Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Marcela Valverde-Monge, Mar Fernández-Nieto, Vanessa Balugo López, J.M. Rodrigo-Muñoz, J.A. Cañas, Beatriz Sastre, Manuela García del Potro, Manuel De las Heras, Victoria del Pozo, Joaquin Sastre
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Purificación Gonzalez-Delgado, Esther Caparrós, M Victoria Moreno, Begoña Cueva, Javier Fernández
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Mirna Chehade, Stacie M. Jones, Robbie D. Pesek, A. Wesley Burks, Brian P. Vickery, Robert A. Wood, Donald Y.M. Leung, Glenn T. Furuta, David M. Fleischer, Alice K. Henning, Peter Dawson, Robert W. Lindblad, Scott H. Sicherer, J. Pablo Abonia, Joseph D. Sherrill, Hugh A. Sampson, Marc E. Rothenberg
Eosinophilic esophagitis (EoE) is increasingly common, but data on phenotypic aspects are still incomplete.
To describe the clinical, endoscopic and histopathological features of a large number of children and adults with EoE across the US.
This was a multi-site single visit registry enrolling subjects aged 6 months-65 years with EoE. Participants provided responses regarding their medical history, with verification of the diagnosis and history by the study teams.
705 subjects were analyzed (median [IQR] age at enrollment 11.2 [6.7-17.7] years, 68.2% male, 87.9% whites). 67 subjects had concurrent gastrointestinal eosinophilia, with gastric mucosa most common. An age and race-dependent time gap was present between symptom onset and time of diagnosis (adults and whites with longer gap). Food allergy and atopic dermatitis were associated with a decrease in this gap. Symptoms varied with age (more dysphagia and food impaction in adults) and with race (more vomiting in non-whites). Esophageal rings and strictures at diagnosis were more common in adults, although esophageal eosinophilia was comparable among age groups. Concomitant allergic disease (91%), infectious/immunological disorders (44%), neurodevelopmental disorders (30%) and failure to thrive (21%) were common. Depression/anxiety increased with age. EoE was reported in 3% of parents and 4.5% of siblings.
Gastrointestinal eosinophilia is present in ∼10% of EoE patients; the symptom-diagnosis time gap is influenced by age, race, food allergy and atopic dermatitis; symptoms vary with race; concurrent infectious/immunological disorders and mental health disorders are common; and the level of esophageal eosinophils is comparable in patients with and without fibrostenotic features.
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Hille Suojalehto, Joaquin Sastre, Emilia Merimaa, Irmeli Lindström, Katri Suuronen
Two-component epoxy resin systems (ERS) composed of epoxy resin and polyamine hardeners are extensively used in industrial and construction coating. Triglycidyl isocyanurate (TGIC) is another type of epoxy derivative, mostly encountered in polyester powder paints. Epoxy compounds are well known skin sensitizers, but their respiratory sensitizing potential is largely unknown.
We report patients examined for occupational asthma from epoxy compounds.
We retrospectively reviewed patient files of cases tested with a placebo-controlled specific inhalation challenge (SIC) according to their workplace exposure: either by mixing epoxy resin and the polyamine hardener of a two-component paint or by dusting or heating TGIC-containing powder paint. The data were collected from the Finnish Institute of Occupational Health and at the Fundación Jiménez Díaz Hospital, Spain, in 1997–2018. We also measured airborne polyamine and solvent vapours at the workplace and during SIC with ERS.
Altogether 113 patients with work-related asthma symptoms underwent SIC with ERS. Fifteen cases (13%) had positive SIC reactions confirming occupational asthma; in 12 cases reactions were late type, in one case early and in two cases combined. The median duration of exposure of occupational asthma patients was ten years, two of them (13%) had a diagnosis of allergic contact dermatitis from ERS compounds. In addition, three cases had a positive SIC reaction to TGIC. The airborne polyamine levels measured were low.
ERS and TGIC can cause sensitizer-induced occupational asthma in some exposed workers. Respiratory exposure to ERS is difficult to demonstrate using air measurements.
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Ryan W. Nelson, Amy E. O'Connell, Fayhan Alroqi, Kosuke Kawai, Michael C. Young, Ana Dioun Broyles
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Manuel Jorge Rial, Blanca Barroso, Joaquín Sastre
Publication date: Available online 1 August 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Takazumi Yoshida, Rieko Kondo, Takahiko Horiguchi
Clinical &Experimental Immunology, EarlyView.
