RESUMO
Aesthetic plastic surgery is a consumer-driven industry, subject to influence by financial forces. A changing economic environment may thus impact on the demand for surgery. The aim of this study was to explore trends in demand for bilateral breast augmentation (BBA) in consecutively presenting patients over an 11-year period and to examine if a correlation exists between these trends and changes in Gross Domestic Product (GDP), a key economic indicator. This study revealed a correlation between annual number of breast augmentation procedures performed and GDP values (r 2 = 0.34, p value = 0.059). Additionally, predicted number of BBA procedures, based on predicted GDP growth in Ireland, strongly correlated with actual number of BBA performed (r 2 = 0.93, p value = 0.000001). Predicted GDP growth can potentially forecast future demand for BBA in our cohort allowing plastic surgeons to modify their practice accordingly. 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 .
Assuntos
Produto Interno Bruto/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Mamoplastia/economia , Feminino , Previsões , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Irlanda/epidemiologia , Mamoplastia/tendências , Estudos RetrospectivosRESUMO
UNLABELLED: Aesthetic surgery is a rapidly expanding industry and patient safety is a fundamental issue. The need for regulation has been outlined by the Professional Standards for Cosmetic Practice Report, published by the Royal College of Surgeons in January 2013 which highlighted standards of patient care. The aim of this study was to review institutional compliance with these standards. A retrospective chart review of 40 consecutive patients who underwent either bilateral breast augmentation or bilateral breast reduction between November 2012 and November 2013 within our unit was performed. Compliance with standards relating to practice management, patient consultation, patient communication and record-keeping was examined. While details of past medical history were recorded in most cases, few consultations referred to psychiatric history and cosmetic surgical history specifically. Perioperative documentation and compliance with surgical safety processes were excellent. As a self-regulating profession, it is important that plastic surgeons take the lead in auditing their practice against such published standards. We urge all professionals who carry out cosmetic procedures to regularly review their practice, thereby promoting accountability and maintaining the trust of the general public in the aesthetic surgery industry. 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 .
Assuntos
Competência Clínica/normas , Fidelidade a Diretrizes/normas , Mamoplastia/normas , Cirurgia Plástica/normas , Estudos de Coortes , Feminino , Humanos , Mamoplastia/métodos , Guias de Prática Clínica como Assunto/normas , Encaminhamento e Consulta , Estudos Retrospectivos , Medição de Risco , Cirurgia Plástica/métodos , Resultado do TratamentoRESUMO
The practice of medicine is occasionally volatile and increasingly litigious. Within the specialities, plastic surgery has a high risk, with negative outcomes seen as dissatisfaction, as compared to actual physical harm. To date, most research has focused on potential triggers for litigation, such as poor communication and perceived behavioural deficiencies among physicians. Few studies have addressed patient characteristics or socioeconomic factors. The 'Influence of Socio-Economic Factors on Attitudes Towards Surgery' questionnaire was designed to reflect these goals. It was distributed for a 12-month period to patients in an Emergency Department waiting room. Three hundred twelve completed questionnaires were submitted for analysis. Within the study population, we identified certain socioeconomic trends among those with a low threshold to pursue litigation. Patients with a low threshold to sue were more likely to be male, aged 25-55 years, currently unemployed, without dependents and divorced. However, these parameters did not reach statistical significance. Although these characteristics are interesting, they cannot reliably identify or predict those with a low threshold for litigation. For now, the clinical focus should remain on careful adherence to best practice in an effort to reduce the risk of potential litigation.
Assuntos
Atitude , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Pacientes/psicologia , Cirurgia Plástica/legislação & jurisprudência , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa , Autorrelato , Fatores Socioeconômicos , Adulto JovemRESUMO
Deregulated expression of the type I cytokine receptor, CRLF2, is observed in 5-15% of precursor B-cell acute lymphoblastic leukaemia (B-ALL). We have previously reported the genomic landscape of patients with CRLF2 rearrangements (CRLF2-r) using both whole genome and exome sequencing, which identified a number of potential clonal and sub-clonal genomic alterations. In this study, we aimed to assess when the CRLF2-r; IGH-CRLF2 or P2RY8-CRLF2, arose during the evolution of both Down syndrome-ALL (DS-ALL) and non-DS-ALL. Using fluorescence in situ hybridisation, we were able to track up to four structural variants in single cells from 47 CRLF2-r B-ALL patients, which in association with our multiplex single-cell analysis of a further four patients, permitted simultaneous tracking of copy number alterations, structural and single nucleotide variants within individual cells. We observed CRLF2-r arising as both early and late events in DS and non-DS-ALL patients. Parallel evolution of discrete clones was observed in the development of CRLF2-r B-ALL, either involving the CRLF2-r or one of the other tracked abnormalities. In-depth single-cell analysis identified both linear and branching evolution with early clones harbouring a multitude of abnormalities, including the CRLF2-r in DS-ALL patients.
