A porcine model for robotic training harvest of the rectus abdominis muscle

Publication date: Available online 26 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): V. Louis, L. Chih-Sheng, D. Chevallier, J.C. Selber, F. Xavier, P.A. Liverneaux
Conventional open surgical approaches for the harvesting of the rectus abdominis muscle carry a high risk of morbidity. It is possible to reduce these risks by using laparoscopy or robot-assisted techniques. This work hypothesizes that a porcine model could be used for learning the robot-assisted collection of the rectus abdominis. The rectus abdominis was taken in 3 stages in 3 pigs: installation of the robot, surgical approaches with 4 trocars, dissection and collection of the muscle. The average operating time was 1h20min and the average muscular length was 16cm. Our results showed a learning curve for the robot-assisted harvesting of the rectus abdominis on a porcine model.

Is thoracic outlet syndrome common after nuss procedure?

Publication date: Available online 26 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Wenlin Wang
We try to discuss the results of Nagasao and Colleagues, claiming thoracic outlet syndrome is not a rare complication after Nuss procedure. According to our experience, this syndrome is not common.

Re: antibiotic prophylaxis in breast reduction surgery: a systematic review and meta-analysis.

Publication date: Available online 26 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Janak Bechar, Joanna Skillman, Joseph Hardwicke

Clinical Snippets

Issue Information

Hypopharyngeal Evaluation in Obstructive Sleep Apnea with Awake Flexible Laryngoscopy: Validation and Updates to Cormack-Lehane and Modified Cormack-Lehane Scoring Systems

Abstract

Objective

To validate the use of Cormack-Lehane and Modified Cormack-Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnea.

Study Design

Validation study using samples collected from a prospective database.

Setting

University Medical Center.

Participants

Data was obtained from a retrospective review of a prospective database of flexible fiberoptic examination recordings in 274 consecutive OSA subjects (Stanford Sleep Medicine/Surgery Clinic).

Main Outcome Measures

Single still images from awake fiberoptic laryngoscopy examinations of the vocal cords from 90 different patients were presented to 2 experts and 4 novice raters. Raters used two grading systems (Cormack-Lehane scale and Modified Cormack-Lehane) to rate vocal cord visualization. Percent agreement and Cohen's kappa statistical analysis were used to evaluate inter-rater reliability and intra-rater reliability for each grading system. Feedback from the participants was then used to propose updates to further improve upon the existing grading scales for their applicability to awake flexible endoscopy.

Results

The Cormack-Lehane and Modified Cormack-Lehane scale both communicate un-obstructed and restricted views of the vocal cords reliably. Compared to the 4-grade scale, however, a modified 5-grade Vocal Cord Grading System allows for better objective communication of common variations in hypopharyngeal airway visualization.

Conclusion

We propose a 5-Grade Vocal Cord Grading System that builds upon existing grading systems to allow for efficient and reliable communication of hypopharyngeal airway examination during awake fiberoptic laryngoscopy.

This article is protected by copyright. All rights reserved.

The impact of olive mill wastewater spreading on soils using integrated approach of proximal soil survey, spatial, and multivariate analyses

Abstract

Olive oil production generates a large amount of olive mill wastewater (OMW), the most difficult to treat of agro-industrial effluents. Spreading of OMW across the soilscape has become the most frequently used practice in several Mediterranean basin countries but is hotly debated because of its potential to impair soil environs. The research hypothesis states that soil deterioration is correlated strongly with the spatiotemporal rate of OMW application; thus, the spatial pattern of the soil attributes should be established in conjunction with the rate of OMW spreading. The spatial pattern was ascertained using proximal soil sensing that measures the apparent electrical conductance (EC_a). Eight representative locations were identified using grouping analysis of the EC_a data. The soils were analyzed for selected physical and chemical attributes known to be affected by OMW spreading as well as ancillary parameters needed for the calibration of the EC_a. Discriminant analysis successfully categorized 76% of the EC_a groups, selecting CEC, sand, pH, and ESP as the most powerful discriminatory variables in the grouping analysis. The correlation coefficients between the measured EC_a, and the calculated EC_a, and soil moisture were very high (r > 0.77, P < 0.05), suggesting that the proximal soil survey results are well calibrated. The spreading of untreated OMW over more than 7 years did not impair the soils under study. No significant changes in soil chemo-physical properties such as pH (< 7.66), electrical conductivity in saturated paste (< 3.58 dS m⁻¹), sodium adsorption ratio (< 2.3), potassium adsorption ratio (< 0.33), exchangeable sodium percentage (< 3.85%), and unsaturated hydraulic conductivity (< 0.3 cm h⁻¹) were found in comparison with untreated soils. The results support the premise that moderate quantities of OMW (50–70 m³ ha⁻¹ year⁻¹) equally spread over the soilscape will have little impact on soil health.