Oil pollution is one potential consequence of industry development, and oil contamination occurs in countries around the world. However, few studies have examined the detrimental effects of oil on plant anatomy. Therefore, the objectives of this study were (1) to determine the impacts of crude oil on the physiological and anatomical parameters of Ischaemum muticum L. (Poaceae) and (2) to examine its potential as a bioindicator of oil pollution. Experimental plants were treated with one of four concentrations of crude oil (1%, 2%, 3%, and 4% volume/weight) and compared to control plants (no oil applied). Four physiological and 23 anatomical parameters were measured 7, 15, 30, 45, and 60 days after treatment. Crude oil negatively affected both physiological traits (leaf width and chlorophyll content) and anatomical traits (midrib vascular bundle height, leaf cutin thickness, leaf vascular bundle width and height, abaxial and adaxial margin cutin thickness, adaxial stomata density, adaxial short cell width, and abaxial long cell width). In general, the affected traits were modified by even the lowest oil concentration tested (1%). We discuss the potential of I. muticum as a bioindicator of oil pollution, given its prevalence in coastal areas of the paleotropics and its sensitivity to oil contamination.
Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.
Metabolic Syndrome and Related Disorders, Ahead of Print.
Publication date: Available online 31 July 2018
Source: The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Rebecca R. Saff, Yu Li, Nikita Santhanakrishnan, Carlos A. Camargo, Kimberly G. Blumenthal, Li Zhou, Aleena Banerji
The study of allergic drug reactions has been limited due to challenges in identifying and confirming cases.
To determine the utility of ICD-9-CM codes for identifying inpatient allergic drug reactions and compare findings to prior data in the emergency department.
By reviewing medical records of inpatients with ICD-9-CM codes and E codes suggestive of allergic drug reactions at a large urban academic medical center, we determined codes that yielded the most drug allergy cases and identified culprit drugs.
In 2005 and 2010, 3,337 and 5,282 possible allergic drug reactions during hospitalization were identified and 1,367 were reviewed. Allergic drug reactions were found in 409 (30.1%) of the reviewed charts with 172 (29.7%) in 2005 and 237 (30.5%) in 2010. The codes that identified the highest percentage of true allergic drug reactions were: Dermatitis due to drug (693.0), allergic urticaria (708), angioneurotic edema (995.1) and anaphylaxis (995.0). Antibiotics were the most common cause (44.4%); however, multiple drugs classes were often identified as likely culprits.
Specific ICD-9-CM codes can identify patients with allergic drug reactions, with antibiotics accounting for almost half of true reactions. The majority of patients with codes 693.0, 995.1, 708, and 995.0 had allergic drug reactions, with 693.0 as the highest yield code. An aggregate of multiple specific codes consistently identifies a cohort of patients with confirmed allergic drug reactions.
Publication date: Available online 31 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): Hemanth Naick Banavath, Srinivasa Rao Allam, Stella Sravanthi Valathati, Alok Sharan, Baskaran Rajasekaran
Chronic myelogenous leukemia (CML) is a myeloproliferative disorder occurs in the pluripotent hematopoietic stem cell. Currently, first-generation tyrosine kinase inhibitor (TKI) imatinib is the mainstay for the treatment of CML. Second generation TKI's like ponatinib, dasatinib, nilotinib, and bafetinib were treated against resistant CML. However, several CML patients develop resistance towards all existing inhibitors. Curcumin (Curcuma longa) a plant-derived natural compound is an effective bioactive component against various cancers including CML. Many studies have shown that curcumin induces time- and dose-dependent apoptosis in CML cells by regulating various downstream molecular regulators. Despite curcumin's selective cytotoxicity towards cancer cells, it has very poor bioavailability both in in-vitro and in-vivo conditions. In this present study, we have used femtosecond laser (fs-laser) pulses to ablate the cell membrane and standardized the conditions required for creating a cell membrane pores with less lethality. Following, fs-laser pulse irradiated K562 cells were incubated along with curcumin 30 μM for 0 h, 6 h,12 h and 24 h interestingly irradiated cells have shown higher sensitivity towards curcumin than non-irradiated cells. Immunoblotting studies showed higher induction levels of cleaved caspase 3 and 9 in irradiated population than non-irradiated. In summary, the results prove that irradiation by fs-laser pulses enhanced the bioavailability of curcumin and shows caspase-mediated cell death in irradiated CML cells than other populations.
