A Prospective, Multicenter Trial on the Efficacy and Safety of Poly-L-Lactic Acid for the Treatment of Contour Deformities of the Buttock Regions.

BACKGROUND: There is a significant emphasis on minimally invasive whole-body rejuvenation throughout the world. Recently, gluteal aesthetics have become an increasingly common patient concern. Although the application of poly-L-lactic acid (PLLA) to the face is already well known, there are relatively fewer publications on its use in other corporeal regions. This study aims to extend previous findings by evaluating the efficacy and safety of PLLA in the treatment of contour (including lifting) deformities of the buttock region. METHODS: This was a prospective, multicenter (3 sites), single cohort, open-label clinical trial. Thirty female subjects were treated with PLLA in the bilateral buttocks, with three treatment sessions, each spaced one month apart and followed for six months after completion of the treatment regimen. At each visit, various safety and clinical efficacy parameters were collected, these included: Global Assessment of Improvement Scale (GAIS), subject satisfaction, skin hydration, elasticity, scaliness, roughness, and 3-dimensional imagery. RESULTS: Six months following the last treatment, 84.00% of patients were rated as having “improved” or more on the physician assessed GAIS, accompanied by a 96.00% patient satisfaction rate. Approximately three vials of PLLA, per buttock and treatment were used. There were no serious adverse events throughout the duration of the trial, nor adverse events related to the investigational device. The most common subject-reported adverse events included pain during treatment (Mean: 70.97%) and bruising (Mean: 28.80%). Objective improvements were persistent after treatment in measurements of skin elasticity (improved 63.5% - 82.5% from weeks 16-32), hydration (increased ~11 Corneometer® units by week 16), roughness (decreased 36.95% at week 32), and scaliness (desquamation; decreased 60.41% at week 32). CONCLUSIONS: PLLA is safe and effective for the indication of buttock contouring and improving parameters of skin health. PLLA can provide long-lasting effects with a high level of patient and physician satisfaction. J Drugs Dermatol. 2022;21(3):304-308. doi:10.36849/JDD.5924.

Utility outcome assessment of pes planus deformity.

BACKGROUND: Despite being a common condition, there are no objective measures in the literature to reflect the burden of pes planus on affected individuals. Our primary objective was to evaluate this burden by recruiting a sample from the general population using validated utility outcome measures. METHODS: Participants were recruited online and filled a questionnaire to help measure the health burden of pes planus. Three recognized utility outcome scores were used to compare the health burden of monocular blindness, binocular blindness, and pes planus. These included the standard gamble (SG), time trade-off (TTO), and visual analogue score (VAS). Paired t test, independent t test, and linear regression were used for statistical analysis. RESULTS: Ninety-two participants were included in the final analysis. The utility outcome scores (VAS, TTO, SG) for pes planus were 73±17, 0.90±0.08, and 0.88±0.12, respectively. The linear regression analysis showed that age was inversely proportional to the time trade-off. However, race, educational level, and income were not significant predictors of utility outcome score for pes planus. CONCLUSIONS: This study shows that the perceived burden of living with pes planus is comparable to living with some debilitating conditions. Our participants were willing to sacrifice 3.6 years of life, and have a procedure with a theoretical 12% mortality risk to attain perfect health.

Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p < .05). Age, gender, race, income, and education were not statistically significant independent predictors of the utility scores for hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity.

The impact of living with severe lower extremity lymphedema: a utility outcomes score assessment.

BACKGROUND: Debilitating lower extremity lymphedema can be either congenital or acquired. Utility scores are an objective measure used in medicine to quantify degrees of impact on an individual's life. Using standardized utility outcome measures, we aimed to quantify the health state of living with severe unilateral lower extremity lymphedema. METHODS: A utility outcomes assessment using visual analog scale, time trade-off, and standard gamble was used for lower extremity lymphedema, monocular blindness, and binocular blindness from a sample of the general population and medical students. Average utility scores were compared using a paired t test. Linear regression was performed using age, race, and education as independent predictors. RESULTS: A total of 144 prospective participants were included. All measures [visual analog scale, time trade-off, and standard gamble; expressed as mean (SD)] for unilateral lower extremity lymphedema (0.50 ± 0.18, 0.76 ± 0.22, and 0.76 ± 0.21, respectively) were significantly different (P < 0.001) from the corresponding scores for monocular blindness (0.64 ± 0.18, 0.84 ± 0.16, and 0.83 ± 0.17, respectively) and binocular blindness (0.35 ± 0.17, 0.61 ± 0.28, and 0.62 ± 0.26, respectively). CONCLUSIONS: We found that a sample of the general population and medical students, if faced with severe lymphedema, is willing to theoretically trade 8.64 life-years and undergo a procedure with a 24% risk of mortality to restore limb appearance and function to normal. These findings provide a frame of reference regarding the meaning of a diagnosis of severe lower extremity lymphedema to a patient and will allow objective comparison with other health states.

