JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.
Δευτέρα 16 Απριλίου 2018
Treatment of acrodermatitis continua of Hallopeau with ustekinumab as monotherapy after failure of anti‐TNF agents
ÖGDV Preisträger stellen sich vor: Der Wissenschaftspreis der ÖGDV 2017 ging an Dr. rer. nat. Stefan Hainzl und Dr. rer. nat. Patricia Peking aus Salzburg
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 527-528, April 2018.
Der subkutan gestielte retroaurikuläre Insellappen zur Rekonstruktion von Defekten des Cavum conchae
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 508-510, April 2018.
Journal‐Club
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 526-526, April 2018.
In Memoriam Prof. Dr. Ludwig Suter 1938–2018
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 535-536, April 2018.
3rd Science Days of the Austrian Society of Dermatology and Venereology – ÖGDV Forschungstage
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 532-533, April 2018.
ÖGDV Preisträger stellen sich vor: Der Österreichische Dermatologenpreis – Unilever Preis 2017 ging an Dr. Thomas Kocher aus Salzburg
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 529-531, April 2018.
Perichondritis am Ohr eines afghanischen Immigranten
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 500-503, April 2018.
Schmerzhafte gruppierte erythematöse Papeln in segmentaler Anordnung
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 496-499, April 2018.
Vernarbende Alopezien
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 435-463, April 2018.
Nicht IgE‐vermittelte Hypersensitivität auf Macrogol 6000
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 478-480, April 2018.
S1‐Leitlinie – Dermatosen bei dermaler Lymphostase
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 512-524, April 2018.
Tattooentfernung mit Laser: Gibt es bereits Pikosekundenlaser?
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 467-469, April 2018.
Die Wirksamkeit einer neuen Nagelspange für die Behandlung von eingewachsenen Nägeln
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 417-425, April 2018.
Kutanes Pseudolymphom nach quadrivalenter HPV‐Impfung – eine seltene Nebenwirkung
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 465-467, April 2018.
Patient satisfaction in 1,827 patients following various methods of facial reconstruction based on age, defect size and site
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 426-433, April 2018.
Anuläres paraneoplastisches bullöses Pemphigoid imitiert lineare IgA‐Dermatose bei einem 40‐jährigen Patienten
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 481-483, April 2018.
S1 Guidelines – Dermatoses associated with dermal lymphostasis
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 512-523, April 2018.
Multibazilläre Lepra mit dem Erscheinungsbild einer Sinusitis und eines chronischen, persistierenden Angioödems
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 470-472, April 2018.
Cicatricial alopecia
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Volume 16, Issue 4, Page 435-461, April 2018.
In vivo reflectance confocal microscopy combined with the ‘spaghetti technique’ for the identification of surgical margins of lentigo maligna: experience in 70 patients
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Generalized pustular psoriasis: a review and update on treatment
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Who will treat inflammatory skin diseases in the year 2020?
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Oral psoriasis and SIBO: is there a link?
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Circular RNA expression profile analysis of severe acne by RNA‐Seq and bioinformatics
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Google search trends in psoriasis: a pilot evaluation of global population interests
Journal of the European Academy of Dermatology and Venereology, EarlyView.
Efficacy of suplatast tosilate in a case of recurrent eosinophilic annular erythema
International Journal of Dermatology, EarlyView.
Lichen striatus following scarlet fever in a 3‐year‐old female patient
International Journal of Dermatology, EarlyView.
Granulocyte colony‐stimulating factor‐producing melanoma treated with the combination of dabrafenib and trametinib
International Journal of Dermatology, EarlyView.
Vedolizumab‐induced acne in inflammatory bowel disease
International Journal of Dermatology, EarlyView.
Concentric targetoid scaly plaques in a patient with severe rheumatoid arthritis
International Journal of Dermatology, EarlyView.
Heavily pigmented fibroepithelioma of Pinkus mimicking melanoma
International Journal of Dermatology, EarlyView.
Gray‐bluish cutaneous pigmentation and ice‐pick scars induced by vandetanib therapy
International Journal of Dermatology, EarlyView.
Transient improvement of skin symptoms in an adult patient with pediatric‐onset cutaneous mastocytosis treated with interferon‐α
International Journal of Dermatology, EarlyView.
A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors
International Journal of Dermatology, EarlyView.
Issue Information
International Journal of Dermatology, Volume 57, Issue 5, Page i-iii,503-504, May 2018.
Teaching & Learning Tips 7: small‐group discussion
International Journal of Dermatology, Volume 57, Issue 5, Page 583-586, May 2018.
A case of pigmentary mosaicism associated with diploid/triploid mixoploidy
International Journal of Dermatology, EarlyView.
Religious stigmata: a dermato‐psychiatric approach and differential diagnosis
International Journal of Dermatology, EarlyView.
Novel use of combination therapeutic plasma exchange and rituximab in the treatment of nivolumab‐induced bullous pemphigoid
International Journal of Dermatology, EarlyView.
Mohs micrographic surgery for basal cell carcinoma of the scrotum
International Journal of Dermatology, EarlyView.
Skin ultrasound is a useful tool for evaluating and monitoring eosinophilic fasciitis
International Journal of Dermatology, EarlyView.
Is pleasure all that is good about experience?
Abstract
Experientialist accounts of wellbeing are those accounts of wellbeing that subscribe to the experience requirement. Typically, these accounts are hedonistic. In this article I present the claim that hedonism is not the most plausible experientialist account of wellbeing. The value of experience should not be understood as being limited to pleasure, and as such, the most plausible experientialist account of wellbeing is pluralistic, not hedonistic. In support of this claim, I argue first that pleasure should not be understood as a broad term to describe valuable experiences generally. I then analyze responses to the main argument against a monistic view on the value of experience: the philosophy of swine objection. I argue that such responses deviate from the central hedonistic view that only pleasure and pain matter for wellbeing. I then argue that the argument can be avoided on a pluralistic account, and formulate a plausible candidate for an account of pluralistic experientialism, in which, besides pleasure, non-hedonic aspects of experience like novelty, compassion, and aesthetic value also contribute to wellbeing.
Algebraic structuralism
Abstract
This essay is about how the notion of "structure" in ontic structuralism might be made precise. More specifically, my aim is to make precise the idea that the structure of the world is (somehow) given by the relations inhering in the world, in such a way that the relations are ontologically prior to their relata. The central claim is the following: one can do so by giving due attention to the relationships that hold between those relations, by making use of certain notions from algebraic logic.
Determination of optimal ultrasound planes for the initialisation of image registration during endoscopic ultrasound-guided procedures
Abstract
Purpose
Navigation of endoscopic ultrasound (EUS)-guided procedures of the upper gastrointestinal (GI) system can be technically challenging due to the small fields-of-view of ultrasound and optical devices, as well as the anatomical variability and limited number of orienting landmarks during navigation. Co-registration of an EUS device and a pre-procedure 3D image can enhance the ability to navigate. However, the fidelity of this contextual information depends on the accuracy of registration. The purpose of this study was to develop and test the feasibility of a simulation-based planning method for pre-selecting patient-specific EUS-visible anatomical landmark locations to maximise the accuracy and robustness of a feature-based multimodality registration method.
Methods
A registration approach was adopted in which landmarks are registered to anatomical structures segmented from the pre-procedure volume. The predicted target registration errors (TREs) of EUS-CT registration were estimated using simulated visible anatomical landmarks and a Monte Carlo simulation of landmark localisation error. The optimal planes were selected based on the 90th percentile of TREs, which provide a robust and more accurate EUS-CT registration initialisation. The method was evaluated by comparing the accuracy and robustness of registrations initialised using optimised planes versus non-optimised planes using manually segmented CT images and simulated ( \(n=9\) ) or retrospective clinical ( \(n=1\) ) EUS landmarks.
Results
The results show a lower 90th percentile TRE when registration is initialised using the optimised planes compared with a non-optimised initialisation approach (p value \(< 0.01\) ).
Conclusions
The proposed simulation-based method to find optimised EUS planes and landmarks for EUS-guided procedures may have the potential to improve registration accuracy. Further work will investigate applying the technique in a clinical setting.