Publication date: Available online 31 July 2018
Source: Journal of Photochemistry and Photobiology B: Biology
Author(s): P. Morlière, A.M.S. Silva, R.S.G.R. Seixas, F. Boscá, J.-C. Mazière, J. Ferreira, R. Santus, P. Filipe
The phototoxicity of voriconazole (VN) prescribed in the treatment of severe fungal infections is frequently reported. Its major metabolite, a N-oxide derivative (VNO), was suspected to be the photosensitizer because it shows a maximum absorbance at ~310 nm in aqueous solutions. It was reported that the VNO photoproduct (VNOP) was phototoxic to human keratinocytes. Steady state and laser flash photolyses were performed to shed light on the phototoxic properties of VNO and VNOP. The quantum yield of the VNOP production by UVB-UVA light in buffered or alcoholic solutions is 0.6. VNOP has been identified as (2R,3S)-2-(2,4-difluorophenyl)-3-(5-fluoro-7-oxa-1,3-diazabicyclo[4.1.0]hepta-2,4-dien-4-yl)-1-(1H-1,2,4-triazol-1-yl)butan-2-ol. VNOP undergoes a marked thermal degradation and an efficient UVA photolysis with well differentiated kinetics and end-products. The temperature-dependent VNOP dark degradation produces a single product VNOPD identified as 6-[(2S,3R)-3-(2,4-difluorophenyl)-3-hydroxy-4-(1H-1,2,4-triazol-1-yl)butan-2-yl]-5-fluoropyrimidin-4-ol with absorbance maximum at 308 nm and ε = 2700 M−1 cm−1. Under UVB-UVA irradiation, VNOPD, the stable end-product, is a remarkable photodynamic photosensitizer towards Trp and His. The Trp photo-oxidation (Φox(Trp) = 0.13) mainly involves type I radical reactions whereas His is oxidized by 1O2 (Φox(His) = 0.012). These results force us to question the validity of the in vitro photosensitization of human keratinocytes by VNO and VNOP previously reported.
Voriconazole N-oxide (VNO) and its photoproduct (VNOP) are not photosensitizers, but the VNOP degradation product (VNOPD) is a photodynamic agent
To present the second known case of nasal alar schwannoma, first since 1973, with important considerations for surgical management.
We present the case of a 25-year-old male with a 5-year history of progressively enlarging, non-tender, right alar mass with resultant ipsilateral nasal congestion and dyspnea secondary to nasal valve collapse. The mass was located cephalic to the mid-lateral aspect of the lower lateral crural cartilage, which extended to the pyriform aperture. The mass was removed in an en bloc fashion using an endonasal rhinoplasty approach with placement of an alar batten graft for valve stabilization. The surgical pathology of the mass was consistent with schwannoma.
Regardless of the rarity, schwannoma should remain on the list of possible etiologies for a nasal alar mass. Depending on the size and concurrent mass effect, the external nasal valve may be compromised requiring careful evaluation and operative stabilization for optimal postsurgical outcome.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Breast reconstruction with a Becker-type expander is a common technique following mastectomy. However, inconsistency remains in the literature regarding risk factors for the survival of a Becker-type expander following immediate breast reconstruction. This study's purpose is to investigate possible risk factors for the Becker-type expander survival and to evaluate the complications related to expander removal following immediate breast reconstruction.
We performed a retrospective chart review of consecutive women who underwent a mastectomy followed by immediate breast reconstruction with a Becker-type expander from November 2010 to November 2016. Electronic medical records were analyzed retrospectively for demographic, clinical, operative characteristics, and outcomes. Univariate Cox regression analysis was performed to determine the risk factors for the survival of the Becker-type expander following immediate breast reconstruction.