Population preferences of undergoing brachioplasty for arm laxity.

BACKGROUND: The number of patients requesting surgical procedures performed for brachioplasty and massive weight loss is increasing. The authors set out to quantify the health state utility outcome assessment of living with arm deformity requiring brachioplasty. METHODS: Utility assessments using the visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities scores for arm deformity, monocular blindness, and binocular blindness from a sample of the general population and medical students. Linear regression and Student t test were used for statistical analysis. A P value less than 0.05 was deemed statistically significant. RESULTS: All the measures for arm deformity of the 107 volunteers (VAS, 0.80 ± 0.14; TTO, 0.91 ± 0.12; SG, 0.94 ± 0.10) were significantly different (P < 0.001) from the corresponding measures for monocular blindness and binocular blindness. When compared to the sample of the general population, having a medical education demonstrated a statistical significance of being less likely to trade years of life and less likely to gamble risk of death for a procedure such as a brachioplasty. Race and sex were not statistically significant independent predictors of risk acceptance. CONCLUSIONS: We have objectified the health state of living with upper arm deformity requiring brachioplasty. Utility outcome scores (VAS, 0.80 ± 0.14; TTO, 0.91 ± 0.12; SG, 0.94 ± 0.10) were comparable to living with health states such as aging neck needing rejuvenation, excess skin in the thighs necessitating thigh lift, and massive weight loss requiring panniculectomy based on previously reported studies.

Living with a unilateral mastectomy defect: a utility assessment and outcomes study.

BACKGROUND: The gold standard for the treatment of breast cancer includes mastectomy surgery. Our goal was to quantify the health state utility assessment of living with unilateral mastectomy. METHODS: The visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities for unilateral mastectomy, monocular blindness and binocular blindness from a prospective sample of the general population and medical students. RESULTS: All measures (VAS, TTO, SG) for unilateral mastectomy (0.75 SD 0.17, 0.87 SD 0.14, and 0.86 SD 0.18, respectively) of the 140 volunteers were significantly different from the corresponding scores for monocular (0.61 SD 0.18, 0.84 SD 0.17, and 0.84 SD 0.18, respectively) and binocular blindness (0.38 SD 0.17, 0.67 SD 0.24, and 0.69 SD 0.23, respectively). Age, gender, race, education, and income were not statistically significant independent predictors of utility scores. CONCLUSION: In a sample of the general population and medical students, utility assessments for living with unilateral mastectomy were comparable with those of living with bilateral mastectomy and severe breast hypertrophy. Our sample population, if faced living with unilateral mastectomy was willing to gamble a theoretical 14% chance of death and willing to trade 4.2 years of existing life-years.

Thigh laxity after massive weight loss: a utilities outcomes assessment.

BACKGROUND: The presence of excess skin after massive weight loss, particularly in the thighs, not only contributes to a negative body image but can also lead to functional deficits in mobility. In the present study, we quantified the health state utility of living with excess skin in the thighs in an attempt to objectively establish the burden on the quality of life in patients living with excess thigh skin laxity. METHOD: Using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG), we compared the utility outcome scores for thigh skin excess with monocular and binocular blindness from a prospective sample of medical students and the general population. Utility scores were compared using paired t test. Linear regression was performed using age, race, and education as independent predictors of each of the utility scores. RESULTS: One hundred thirty-four prospective participants were enrolled during a 6-month period, and 112 participants met our inclusion criteria. The utility outcome scores for thigh lift (VAS, TTO, and SG, 0.77 ± 0.15, 0.90 ± 0.11, and 0.89 ± 0.14, respectively) were statistically different from binocular blindness (VAS, TTO, and SG, 0.37 ± 0.18, 0.70 ± 0.23, and 0.70 ± 0.26; P < 0.001), but other than VAS (0.67 ± 0.15, P < 0.001), similar to monocular blindness (TTO and SG, 0.89 ± 0.13 and 0.81 ± 0.14, respectively; P > 0.05). SG (0.89 ± 0.14 vs 0.97 ± 0.02, P = 0.003) and TTO (0.89 ± 0.11 vs 0.95 ± 0.03, P = 0.038) were different between general population and medical students, respectively, corresponding to 3.96 versus 1.80 potential years willing to be traded (P < 0.05). Additionally, SG was higher in whites versus nonwhites who were willing to take a potential 8% chance of mortality compared to 15%, respectively (P = 0.001), to achieve "perfect" health. CONCLUSIONS: We have objectified the utility of living with thigh deformity after massive weight loss. Our sample population if faced with the condition was willing to sacrifice a potential 3.6 years of life and potentially undergo a procedure with 11% chance of mortality to address excess thigh laxity.