Quinazoline clubbed 1,3,5-triazine derivatives as VEGFR2 kinase inhibitors: design, synthesis, docking, in vitro cytotoxicity and in ovo antiangiogenic activity
Abstract
A series of quinazoline clubbed 1,3,5-triazine derivatives (QCT) were synthesized and evaluated for their in vitro anticancer activity against HeLa (human cervical cancer), MCF-7 (human breast cancer cell), HL-60 (human promyelocytic leukemia cell), HepG2 (human Hepatocellular carcinoma cell), and one normal cell line HFF (human foreskin fibroblasts). In vitro assay result encouraged to further move towards in ovo anticancer evaluation using chick embryo. The series of QCT derivatives showed higher anticancer and antiangiogenic activity against HeLa and MCF-7 cell lines. In the series, synthetic molecule 8d, 8l, and 8m displayed significant activity. Further, these results substantiated by docking study on VGFR2. SAR study concluded that the potency of drugs depends on the nature of aliphatic substitution and the heterocyclic ring system.
Graphical Abstract
In vivo estimation of target registration errors during augmented reality laparoscopic surgery
Abstract
Purpose
Successful use of augmented reality for laparoscopic surgery requires that the surgeon has a thorough understanding of the likely accuracy of any overlay. Whilst the accuracy of such systems can be estimated in the laboratory, it is difficult to extend such methods to the in vivo clinical setting. Herein we describe a novel method that enables the surgeon to estimate in vivo errors during use. We show that the method enables quantitative evaluation of in vivo data gathered with the SmartLiver image guidance system.
Methods
The SmartLiver system utilises an intuitive display to enable the surgeon to compare the positions of landmarks visible in both a projected model and in the live video stream. From this the surgeon can estimate the system accuracy when using the system to locate subsurface targets not visible in the live video. Visible landmarks may be either point or line features. We test the validity of the algorithm using an anatomically representative liver phantom, applying simulated perturbations to achieve clinically realistic overlay errors. We then apply the algorithm to in vivo data.
Results
The phantom results show that using projected errors of surface features provides a reliable predictor of subsurface target registration error for a representative human liver shape. Applying the algorithm to in vivo data gathered with the SmartLiver image-guided surgery system shows that the system is capable of accuracies around 12 mm; however, achieving this reliably remains a significant challenge.
Conclusion
We present an in vivo quantitative evaluation of the SmartLiver image-guided surgery system, together with a validation of the evaluation algorithm. This is the first quantitative in vivo analysis of an augmented reality system for laparoscopic surgery.
Fiducial-based fusion of 3D dental models with magnetic resonance imaging
Abstract
Purpose
Magnetic resonance imaging (MRI) is widely used in study of maxillofacial structures. While MRI is the modality of choice for soft tissues, it fails to capture hard tissues such as bone and teeth. Virtual dental models, acquired by optical 3D scanners, are becoming more accessible for dental practice and are starting to replace the conventional dental impressions. The goal of this research is to fuse the high-resolution 3D dental models with MRI to enhance the value of imaging for applications where detailed analysis of maxillofacial structures are needed such as patient examination, surgical planning, and modeling.
Methods
A subject-specific dental attachment was digitally designed and 3D printed based on the subject's face width and dental anatomy. The attachment contained 19 semi-ellipsoidal concavities in predetermined positions where oil-based ellipsoidal fiducial markers were later placed. The MRI was acquired while the subject bit on the dental attachment. The spatial position of the center of mass of each fiducial in the resultant MR Image was calculated by averaging its voxels' spatial coordinates. The rigid transformation to fuse dental models to MRI was calculated based on the least squares mapping of corresponding fiducials and solved via singular-value decomposition.
Results
The target registration error (TRE) of the proposed fusion process, calculated in a leave-one-fiducial-out fashion, was estimated at 0.49 mm. The results suggest that 6–9 fiducials suffice to achieve a TRE of equal to half the MRI voxel size.
Conclusion
Ellipsoidal oil-based fiducials produce distinguishable intensities in MRI and can be used as registration fiducials. The achieved accuracy of the proposed approach is sufficient to leverage the merged 3D dental models with the MRI data for a finer analysis of the maxillofacial structures where complete geometry models are needed.
Enhanced TiO 2 nanorods photocatalysts with partially reduced graphene oxide for degrading aqueous hazardous pollutants
Abstract
Enhanced TiO2 nanorods (TNRs) with partially reduced graphene oxide (RGO) (designated as GT) were prepared for degrading aqueous hazardous pollutants. The degree of RGO oxidation had an important role in affecting the photoelectronic and photocatalytic activities of GT composites. The study examined the impact of the degree of RGO oxidation on the photocatalytic activities. The photocatalytic activity of the materials was investigated for degrading rhodamine b (RhB), methyl orange (MO), methylene blue (MB), and phenol by using ultraviolet (UV) light. The highest photocatalytic activity was observed when the atomic oxygen-to-carbon (O/C) ratio of RGO was 0.130 ± 0.003. This study suggested the photocatalytic performance was maximized by preserving a selected amount of the RGO oxygen-containing groups. The work reported in this study on optimizing the RGO-based TiO2 photocatalyst could serve as a promising approach for preparing and optimizing other types of carbon-based photocatalysts such as graphene-based CdS.
Κυριακή 15 Απριλίου 2018
Upgradation of chemical, fuel, thermal, and structural properties of rice husk through microwave-assisted hydrothermal carbonization
Abstract
The process parameters of microwave hydrothermal carbonization (MHTC) have significant effect on yield of hydrochar. This study discusses the effect of process parameters on hydrochar yield produced from MHTC of rice husk. Results revealed that, over the ranges tested, a lower temperature, lower reaction time, lower biomass to water ratio, and higher particle size produce more hydrochar. Maximum hydrochar yield of 62.8% was obtained at 1000 W, 220 °C, and 5 min. The higher heating value (HHV) was improved significantly from 6.80 MJ/kg of rice husk to 16.10 MJ/kg of hydrochar. Elemental analysis results showed that the carbon content increased and oxygen content decreased in hydrochar from 25.9 to 47.2% and 68.5 to 47.0%, respectively, improving the energy and combustion properties. SEM analysis exhibited modification in structure of rice husk and improvement in porosity after MHTC, which was further confirmed from BET surface analysis. The BET surface area increased from 25.0656 m2/g (rice husk) to 92.6832 m2/g (hydrochar). Thermal stability of hydrochar was improved from 340 °C for rice husk to 370 °C for hydrochar.
Production of mycotoxins by filamentous fungi in untreated surface water
Abstract
Several research studies reported that mycotoxins and other metabolites can be produced by fungi in certain matrices such as food. In recent years, attention has been drawn to the wide occurrence and identification of fungi in drinking water sources. Due to the large demand of water for drinking, watering, or food production purposes, it is imperative that further research is conducted to investigate if mycotoxins may be produced in water matrices. This paper describes the results obtained when a validated analytical method was applied to detect and quantify the presence of mycotoxins as a result of fungi inoculation and growth in untreated surface water. Aflatoxins B1 and B2, fumonisin B3, and ochratoxin A were detected at concentrations up to 35 ng/L. These results show that fungi can produce mycotoxins in water matrices in a non-negligible quantity and, as such, attention must be given to the presence of fungi in water.
A system dynamics model of China’s electric power structure adjustment with constraints of PM10 emission reduction
Abstract
Recently, Chinese state environmental protection administration has brought out several PM10 reduction policies to control the coal consumption strictly and promote the adjustment of power structure. Under this new policy environment, a suitable analysis method is required to simulate the upcoming major shift of China's electric power structure. Firstly, a complete system dynamics model is built to simulate China's evolution path of power structure with constraints of PM10 reduction considering both technical and economical factors. Secondly, scenario analyses are conducted under different clean-power capacity growth rates to seek applicable policy guidance for PM10 reduction. The results suggest the following conclusions. (1) The proportion of thermal power installed capacity will decrease to 67% in 2018 with a dropping speed, and there will be an accelerated decline in 2023–2032. (2) The system dynamics model can effectively simulate the implementation of the policy, for example, the proportion of coal consumption in the forecast model is 63.3% (the accuracy rate is 95.2%), below policy target 65% in 2017. (3) China should promote clean power generation such as nuclear power to meet PM10 reduction target.
Effect of mono and divalent salts on the conformation and composition of a humic acid and on atrazine adsorption
Abstract
We investigated the effects of sodium and calcium chlorides on the conformation and composition of a purified Aldrich humic acid (PAHA), as well as on the adsorption of atrazine. The PAHA was treated with 1, 10, and 100 mM NaCl, CaCl2, or a mixture of NaCl and CaCl2 (molar ratio 5:1) at pH 7.5 and 8.5. The conformation of treated PAHA was characterized by atomic force microscopy (AFM) and transmission electron microscopy (TEM) and spectral changes of functional groups of PAHA by Fourier transform infrared spectroscopy (FTIR). AFM and TEM images showed an increase in the aggregation of the PAHA as salinity increased. FTIR spectra revealed that changes in the aggregation of the PAHA were principally due to the formation of bridged interactions between calcium and carboxylate groups in the PAHA. The adsorption of atrazine on > 0.45 μm PAHA decreased as salt concentrations and pH increased. This reduction of atrazine adsorption was explained by the decrease in available adsorption sites due to agglomeration of PAHA.