A total of 74 Becker-type expanders were used in 72 patients who underwent immediate breast reconstruction. The patients' ages ranged from 27 to 71 years, with a mean ± standard deviation age of 44.6 ± 9.1 years. The most frequent complication was capsular contracture which occurred in 25 breasts (33.8%) followed by mastectomy skin flap necrosis in 6 breasts (8.1%), seroma in 4 breasts (5.4%), nipple-areolar complex necrosis in 4 breasts (5.4%), hematoma in 3 breasts (4.1%), and infection in 2 breasts (2.7%). The mean intraoperative expander fill volume (109.6 ± 66.9 cc [p = 0.039]) and mean total volume (386.5 ± 94.7 cc [p = 0.034]) were both significantly lower for patients with capsular contracture compared with those without capsular contracture. In patients with partial NAC necrosis, the mean mastectomy specimen volume (737.5 ± 242.8 cc) was significantly higher compared with patients without partial NAC necrosis (489.8 ± 219.0 cc; p = 0.027). A univariate Cox regression analysis showed that smoking and neoadjuvant therapy were significantly associated with expander removal (p = 0.023 and p = 0.006, respectively).
The total volume of the expander and intraoperative fill volume of the expander appear to be predictive factors in the development of capsular contracture. However, there is no statistically significant association between radiotherapy and capsular contracture or expander survival in contrast with other published reports. Our findings reveal that the main risk factors for the survival of Becker-type expanders following immediate breast reconstruction are smoking and neoadjuvant therapy. To our knowledge, this is the first study to evaluate the most likely risk factors associated with Becker-type expander survival in immediate breast reconstruction.
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Implant rippling is a frequent complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction. Traditionally, the treatment has been to replace the implant, often placing it in a subpectoral pocket to reduce the risk of recurrence. Other techniques, such as increasing the implant size or tightening the capsule, can also be used. Recently, however, there has been much interest in alternative treatments, including fat grafting or insertion of an acellular dermal matrix.
We review the evidence base for emerging treatments and propose a classification to grade severity, based on the typical clinical presentation of rippling: Grade 1—MILD—rippling is palpable but not visible: (1a) palpable in the lower outer quadrant, (1b) palpable in the upper inner quadrant (cleavage area); Grade 2—MODERATE—rippling is visible only when the patient bends forward; Grade 3—SEVERE—rippling is visible with the patient upright.
Our proposed classification aims to standardise the clinical description of rippling, which will be valuable in determining the efficacy of new treatments and better characterising long-term complications from breast augmentations or reconstructions.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Dermatologic Therapy, EarlyView.
Migraine is a common and disabling disorder. Fibromyalgia has been shown to be commonly comorbid in patients with migraine and can intensify disability. The aim of this study was to determine if patients with ...
The Journal of Dermatology, EarlyView.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Jaehoon Choi, Ryeolwoo Kim, Junhyung Kim, Woonhyeok Jeong, Sang Woo Park, Hyoun Wook Lee, Ho Yun Chung
We assessed whether nicorandil, an adenosine triphosphate–sensitive K + channel opener, reduces burn wound progression in a rat comb burn model. A total of 24 rats were used. Following thermal injury, one dose of nicorandil (10 or 30 mg/kg) was administered intragastrically twice daily for 3 days. At days 1 and 3 after injury, skin was harvested for histopathological examination and protein isolation. Rats treated with the 10-mg/kg and 30-mg/kg doses of nicorandil exhibited significantly increased tissue survival in the zone of stasis at days 1 and 3 after injury. The 10-mg/kg and 30-mg/kg nicorandil doses also significantly increased skin perfusion in the zone of stasis at days 1 and 3 after injury. At 30 mg/kg, nicorandil significantly reduced hypoxia-inducible factor-1α expression in the zone of stasis at day 1 after injury and reduced inflammatory responses in the zone of stasis. The latter effect included decreased polymorphonuclear neutrophil leukocyte infiltration and interleukin-1β release at day 1 after injury. At 30 mg/kg, nicorandil also significantly reduced expression of nuclear factor-κB p65, akey transcriptional factor in the regulation of inflammatory mediators, in the zone of stasis at day 1 after injury. Our study demonstrates that a 30 mg/kg dosing schedule of nicorandil increases tissue survival in the zone of stasis by attenuating ischemia–reperfusion injury. This effect is mediated by the enhancement of skin blood flow and reduction in the inflammatory response. Therefore, our findings suggest that nicorandil has potential clinical applications for patients with burns.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Mikkel Børsen Rindom, Gudjon L. Gunnarsson, Marianne D. Lautrup, René D. Christensen, Jens A. Sørensen, Jørn B. Thomsen
We report a study evaluating and comparing shoulder-related morbidity associated with delayed breast reconstruction using either the conventional latissimus dorsi (LD) flap or the thoracodorsal artery perforator (TAP) flap.