The effects of Moufarrege total posterior pedicle reduction mammaplasty on breastfeeding: a review of 931 cases.

BACKGROUND: Since its original description in 1979, the Moufarrege total posterior pedicle reduction mammaplasty technique has proven to be a safe and reliable procedure providing aesthetic and functional enhancement. OBJECTIVES: To determine if the Moufarrege total posterior pedicle reduction mammaplasty affects successful breastfeeding. METHOD: Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was given. Patients were asked about their ability to lactate and successfully breastfeed preoperatively and postoperatively. The t test and χ(2) test were used to compare means and categorical variables, respectively. Values were also compared with a sample of women (n = 2223) from the Quebec general population as collected by the Longitudinal Study of Child Development in Quebec (ELDEQ, 1998-2002). RESULTS: A total of 931 patients (all women) underwent reduction mammaplasty during the study period at Jewish General Hospital, Montreal, Quebec, Canada (H.S.) or Hopital Hotel-Dieu, Montreal, Quebec, Canada (E.B. and R.M). There was a 62% response rate to the questionnaire. There were no statistically significant differences in the percentage of women able to lactate postoperatively vs preoperatively (98% vs 100%, respectively; P = .2). The percentage of women able to successfully breastfeed for 4 and 6 months was also not statistically different when comparing postoperative vs preoperative ability (4 months: 33% vs 44 %, P = .13; 6 months: 29% vs 28%, P = .77). The sample of women from the Quebec population did not differ statistically from those undergoing the Moufarrege breast reduction in terms of successful breastfeeding for 1, 2, 3, and 4 months (59% vs 67%, 52% vs 47%, 42% vs 41%, and 40% vs 33%, respectively). CONCLUSIONS: The Moufarrege breast reduction technique is a reliable and safe procedure that does not seem to negatively affect the success of breastfeeding based on the results of our retrospective chart review and patient questionnaire. LEVEL OF EVIDENCE: 4.

Utility outcome scores for unilateral facial paralysis.

BACKGROUND: Facial paralysis is a debilitating condition. Dynamic and static facial reanimation remains a challenge for plastic surgeons and requires important resources. Our objective was to quantify the health state utility assessment (ie, utility score outcomes) of living with unilateral facial paralysis. METHODS: Utility assessments using visual analog scale, time trade-off, and standard gamble were used to obtain utility outcome scores for unilateral facial paralysis from a prospective sample of the general population and medical students. RESULTS: A total number of 123 individuals prospectively participated in the study. All measures (visual analog scale, time trade-off, and standard gamble) for unilateral facial paralysis [0.56±0.18, 0.78±0.21, and 0.79±0.21 respectively] were significantly different (P<0.0001) from the corresponding outcome scores for monocular blindness [0.61±0.21, 0.83±0.21, and 0.85±0.18, respectively] and binocular blindness [0.33±0.18, 0.65±0.28, and 0.65±0.29, respectively]. Linear regression analysis using age, race, income, and education as predictors of each of the utility scores for facial paralysis showed no statistical significance. CONCLUSIONS: In samples of the general population and medical students, all utility score outcome measures for facial paralysis were lower than those for monocular blindness. Our sample population, if faced with unilateral facial paralysis, would theoretically undergo facial reanimation procedures with a willingness to sacrifice 8 years of life and be willing to undergo a procedure with a 21% chance of mortality to attain perfect health, respectively.

The impact of living with a functional and aesthetic nasal deformity after primary rhinoplasty: a utility outcomes score assessment.