Itching for answers: Prevalence and severity of pruritus in psoriasis

Abstract

Background/Objectives

Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents.

Method

This was a multi-site cross-sectional observational study conducted in New South Wales, Australia. Psoriasis patients were approached during their outpatient clinic, phototherapy or private consultations. Data on psoriasis characteristics, severity and treatment were collected. The patients were then asked to complete a survey regarding the frequency, severity and aggravators of their psoriasis.

Results

Data were collected from 179 patients with a mean age of 52.3 years, of whom 55% were male. Altogether 63 (35%) had a psoriasis area severity index (PASI) > 10, 42 (24%) were on biological agents and 84 (47%) were receiving phototherapy. The number of patients who reported itch all the time was 40 (22%), most of the time 48 (27%), and never 19 (11%). Patients with nail psoriasis were significantly less likely to have itch all or most of the time (P = 0.01). Itch all or most of the time was significantly more likely in patients with PASI > 10 (P = 0.013). No treatment was associated with reduced itch. Itch was reported to be most frequent in the winter season.

Conclusion

Few patients with psoriasis do not suffer from pruritus. Despite their promise, biological agents are not associated with reduced itch.

Mycosis fungoides occurring at the site of previous herpes zoster eruption

Abstract

Numerous clinicopathological variants of mycosis fungoides have been described in the literature. Dermatomal or zosteriform mycosis fungoides is one reported variant but a clear aetiology has never been documented. We report a case of mycosis fungoides proved by biopsy and immunohistochemistry that developed in a 55-year-old man at the site of previous herpes zoster eruption. We also present a review of the relevant literature to add to the understanding of rare variants of mycosis fungoides and aid in the clinical recognition of zosteriform mycosis fungoides.

Canaliform median raphe cyst

Debabrata Bandyopadhyay

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):108-108

Antihypertensives in dermatology Part I - Uses of antihypertensives in dermatology

P. S. S. Ranugha, Jayadev B Betkerur

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):6-15

Hypertension is a global health problem. Antihypertensives are the mainstay of treatment for hypertension. Some of them were accidentally found to be useful in alopecias and infantile hemangiomas and have now become standard treatment for these conditions as well. Antihypertensives are also being studied for other dermatological indications, where they have shown promising efficacy. This review focuses on the dermatological indications for antihypertensives, discussing the drugs that have been tried, as well as their efficacy, dosage, duration of therapy, and adverse effects.

Involvement of scars in capecitabine induced hand foot syndrome

Bhabani S. T. P. Singh, Tapaswini Tripathy, Bikash Ranjan Kar, Surabhi Singh

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):85-87

Turmeric: A condiment, cosmetic and cure

Hima Gopinath, Kaliaperumal Karthikeyan

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):16-21

Turmeric (Curcuma longa L.) is an integral part of Asian culture and cuisine. It has been used in traditional medicine since centuries. A myriad of health benefits have been attributed to it. Curcumin, the most biologically active curcuminoid in turmeric, is being investigated in pre-clinical and clinical trials for its role in disease prevention and cure. It has antioxidant, anti-inflammatory, antineoplastic, anti-proliferative and antimicrobial effects. We review the chemistry of this plant, its cultural relevance in Indian skin care, and its uses in dermatology.

Erratum: A noncancerous variant of xeroderma pigmentosum type D associated with novel heterozygous missense ERCC2 gene mutation

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):122-122

Risk of venous thromboembolism in patients with bullous pemphigoid: A systematic review and meta-analysis

