui-ci, associée ou non à une alopécie, un prurit ou des sensations douloureuses. À l'heure actuelle, moins de 50 cas de lipœdème du cuir chevelu (alopéciant ou non) ont été rapportés dans la littérature.ObservationNous présentons ici le cas d'une femme de 36 ans, originaire de Côte d'Ivoire, qui a présenté des douleurs associées à une infiltration cliniquement palpable de l'ensemble du tissu sous-cutané du cuir chevelu. L'infiltration a été confirmée par l'imagerie en résonance magnétique (IRM). La biopsie n'était pas contributive.DiscussionNous avons diagnostiqué un nouveau cas de lipœdème du cuir chevelu non alopéciant chez une femme d'origine africaine. Aucune cause n'a été trouvée. L'abstention thérapeutique semblait l'attitude la mieux adaptée.BackgroundLipedematous scalp, with or without alopecia, is a poorly known and rarely reported entity. It was first described in 1935 by Cornbleet. It involves increased thickness of the subcutaneous tissue of the scalp, responsible for an overall thickening of the scalp, which may be associated with alopecia, pruritus or painful sensations. Currently, fewer than 50 cases of lipedematous scalp, both with and without alopecia, have been reported in the literature.Patients and methodsHerein we present the case of a 36-year-old woman from the Ivory Coast, who presented scalp pain associated with infiltration of the entire subcutaneous tissue of the scalp seen clinically and confirmed at MRI. Histology added nothing.DiscussionWe diagnosed a new case of lipedematous scalp in an African woman. No cause was found. Therapeutic abstention appears the best management strategy.

Papulose lymphomatoïde

Publication date: Available online 14 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Andrea, M. Perier-Muzet, S. Dalle

Tumeur fibroépithéliale de Pinkus : corrélation dermatopathologie-dermatoscopie

Publication date: Available online 14 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Huet, G. Barnéon, B. Cribier

Eczéma photo-aggravé à la méthylisothiazolinone

Publication date: Available online 13 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz

Lésions cutanées secondaires à la médecine des ventouses (hijama)

Publication date: Available online 13 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, J.-J. Fraslin

Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative

Abstract

Objectives The goal of this study is to use Perinatal Periods of Risk (PPOR) analysis to differentiate broad areas of risk (Maternal-Health/Prematurity, Maternal Care, Newborn Care, and Infant Health) associated with being Black from those associated with being poor. Methods Phase I PPOR compared two target populations (Black women/infants and poor women/infants) against a gold standard reference group (White, non-Hispanic women, aged 20+ years with 13+ years of education), then against each other. Phase II PPOR further partitioned excess risk into (1) Very-low-birthweight-risk and (2) Birthweight-specific-mortality-risk and identified individual-level risk factors. Results Phase I PPOR revealed Black excess mortality within the Maternal-Health/Prematurity category (67% of total excess mortality). Phase II PPOR revealed that Black excess mortality within this category was primarily due to premature deliveries of very-low-birthweight infants. In a unique extension of the PPOR methodology, a poverty-excess-PPOR was subtracted from the Black-excess-PPOR, and showed that Black women have substantial excess mortality above and beyond that associated with poverty. Subsequent analyses to identify Black-specific risks, controlling for poverty, found that vaginal bleeding, premature rupture of membranes, history of preterm delivery, and having no prenatal care significantly predicted preterm delivery. Conclusions This study demonstrated the utility of PPOR, a standardized risk assessment approach for focusing health promotion efforts. In the study community, PPOR identified that maternal preconception and prenatal factors contributed the greatest risk for Black infants due to prematurity and low birthweight. Higher socioeconomic status did little to mitigate this risk. These findings informed a community-wide plan that integrated evidence-based strategies for addressing systematic racial inequity with strategies for addressing systematic socioeconomic disadvantage.

VCSim3: a VR simulator for cardiovascular interventions

Abstract

Purpose

Effective and safe performance of cardiovascular interventions requires excellent catheter/guidewire manipulation skills. These skills are currently mainly gained through an apprenticeship on real patients, which may not be safe or cost-effective. Computer simulation offers an alternative for core skills training. However, replicating the physical behaviour of real instruments navigated through blood vessels is a challenging task.