We conducted a retrospective cohort study of women over 18 years of age who had a unilateral, delayed breast reconstruction by either an LD or TAP flap at one center over a 56-month period. Shoulder function was assessed using the Constant Shoulder Score (CSS), which evaluated pain, activity of daily life (ADL), range of motion (ROM), and strength. A number of secondary outcomes were also examined.
Forty-nine women were included. Demographic and breast treatment data were comparable between the groups. The mean total CSS score for the reconstructed side of the TAP flap was statistically significantly better than that of the LD flap, with a difference of 10.9 points (95% confidence interval [CI] = 2.6–19.2, p-value 0.01). The mean total CSS score for the nonreconstructed side was not statistically significant between groups, with a difference of 0.1 points (95% CI = -6.1-6.2, p-value 0.98). The subscore analysis revealed that women reconstructed using the TAP flap had a difference of 3.2 points for pain (p-value 0.003) and 5.5 points for ROM (p-value 0.011). The factors ADL and strength were of equal magnitude in both groups.
Patients who undergo delayed breast reconstruction by the TAP flap seem less prone to suffer from postoperative pain and restricted ROM, thereby suggesting that this flap should be considered an advantageous alternative to the conventional LD flap. A randomized clinical trial is warranted to provide sufficient evidence to this statement.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Chiara Stocco, Andrea Figus, Sergio Razzano
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Anne F. Klassen, Manraj N. Kaur, Andrea L. Pusic
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Enrique Salmerón-González, Eduardo Simón-Sanz, Elena García-Vilariño, Alberto Ruiz-Cases
Background
This article describes the use of fibrin sealant for nerve coaptation without sutures in masseter-to-facial nerve transfer; and the results obtained utilizing this technique in a series of eleven patients.
Methods
A retrospective review of eleven patients with facial paralysis grades V-VI was performed. All patients underwent masseter nerve transfer for facial reanimation utilizing a fibrin sealant, without utilizing sutures for coaptation.
Results
The follow up period ranged from 10 to 52 months. All patients recovered oral competence, eye closure, facial tone and a smile grade of 4,45 +/- 0,52 according to Terzis aesthetic and functional evaluation scale. Muscle contraction started 3-9 months postoperatively (average 4,7 +/- 2,3).
Conclusions
The use of fibrin glue without sutures for coaptation in masseter-to-facial nerve transfer, simplifies the procedure and shortens surgical timing, not requiring the logistics of a microsurgical team, with similar results than neurorraphy performed with sutures. The masseter-to-facial nerve transfer is an effective technique for facial reanimation in short-term complete paralysis and mid-term partial paralysis.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Yu Kit Li, Morris Ritz
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Josefine Bunke, Rafi Sheikh, Jenny Hult, Malin Malmsjö
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Alexander J. Baldwin
Mollie Lentaigne was a medical artist who worked at the Queen Victoria Hospital in East Grinstead during the Second World War alongside Archibald McIndoe and his dedicated team. She drew hundreds of medical illustrations for McIndoe and his fellow surgeons during the years between 1940 and 1945. Her illustrations depict the plastic surgery that was carried out in that hospital on the badly burnt RAF servicemen injured during the war that took place in the skies over Europe, which included many aircrew injured during the Battle of Britain.
This project looks at the career of Lentaigne and her role within the surgical team in East Grinstead during that era and explores a number of Lentaigne's illustrations whilst providing context as to the procedures and patients depicted. An examination of Lentaigne's story, using an interview conducted by the author with the artist offers an alternative perspective with which to observe the events that unfolded in East Grinstead during that conflict.
An analysis of these images shows the ability of this artist to portray relatively complex operations with a series of simple pencil or ink diagrams whilst also skilfully engaging the observer's sense of touch. The ability of a medical artist to be selective with her illustrations allowed them to provide clearer, less cluttered images that were preferred by McIndoe when recording the specific surgical procedures for use in the patient's medical records.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Ming Zhu, Fei Liu, Chaozheng Zhou, Li Lin, Yan Zhang, Gang Chai, Le Xie, Fazhi Qi, Qingfeng Li
Augmented reality (AR)-based navigation surgery has evolved to be an advanced assisted technology. The aim of this study is to manifest the accuracy of AR navigation for the intraoperative mandibular angle osteotomy by comparing the navigation with other interventional techniques.