Assuntos
Síndrome de Down/genética , Rearranjo Gênico , Leucemia Mieloide Aguda/genética , Receptores de Citocinas/genética , Análise de Célula Única/métodos , Adolescente , Adulto , Animais , Estudos de Casos e Controles , Criança , Pré-Escolar , Síndrome de Down/complicações , Síndrome de Down/patologia , Feminino , Humanos , Hibridização in Situ Fluorescente , Lactente , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/patologia , Masculino , Camundongos Endogâmicos NOD , Camundongos SCID , Pessoa de Meia-Idade , Mutação , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto , Adulto JovemRESUMO
Self-harm is a common source of referral to plastic and hand surgery services. Appropriate management of these patients is complex and includes the need for close liaison with mental health services. Self-harm is the single biggest risk factor for completed suicide, thereby increasing the risk by a factor of 66.1 This study aimed to analyse the clinical pathway and demographics of patients referred to plastic surgeons following self-harm. This 6-year retrospective series included patients referred to plastic surgeons following self-harm within the Galway University Hospital group. Patients were identified through the Hospital inpatient enquiry system, cross-referenced with data from the National Suicide Research Foundation. Data collected included demographics, psychiatric history, details of self-harm injury, admission pathway and operative intervention. Forty-nine patients were referred to plastic surgery services during the study period, accounting for 61 individual presentations. The male-to-female ratio was 26 (53%) to 23 (47%). Mean age was 40 years (range 21-95 years). Alcohol or illicit substance use was recorded in 17 of 61 (28%) presentations. Mortality from suicide occurred in 4 patients (8%). Mental health assessment was not carried out in 9 presentations (15%). Documentation of need for close or one-to-one observation was made in 11 cases (20%) and was not referred to in 43 cases (83%) following mental health assessment. This study demonstrates significant diversity in the management of this vulnerable patient group and may inform development of referral pathways to improve the safety of transfer, surgical admission and discharge of patients following self-harm, in consultation with mental health services.
Assuntos
Encaminhamento e Consulta , Comportamento Autodestrutivo/cirurgia , Prevenção do Suicídio , Cirurgia Plástica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Automutilação/psicologia , Automutilação/cirurgia , Comportamento Autodestrutivo/psicologia , Adulto JovemRESUMO
Developments in the technique of fluorescence in situ hybridization (FISH) now permit hybridization of sequences ranging from 1 kb to whole genomes. The technique can be used in applications from coarse mapping of whole chromosomes to high-resolution analysis of extended strands of DNA. The complexity, and hence the coverage, of 'paints' prepared by amplification is being improved to the extent that such methods are used in cloning strategies for the generation of region-specific probes. Interphase analysis and comparative genomic hybridization are becoming important tools in cancer cytogenetics, and the potential for routine analysis of fetal cells obtained from maternal blood may provide a fresh approach to prenatal cytogenetic screening. Functional studies of gene activity and nuclear organization are now also possible.