The effect of simulated acid rain on the stabilization of cadmium in contaminated agricultural soils treated with stabilizing agents
Abstract
Stabilization technology is one of widely used remediation technologies for cadmium (Cd)-contaminated agricultural soils, but stabilized Cd in soil may be activated again when external conditions such as acid rain occurred. Therefore, it is necessary to study the effect of acid rain on the performance of different stabilizing agents on Cd-polluted agriculture soils. In this study, Cd-contaminated soils were treated with mono-calcium phosphate (MCP), mono-ammonium phosphate (MAP), and artificial zeolite (AZ) respectively and incubated 3 months. These treatments were followed by two types of simulated acid rain (sulfuric acid rain and mixed acid rain) with three levels of acidity (pH = 3.0, 4.0, and 5.6). The chemical forms of Cd in the soils were determined by Tessier's sequential extraction procedure, and the leaching toxicities of Cd in the soils were assessed by toxicity characteristic leaching procedure (TCLP). The results show that the three stabilizing agents could decrease the mobility of Cd in soil to some degree with or without simulated acid rain (SAR) treatment. The stabilization performances followed the order of AZ < MAP < MCP. Acid rain soaking promoted the activation of Cd in stabilized soil, and both anion composition and pH of acid rain were two important factors that influenced the stabilization effect of Cd.
Congenital Accessory Palpebral Fissure and Eyelid in a Newborn: A Case Report
The occurrence of an accessory palpebral fissure and eyelid is an extremely rare phenomenon. An isolated accessory palpebral fissure and eyelid have been reported only twice in the literature, and in one case as an extension of Delleman syndrome, or oculocerebrocutaneous syndrome. The authors report a case of a full-term newborn who presented with an accessory palpebral fissure and eyelid associated with microcornea, skin polyps and tags, cutis dysplasia, and hypoplasia of the corpus callosum with an otherwise normal systemic workup and negative genetic screening. Detailed surgical management and histopathological analysis of the accessory findings are also described. Accepted for publication February 21, 2018. The authors have no financial or conflicts of interest to disclose Address correspondence and reprint requests to Robert A. Goldberg, M.D., Stein Eye Institute, 300 Stein Plaza, 1st Floor, Los Angeles, CA 90095. E-mail: Goldberg@jsei.ucla.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Similarity in Bilateral Isolated Internal Orbital Fractures
Purpose: In evaluating patients sustaining bilateral isolated internal orbital fractures, the authors have observed both similar fracture locations and also similar expansion of orbital volumes. In this study, we aim to investigate if there is a propensity for the 2 orbits to fracture in symmetrically similar patterns when sustaining similar trauma. Methods: A retrospective chart review was performed studying all cases at our institution of bilateral isolated internal orbital fractures involving the medial wall and/or the floor at the time of presentation. The similarity of the bilateral fracture locations was evaluated using the Fisher's exact test. The bilateral expanded orbital volumes were analyzed using the Wilcoxon signed-rank test to assess for orbital volume similarity. Results: Twenty-four patients with bilateral internal orbital fractures were analyzed for fracture location similarity. Seventeen patients (70.8%) had 100% concordance in the orbital subregion fractured, and the association between the right and the left orbital fracture subregion locations was statistically significant (P
Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital Ptosis
Purpose: To compare 2 surgical techniques (frontalis flap versus maximal anterior levator resection) as first surgical options for the treatment of congenital ptosis with poor levator function in patients younger than 2 years of age with a follow up of 10 years. Methods: A retrospective study of 58 patients (71 eyelids) with severe ptosis and poor levator function who underwent frontalis muscle flap (FMF = 47) or maximal anterior levator resection (ALR = 24) for correction of their ptosis. Eyelid measurements were taken at baseline, 1, 5, and 10 years after surgery. The presence of complications, need for reoperations, and palpebral contour were evaluated. Results: Most patients in both groups required only one surgical procedure with a stable average margin-reflex distance 1 over the 10-year follow-up period in both groups, with no statistically significant difference between the 2 techniques in achieving an adequate palpebral height after one single procedure. Eleven eyelids treated with FMF (23%) and 12 treated with ALR (50%) needed a reoperation, with a statistically significant difference between the 2 techniques. Five ALR patients (21%) and 6 FMF patients (13%) had alterations of eyelid contour. Pop-eyelid and eyelash ptosis were observed in 8% of patients operated with FMF. Conclusion: Good functional and aesthetic results were obtained with both surgical techniques. FMF required fewer reoperations compared with maximal ALR, offering a better long-term result without residual ptosis. Accepted for publication February 4, 2018. Presented at the XXVI SECPOO meeting (Bilbao, 2016), 35º ESOPRS meeting (Athens, 2016), Barcelona Oculoplastics (Barcelona, 2017), BOPSS (London, 2017). The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to LuzMaria Vasquez, M.D., Josep María Lladó 3, Salida 7 Ronda de Dalt. 08035, Barcelona, Spain. E-mail: vasquez@imo.es © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Orbital Inflammatory Syndrome Secondary to Flea Bite
A 34-year-old previously healthy Hispanic male presented to the emergency room complaining of progressive left upper eyelid swelling and pain for more than 2 weeks. He was previously diagnosed and treated for a "pink eye" but failed to improve. He reported a previous "bug bite" around the left lateral canthus a few weeks prior to admission. Computer tomography orbit with contrast showed left exophthalmos, an enhancing left lacrimal gland and orbital inflammatory signs suggestive of possible intraorbital abscess. Intravenous antibiotics did not improve his symptoms. Surgical debridement showed no abscess but inflamed soft tissues and lacrimal gland. Intravenous steroids failed to improve his symptoms. On postoperative day 3, the patient reported that an insect had "jumped" out from his left orbit. Identification of the specimen proved to be a mature flea. Biopsy of the lacrimal gland showed degranulation of eosinophils and foreign body material consistent with probable insect leg parts. Accepted for publication February 19, 2018. Disclosure: Collection and evaluation of protected patient health information was HIPAA-compliant. Address correspondence and reprint requests to Amina I. Malik, M.D., Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Suite 450, Houston, TX 77030. E-mail: aimalik@houstonmethodist.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Σάββατο 14 Απριλίου 2018
Humification process in different kinds of organic residue by composting and vermicomposting: have microbioreactors really accelerated the process?
Abstract
The organic matter existing in nature presents as a complex system of various substances. The humic fraction refers to the humic substances (HS) and consists of humic acids (HA), fulvic acids (FA), and humins, according to solubility in aqueous solution. The physical and chemical characteristics of HA, FA, and humins depend on many factors, among which is the type of original organic material. Two processes for the stabilization of organic materials are known worldwide: composting and vermicomposting. Cattle manure, rice straw, sugarcane bagasse, and vegetable wastes from leaves were the organic residues chosen for the composting and vermicomposting processes. In this study, the differences between the HS extracted from such composted and vermicomposted residues were evaluated. The so-extracted HS were evaluated by spectroscopy in the regions of infrared and ultraviolet-visible, and pyrolysis coupled with gas chromatography with mass spectrometric detection is applied. Thus, we expect that the results obtained here indicate which of the two processes is more efficient in the biotransformation of organic residues in a short period with respect to the HS content. It was also observed that the basic units of the humic fractions generated (although they presented different degrees of maturation) are the same. Altogether, the data reported here bring to light that the structures of the HS are very similar, differing in quantities. These results can still be extrapolated to several other raw materials, since the most variable organic matrices were used here to allow this data extrapolation. In addition, the process seems to lead to the formation of more aliphatic substances, counterpoising what is found in the literature.
Comparison of Lipid Accumulation Product Index with Body Mass Index and Waist Circumference as a Predictor of Metabolic Syndrome in Indian Population
Metabolic Syndrome and Related Disorders, Ahead of Print.
The Effects of a Community-Based Lifestyle Intervention on Metabolic Syndrome and Its Components in Adolescents: Findings of a Decade Follow-Up
Metabolic Syndrome and Related Disorders, Ahead of Print.