BACKGROUND: Revision rhinoplasty for functional deformities can be both an aesthetic and reconstructive surgical challenge. We set out to quantify the health state utility assessment of living with the physical appearance of nasal asymmetry along with having nasal obstruction. The use of utility scores has helped to establish the health burden of living with various medical conditions. We sought to quantify living with a health state of nasal asymmetry with nasal obstruction after primary rhinoplasty using utility outcome scores. METHODS: We used previously validated utility outcome measures to quantify the health burden of this clinical scenario in 128 prospective subjects. These subjects were from a sample of the population and medical students recruited to complete a survey to determine the utility outcome score of revision rhinoplasty using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) tests to obtain utility scores for revision rhinoplasty. Linear regression and Student t test were used for statistical analysis. RESULTS: All measures (VAS, TTO, and SG) for functional nasal deformity (0.80±0.13, 0.90±0.12, and 0.91±0.13, respectively) of the 128 prospective subjects participating in this online study were significantly different (P<0.005) from the corresponding scores for monocular blindness (0.63±0.15, 0.85±0.16, and 0.85±0.19, respectively) and binocular blindness (0.38±0.18, 0.66±0.25, and 0.69±0.24, respectively). Being white was inversely related to the VAS utility scores for rhinoplasty (P<0.05). Additionally, female sex was positively correlated to the TTO score. Age, income, and education were not predictors of utility scores. CONCLUSIONS: In a sample of the population and medical students, VAS, TTO, and SG utility scores for revision rhinoplasty were determined and can be compared objectively with other health states and diseases with known utility scores. In a preoperative setting, women were objectively willing to potentially "trade" more years of life to treat a functional nasal deformity. If faced with a deformed nose after primary rhinoplasty, our sample population would consent to undergo a revision rhinoplasty procedure with a theoretical 9% chance of mortality and were willing to trade 3.6 years of their remaining life.

Salter-harris type 2 fracture of the proximal phalanx of the thumb with a rotational deformity: a case report and review.

Hand fractures are the most common site of injury in the pediatric population. They commonly involve the epiphyseal growth plates, and their standard classification is that of Salter-Harris (SH). Rotational deformities after SH fractures are rarely reported in literature. However, only 5 degrees of angulation can cause evident rotational deformity. This could be seen clinically and reconfirmed with radiologic evaluation. Up to this date, there are only a few cases of SH fractures with rotational deformity that have been described. We present 2 cases of SH type 2 with evidence of rotational deformity, which were reduced under local anesthesia in the emergency department. A review of literature is performed. Thus, examination for rotational deformities in SH fractures should be kept in mind. A satisfactory closed reduction under local anesthesia can be obtained.

Pediatric boutonniere deformity after blunt closed traumatic injury.

The boutonniere deformity (BD) is a well-described condition in hand surgery. Treatment of acute traumatic BD includes splinting of the proximal interphalangeal joint in extension for 4 to 5 weeks, which often leads to acceptable results. However, the chronic BD is more problematic and often requires surgical intervention with poor functional outcomes. Boutonniere deformity is extremely rare in the pediatric population. We present the case of a 9-year-old girl who presented to the emergency department with an acute traumatic BD after a fall. Being an uncommon entity in this patient population, the patient was referred to the plastic surgery clinic and was subsequently treated appropriately with splinting, resulting in favorable results as early as 4 weeks. To our knowledge, this is the first reported case of BD in the pediatric patient population. Recognition and timely management of BD in a pediatric patient should not be overlooked to obtain favorable results.

Utility assessment of body contouring after massive weight loss.

BACKGROUND: The number of surgical procedures performed for obesity and massive weight loss (MWL) is increasing. The authors set out to quantify the health state utility assessment of living with MWL that can occur after such procedures. METHODS: Utility assessments using the visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities for MWL, monocular blindness, and binocular blindness from a sample of the general population and medical students. RESULTS: All the measures for MWL of the 100 volunteers (VAS, 0.79 ± 0.13; TTO, 0.89 ± 0.12; SG, 0.89 ± 0.15) were significantly different (p < 0.005) from the corresponding measures for monocular blindness (0.63 ± 0.18, 0.84 ± 0.17, and 0.86 ± 0.16, respectively) and binocular blindness (0.31 ± 0.17, 0.63 ± 0.28, and 0.66 ± 0.27, respectively) except for the SG utility measure comparing monocular blindness with MWL. Age was inversely proportional to the TTO utility scores for MWL (p < 0.05). Caucasian race and medical education were independent predictors of SG utility scores (p < 0.05). CONCLUSION: In a sample of the general population and medical students, SG utility assessments for MWL were comparable with those for monocular blindness. Utility assessment of living with MWL varied with race (VAS and SG) and education (SG). The sample population, if faced with MWL, would consent to undergo a procedure such as body contouring with an 11% chance of death and be willing to trade 4 years of their life.

