Teenager with persistent facial edema and induration.

INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most common oncological disease in the pediatric population; however, skin infiltration occurs only in 1-3% of the patients and almost always manifests after the diagnosis is made. CLINICAL CASE: A male teenage patient who presented with facial edema and infiltration, associated with systemic symptoms such as asthenia and adynamia. On physical examination, the patient presented facial edema and indurated plaques, as well as cervical, inguinal, and axillary adenopathy. Complete blood count showed pancytopenia and a chest X-ray revealed a mediastinal mass. Due to a high suspicion of malignancy a bone marrow and skin biopsy was taken, both with pre-B ALL. Chemotherapy was started and the patient is now in maintenance phase. CONCLUSIONS: Leukemia cutis manifestations are heterogenous, from a small papule to a big nodule. It is more common in patients with acute myeloid leukemia and it is rare in patients with pre-B ALL, specially in the pediatric population. The diagnosis should be done with a biopsy and the treatment is with systemic chemotherapy. The diagnosis should always be considered in patients with unexplained edematous or indurated lesions, especially in the context of systemic symptoms.

INTRODUCCIÓN: La leucemia linfoblástica aguda es la enfermedad oncológica más común en la edad pediátrica; sin embargo, la infiltración a la piel solo ocurre en el 1-3% de los pacientes y se manifiesta habitualmente posterior al diagnóstico de leucemia. CASO CLÍNICO: Adolescente varón que acude a urgencias de nuestra unidad por presentar edema facial persistente, junto con astenia y adinamia. En la exploración física presenta edema facial con placas difusas induradas y adenopatía cervical, inguinal y axilar. Se decide realizar una biometría hemática, que muestra pancitopenia, y una radiografía de tórax, que revela una masa mediastinal. Por sospecha de malignidad se decide realizar una biopsia de médula ósea y de piel, dando como resultado leucemia linfoblástica pre-B en ambas. Se inició quimioterapia y actualmente se encuentra en fase de mantenimiento. CONCLUSIONES: Las manifestaciones clínicas de leucemia cutis son heterogéneas, desde una pápula pequeña hasta lesiones nodulares de diferentes tamaños. Lo más común es verlas en pacientes con leucemia mieloide aguda, y es muy raro en pacientes con leucemia linfoblástica aguda pre-B, especialmente en la edad pediátrica. El diagnóstico se realiza con una biopsia de piel y el tratamiento es con quimioterapia sistémica. Es importante tener en mente este diagnóstico en pacientes con síntomas sistémicos de leucemia.

Extremely Low Birth Weight Infant (Gestational Age of 29 Weeks) With Kabuki Syndrome Type I: Case Report and Literature Review.

BACKGROUND: This paper aimed to investigate the clinical phenotype of Kabuki syndrome (KS) in premature infants. METHODS: This paper presents a case of an extremely low birth weight infant (gestational age 29 weeks) with KS1 caused by a variant in the KMT2D gene. The clinical, pathological, and differential diagnostic findings were comprehensively analyzed. A thorough literature review was also performed to enhance the understanding of KS, revealing its unique features and prognostic significance. RESULTS: The infant was a male with a gestational age of 29 weeks and a birth weight of 850 g. He had intrauterine growth retardation, characterized by cleft palate, sacrococcygeal skin depressions, and recurrent metabolic acidosis. Whole-exome sequencing revealed the c.4267C > T (p.Arg1423Cys) variant in the KMT2D gene, which was absent in his parents. The patient was discharged after 67 days of treatment, and he was followed up to 19 months of corrected gestational age, with growth retardation and expression language delay. Ten previous studies on preterm infants were retrieved, with 10 preterm infants. They all had characteristic facial features, such as long blepharophimosis, sparse and lateral 1/3 eyebrows, and large and prominent/cupped ears. Other manifestations were extrauterine growth delay (7/10), abnormal development of the cardiovascular system (7/10), abnormal development of the nervous system (5/10), and cleft palate (2/10). CONCLUSIONS: Kabuki syndrome is a rare hereditary disorder involving multiple organs and systems. Genetic assessment for preterm infants with congenital abnormalities is recommended.

Loss of PHF6 causes spontaneous seizures, enlarged brain ventricles and altered transcription in the cortex of a mouse model of the Börjeson-Forssman-Lehmann intellectual disability syndrome.

Börjeson-Forssman-Lehmann syndrome (BFLS) is an X-linked intellectual disability and endocrine disorder caused by pathogenic variants of plant homeodomain finger gene 6 (PHF6). An understanding of the role of PHF6 in vivo in the development of the mammalian nervous system is required to advance our knowledge of how PHF6 mutations cause BFLS. Here, we show that PHF6 protein levels are greatly reduced in cells derived from a subset of patients with BFLS. We report the phenotypic, anatomical, cellular and molecular characterization of the brain in males and females in two mouse models of BFLS, namely loss of Phf6 in the germline and nervous system-specific deletion of Phf6. We show that loss of PHF6 resulted in spontaneous seizures occurring via a neural intrinsic mechanism. Histological and morphological analysis revealed a significant enlargement of the lateral ventricles in adult Phf6-deficient mice, while other brain structures and cortical lamination were normal. Phf6 deficient neural precursor cells showed a reduced capacity for self-renewal and increased differentiation into neurons. Phf6 deficient cortical neurons commenced spontaneous neuronal activity prematurely suggesting precocious neuronal maturation. We show that loss of PHF6 in the foetal cortex and isolated cortical neurons predominantly caused upregulation of genes, including Reln, Nr4a2, Slc12a5, Phip and ZIC family transcription factor genes, involved in neural development and function, providing insight into the molecular effects of loss of PHF6 in the developing brain.