A retrospective study was conducted with 93 post-surgical patients with mandibular angle hypertrophy admitted at our plastic and reconstructive surgery department between September 2011 and June 2016. Thirty-one patients received osteotomy conducted using a navigation system based on augmented reality (AR group), 28 patients received osteotomy conducted using individualised templates (IT group) and the remaining 34 patients received osteotomy performed by free hand (free-hand group). The post-operative computed tomography (CT) images were reviewed and analysed by comparing with pre-surgical planning generated by three-dimensional (3D) software. The preparation time, cutting time, whole operating time and discrepancy in osteotomy lines were measured.
The preparation time was much shorter for the free-hand group than that for the AR group and the IT group (P < 0.01). However, no significant difference in the whole operating time was observed among the three groups (P > 0.05). In addition, the discrepancy in osteotomy lines was lower for the AR group and in the IT group than for the free-hand group (P < 0.01).
The navigation system based on AR has a higher accuracy, more reliability and better user friendliness for some particular clinical procedures than for other techniques, which has a promising clinical prospect.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Martinus M. van Veen, Steven F.S. Korteweg, Pieter U. Dijkstra, Paul M.N. Werker
The temporalis muscle transposition is a reliable, one-stage reanimation technique for longstanding facial paralysis. In the variation described by Rubin, the muscle is released from the temporal bone and folded over the zygomatic arch towards the modiolus. This results in unsightly temporal hollowing and zygomatic bulging. We present a modification of this technique, which preserves the temporal fat pad in its anatomical location as well as conceals temporal hollowing and prevents zygomatic bulging.
The data of 23 patients treated with this modification were analysed. May classification was used for evaluation of mouth reanimation. Experts and patients scored visibility of the contour deformity on a 100-mm visual analogue scale (VAS) (score 0 = poor/100 = best). 3D images of the face were used to measure temporal hollowing and zygomatic bulging. 3D images were compared to those of controls with a similar gender and age distribution.
After a median follow-up of 5.7 years, all patients achieved symmetry at rest. Eleven patients achieved symmetry while smiling with closed lips (May classification "Good"). A median (interquartile range [IQR]) VAS score of 19 (6; 41) was given by experts and 25 (5; 59) by patients themselves. 3D volumes of zygomatic bulging differed from those of control subjects, although all volume differences were small (median <3.3 ml) and temporal hollowing did not differ significantly.
On the basis of our results, we conclude that our modified Rubin temporalis transposition technique provides an elegant way to conceal bulging over the zygomatic arch and prevents temporal hollowing, without the need for fascial extensions to reach the modiolus.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Abdulla Ibrahim, Mahmoud K. Nassar, Daniel J. Jordan, Manish Sinha, Fiona J. Hogg
The Adult Exceptional Aesthetic Referral Protocol (AEARP) encompasses a series of aesthetic procedures which, as they do not treat an underlying disease process, are not routinely available within the National Health Service. Provision of these services can only be provided on an exceptional basis.
In this prospective study, we evaluated the referral process and outcomes of 1122 patients referred under the AEARP over a 3.5-year period. Referrals were screened by a vetting panel comprising of a plastic surgeon, clinical nurse specialist, and clinical psychologist. Following initial vetting, supported patients underwent psychological assessment. Patients supported by psychology were assessed in clinic, and if deemed clinically suitable, were offered surgery.
Overall, 20% (225/1122) of referrals were supported for surgery. Following primary vetting, 57% (640/1,122) of referrals were supported, 40% (197/492) of referrals to clinical psychology were supported, and 65% (225/345) of the remaining cases referred for consultation were supported for surgery. Unsupported referrals included those not fulfilling the referral guidelines or those with contraindications.
The AEARP is simple and effective to implement, and has been instrumental in streamlining the referral-to-outcome process in a centralised, transparent, and fair manner. It reduces a potential high number of clinic appointments where patients do not meet the aesthetic criteria and/or fail to attend – thereby helping to streamline other surgical pathways by improving clinic efficiency. Moreover, it aids referring clinicians and patient education around aesthetic issues including a holistic approach. Wide adoption of such standards may reduce waiting times, facilitate cost savings, and ultimately enhance patient outcomes.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Xuebing Liang, Keming Wang, Sunitha Malay, Kevin C. Chung, Jiguang Ma
Both autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer complications.