Metabolic Syndrome and Vitamin D Levels in Patients with Obstructive Sleep Apnea Syndrome
Metabolic Syndrome and Related Disorders, Ahead of Print.
Does Simultaneous Liposuction Adversely Affect the Outcome of Thread Lifts? A Preliminary Result
Abstract
Background
Along with advances in thread lift techniques and materials, ancillary procedures such as fat grafting, liposuction, or filler injections have been performed simultaneously. Some surgeons think that these ancillary procedures might affect the aesthetic outcomes of thread lifting possibly due to inadvertent injury to threads or loosening of soft tissue via passing the cannula in the surgical plane of the thread lifts. The purpose of the current study is to determine the effect of such ancillary procedures on the outcome of thread lifts in the human and cadaveric setting.
Methods
We used human abdominal tissue after abdominoplasty and cadaveric faces. In the abdominal tissue, liposuction parallel to the parallel axis was performed in one area for 5 min. We counted 30 passes when liposuction was performed in one direction. This was repeated as we changed the direction of passages. The plane of thread lifts (dermal vs subcutaneous) and angle between liposuction and thread lifts (parallel vs perpendicular) were differentiated in this abdominal tissue study group. Then, we performed parallel or perpendicular thread lifts using a small slit incision. Using a tensiometer, the maximum holding strength was measured when pulling the thread out of the skin as much as possible. We also used faces of cadavers to prove whether the finding in human abdominal tissue is really valid with corresponding techniques.
Results
Our pilot study using abdominal tissue showed that liposuction after thread lifts adversely affects it regardless of the vector of thread lifts. In the cadaveric study, however, liposuction prior to thread lifting does not significantly affect the holding strength of thread lifts.
Conclusions
Liposuction or fat grafting in the appropriate layer would not be a hurdle to safely performing simultaneous thread lifts if the target lift tissue is intra-SMAS or just above the SMAS layer.
Level of Evidence V
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.
Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity
Abstract
Background
Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, "bulbous pinch" LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen.
Objectives
The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face.
Methods
We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups.
Results
There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally.
Conclusion
Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60–70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration.
Level of Evidence IV
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.
Longitudinal Analysis of Superficial Midfacial Fat Volumes Over a 10-Year Period
Abstract
Background
Volumetric changes to facial fat that occur with aging remain poorly understood. The aim of this study was to evaluate for longitudinal changes to midfacial fat volumes in a group of individuals.
Methods
We conducted a retrospective longitudinal study of adult subjects who underwent multiple facial computed tomographic (CT) scans timed at least 8 years apart. Subjects who underwent facial surgery or suffered facial trauma were excluded. Facial CT scans were analyzed, and superficial cheek fat volumes were measured and compared to track changes that occurred with aging.
Results
Fourteen subjects were included in our analysis of facial aging (5 male, 9 female; mean initial age 50.9 years; mean final age 60.4 years). In the right superficial cheek there was an increase in mean (SD) superficial fat volume from 10.33 (2.01) to 10.50 (1.80) cc, which was not statistically significant (P = 0.75). Similar results were observed in the left cheek. There were no statistically significant longitudinal changes to caudal, middle, or cephalad subdivisions of bilateral superficial cheek fat. A simple linear regression was performed to predict superficial cheek fat pad volume based on age which did not reach statistical significance (P = 0.31), with an R2 of 0.039.
Conclusions
This study is the first to quantitatively assess for longitudinal changes to midfacial fat in a group of individuals. Superficial cheek fat remained stable as subjects aged from approximately 50 to 60 years old, with no change in total volume or redistribution within a radiographically defined compartment.
Level of Evidence IV
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.
Bone and Soft Tissue Nasal Angles Discrepancies and Overlying Skin Thickness: A Computed Tomography Study
Abstract
Background
The aim of this study was to derive the normal values for bone and soft tissue nasal angles as well as the overlying skin thickness and to attempt to determine the correlation between differences in bone and soft tissue angles and overlying skin thickness in Middle Eastern patients.
Materials and Methods
Three-dimensional cephalometric analysis was performed for 100 patients who underwent computed tomography of the paranasal sinuses. The nasofrontal angle, pyramidal angle-nasal root, pyramidal angle-tip of the nasal bone, and overlying skin thickness were measured, and the results were analyzed according to sex, age, and body mass index (BMI).
Results
All soft tissue angles were significantly larger than the bone angles, with the mean difference being 11.62°, 30.80°, and 27.05° for the nasofrontal angle (P = 0.000), pyramidal angle-nasal root (P = 0.000), and pyramidal angle-tip of the nasal bone (P = 0.000), respectively. The mean overlying skin thickness was 3.89 ± 1.48 mm at the nasion, 1.16 ± 0.6 mm at the rhinion, and 2.93 ± .97 mm at the nasal tip. Differences in the nasofrontal angle were strongly correlated with the skin thickness at the nasion (P = 0.001).
Conclusion
A simple clinical exam of the soft tissue nasal angles does not reflect the underlying bone angles that will be encountered during rhinoplasty. BMI does not influence nasal shape, and rhinoplasty surgery should take into account the ethnic group, age, and sex of the patient. Surgeons should leave a minor skeletal hump at the end of the nasal bone for Middle Eastern patients.
Level of Evidence IV
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.
Shape, Position and Dimension of the Nipple Areola Complex in the Ideal Male Chest: A Quick and Simple Operating Room Technique
Abstract
Introduction
The anatomical features of the chest identify an individual as male or female and even the smallest details of these features determine the appropriate appearance for each gender. In female-to-male patients, the creation of an aesthetically pleasing male chest is the most important step. Incorrect positioning of the nipple areola complex (NAC) on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation.
Patients and Methods
We have analyzed the anatomical chest features of 26 water polo players, to verify our hypothesis of the relationship between the pectoralis major muscle and NAC and to create a method for repositioning the NAC that is applicable in the operating room, is easy, practical and reproducible without the use of formulas and based on an easily identifiable landmark.
Results
In our reference group, the NAC has a constant relationship with the pectoralis major muscle, positioned on average 3 cm medial to the lateral border of the pectoralis muscle and 2.5 cm above the inferior pectoralis major insertion. This supports our hypothesis and our surgical technique. We use the index finger to find a vertical axis and a line 2.5 cm above the inferior pectoralis shadow to find the horizontal axis. We also introduce a modification to the receiving site to recreate an oval areola more similar to that of an ideal male chest.
Conclusions
Our anatomical study and statistical analysis support a consistent relationship between the position and shape of the NAC and the borders of the pectoral muscle. We have used this relationship to develop our "trick," which is easily applicable in the operating room to find the NAC position without using formulas and numbers. This method allowed us to place the NAC in a position very close to that of a typical male subject, and it permitted us to reduce the surgery time.
Level of Evidence IV
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.
Axillary Accessory Breast: Optimal Time for Operation
Abstract
Background
Accessory breasts are usually located in the axilla. Symptoms associated with an axillary accessory breast (AAB) may newly develop or worsen after pregnancy. After childbirth, AAB engorgement and hyperplasia may occur due to milk formation. We evaluated the optimal time for AAB excision and assessed variations in clinical presentations and surgical outcomes associated with pregnancy.
Methods
In total, 540 women whose symptoms began from puberty and underwent AAB excision were retrospectively analyzed. Group 1 comprised 416 patients who underwent operations before pregnancy, and Group 2 comprised 124 patients who underwent operations after childbirth. AABs were classified according to the Damsoyu–Lee (DL) classification. Satisfaction was measured by pain and cosmesis 3 months postoperatively.
Results
Group 2 had more patients with severe symptoms [DL class II (n = 8, 6.5%) and III (n = 15, 12.1%)] than Group 1 (p = 0.049). The specimen weight and liposuction volume were greater in Group 2. The reoperation rate was also higher in Group 2 [loosening skin excision (n = 4, 3.2%) and remnant gland excision (n = 3, 2.4%)] (p = 0.032). In Group 2, 31 (25%) patients had AAB engorgement after childbirth and 7 (5.6%) had milk secretion from the accessory nipple after childbirth. The overall satisfaction score was lower in Group 2 than 1.
Conclusions
Pregnancy may cause accessory breast gland hyperplasia. After childbirth, symptoms such as AAB engorgement and milk secretion from the accessory nipple may occur. The optimal timing for operation for AAB appears to be before the onset of pregnancy because of lower reoperation rates and greater patient satisfaction.
Level of Evidence IV
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.