Preoperative diplopia: the most important prognostic factor for diplopia after surgical repair of pure orbital blowout fracture.

BACKGROUND: No consensus exists in the literature regarding the risk factors associated with new or residual diplopia after pure orbital blowout fracture (BOF) repair. OBJECTIVE: To assess and evaluate the risk factors associated with diplopia after surgical repair of pure BOF. METHODS: Patients with pure BOF who were managed surgically were identified in an 11-year period at the McGill University Health Center. The association between new or residual diplopia postsurgical repair and various risk factors was assessed using chi and Fisher exact tests, and multivariate analysis was conducted using logistic regression. RESULTS: A total of 61 patient charts were reviewed. Results demonstrated the presence of preoperative diplopia and radiologic evidence of extraocular muscle (EOM) swelling to be strongly associated with diplopia at 6 months after repair (P < 0.05). Patients who presented preoperatively with diplopia had a 9.91 times greater probability of developing diplopia postoperatively (P = 0.035; 95% confidence interval, 1.17-83.80). CONCLUSIONS: Preoperative diplopia is the best predictor of the presence of postoperative diplopia after BOF repair. Initial injury to the EOM leading to EOM swelling and preoperative diplopia seems to be the origin of diplopia after surgical repair of pure BOF.

Analysis of Utility Assessment Scores to Objectify the Health Burden Caused by Breast Conservation Therapy.

BACKGROUND: Lumpectomy followed by radiation, known as breast conservation therapy (BCT), is a viable surgical treatment option for early-stage breast cancer. However, the current literature suggests that patients prefer mastectomy over BCT, likely due to the wide variety of postmastectomy reconstructive options. Our aim is to investigate the objective health burden of living with BCT to help surgeons gain a better understanding of patient treatment preferences. METHODS: Three validated health state utility tools were used to objectify the burden of living with post-BCT results: visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). A prospective sample of the general population and medical students were recruited, and their responses analyzed to attain these scores. RESULTS: Utility scores for living with BCT are VAS 0.81 ± 0.19, TTO 0.93 ± 0.10, and SG 0.92 ± 0.14. The TTO and SG suggest a willingness to trade 2.5 years of life years and an 8% chance of death undergoing reconstructive procedures to correct a BCT defect, respectively. Age, gender, race, education, and income were not statistically significant independent predictors for higher or lower utility scores. CONCLUSION: The impact of the health burden of BCT was ascertained using validated objective numeric utility scores. These indices demonstrate a willingness to trade less life years to undergo correction of a BCT defect than reconstruction following unilateral mastectomy. They can provide surgeons with the best objective understanding of patient preferences for shared decision-making in the management of breast cancer.

HISTORIQUE: La lumpectomie suivie d'une radiothérapie, ou conservation mammaire (CM), est un traitement chirurgical viable du cancer du sein précoce. Selon les publications, les patients préfèrent toutefois la mastectomie à la CM, probablement en raison du large éventail de possibilités de reconstructions après la mastectomie. Les chercheurs visent à explorer le fardeau objectif d'une vie avec une CM pour la santé, afin d'aider les chirurgiens à mieux comprendre les préférences des patientes en matière de traitement. MÉTHODOLOGIE: Les chercheurs ont utilisé trois outils utilitaires validés sur l'état de santé pour objectiver le fardeau de la vie après une CM : l'échelle visuelle analogique (ÉVA), l'arbitrage temporel (AT) et le pari standard (PS). Ils ont recruté un échantillon prospectif de la population générale et d'étudiants en médecine et ont analysé leurs réponses pour obtenir les scores. RÉSULTATS: Les scores d'utilité d'une vie avec une CM s'établissent comme suit : ÉVA 0,81 ± 0,19, AT 0,93 ± 0,10 et PS 0,92 ± 0,14. L'AT et le PS indiquent respectivement la volonté de perdre 2,5 années de vie et d'accroître le risque de décès de 8 % pendant les interventions de reconstruction pour corriger une anomalie de CM. L'âge, le genre, la race, l'instruction et le revenu n'étaient pas des prédicteurs indépendants statistiquement significatifs des scores d'utilité plus élevés ou plus faibles. CONCLUSION: Les chercheurs ont évalué les répercussions du fardeau de la CM sur la santé au moyen de scores d'utilité numériques validés. Ces indices démontrent la volonté de réduire le nombre d'années de vie pour corriger une anomalie de la CM plutôt qu'une reconstruction après une mastectomie unilatérale. Ils peuvent aider les chirurgiens à mieux comprendre les préférences des patientes pour parvenir à une décision commune en matière de prise en charge du cancer du sein.