The authors review current literature to evaluate complication and satisfaction rates with different materials used in rhinoplasty.
A comprehensive literature search of articles was conducted in Embase and PubMed published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-Tex, or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analyzed were complications and postoperative satisfaction. After data extraction, meta-analysis using the random effect model was performed to summarize outcome parameters among different implant types.
Fifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher than that of other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes.
Our analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to the nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high-quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Deepti Gupta, Upendra Sharma, Shashank Chauhan, Shamendra Anand Sahu
Scars have multiple cosmetic and functional sequelae, and revision surgeries are an attempt to ameliorate these effects. Reduction of spread of the revised scar is one of the main objectives of revision procedures. Provision of prolonged dermal support to wound can theoretically reduce spread of the scar. We carried out a randomized controlled trial and objectively evaluated the impact of two commonly used absorbable sutures, Polyglactin 910 and Polydioxanone, on scar spread and quality. Sixty patients with post-traumatic scars of 1 year in duration were enrolled in the study and randomly divided into two groups of 30 each. After recording the demographic data and baseline scar characteristics, revision of the scar was carried out by elliptical excision and primary suturing. In Group 1, Polyglactin 910 6-0 suture (Vicryl, Ethicon, Johnson and Johnson Ltd., India) was used for dermal suturing, whereas, in Group 2, Polydioxanone 6-0 suture (PDS II, Ethicon, Johnson and Johnson Ltd., India) was used. The scar spread in terms of scar width, and scar quality with Vancouver Scar Scale (VSS) was evaluated at 1, 3 and 4 months postoperatively. The two groups were well matched for demographics and baseline scar characteristics. On follow-up, the mean scar width in Group 1 was significantly more than that in Group 2. VSS score was significantly lower in Group 2 at the third and fourth month follow up, signifying better scar quality. Suture extrusion was noticed in 3 cases in Group 1.
Compared to Polyglactin 910, Polydioxanone sutures, when used for intradermal suturing in revision of facial scars, result in a significantly decreased scar spread and better scar quality.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): K. Khan, R. Mykula, R. Kerstein, N. Rabey, T. Bragg, A. Crick, S. Heppell, P. Budny, M. Potter
A 5-year follow-up study of 633 cutaneous squamous cell cancer (SCC) excisions was performed by collecting data on rates of local recurrence (LR) and lymph node (LN) metastasis.
A retrospective analysis of patients was performed across four regional plastic surgery centres (Stoke Mandeville Hospital, Aylesbury; John Radcliffe Hospital, Oxford; Salisbury District Hospital, Salisbury and Queen Alexandra Hospital, Portsmouth) assessing rates of LR and LN metastasis.
We report 5-year outcomes from 598 SCCs (95% follow-up rate). The total recurrence rate (LR and LN metastasis) was 6.7% (n = 40) at 5 years, with 96% of these occurring within 2 years. Median time to LR was 9 months (1–57), with 76.9% (n = 20) undergoing further wide local excision. Median time to LN metastasis was 5.5 months (1–18 months). There were two cases of disease-related death. Only 15% (n = 6) of incomplete excisions recurred. Interestingly, 19.1% (n = 9) of 47 SCCs with perineural invasion on original histopathology recurred versus only 5.6% (n = 31) of the 551 SCCs without perineural invasion (p = 0.005).
This study is one of the largest studies to date following up 598 SCC excisions at 5 years with total recurrence rates comparable to those in current published literature. We report perineural invasion as a significant predictor of recurrence and that 96% of total recurrence occurred within 2 years. This is in contrast to current UK guidelines (75% at 2 years, 95% at 5 years), thus suggesting that shorter length of hospital follow-up may be reasonable.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Łukasz Paluch, Piotr Pietruski, Jerzy Walecki, Bartłomiej Henryk Noszczyk
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Mehran Dadras, Christian Böhm, Christoph Wallner, Johannes Maximilian Wagner, Björn Behr, Marcus Lehnhardt, Adrien Daigeler
Septic arthritis of the wrist is a serious condition, yet little is known about its long-term outcome. A retrospective analysis of 22 patients treated for bacterial septic arthritis of the wrist was conducted with subsequent follow-up of 18 patients with a median period of 44 months to assess functional results via DASH-Score and clinical examination.