Buttock Lifting Using Elastic Thread (Elasticum ® ) with a New Classification of Gluteal Ptosis
Abstract
Purpose
Conventional buttock lifting is invasive, so it is difficult to recommend it to patients especially to those who do not have severe gluteal ptosis. In addition, the gluteal area is a large area change among the joints. Therefore, this surgery can cause pain during hip flexion after lifting using a conventional thread. The authors report on buttock lifting using an elastic thread with high satisfaction from patients.
Methods
From July 2016 to June 2017, 60 patients were enrolled in this study. The degree of gluteal ptosis was graded from Grade 0 to Grade 6. All patients underwent lifting of both buttocks using Elasticum®. We drew a circle along the outer edge of the buttock and another small circle inside the first circle. A stab incision was done at 5 points (A, B, C, C′, and D), and then according to the circle, lifting was done. Postoperative grade changes and complications were evaluated.
Result
Grades 2–5 were lifted to at least Grade 2 after surgery, but Grade 6 was at most Grade 3 (14.2%), with 85.8% of these to either Grade 5 or Grade 6. Seven patients (11.67%) complained of postoperative pain, and 6 patients (10.00%) showed skin dimpling or creases 10 days after surgery, all of which disappeared at 1 month after surgery.
Conclusion
Buttock lifting with elastic thread is effective in pre-ptosis to moderate gluteal ptosis. Because of the elasticity of the thread, postoperative pain is low on hip flexion, so the lifting is done naturally.
Level of Evidence IV
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.
Epicanthal Restoration Surgery with Scar Excision in Severe Epicanthal Scar
Abstract
Background
Medial epicanthoplasty is a common aesthetic surgery in Asia to remove the epicanthal fold. With increasing use of this surgery, unsatisfactory results have grown. Several methods have been developed to correct it. However, there are limitations in restoration if the patient has a severe scar or does not have enough skin for reconstruction. By aggressively removing scar tissue, the authors present a better reverse redraping epicanthoplasty.
Methods
The procedure was performed on 512 patients who had complications of medial epicanthoplasty from May 2011 to October 2015. The mean age was 31.3 years. Those who had already undergone reconstruction were 15.4% (n = 79). Of these, 68 patients received a V–Y flap and the rest had V–Y modification surgery. After the design, the skin-muscle flap was dissected and elevated. The upper and lower eyelid skin was pulled medially. The previous scar tissue was widely excised while removing skin excess, and the new epicanthal fold was created without a rectangular shape.
Results
The mean interepicanthal distance has been increased from 32.8 to 36.6 mm. The mean lengthening effect is 3.8 mm. Lacrimal lake exposure, fierce and narrow appearance, and incomplete medial eyelid closure were improved.
Conclusions
Medial epicanthoplasty is a common cosmetic surgery in the Asian population. A demand for an effective reconstructive method has grown in association with higher complication rates. The authors have better results to make a natural epicanthal fold through aggressive scar removal in the reverse redraping epicanthoplasty.
Level of Evidence IV
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.
Judicial Precedent-Based Clinical Practice Guidelines of Propofol in Sedative Esthetic Surgery
Abstract
Background
Propofol is has been widely used for sedation in the field of esthetic surgery because of its favorable pharmacokinetic profile. Propofol sedation-induced side effects are rare. However, when present, they can be serious. The number of malpractice claims associated with propofol sedation has increased in recent years. This study aims to show which procedures lead to the most claims in the field of esthetic surgery through a review of Korean precedents.
Methods
Thirteen precedent cases of propofol sedation in the field of esthetic surgery were collected between 2000 and 2016. We analyzed the type of procedure, administration route, anesthesia provider, complications, timing of damaging events, average indemnification, plaintiff's (patients) winning rate, ratio and the reason of limitation of liability and the key factors affecting the judgement in these cases.
Results
Most plaintiffs were women, and in most cases (11/13, 73.3%), the times of the damaging events were in maintenance and the anesthesia provider was the surgeon. The most common complication related to propofol sedation was hypoxic brain damage. Among the 13 cases, 12 were won by the plaintiff. The mean claim settlement was 339,455,814 KRW (USD 301,792.15). The key factors affecting the judgement were administration method and staff, monitoring method, preparation of emergency kit, response to emergencies, transfer to a higher-level hospital, detailed medical recording about event and informed consent.
Conclusion
The number of claims owing to propofol sedation after esthetic surgery is increasing. Close monitoring during the operation, immediate reaction to an event and thorough medical records were main key factors that influenced the judgement. Preoperative explanation about the possibility of complications was important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns.
Level of Evidence V
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.
Correction to: Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality
Abstract
The second to last sentence in the Results section of the Abstract should be corrected to, "At 180-days follow-up, there was a significant improvement in total VAS scores."
Our Surgical Repair for Macrostomia with Two Novel Small Triangular Flaps Long-term Follow-up and Results
Background: The surgical methods for repairing congenital macrostomia should be carefully selected from both functional and aesthetic points of view. The surgical correction of macrostomia results in normal orbicularis oris function and symmetry of the repaired lip. Herein, we report our novel technique and the results obtained, assessed retrospectively. Methods: Twelve primary cases of macrostomia underwent surgical repair between 1996 and 2013. The age at operation ranged from 3 to 78 months. Our operative procedure uses two small triangular flaps with a superficial layer of orbicularis muscle to preserve the dynamic action of muscle fibers attached to the skin of the triangular flaps, with suturing across the orbicularis muscle bundles. The optimal length of a medial small triangular flap is 1.5-2.0 mm, and the length of a lateral flap is 5-8 mm. Evaluation was based on the degree of symmetry of the lips as a ratio of the affected side to the non-affected side, as well as the scar characteristics. Results: The follow-up period in this retrospective study ranged from 3 to 21 years. The same method was applied to all 12 cases, and the results over several years showed satisfactory outcomes, in the reconstruction of a natural appearance and dynamic function of the oral commissure. Conclusions: Our technique is very useful in the primary operation for macrostomia as the dynamic action of muscle fibers is preserved, if the muscle is not dissected from the skin in the cleft margin that includes the two medial small triangular flaps. The authors have no financial Interest to declare in relation to the content of this article. Presented at The 13th International Congress on Cleft Palate and Related Craniofacial Anomalies in Mahabalipuram, India on February 8-11, 2017. Corresponding author: Keisuke Imai, MD, Department of Plastic & Reconstructive Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, Osaka, Japan. Imai-k@abox3.so-net.ne.jp ©2018American Society of Plastic Surgeons
Using the BODY-Q to Understand Impact of Weight Loss, Excess Skin and the Need for Body Contouring Following Bariatric Surgery
Background: A consequence of bariatric surgery is redundant skin for most patients. We measured health-related quality of life and appearance following bariatric surgery in relation to weight loss, excess skin and need for body contouring. Methods: The sample included participants from the BODY-Q field-test study recruited between November 2013 and July 2014 from a bariatric program in Canada. Participants were invited to complete BODY-Q scales and questions to assess weight loss, amount of excess skin and need for body contouring, between 7 June 2016 and 29 November 2016. Results: 214 patients responded (75% response rate). Of the 210 who had bariatric surgery, percentage total weight loss (%TWL) ranged from 4 to 58%; most were left with excess skin (n=196, 93%) and needed body contouring (n=168, 80%). Average time since bariatric surgery was 3.4 years (0.4 to 7.6). Higher %TWL correlated with more excess skin (r=0.24, p=0.001), the need for more body contouring procedures (r=0.29,
“Chronic Recurrent Multifocal Osteomyelitis of the Mandible: A Diagnostic Challenge”