Desmoid tumors of the pediatric mandible: case report and review.

Desmoid tumors are benign fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. These rare neoplasms have been shown to account in 0.03% of all cancers. Twenty-five percent of all desmoid tumors occur in children under 15 years of age. The infrequency of these tumors has limited studies to case reports and retrospective reviews dictating the authors recommended treatments and management. We present a case report of desmoid tumor involving the left mandible in a 14-month-old infant. His treatment course included 2 excisions, removal of the free rib graft secondary to persistence of the tumor, and wound dehiscence, and later a free fibular osteomyocutaneous flap for reconstruction. We then retrospectively reviewed all published data of desmoid tumor involving the pediatric mandible since 1950 to 2007 in the PubMed database. Forty cases have been reported, which had a M:F ratio of 1:1 with an average age of 5.3 (standard deviation [SD] +/- 4.5) years. There appeared to be left-sided predominance of desmoid tumors in the pediatric mandible with a ratio of 3:1. The mean size of the tumors was 4.6 cm (SD +/- 2.1) at the largest diameter. We have tabulated the relevant data of all the cases including the methods of treatment and recurrence. It is found that when compared with conservative management, radiation therapy, chemotherapy, and curettage or surgical local excisions as treatment options the most efficient treatment was partial mandiblectomy, which resulted in complete tumor dissipation with no tumor recurrence. In summary, this is the largest review of the pediatric desmoid tumor of the mandible to date where we provide for the first time an algorithm for the management and treatment of the pediatric desmoid tumor of the mandible.

The pharmacological response of ischemia-related atrial fibrillation in dogs: evidence for substrate-specific efficacy.

OBJECTIVE: Acute atrial ischemia produces a substrate for atrial fibrillation (AF) maintenance, but the response of this substrate to antiarrhythmic-drugs has not been defined. The present study assessed the effects of class 1-4 antiarrhythmic-drugs on the electrophysiological consequences of acute atrial ischemia, and compared effects in ischemic AF with those in vagal AF. METHODS AND RESULTS: Isolated atrial ischemia was created by ligating a right coronary artery branch perfusing the right atrial free wall. Experiments were performed in dogs treated with loading and maintenance doses of flecainide (class 1; n=5), nadolol (class 2, n=7), dofetilide (class 3, n=5), or diltiazem (class 4, n=7) prior to coronary artery occlusion. Dogs subjected to coronary occlusion without pre-treatment (n=10) served as controls. Coronary artery occlusion substantially increased AF duration, e.g. from 7+/-4 s (pre-ischemic baseline) to 876+/-245 s at 3 h of ischemia, and caused substantial ischemic zone conduction slowing. Diltiazem and nadolol prevented AF promotion (AF durations 12+/-8 s and 4+/-1 s at 3 h of ischemia respectively; each p<0.001 vs control) and suppressed ischemic conduction slowing. Flecainide and dofetilide failed to prevent ischemia-induced AF promotion (e.g. AF duration at 3-hour ischemia 779+/-417 and 801+/-414 respectively, p=NS vs control) and failed to alter ischemia-induced conduction slowing. A different pattern of response occurred with vagal AF: flecainide was highly effective in reducing vagal AF duration; dofetilide, diltiazem, and nadolol were ineffective. CONCLUSIONS: Beta-blockade and Ca(2+) antagonism suppress the arrhythmic consequences of acute atrial ischemia, whereas Na(+) channel or K(+)-channel block are ineffective. These results are relevant to understanding the effects of different classes of antiarrhythmic-drugs on AF occurring in coronary disease patients.

Impact of Living With Scoliosis: A utility Outcome Score Assessment.