Arthrotomy was used to treat all patients; in 19 patients, multiple operations were needed to cure the infection. Follow-up revealed a mean DASH-score of 34 (SD 22) and a significant correlation with needed surgical radicality and number of needed operations. The range of motion of the wrist and grip strength of the affected side was 49% (SD 20%) and 70% (SD 28%) of the contralateral side, respectively. In conclusion, septic arthritis of the wrist leads to long-term functional restrictions with a strong correlation with the stage of the disease. Hence, early diagnosis and treatment are paramount.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Rafael Sanjuan-Cerveró, Francisco J. Carrera-Hueso, Pedro Vazquez-Ferreiro, Clayton A. Peimer
Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease (DD) treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block before CCH injection in reducing procedural pain and to analyze its impact on adverse effects. We performed a prospective, single-center study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, whereas in the second group (BLOCK), it was performed before CCH injection and finger extension. Pain was assessed on a 10-item numerical rating scale. Our results show that pain scores were clearlylower in the BLOCK group than in the NO-BLOCK group: 4.72 vs. 0.61 for CCH injection and 3.43 vs. 0.82 for finger extension. Patients who rated CCH injection pain with a score of 4 or higher were 11 times more likely to experience pain during extension. There was a weak correlation between the use of wrist block for CCH injection and the occurrence of skin lacerations (Spearman's rho = -0.222, p < 0.01) and the presence of pruritus (Spearman's rho = 0.183, p < 0.07). In conclusion, wrist block before CCH injection is an effective measure of decreasing perceived pain throughout the different stages of CCH treatment in patients with DD.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Brielle Weinstein, Peter W. Henderson, Jessica J. Means, Andrew L. Weinstein, Martin R. Prince, Christine H. Rohde
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Patrick P. Bletsis, Lesley R. Bouwer, Klaas H. Ultee, Michel Cromheecke, Berend van der Lei
Literature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants, and thus far, studies have failed to demonstrate the visible difference in implants that are in practice compared to those that are round. This study was undertaken to evaluate (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants and (2) their opinion with regard to naturalness and attractiveness of these augmented breasts.
Twenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 to 400 g. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive, and unattractive breast shapes on a schematic depiction of breast types with varying upper poles.
The rate of correct implant identifications was 74.0% (1480/2000 observations, p < 0.001) in the lay and 67.3% (202/300 observations, p < 0.001) in the surgeon cohort. Breasts with anatomical implants were rated as significantly more natural (3.3 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.3 ± 1.0 vs. 2.2 ± 0.9, p < 0.001, respectively) and more attractive (3.1 ± 1.0 vs. 2.6 ± 1.0, p < 0.001 and 3.6 ± 0.9 vs. 2.7 ± 0.9, p < 0.001, respectively) versus round implants by both lay participants and surgeons. Participants preferred breasts with a neutral or slightly negative upper pole contour.
Participants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive.
Publication date: August 2018
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 8
Author(s): Tyler Safran, Benjamin Beland, Alex Viezel-Mathieu, James Lee
Through a comparison of the logic of socio-economic and technical development in Marx with the logic of technical invention in Simondon, I argue the thesis that worker's democracy is the forgotten political form that offers a viable alternative to both capitalism and Soviet-style Communism, the dominant political régimes of the Cold War period that have not yet been surpassed. Marx's detailed account of the capitalist technical logic from handwork through manufacture to industry is a logic of continuous concretization in Simondon's sense. Its immanent teleology is the exclusion of living labor through automation such that freedom is understood as free time apart from labor and technical activity. A post-capitalist society would require a conception of freedom in labor, such as that held by the early Marx, that demands a leap from this logic of concretization to a new technical object. Such a new technical object would require workers to engage in technical activity that continues the activity of invention in Simondon's sense. Through these interpretive and argumentative links, Simondon's possibility of transindividual technical activity and knowledge can be seen as, in socio-political terms, aiming at workplace democracy. In philosophical terms, it aims to displace the priority of thought and imagination over activity and to locate both within an ongoing impersonal task which contains the possibility of individual and social self-realization.
Journal of the European Academy of Dermatology and Venereology, EarlyView.