Summary: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disorder of children and adolescents characterized by mono- or multi-focal inflammatory bone lesions that are culture-negative on biopsy, associated with periods of exacerbation and resolution that can last over several months to years. Although it is predominantly a disease of long bones and the spine, craniofacial involvement is not uncommon, affecting the mandible in up to a fifth of cases. Similarities with other etiologies of osteitis in clinical presentation and imaging, as well as the lack of specific symptoms or laboratory tests, make CRMO mainly a diagnosis of exclusion. An accurate diagnosis is required for appropriate treatment in order to induce remission. This manuscript highlights the challenges faced by plastic and oral surgeons in diagnosing mandibular CRMO, and describes two pediatric patients affected with the disease. Both cases were initially confused with other entities, leading to unnecessary initial treatments and a delayed diagnosis. A review aimed at surgeons summarizes the major aspects of this condition so that it is considered as a differential diagnosis in young patients presenting with a facial bony mass. * Camison and Mai are co-first authors Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Joseph E. Losee, MD, FACS, FAAP, Division Chief, Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Children's Hospital Drive, 45th & Penn, Pittsburgh, PA. 15224, Phone: 412-692-6203, Fax: 412-692-5263 ©2018American Society of Plastic Surgeons
Surgeon volume and the outcomes of Dupuytren’s surgery: Results from a Dutch multicenter study
Objective: For a number of major complex surgical procedures, the outcomes are better when performed by surgeons with higher procedure volumes. The purpose of this study was to examine the relations between surgeon procedure volume and the outcomes of Dupuytren's surgery. Design: Observational study from 2011-14 Setting: Consortium of 6 dedicated hand surgery practice sites in The Netherlands Participants: 588 patients who underwent surgery for Dupuytren's contracture by one of the 16 surgeons from the participating sites. Exposure: Annual surgeon volume Main outcome measures: The degree of residual contracture, full release rate and any postoperative adverse event examined within 3 months of surgery. Results: Mean annual surgeon volume was 51 among the 16 surgeons, and ranged from 4 to 86 procedures. The majority of patients had primary Dupuytren's contracture (79%) and underwent open fasciectomy (74%). Multivariable regression analyses showed that surgeon volume was linearly related to all three outcomes, and identified no optimal volume threshold. Performing 10 additional procedures per year was independently associated with nearly 0.8 degree less residual contracture (p=0.002), 9% higher odds of attaining a full release (p=0.037), and 11% lower odds of experiencing an adverse event (p
Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate: A Randomized Controlled Trial
Background: Is one or two-stage palatoplasty more effective preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? Methods: This parallel blocked randomized controlled trial included 100 patients with non-syndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into 2 groups of 50 each. Group A had one-stage palatoplasty at age 12-13 months while group B had two-stage palatoplasty with soft palatoplasty at age 12-13 months and hard palatoplasty at age 24-25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C were the non-cleft controls (n=20, age 6 years) for speech using nasometry. Fistula rates, ratings of hypernasality and nasalance scores were compared between groups A and B. Nasometry recordings of group A and B were compared with control group C. Results: There was no difference in fistula rates between groups A and B (p=0.409; 95% CI=[0.365...11.9]). Mean nasalance scores of group A showed higher nasalance than group B (p=0.006, 95CI=[1.16…6.53]). Perceptual analysis showed no difference between groups A and B (p=0.837 and p=1.000). When compared to group C, Group A showed higher mean nasalance (p=0.837 and p=1.000) while group B showed no difference (p=0.088, 95% CI=[-0.14…2.02]). Conclusion: There was no difference in fistula rates between groups. Nasalance was slightly higher in patients who had one-stage palatoplasty when compared to those that had two-stage palatoplasty, but the difference may not be clinically significant. Financial disclosure and products page: Sources of funds supporting the work This study was partly funded by the former World Health Collaborating Centre, Radboudumc Nijmegen, The Netherlands. Statement of financial interest No financial interest to declare Corresponding Author: Rajgopal R. Reddy, Deputy Director, GSR Institute of Craniofacial Surgery, # 17-1-383/55, Vinay Nagar Colony, I. S. Sadan, Saidabad, Hyderabad- 500 059, Telephone:+91405764884, Facsimile: +91 40 24530000, Email: raj@craniofacialinstitute.org ©2018American Society of Plastic Surgeons
“Forearm Based Turnover Muscle Flaps for Elbow Soft Tissue Reconstruction: A Comparison of Regional Coverage Based on Distal Flap Perfusion.”
Background: Elbow wounds pose a reconstructive challenge. Prior studies have described the vascular anatomy of both the brachioradialis (BR) and flexor carpi ulnaris (FCU) muscle flaps. The goal of this study was to describe the distal flap perfusion of the flexor carpi radialis (FCR), with a direct comparison of the BR, FCU, and FCR muscle flaps for coverage around the elbow. Methods: Six fresh-frozen upper extremity specimens were dissected for BR, FCR, and FCU flaps. Vascular data from prior studies was combined with our anatomical measurements to determine the area of perfused coverage around the elbow for the BR and FCU. The FCR flap distal vascular perfusion was separately examined with transverse sections at 1 cm intervals after India-ink injections to determine distal flap perfusion and elbow coverage. Perfusion data was plotted on an x- and y-axis over the posterior elbow. Results: The BR muscle covered an average of 56% of the x-axis and 7.4% of the y-axis. The FCU muscle covered an average of 90% of the elbow along the x-axis and 23.3% of elbow along the y-axis. Based on our perfusion data, the FCR covered an average of 34% of the x-axis and 4.8% of the y-axis. Conclusion: The FCU muscle provides the most versatile and robust coverage over the posterior elbow, followed by the BR muscle which consistently provides coverage over the lateral epicondyle. The FCR may be used in select cases for lateral epicondyle coverage and may be considered as a secondary option. Presented at the 71st Annual Meeting for the American Society for the Surgery of the Hand in Austin, Texas, from September 29 to October 1, 2016; Annual Meeting for American Association for Hand Surgery in Waikoloa, Hawaii, from January 11 to January 14, 2017. Financial Disclosure Statement: Financial support for this study was provided from funds awarded through the Piedmont Orthopedic Society Research Grant (https://ift.tt/2GVPRmi). Corresponding Author: Yash J. Avashia, MD, Division of Oral, Maxillofacial, and Plastic Surgery, Duke University Medical Center, 40 Duke Medicine Circle, M150, Green Zone, DUMC 2824, Durham, NC 27710, Email Address: yja@duke.edu ©2018American Society of Plastic Surgeons
The impact of once versus twice daily enoxaparin prophylaxis on risk for venous thromboembolism and clinically relevant bleeding
Introduction: Venous thromboembolism (VTE) is a life or limb threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of VTE and the risk of medication related adverse drug events, specifically bleeding, remains unknown. Methods: This study compared pharmacodynamic and clinical outcomes, including 90-day VTE and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was post-operative anticoagulation strategy. Patients in Trial #1 received enoxaparin 40mg once daily for the duration of inpatient stay, and patients in Trial #2 received enoxaparin 40mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice daily prophylaxis strategy to achieve in range anti-Factor Xa levels. Results: The study compared 94 patients who received once daily enoxaparin to 118 patients who received twice daily enoxaparin. Twice daily enoxaparin was associated with a significant decrease in 90-day acute VTE (0% vs. 5.3%, p=0.012) and a non-significant increase in 90-day clinically relevant bleeding (6.8% vs. 3.2%, p=0.25). Twice daily enoxaparin at 0.4-0.5mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and over-anticoagulation, based on anti-Factor Xa levels. Conclusion: Twice daily enoxaparin is superior to once daily enoxaparin for 90-day acute VTE risk reduction. Twice daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight based twice daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic & reconstructive surgery. Meeting Disclosure: These data have not been presented. Financial disclosure page: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Funding for this study was provided by the Plastic Surgery Foundation (National Endowment for Plastic Surgery grant, to CJP) and the Agency for Healthcare and Research Quality's R03 mechanism (1 R03 HS024326, to CJP). Dr. Pannucci also receives research support from the American Association of Plastic Surgeon's AAPS/PSF Academic Scholar Award. CLINICAL TRIAL IDENTIFIER: Studies registered on clinicaltrials.gov: NCT02411292 and NCT02687204 ACKNOWLEDGEMENTS: Funding for this study was provided by the Plastic Surgery Foundation (National Endowment for Plastic Surgery, to CJP) and the Agency for Healthcare and Research Quality (1 R03 HS024326, to CJP). Dr. Pannucci also receives research support from the American Association of Plastic Surgeon's AAPS/PSF Academic Scholar Award. Corresponding Author: Christopher J. Pannucci, MD MS, Assistant Professor, Division of Plastic Surgery, Division of Health Services Research, University of Utah, 801 581 7719 (phone), 801 581 5794 (fax), Christopher.Pannucci@hsc.utah.edu ©2018American Society of Plastic Surgeons
Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review.”
