Functional and Aesthetic Factors Associated with Revision of Rhinoplasty.

BACKGROUND: Surgical revision rate of rhinoplasty is from 5% to 15% in literature. The aims of our study were to define the rate and the predictive factors for surgical revision of rhinoplasty. METHODS: We have realized a single-center case/control study including 62 patients who underwent surgical revision among 732 patients who underwent closed rhinoplasty between 2005 and 2015. Data of each rhinoplasty were collected from medical records and photographs. Statistical analyses were used. RESULTS: The surgical revision rate was 8.6%. After multivariate analysis, 4 factors were statistically significant and independently associated with surgical revision: "preexisting respiratory functional disorder" [odds ratio OR = 3.30; 95% CI (1.47-7.76); P = 0.004], "wide nasal bone and side walls" [OR = 3.94; 95% CI (1.49-11.25); P = 0.007], "deviated nasal bone and side walls" [OR = 2.68; 95% CI [1.14-6.58]; P = 0.02] and the use of camouflage grafts [OR = 0.26; 95% CI [0.07-0.89]; P = 0.04]. CONCLUSIONS: Closed rhinoplasties have similar revision rate to open techniques. Revision surgeries are justified by functional or aesthetic disorders. The interests of this study are to better inform patients and to adapt operative management. We provide here some recommendations with focus on the keys to successful rhinoplasty surgery.

Reappraisal of primary hepatic lymphoma: Is surgical resection underestimated?

Primary hepatic lymphoma (PHL) is defined as a lympho-proliferative disorder limited to the liver without any involvement of the spleen, lymph nodes, bone marrow or blood. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type counting more than 60-80% of all PHL. Usually, it occurs in middle-aged men with aspecific symptoms and diagnosis is confirmed by histopathology. In order to expand current knowledge and to investigate an optimal therapeutic strategy, a systematic review of literature was conducted in February 2016. A total of 274 articles were retrieved, and after exclusion, 55 were retained, reporting 147 cases of PHL. Patients were mainly men (64.9%) with a median age at diagnosis of 57 years (range: 17-92) and right hepatic lobe involvement (69.6%). Among the 147 patients, 9% received no therapy while 77% underwent treatment including chemotherapy, surgery and radiotherapy in 64%, 26% and 1% of cases, respectively. Mean follow-up was 22.6 months (range: 0.2-360). Overall mortality was 29.2% with a 90-day mortality of 26%. Risk factors for increased mortality include; bilobar lesions (p = 0.001), right lobe localisation (p = 0.003) and non-surgical approach or the absence of any treatment (p = 0.001). A trend towards favourable outcomes for young patients (mean = 50.4 years) with a large liver lesion was achieved by surgical management of PHL but this did not achieve statistical significance. Statistical analysis indicates that in cases of resectable disease, an aggressive surgical approach in selected patients leads to increase long-term survival. Thus, two hypotheses should be assessed in further randomized studies: 1°) resectable PHL is a less severe form or 2°) hepatectomy is an effective treatment for PHL.

Predicting falls with the cognitive timed up-and-go dual task in frail older patients.

BACKGROUND: The cognitive timed up-and-go dual task (CogTUG) has been proposed to improve the performance of the timed up-and-go (TUG) test for predicting falls in older patients and as a screening tool for early detection of frailty. We aimed to determine whether the CogTUG score is associated with a history of falls in frail older outpatients with gait disorders. METHODS: This retrospective study involved outpatients >75 years old with or without previous falls who were admitted from 2012 to 2014 to a geriatric day hospital for gait disorders. Patients took the TUG and CogTUG tests on the day of comprehensive geriatric assessment. RESULTS: Among the 161 patients included (157 analyzed; mean age 84.4±6.2 years; 72% women), 84 (53.5%) had fallen in the previous year: 105 (66.9%) were considered pre-frail and 52 (33.1%) frail. As compared with non-fallers, fallers had lower Tinetti balance scores (P=0.0004) and handgrip strength (P=0.03), more lost weight (P=0.04), and they took longer to perform the TUG test (P=0.04). Fallers and non-fallers did not differ in time taken to perform the CogTUG test (30.7±11.2 vs. 28.5±10.2s, P=0.20). History of falls was associated with only weight loss (odds ratio 3.43; 95% CI 1.13-11.30, P=0.03) and handgrip strength (0.88; 0.78-0.97, P=0.02) on multivariate analysis. CONCLUSION: Unlike TUG scores, the CogTUG score was not associated a history of falls in frail older outpatients with gait disorders. Our results underline that weight loss and low muscle strength are related to falls.

Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women.

In women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 × 10(9) /l in 35·6% of pregnancies. During pregnancy the median platelet count nadir was 66 × 10(9) /l (25th-75th percentile: 42-117), with platelet count <30 × 10(9) /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 × 10(9) /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6·8-20·2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53·9% vs. 10·3%, P < 0·001). For 8·3% of the pregnancies (95% CI: 3·8-15·1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16·7, 95% CI: 2·61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.

Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.

OBJECTIVE: Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice. METHODOLOGY AND MAIN FINDING: Three electronic data bases were searched over a 30 years period (1978-2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility. CONCLUSION: The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.