Assuntos
Citogenética/métodos , Animais , Aberrações Cromossômicas , Primers do DNA , Replicação do DNA , Feminino , Genoma , Humanos , Hibridização in Situ Fluorescente , Interfase/genética , Meiose/genética , Sondas Moleculares , Hibridização de Ácido Nucleico , Gravidez , Diagnóstico Pré-NatalRESUMO
Diabetes is an independent risk factor for development of heart failure and has been associated with poor outcomes in these patients. The prevalence of diabetes continues to rise. Using routine HbA1c measurements on inpatients at a tertiary hospital, we aimed to investigate the prevalence of diabetes amongst patients hospitalised with decompensated heart failure and the association of dysglycaemia with hospital outcomes and mortality. 1191 heart failure admissions were identified and of these, 49% had diabetes (HbA1c ≥ 6.5%) and 34% had pre-diabetes (HbA1c 5.7-6.4%). Using a multivariable analysis adjusting for age, Charlson comorbidity score (excluding diabetes and age) and estimated glomerular filtration rate, diabetes was not associated with length of stay (LOS), Intensive Care Unit (ICU) admission or 28-day readmission. However, diabetes was associated with a lower risk of 6-month mortality. This finding was also supported using HbA1c as a continuous variable. The diabetes group were more likely to have diastolic dysfunction and to be on evidence-based cardiac medications. These observational data are hypothesis generating and possible explanations include that more diabetic patients were on medications that have proven mortality benefit or prevent cardiac remodelling, such as renin-angiotensin system antagonists, which may modulate the severity of heart failure and its consequences.
Assuntos
Diabetes Mellitus/epidemiologia , Hemoglobinas Glicadas/análise , Insuficiência Cardíaca/sangue , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Pacientes Internados , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Análise de SobrevidaRESUMO
INTRODUCTION: Extrahepatic Portal Hypertension (EPH) is defined as extrahepatic hypertension of the portal venous system in the absence of liver cirrhosis. Isolated splenic vein stenosis/occlusion as one of the causes of extrahepatic portal hypertension is uncommon, comprising less than 5 % of all cases of portal hypertension. However, it is an increasingly recognised complication of both acute and chronic pancreatitis, and with the advent of more effective diagnostic methods, interventional radiological methods for its management are also becoming more effective. Often these would negate the need for invasive splenectomy surgery for the treatment of symptomatic hypersplenism and varices. METHODS: A case of a 38 year old gentleman, known to have Crohn's disease, presented with severe acute gallstone pancreatitis with necrosis of the pancreatic neck and body. His course was very complicated, requiring two laparotomies and various interventional drainages of variceal bleeds. As a result of non resolving recurrent variceal haemorrhage, it was decided to proceed with splenic vein stenting to relieve the consequences of splenic vein stenosis. A percutaneous transhepatic splenic vein stent was deployed. RESULTS: Immediate decompression of the varices was noted with no further haemmorrhage. CONCLUSION: There are little data to date on splenic vein stenting in the setting of EPH secondary to non-malignant pancreatic disease. We report a case managed successfully with splenic vein stenting and review the existing literature.
Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Veia Esplênica , Stents , Adulto , Constrição Patológica/patologia , Drenagem/métodos , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/etiologia , Masculino , Pâncreas/patologiaRESUMO
Renal transplantation is the most frequently performed transplant procedure. Immunosuppressive therapies have dramatically increased survival rates in transplant recipients but are associated with an increased risk of skin cancers. Recent changes in immunosuppressive strategies have been adopted with the aim of reducing this challenging adverse effect. Despite these new strategies, cutaneous malignancies tend to be numerous, aggressive and associated with a higher risk of local and distant dissemination than in the non-transplant population. This represents a significant workload for transplant physicians, dermatologists, and head and neck and plastic surgeons. This review highlights key concepts in the pathogenesis of skin cancer in transplant patients, the impact current and evolving immunosuppressive strategies and regimens will have on the epidemiology, and the management of cutaneous malignancies in renal transplant patients, with particular focus on the implications for the plastic surgery community.
Assuntos
Carcinoma Basocelular/etiologia , Carcinoma de Célula de Merkel/etiologia , Carcinoma de Células Escamosas/etiologia , Terapia de Imunossupressão/efeitos adversos , Transplante de Rim , Melanoma/etiologia , Neoplasias Cutâneas/etiologia , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/terapia , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/terapia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Humanos , Terapia de Imunossupressão/métodos , Melanoma/epidemiologia , Melanoma/terapia , Prevalência , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/etiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapiaRESUMO
Multiplex FISH (M-FISH) represents one of the most significant developments in molecular cytogenetics of the past decade. Originally designed to generate 24 colour karyotyping, the technique has spawned many variations and an equally diverse range of applications. In tumour and leukaemia cytogenetics, the two groups that have been targeted represent both ends of the cytogenetic spectrum: those with an apparently normal karyotype (suspected of harbouring small rearrangements not detectable by conventional cytogenetics) and those with a complex aberrant karyotype (which are difficult to karyotype accurately due to the sheer number of aberrations). In research, mouse M-FISH provides a powerful tool to characterize mouse models of a disease. In addition, the ability to accurately karyotype single metaphases without selection makes M-FISH the perfect tool in chromosome breakage studies and for characterizing clonal evolution of tumours. Finally, M-FISH has emerged as the perfect partner for the developing genomic microarray (array CGH) technologies, providing a powerful approach to gene discovery.