Background: Aloe vera has been used to treat wounds since ancient times. However, the efficacy of Aloe vera for burns and split-thickness skin graft (STSG) donor sites are inconclusive. Methods: A double-blind, randomized, controlled trial was conducted. Patients who underwent STSG harvesting from the thigh were included. STSG donor sites were divided into two groups: Aloe vera group and placebo group. The visual analogue scale (VAS) score evaluated pain and complete epithelialization was assessed. We searched electronic databases and included only international clinical trials published in the English language. Results: Twelve patients with 24 donor sites participated. Times to complete epithelization for the Aloe vera and placebo groups were 11.5 + 1.45 and 13.67 + 1.61 days (p
Eliminating Geographical Bias Improves Match Results: An Analysis of Program Preferences and Their Impact on Rank Lists and Results
Background: Previous studies have demonstrated that programs emphasize USMLE scores, publications, and geography in creating rank lists. We aimed to quantify the importance of geography and to determine how eliminating geographic preferences would affect Match outcomes. Methods: The Match algorithm was implemented and validated on six years of de-identified data from SF Match (2009-2014). A "consensus" ranking was generated for each year—all applicants were ordered into a single list using Markov chain rank aggregation. Each program's rank list was reordered using the consensus list, and a new Match result simulated. Statistical analysis was carried out with Microsoft Excel. Results: Variation of program rank lists from the consensus rank list was driven by geography (training in the same medical center or state as the ranking program), "pedigree" (top 25 ranking of applicants' prior training), and foreign medical graduation status. Step 1 scores, publications, and medical school or residency region were not factors. The simulated Match resulted in a slight increase in the match rate. The median normalized number needed to match decreased from 6.7 to 6.5, and 80% of applicants had an unchanged or better result compared to the actual Match. Conclusions: Geography is the primary driver of variation between program rank lists. Removing this variation would result in fewer unfilled positions, no significant change in average number needed to match, and improved Match outcomes for most applicants. Programs should critically evaluate whether their geographic biases reflect underlying information about applicant quality. Acknowledgments: Financial disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding author: Purushottam Nagarkar, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 4th Floor, Dallas, TX 75390, Purushottam.Nagarkar@utsouthwestern.edu ©2018American Society of Plastic Surgeons
Asymptomatic Deep Vein Thrombosis During Free Flap: Concerns in Free Flap Surgery
Background: Venous insufficiency is the most frequent cause of failure in free flap reconstruction of the lower extremity. When deep vein thrombosis (DVT) is detected during preoperative assessment of the lower extremity, decisions regarding treatment plans become difficult, and no relevant guidelines regarding surgery and preoperative treatment of patients with DVT who need a free flap transfer are currently available. Methods: In order to find a relevant guideline in decision-making regarding surgery and preoperative treatment of patients with DVT who require free flap reconstruction, a systematic literature review was conducted searching MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and 2015. In addition, we introduced six of our cases of DVT diagnosed before free flap operation in which the flap survived. Results: The literature review identified two articles that discussed intra-operative DVT diagnosed in three patients, including the reported cases. Analyses included epidemiology, etiology, and management strategy. A consensus for the management of asymptomatic DVT before free flap is still lacking. In our cases, successful flap transfer was possible by proceeding with an appropriate preoperative evaluation, intensive anticoagulation treatment, intraoperative reperfusion procedure, and postoperative care. Conclusion: Preoperatively detected asymptomatic DVT is not a contraindication for free flap reconstruction, and a flap transfer can be successfully performed with suitable planning and management. Acknowledgement: None Financial Disclosure: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and / or publication of this article. Funding: The work was supported by the Ewha Womans University Research Grant of 2015. Corresponding author: Bo Young Park, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Korea, Mok 5-dong, Yangcheon-Gu, Seoul, S. Korea, 158-710, Tel.: 82-2-2650-5149/ Fax: 82-2-3410-0036/ E-mail: byps@icloud.com ©2018American Society of Plastic Surgeons
Enhancement of Progenitor Cells by Two Step Centrifugation of Emulsified Lipoaspirates
Background: Adipose-derived stem cells (ASCs), endothelial progenitor cells (EPCs) and soluble factors jointly contribute to the regenerative effect of fat grafts. The nanofat grafting technique is a simple method to mechanically emulsify the lipoaspirate and increase the ASC yield in the lipoaspirate. In the present study, we evaluated our extended nanofat grafting method that includes two additional centrifugation steps and results in a lipoaspirate of low volume that we termed "lipoconcentrate". Furthermore, we investigated the oily fractions after centrifugation for its regenerative potential. Methods: Lipoaspirates of 20 healthy patients were collected and processed by emulsification and/or centrifugation. Six groups were created: native (not emulsified) fat, 1x centrifuged native fat, 2x centrifuged native fat, nanofat (emulsified), 1 x centrifuged nanofat and lipoconcentrate (=2x centrifuged nanofat). The oily phases after the centrifugation steps also were collected. Progenitor cells and protein levels of bFGF, IGF-1, MMP-9, PDGF-BB and VEGF-A were measured by flow cytometry and immunoassays, respectively. Results: Lipoconcentrate contained significantly higher numbers of ASCs and EPCs per gram when compared to all other fractions. No difference in the content of all five soluble factors between the groups was found. The oily phases after centrifugation showed none or very little numbers of ASCs, EPCs and none or very low levels of soluble factors. Conclusion: Centrifugation of emulsified lipoaspirates increases the progenitor cell count in the lipoaspirate. The oily phase after centrifugation of lipoaspirates may be disposable due to the little content of progenitor cells and soluble factors. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript Corresponding author: Norbert Pallua, M.D., Ph.D., Department of Plastic Surgery and Hand Surgery – Burn Center, University Hospital of the RWTH Aachen , Pauwelsstrasse 30 52074 Aachen, Germany. Phone: +49 241 8089701, Fax +49 241 8082448, email: npallua@ukaachen.de ©2018American Society of Plastic Surgeons
Liposuction aspirate fluid-ASCs injection and secondary healing in fingertip injury, a pilot study.
BACKGROUND: Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. This prospective study compares the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid (LAF). METHODS: 40 consecutive patients with a fingertip injury were dichotomized into group A (control group: conservative approach) and B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStemEvo®kit), allowing the nonenzymatic separation of LAF, which was then injected at injured site. Objective outcomes were time for healing, strength, mobility of joint, touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability and aesthetic result. An aliquot of LAF was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays. RESULTS: The average number of days for healing was 22,3 days in group B and 24,9 in group A (p
Anatomical consideration for the safe elevation of the deep circumflex iliac artery in the flap surgery
Background: Deep circumflex iliac artery (DCIA) osteocutaneous flap transfer was frequently applied to large defects in the maxillary and mandible regions, but the utilization rate has gradually decreased due to the complicated anatomy of the DCIA. This study investigated the comprehensive anatomy of the DCIA in relation to flap surgery with the aim of providing navigational guidelines for safe DCIA harvesting. Methods: Sixty-two sides of the hemiabdominal wall were dissected in fixed Korean cadavers. Several dimensions of the DCIA and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified. Results: The mean distance between the anterior superior iliac spine (ASIS) and the lateral border of the femoral artery was 57.5 mm. The DCIA generally originated almost at the same level as the inguinal ligament (IL), and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the ASIS, but no transverse branch pierced the transversus abdominis muscle medial to the ASIS. Conclusion: The incision line for safe DCIA harvesting was parallel and 2 cm superior to the IL and 6 cm from the ASIS. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the DCIA originating above or below the IL will be another useful guide for easily detecting the DCIA. Financial Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work. *Correspondence to: Woo-Chul Song, M.D., Ph.D., Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea. Telephone: +82-2-20307836, Fax: +82-2-20307819, E-mail: anatomy@kku.ac.kr ©2018American Society of Plastic Surgeons
National Mortality Rates After Outpatient Cosmetic Surgery and Low Rates of Perioperative Deep Vein Thrombosis Screening and Prophylaxis