Methods

We have developed VCSim3—a virtual reality simulator for cardiovascular interventions. The simulator leverages an inextensible Cosserat rod to model virtual catheters and guidewires. Their mechanical properties were optimized with respect to their real counterparts scanned in a silicone phantom using X-ray CT imaging. The instruments are manipulated via a VSP haptic device. Supporting solutions such as fluoroscopic visualization, contrast flow propagation, cardiac motion, balloon inflation, and stent deployment, enable performing a complete angioplasty procedure.

Results

We present detailed results of simulation accuracy of the virtual instruments, along with their computational performance. In addition, the results of a preliminary face and content validation study conveyed on a group of 17 interventional radiologists are given.

Conclusions

VR simulation of cardiovascular procedure can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. VCSim3 is still a prototype, yet the initial results indicate that it provides promising foundations for further development.

Two cases of occupationally acquired Mycobacterium marinum infection in Chinese restaurant workers in Melbourne, Australia

UK trends of allergic occupational skin disease attributed to fragrances 1996–2015

Summary

Background

Fragrances are well known to cause allergic contact dermatitis (ACD). Occupationally related cases occur, with certain groups being at higher risk.

Objective

To investigate the incidence of occupationally related cases of cutaneous fragrance allergy and to evaluate trends.

Method

Data on incident cases of occupational ACD caused by fragrances between 1996 and 2015 (inclusive) reported to the EPIDERM surveillance scheme were analysed.

Results

Of the cases reported to EPIDERM during the study period, 5.2% had ACD attributed to fragrances. The highest annual incidence rates were observed in women. Hairdressers, beauticians and people working in related occupations had a 47-fold higher incidence rate ratio than the reference category (the average of all other occupations combined). Trends analysis suggested a non-significant increase in fragrance allergy over the study period among all occupations, and beauty and food workers, and a slight decrease in healthcare workers.

Conclusions

Fragrance allergy is a significant problem in an occupational setting. Although there was no significant change in the incidence of fragrance-related allergic occupational contact dermatitis (OCD) during the 20-year study period, this does not mirror the trend in OCD, which is falling. Fragrance allergy continues to be a major contributor to OCD, and contributes to a greater proportion of cases.

Indeterminism in the brain

Abstract

Does the brain behave indeterministically? I argue that accounting for ion channels, key functional units in the brain, requires indeterministic models. These models are probabilistic, so the brain does behave indeterministically in a weak sense. I explore the implications of this point for a stronger sense of indeterminism. Ultimately I argue that it is not possible, either empirically or through philosophical argument, to show that the brain is indeterministic in that stronger sense.

Non-Fictional Narrators in Fictional Narratives

Abstract

This paper is about non-fictional objects in fictions and their role as narrators. Two central claims are advanced. In part 1 it is argued that non-fictional objects such as you and me can be part of fictions. This commonsensical idea is elaborated and defended against objections. Building on it, it is argued in part 2 that non-fictional objects can be characters and narrators in fictional narratives. As a consequence, three fundamental and popular claims concerning narrators are rejected. In particular, it is shown that some fictional narratives have non-fictional internal narrators, some have no internal fictional narrator, and, most controversially, that the author of a fictional narrative can be identical to its internal narrator.

A novel model of humanised keloid scarring in mice

Abstract

Treatments for keloid scarring are a major challenge to scientists and physicians for their unknown aetiology. Although several models, including monolayer cell culture to tissue-engineered models, were developed, further research on keloid has more or less been hindered by the lack of appropriate animal models. Because these aberrant scars are specific to humans, we obtained human normal and keloid skin tissues and isolated dermal fibroblasts from them. Cell morphology, growth and immunohistochemical staining of myofibroblastmarker α-SMA were examined, and the cell medium of 2-hour culture and 24-hour culture was implanted on the back of nude mice. The cell medium of 2-hour culture and 24-hour culture was also analysed by a protein array for the detection of distinction in inflammatory factors. We showed that keloid fibroblasts had similar morphology and growth compared to normal skin fibroblasts, but the α-SMA expression was obviously up-regulated. After 6 weeks, mice of the 2-hour keloid-derived culture medium group exhibited keloid-like hypertrophic nodules macroscopically, while mice of 24-hour keloid-derived culture medium group were similar to normal skin. Histological findings confirmed that the reconstituted skin tissues had the typical features of human keloids. The protein array data revealed that RANTES were involved in humanised fibrotic occurrence in mice, also suggesting they were important modulators of this inflammatory event. This novel model might help to understand the key events that result in the formation of these abnormal scars and provide new therapeutic options.