Assuntos
Citogenética/tendências , Hibridização in Situ Fluorescente , Linfoma de Burkitt/genética , Aberrações Cromossômicas , Humanos , Cariotipagem , Translocação GenéticaRESUMO
The PAX5 gene, encoding the B-cell-specific activator protein, is a critical determinant of commitment to the B-lymphocyte pathway. This gene, mapped at 9p13, is juxtaposed to the immunoglobulin heavy chain (IgH) gene as a result of the t(9;14)(p13;q32), a rare but recurring translocation found in a subset of B-cell non-Hodgkin's lymphoma cases. In all of these, this translocation results in deregulated expression of the gene product because of the proximity of IgH. We present here the molecular characterization of a previously reported acute lymphoblastic leukemia case carrying a t(9;12)(q11;p13) translocation. Using 5' rapid amplification of cDNA ends PCR, a novel chimeric transcript was identified that contained the NH(2)-terminal region of PAX5 and most of the ETV6/TEL gene on 12p13. According to the fusion transcript, the resulting chimeric protein would retain the PAX5 paired-box domain and both the helix-loop-helix and DNA binding domains of TEL. Thus, it is reasonable to hypothesize that this protein could act as an aberrant transcription factor. This is the first report of PAX5 rearrangement in a human malignancy resulting in a chimeric transcript.
Assuntos
Proteínas de Ligação a DNA/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Proteínas/genética , Proteínas Repressoras , Fatores de Transcrição/genética , Sequência de Bases , Northern Blotting , Cromossomos Humanos Par 12 , Cromossomos Humanos Par 9 , Humanos , Hibridização in Situ Fluorescente , Dados de Sequência Molecular , Fator de Transcrição PAX5 , Proteínas Proto-Oncogênicas c-ets , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Translocação Genética , Variante 6 da Proteína do Fator de Translocação ETSRESUMO
Chromosomal analysis of a non-Hodgkin's lymphoma revealed a t(11;14)(q23;q32) translocation amongst other abnormalities. To investigate the molecular basis of this translocation, a cosmid library was constructed from the tumour DNA and the rearranged IGH locus was isolated in a single cosmid. Fluorescence in situ hybridization confirmed that the cloned region contained sequences from chromosome 11q23 fused to chromosome 14q32. Sequence analysis identified the breakpoint as a fusion between a region from the switch segment of the C gamma 4 gene of the IGH locus and an unknown sequence on chromosome 11. The chromosome 11 sequence maps proximal to the CD3 gene cluster and is therefore distinct from both the HTRX1 gene (rearranged in acute leukaemias) and the RCK gene (rearranged in a cell line derived from a histiocytic B-cell lymphoma). This newly identified region contains a cluster of rare cutting restriction enzyme sites located within 200 bases of the breakpoint, suggestive of a CpG island. Although this t(11;14)(q23;q32) translocation and that in the RC-K8 cell line affect different regions on chromosome 11, the breakpoints on chromosome 14 were found to have occurred at equivalent positions of S gamma 2 and S gamma 4 segments.