Background: Concerns have arisen over reports of deaths occurring after certain outpatient plastic surgery procedures. Here, we present a detailed analysis of the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF) database and report on deaths occurring after outpatient cosmetic surgical procedures, causative factors, and venous thromboembolism (VTE) screening rates. Methods: A retrospective analysis of the AAAASF database was performed for the years 2012-2017. We retrieved data for all deaths occurring in association with cosmetic plastic surgery procedures. Patient demographics, procedural data, VTE risk factor assessment, and cause of death were analyzed. De-identified medical records, including coroner's reports, were reviewed where available. Results: Data for 42 deaths were retrieved. Of these, 90.5% (n=38) were female, and 61.9% were Caucasian (n=26). Mean age was 51.6 years (standard deviation, SD ±14.8), while mean BMI was 29.5kg/m2 (SD ±5.5). Overall, 54.8% of these deaths occurred after abdominoplasty: 42.9% in isolation, 9.5% in combination with breast surgery, and 2.4% with facial surgery. Of the causes of death, most (38.1%) were thromboembolic in origin. Notably, in 25 of 42 cases, VTE risk factor assessment was incorrect or absent (59.5%). Conclusions: Accreditation agencies provide transparency and insight into outpatient surgical mortality on a national scale. Results suggest that adoption of venous thromboembolism screening techniques may not be universal despite an existing large body of published evidence. Optimization of thromboembolism prevention pathways remains vital, and consideration of anticoagulation in those undergoing abdominoplasty may be important in lowering outpatient mortality. Financial Disclosures: Dr. Gary Brownstein, Dr. Lawrence Reid, and Dr. David Watts are on the Executive Committee for the American Association for Accreditation of Ambulatory Surgery Facilities and receive an annual stipend. None of the remaining authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Correspondence may be directed to: Samuel J Lin, MD, MBA, 110 Francis St., Suite 5A, Boston, MA 02215, Tel: 617-632-7369, sjlin@bidmc.harvard.edu David Watts, MD, American Association for Accreditation of Ambulatory Surgery Facilities, Gurnee, Illinois, Tel. 856-691-0200, dwatts@aaaasf.org ©2018American Society of Plastic Surgeons
Ganoderma Lucidum Polysaccharide Peptide Attenuates Skin Flap Ischemia-Reperfusion Injury in a Thioredoxin-Dependent Manner
Background: Thioredoxin-1 (Trx-1) plays an important role in defensing the skin flap ischemia-reperfusion injury. Ganoderma lucidum polysaccharide peptide (GLPP) is the major component of Ganoderma lucidum, which possesses potent antioxidant and antiapoptotic activity. Our study aims to determine whether GLPP could attenuate the skin flap ischemia-reperfusion injury and investigate possible mechanisms involved. Methods: The dermoprotective effect and mechanisms were assessed by an in vivo mouse ischemia-reperfusion flap model and an in vitro epithelial skin cell hypoxia/reoxygenation model. GLPP was administered to mice and cells before the procedures of ischemia-reperfusion and hypoxia/reoxygenation, respectively. Trx-1 inhibitor PX-12 was introduced in the counterevidence group. The flap tissues and cells were tested by hematoxylin-eosin and immunohistochemistry staining, TUNEL assay, SOD and MDA measurement, and Western blot. Results: The survival rates of ischemia-reperfusion flaps and hypoxia/reoxygenation cells increased significantly following GLPP treatment. Mitigated tissue damage, reduced apoptosis, and enhanced antioxidant activity were observed in ischemia-reperfusion flaps replenishing GLPP. Western blot analysis revealed Trx-1 depletion and a remarkable increase in ASK-1, p-p38, cl-caspase-3 and c-PARP abundance in ischemia-reperfusion flaps and hypoxia/reoxygenation cells, while GLPP dramatically upregulated Trx-1 and reduced the apoptosis-related protein expression. However, the rescue effect of GLPP was notably blunted by supplementation with PX-12. Conclusions: Our investigation highlights the protective role of GLPP in skin flap ischemia-reperfusion injury through Trx-1-dependent antioxidant and antiapoptotic pathway. This initial foray demonstrates the therapeutic value of GLPP against ischemia-reperfusion and facilitates the understanding of its dermoprotective mechanism. Disclosure: The authors have no financial interest to disclose in relation to the content of this article. Acknowledgements: The authors thank Prof. Baoxue Yang, Peking University Health Science Center, and Prof. Zhibin Lin, Fuzhou Institute of Green Valley Bio-Pharm Technology, for kindly providing the compound of Ganoderma lucidum polysaccharide peptide. This work was supported by National Natural Science Foundation of China (grants No. 81703167, 81703591). *Corresponding author: Address correspondence to: Zhuming Yin, M.D., Department of Breast Reconstruction, Tianjin Medical University Cancer Institute and Hospital, Tiyuanbei, Huanhu West Road, Hexi District, Tianjin 300060, China. Phone: +86-22-23340123-1173, E-mail: yinzhuming@tmu.edu.cn ©2018American Society of Plastic Surgeons
Incomplete facial paralysis - The use of the ipsilateral residual facial nerve as a donor nerve for facial reanimation.
Background: The reconstructive approach for incomplete facial paralysis is not yet determined. In this article we present a new surgical approach for patients with incomplete facial paralysis in which residual, ineffective movement is detected pre-operatively in the ipsilateral bucco-zygomatic territory of the paretic facial nerve. Methods: Sixteen patients with incomplete facial paralysis were found eligible for the procedure and underwent one-stage facial reanimation by the senior author (E.G.). Reanimation was performed using free gracilis muscle transfer with neural coaptation to an active facial nerve branch/es responsible for the pre-detected bucco-zygomatic residual movement. Patients were reviewed in a systematic fashion using a combined still photo and video scoring scale for symmetry at rest and at dynamic states. Results: Following surgery, improved symmetry was observed in the majority of observations of the mouth region at rest and while smiling and nasolabial fold region while smiling. There was no significant change in symmetry in the majority of observations of the eye region at rest and while smiling and nasolabial fold region at rest. Video assessment of dynamic facial symmetry while smiling demonstrated improved symmetry in 91% of the observations (n=191 observations). Comparison of mean scores for dynamic smile symmetry produced a statistically significant improvement of 1.68 points following surgery (p
Diagnóstico histológico de lesiones melanocíticas y melanoma: todo un desafío
Publication date: Available online 7 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): D. Morgado-Carrasco, S.S. Ertekin, A. Combalia, L. Ferrandiz
Dermatitis por contacto fotoalérgica a protectores solares con oxibenzona en La Plata, Argentina
Publication date: Available online 11 April 2018
Source:Actas Dermo-Sifiliográficas
Author(s): J.P. Russo, A. Ipiña, J.F. Palazzolo, A.B. Cannavó, R.D. Piacentini, B. Niklasson
AntecedentesLa dermatitis por contacto fotoalérgica (DCFA) a oxibenzona fue por primera vez documentada en 1980, siendo hoy el principal fotoalérgeno de Estados Unidos de América, Canadá y el cuarto en Europa. En Argentina no existen datos ni publicaciones con respecto a esta reacción cutánea.ObjetivoConocer el porcentaje de pacientes con fotosensibilidad afectados con fotoalergia a oxibenzona.MetodologíaEstudio descriptivo de corte transversal. Un total de 35 pacientes con reacciones fotosensibles con prueba del fotoparche en el Centro de investigación del Hospital Público San Martín, en la ciudad de La Plata, fueron estudiados durante los años 2015 y 2016.ResultadosSe observó el 17,14% de DCFA, presentando 5 (14,28%) pacientes al menos una reacción positiva a oxibenzona en el test de fotoparche, 4 pacientes solo en la zona irradiada con 5J/cm2 (de UVA) y solo un paciente tanto en la zona irradiada como en la no irradiada.ConclusionesLa DCFA a protectores solares compuestos por oxibenzona es frecuente y se presume infradiagnosticada debido a la falta de estudios confirmatorios como la prueba del fotoparche. El porcentaje de sensibilización varía de acuerdo con cada región, sobre todo por las distintas composiciones y costumbres de uso en protectores solares, cosméticos y tratamiento tópico.BackgroundPhotoallergic contact dermatitis (PACD) to oxybenzone was reported for the first time in 1980. Oxybenzone is the most common photoallergen in the United States and Canada and the fourth most common .in Europe. There are no studies or data on the prevalence of oxybenzone PACD in Argentina.ObjectiveTo determine the proportion of photosensitive patients with PACD to oxybenzone.MethodsWe conducted a descriptive cross-sectional study of 35 patients with photosensitivity reactions confirmed by photopatch testing at the Research Center of Hospital Público San Martín in La Plata, Argentina, in 2015 and 2016.ResultsPACD was identified in 6 patients (17.14%). Five of these (14.28%) had at least one positive reaction to oxybenzone in the photopatch test; 4 had a reaction at irradiated sites only (5 J/cm2 UVA) and one had a reaction at both irradiated and nonirradiated sites.ConclusionsPACD to sunscreens containing oxybenzone is common and is probably underdiagnosed due to a lack of confirmation by photopatch tests or other diagnostic tools. Sensitization rates vary according to region and are influenced by sunscreen ingredients and variations in the use of sunscreen products, cosmetics, and topical drugs.
Graphical abstract
Εγγραφή σε:
Αναρτήσεις (Atom)
-
A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