Review Symposium of David Corey, The Sophists in Plato’s Dialogues

Occupational hand eczema and/or contact urticaria: factors associated with change of profession or not remaining in the workforce

Summary

Background

Occupational hand eczema and/or contact urticaria may have social consequences such as change of profession or not remaining in the workforce.

Objectives

To identify factors associated with job change in a cohort of participants with recognised occupational hand eczema/contact urticaria

Methods

A registry-based study including 2703 employees with recognised occupational hand eczema/contact urticaria in Denmark in 2010/2011. Four to five years later the participants received a follow-up questionnaire, comprising questions on current job situation (response rate 58.0%).

Results

At follow-up, 51.3% of the participants were no longer in the same profession. 32.5% had changed profession and 18.8% were no longer in employment. Change of profession was associated with young age, positive patch test, low educational level and severity of hand eczema/contact urticaria. With regard to specific professions, cleaning personnel changed profession significantly more often than other workers [71.4% (OR = 2.26)], health care workers significantly less often than other workers [34.0% (OR = 0.36)].

Conclusion

Job change occurs frequently during the first years after recognition of occupational hand eczema/contact urticaria and more often among patients with positive patch test reactions, with severe hand eczema/contact urticaria. Whether job changes improve the prognosis of occupational hand eczema/contact urticaria remains to be established.

The current status of Aureobasidium pullulans in biotechnology

Abstract

Different strains of the saprophytic yeast-like fungus Aureobasidium pullulans (Ascomycota: Dothideales) exhibit different biochemical characteristics, while their ubiquitous occurrence across diverse habitats and environmental conditions makes them an easily accessible source for biotechnological exploitation. They are useful in agricultural and industrial applications. Their antagonistic activities against postharvest pathogens make them suitable bioagents for the postharvest preservation of fruits and vegetables, while they possess antimicrobial activities against bacteria and fungi. Additionally, A. pullulans appears to be a potent source of single-cell protein. Many strains of A. pullulans harbor a wide range of industrially important enzymes, while the trademark exopolysaccharide pullulan that they produce has been extensively studied and is currently used in many applications. They also produce poly (β-l-malic acid), heavy oil liamocins, siderophore, and aubasidan-like β-glucan which are of interest for future applications. Ongoing studies suggest that A. pullulans holds many more interesting properties capable of further potential biotechnological applications.

A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound

ABSTRACT

The occurrence of calcific myonecrosis of the anterior compartment of the leg is rare. Common risk factors include a history of trauma, although little is known about the exact pathophysiology, latency period or triggering factors resulting in disease progression. Macroscopically, it begins with a single muscle being replaced by a fusiform calcified mass, which progresses peripherally.

We present a rare case of a 7-year history of chronic discharging sinus overlying the site with protruding calcified muscle and discuss the senior author's wound management strategy and surgical considerations.

The initial approach used dressing applications to reduce wound exudate while obtaining repeated imaging for disease progression comparison. Repeated CT scans showed significant disease progression from a single solitary amorphous soft tissue calcification to disseminated scattered calcified myonecrosis. In planning such surgeries, extensive debridement and temporary wound coverage is the first stage. Subsequent definitive coverage includes skin grafting of the remaining defect.

Use of epidermal skin grafts in chronic wounds: a case series

Abstract

In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3–180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.

The inter-rater reliability between nurse-assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter-rater reliability between one expert-nurse and four clinical-nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria.

A quasi-experimental design was used to collect the data. In comparison to phase 1 in which 'open questions' were asked, in phase 2 a pre-printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter-rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate.

In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter-rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect- and a perfect agreement for malodour and pain, respectively.

According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre-printed form than making use of an 'open questions' form. To provide this with a higher level of evidence, there is need for more well conducted studies.