Patompong Ungprasert, Karn Wijarnpreecha, Charat Thongprayoon

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):22-26

Background and Objectives: Increased risk of venous thromboembolism is observed in several autoimmune inflammatory disorders. However, data on bullous pemphigoid, one of the most common autoimmune blistering disorders, is limited. This systematic review and meta-analysis was conducted to summarize all available evidence. Methods: Two investigators independently searched published studies indexed in MEDLINE and EMBASE from inception to July 2016 using the terms for bullous pemphigoid and venous thromboembolism. The inclusion criteria were as follows: (1) cohort or case-control study evaluated the association between bullous pemphigoid and risk of venous thromboembolism, (2) effect estimates were provided as odds ratios, relative risk, hazard ratio, standardized incidence ratio with 95% confidence intervals, and (3) subjects without bullous pemphigoid were used as comparators for cohort studies, while subjects without venous thromboembolism were used as comparators for case-control studies. Point estimates and 95% confidence intervals were extracted from each study and were pooled together using the random-effect model, generic inverse variance method of DerSimonian and Laird. Cochran's Q test and the I2 statistic were used to evaluate the statistical heterogeneity. Results: Two retrospective cohort studies, one prospective cohort study, and one case-control study met the eligibility criteria and were included in the meta-analysis. The pooled odds ratio was 2.69 (95% confidence interval, 1.79–4.05). Statistical heterogeneity was high with I2 of 77%. Limitation: Limited accuracy of diagnosis of primary studies and high between-study heterogeneity. Conclusion: This meta-analysis demonstrated that patients with bullous pemphigoid have a significantly increased risk of venous thromboembolism.

Dermoscopy and scanning electron microscopy in two cases with hair shaft damage secondary to hair straightening

Feroze Kaliyadan, BB Gosai, Walid Naief Ali Al Melhim, Hani Mohammed Al Rasasi, P Joel Kuruvilla

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):95-97

A study of the histopathology of palmo-plantar psoriasis and hyperkeratotic palmo-plantar dermatitis

Ashwin Rao, Sujay Khandpur, M Kalaivani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):27-33

Background and Objectives: Palmo-plantar psoriasis and dermatitis show several overlapping clinical features. We undertook this retrospective study to elucidate and compare the histological findings in these two dermatoses. Materials and Methods: Biopsies of 31 clinically diagnosed cases of palmo-plantar psoriasis and 24 cases of hyperkeratotic palmo-plantar dermatitis, with concomitant presence of representative lesions at other body sites, were retrieved and analysed. Results: Histologically, confluent parakeratosis, suprapapillary thinning and dermal edema were observed in significantly greater number of palmo-plantar psoriasis biopsies while an inflammatory infiltrate confined to the papillary dermis only, was a significant feature in palmo-plantar dermatitis. The two conditions could not be differentiated on the basis of features like focal parakeratosis, presence of neutrophils and fibrin globules in the stratum corneum, hypogranulosis, acanthosis, spongiosis, rete ridge pattern, or vascularity. Conclusion: Histopathology of palmo-plantar psoriasis and dermatitis can have several overlapping features. In our study, we found only few features as strong pointers towards psoriasis.

Phacomatosis pigmentokeratotica: A very rare twin spotting phenomenon

Darshan R Karia, Apeksha N Solanki, Ashish G Jagati, Bela J Shah

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):120-120

Prevalence of ocular findings in a sample of Egyptian patients with psoriasis

Salma Samir Omar, Hany Ahmed Helaly

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):34-38

Background: Psoriasis is a common disorder worldwide. The prevalence of psoriasis in Egypt, an African country with a Caucasian population, ranges 0.19–3%. Despite this relatively high prevalence of psoriasis, there are no epidemiologic data regarding the burden of associated eye affection. Determining the magnitude of the problem could help in offering better integrated health services. Aim: The purpose of this study was to evaluate eye involvement in a sample of Egyptian psoriatic patients. Patients and Methods: This case-control study included 100 patients with psoriasis and 100 age and sex matched healthy controls. Psoriasis extent and severity was graded by psoriasis area and severity index (PASI). Complete ophthalmological examination and tests for dry eye were performed to all subjects. Results: The mean age of the psoriasis group was 50.7 ± 14.3 years. Thirty eight percent of the cases were females. The mean duration of psoriasis was 10.1 ± 7.5 years. Psoriasis patients had more conjunctival injection (n = 40, P = 0.035), more pinguecula (n = 38, P = 0.048) than controls. Ocular surface disease index (OSDI), tear breakup time (TBUT), Schirmer I, and Rose Bengal staining showed statistically significant positive results in the psoriasis group. Conclusion: This is the first report on the prevalence of eye comorbidities in Egyptian psoriatic patients. Dry eyes were more common with psoriasis, particularly the erythrodermic type. Other ocular findings were not statistically significantly different except for conjunctival injection and pinguecula.

Acral porokeratosis associated with anonychia

Gurumoorthy Rajesh, Prakash Devan, Subramaniam Keerthi, Kaliaperumal Karthikeyan

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(1):81-82