STUDY DESIGN: Survey. OBJECTIVE: The aim of this study was to objectify the burden of adolescent idiopathic scoliosis (AIS) to better advocate for scoliosis care in the future. SUMMARY OF BACKGROUND DATA: AIS is a common spinal deformity that can affect individuals on many levels. Patients with big curves usually seek medical advice for surgical correction of their deformity. METHODS: Participants completed an online questionnaire to help measure the health burden of AIS. Three utility outcome measures were then calculated. These included the visual analog scale, time trade off, and standard gamble. Student t test and linear regression were used for statistical analysis. RESULTS: One hundred and ten participants were included in the analysis. The mean visual analog scale, time trade off, and standard gamble scores for AIS were 0.77 ±â€Š0.16, 0.90 ±â€Š0.11, and 0.91 ±â€Š0.13, respectively. Factors such as age, sex, income, and level of education were dependent predictors of utility scores for AIS. CONCLUSION: Our participants demonstrated a significant perceived burden of AIS. If faced with AIS, participants were willing to sacrifice 3.6 years of their lives and undergo a procedure with 9% mortality rate to gain perfect health. Such findings can guide future allocation of resources for better scoliosis care and management. LEVEL OF EVIDENCE: 4.

Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods.

BACKGROUND: Umbilical reconstruction is an important component of deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study evaluated the aesthetics of three different umbilical reconstruction techniques during DIEP flap breast reconstruction. METHODS: From January to April of 2013, a total of 29 consecutive patients undergoing DIEP flap breast reconstruction were randomized intraoperatively to receive one of three umbilicoplasty types: a diamond, an oval, or an inverted V incision. Independent plastic surgeons and members of the general public, identified using an online "crowdsourcing" platform, evaluated aesthetic outcomes in a blinded fashion. Reviewers were shown postoperative photographs of the umbilicus of all patients and a four-point Likert scale was used to rate the new umbilicus on the size, scar formation, shape, localization, and overall appearance. RESULTS: Results for the focus group of independent plastic surgeons and 377 members of the public were retrieved (n = 391). A total of 10 patients (34.5 percent) were randomized into having the diamond incision, 10 (34.5 percent) had the oval incision, and nine (31.0 percent) had the inverted V incision. Patients were well matched in terms of overall characteristics. The general public demonstrated a significant preference for the oval incision in all five parameters. There was no preference identified among surgeons. CONCLUSION: This study provides evidence that a sample of the U.S. general public prefers the aesthetics of the oval umbilicoplasty incision, which contrasted with the lack of preference identified within this focus group of plastic surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Atrial ischemia promotes atrial fibrillation in dogs.

BACKGROUND: Coronary artery disease is a significant risk factor for atrial fibrillation (AF), but the basis for this association is incompletely understood. The present study evaluated the hypothesis that atrial ischemia can create a substrate for AF maintenance. METHODS AND RESULTS: Atrial ischemia was induced by occlusion of an atrial arterial branch that did not provide blood flow to the ventricles. Atrial-arterial occlusion increased the duration of AF induced by burst pacing from 57+/-32 seconds (control) to 803+/-214 seconds (P<0.001) after 0.5 hour of occlusion and to 887+/-209 seconds (P<0.001) after 3 hours of occlusion. Prolonged AF (>20 minutes) was induced in 0 of 16 dogs (0%) under control conditions, 7 of 16 (44%, P<0.01) at 0.5 to 3 hours, and 5 of 13 (38%, P<0.01) 3 to 5 hours after occlusion. Atrial conduction was slowed substantially within the ischemic zone: eg, conduction delay was 8+/-1 ms at a cycle length of 200 ms, control, versus 22+/-5 ms (P<0.01) after 0.5 hours and 27+/-5 ms (P<0.001) after 3 hours of ischemia. Refractoriness was initially unaffected but was prolonged 5 hours after occlusion. Phase-delay analysis and high-density mapping confirmed severe conduction slowing in the ischemic zone. Histological examination confirmed the location of ischemic regions and revealed extensive ischemia-induced necrosis at sites of conduction delay. CONCLUSIONS: Experimental atrial ischemia creates a substrate for AF maintenance, apparently by causing local conduction slowing that promotes reentry. These results suggest that atrial ischemia may significantly promote AF, and may be relevant to AF mechanisms in association with coronary artery disease.