Assuntos
Cromossomos Humanos Par 11 , Cromossomos Humanos Par 14 , Linfoma não Hodgkin/genética , Proto-Oncogenes , Fatores de Transcrição , Translocação Genética , Adulto , Sequência de Bases , Mapeamento Cromossômico , Clonagem Molecular , DNA , Proteínas de Ligação a DNA/genética , Histona-Lisina N-Metiltransferase , Humanos , Masculino , Dados de Sequência Molecular , Proteína de Leucina Linfoide-Mieloide , Homologia de Sequência do Ácido NucleicoRESUMO
Juvenile myelomonocytic leukemia (JMML) is a rare disorder of early childhood, to which no recurrent chromosome rearrangement has been yet associated. We report a case where leukemic cells harbored a 46,XX,der(12)t(3;12) (q21 approximately 22;p13.33) karyotype, resulting in partial trisomy of 3q. The origin of chromosome material translocated to chromosome 12 was assessed by chromosome painting using a whole chromosome 3-specific probe. The breakpoint regions were defined by FISH using YAC probes from 3q and 12p chromosomal regions. Interestingly, partial trisomy of 3q has been detected in a previously reported JMML case, consequent to the presence of a der(15)t(3;15)(q13.1;q26). The involvement of a similar chromosome 3 rearrangement in these two JMML cases suggests the hypothesis that either the resulting duplication of some gene/s on 3q or the loss of heterozygosity (LOH) of some gene/s on 3p may be involved in one of the steps leading to JMML. On the other hand, it cannot be ruled out that the relevant mutation in our case might be consequent to the particular breakpoints at bands 3q21 approximately 22 and 12p13.3, that may alter the structure and/or expression of the involved gene/s.
Assuntos
Aberrações Cromossômicas/genética , Leucemia Mielomonocítica Crônica/genética , Transtornos Mieloproliferativos/genética , Proteínas Repressoras , Transtornos Cromossômicos , Mapeamento Cromossômico , Cromossomos Humanos Par 12 , Cromossomos Humanos Par 3 , Proteínas de Ligação a DNA/genética , Humanos , Hibridização in Situ Fluorescente , Proteínas Proto-Oncogênicas c-ets , Fatores de Transcrição/genética , Translocação Genética , Trissomia , Variante 6 da Proteína do Fator de Translocação ETSRESUMO
Cytogenetic analysis of a bone marrow aspirate from a patient with acute lymphoblastic leukemia (ALL) revealed the presence of a complex karyotype containing the translocation, t(14;18)(q32;q21). Further investigations using fluorescence in situ hybridization (FISH) allowed the characterization of an additional translocation, t(8;9)(q24;p1?). The association of t(14;18)(q32;q21) and t(8;9)(q24;p13) has recently been described in two patients with de novo ALL (Nacheva et al. Blood 1993;82:231-240) and this report supports these findings.
Assuntos
Cromossomos Humanos Par 14 , Cromossomos Humanos Par 18 , Cromossomos Humanos Par 8 , Cromossomos Humanos Par 9 , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Translocação Genética , Adulto , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , MasculinoRESUMO
Monosomy 7 (-7) and deletion of the long arm of chromosome 7, del(7q), are frequent non-random findings in the myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML), particularly associated with therapy-related disease (t-MDS and t-AML). The cytogenetic breakpoints of 7q deletions are variable, with both terminal and interstitial deletions reported. It is now believed that most deletions are interstitial, and that the variability in reported breakpoints may be due to the difficulty in determining whether the terminal, pale staining G band is present. It has also been suggested that some reported deletions of 7q may be cryptic translocations. To address these questions, we carried out fluorescence in situ hybridization (FISH) studies on leukaemic cells from a large series of patients using a chromosome 7-specific paint and a 7q telomere-specific probe. Of the 26 cases studied, seven were 'pure' deletions (ie without the involvement of other chromosomes); four were interstitial and two terminal. One further patient had two clones each with a different deletion: one with a terminal del(7)(q22) and the second with an interstitial del(7)(q32-qter). A further nine cases had unbalanced translocations with deletion of 7q terminal sequences. The remaining 10 cases were translocations and complex rearrangements, some involving interstitial deletions of 7q. In two cases in which del(7q) was reported as the sole cytogenetic abnormality by G-banding, FISH revealed cryptic translocations involving 7q.
Assuntos
Deleção Cromossômica , Cromossomos Humanos Par 7 , Leucemia/genética , Síndromes Mielodisplásicas/genética , Translocação Genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bandeamento Cromossômico , Feminino , Humanos , Hibridização in Situ Fluorescente , Lactente , Cariotipagem , Masculino , Pessoa de Meia-IdadeRESUMO
A 25-year-old male right-hand dominant warehouse operator presented with two hand infections within 12 weeks both requiring surgical drainage and antimicrobial therapy. Subsequent testing confirmed Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA). This case highlights the need for prompt multidisciplinary management of hand infections to consider, diagnose and manage atypical infections.