Enhancement of Facial Rejuvenation Through a Combination of 1565 nm Non-Ablative Fractional Laser with 30% Supramolecular Salicylic Acid.

The 1565 nm non-ablative fractional laser can effectively stimulate collagen regeneration, achieving the effect of skin rejuvenation and anti-aging. In recent years, it has been widely used in dermatology, especially in facial rejuvenation, treatment of stretch marks, and acne scar treatment, with significant results. However, after the 1565 nm non-ablative fractional laser treatment, patients may experience short-term erythema and edema. The inflammation after treatment may also cause pigmentation, making it difficult for some patients to accept. This article introduces a treatment method of 1565 nm non-ablative fractional laser combined with 30% super molecular salicylic acid for facial rejuvenation, effectively reducing posttreatment erythema and post-inflammatory pigmentation. The method includes specific treatment steps and the respective endpoint reactions of each step. The method starts by selecting appropriate energy parameters for the 1565 nm non-ablative fractional laser treatment, followed immediately by the application of 30% supramolecular salicylic acid. The treatment should be stopped when a frosty reaction occurs. The purpose of this project is to provide patients with a safer new method of facial rejuvenation treatment.

Facial reconstruction with thinned anterolateral thigh free flap.

Facial reconstruction is challenging for plastic surgeons, as it can be difficult to decide the best approach. One technique that has been widely used is the anterolateral thigh (ALT) flap due to its numerous benefits. However, its thickness can be a drawback, especially regarding facial reconstruction. The thinning technique is not a new novel, but how to apply it to the ALT flap to get the best result hasn't been reported yet. Our study involved 117 patients, and we used 73 thinned ALT flaps to determine the best method to increase the flap's safety. After thinning, we significantly reduced the flap's thickness from an average of 22.5 mm to 5.9 mm, making it more suitable for contouring purposes. We apply a thinned ALT flap for coverage, contouring, and recreating the facial 3D structure. The 12/45 flap has the chance to make the multiple-paddle ALT flap, which helps to reconstruct difficult positions even more flexibly. The key to successfully thinning the ALT flap is understanding the perforator's structure and pathway through the fascia. With the thinning technique, we have overcome the limitations of the flap's thickness, making it suitable for use in whole-body reconstruction. The ALT flap can overcome the restriction of its thickness and can be applied even more extensively in whole-body reconstruction.

The Free Flap Reconstruction of Facial Defects after Squamous Cell Carcinoma Excision.

Background and Objectives: Cutaneous squamous cell carcinoma is the second most common skin cancer. There are many methods for the reconstruction of facial subunit defects after skin cancer excision. The face is vital to a person's life and should be reconstructed considering functional and aesthetic aspects. Despite a variety of flap types and techniques, it is still challenging to meet the various demands. The aim of this study was to compare free flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma. Materials and Methods: This study included 14 patients from January 2021 to June 2023. Patients who underwent facial SCC resection and subsequent reconstruction using free flaps were analyzed retrospectively. Age, sex, and localization were recorded. Follow-ups ranged from 5 to 21 months, with an average of 13 months. Results: All free flaps survived well except one case of partial flap necrosis. In most patients, good to excellent functional and aesthetic results were obtained. The donor site healed uneventfully in all patients. Conclusions: Free flap reconstruction is an excellent choice in wide skin oncologic defects. In terms of texture, it also could be a good surgical method. The use of a fraxel laser can progressively facilitate improved color matching with the surrounding skin.

Effects of facial forms and midline deviations and rolls on female facial beauty according to laypeople, orthodontists, and prosthodontists or restorative dentists.

No study has examined the simultaneous effect of facial forms, midline deviations and midline angulations on facial beauty. Therefore, this comprehensive study aimed to evaluate these and many other hypotheses. This psychometric study was performed on 15,042 observations. A female frontal photograph was edited to 45 perceptometric images with controlled anatomical alteration: 3 facial forms (euryprosopic [brachyfacial], mesoprosopic [mesofacial], leptoprosopic [dolichofacial]), each having either 9 bidirectional midline deviations (0, 1, 2, 3, and 4 mm deviated to the left and right) or 7 bidirectional midline angular deviations (0°, 5°, 10°, and 15° deviated to the left and right). One of the photographs were repeated. These 46 images were esthetically judged by 327 participants (243 laypeople, 49 orthodontists, and 35 'prosthodontists or restorative dentists'). Hierarchical mixed-model multiple linear regressions and post hoc tests were adopted to evaluate the simultaneous impacts of the photomodel's facial forms, midline deviations to the right or left, and midline rolls to the right or left plus sex, age, experience, and dental specialty of the referees on their perception of facial beauty as well as the tolerable zones of midline alterations. These were also done separately for each specialty group, and also for each facial face. Ideal combinations of anatomic features were determined using repeated-measures ANOVAs. Differences between esthetic preferences of different groups in terms of each image were assessed using one-way ANOVAs and t-tests (α = 0.05, α = 0.008, α = 0.001). All 5 anatomical features significantly and independently influenced perception of facial beauty. The tolerance threshold for midline deviations was 1 mm deviations to the right and left sides. For midline rolls, the only tolerable form was the no-roll ('on') midline; the judges preferred right-oriented defects over left-sided ones. The most beautiful facial form was mesoprosopic, followed by leptoprosopic. Men perceived the female face slightly more attractive than did women. The viewers' specialty (or lack of it), their age, or their experience did not affect their esthetic preferences. Predictors of esthetic preferences were all 5 anatomical features plus views' sex, but not their dental specialty, age, or experience. Zones of acceptability and also the ideal range of anatomical features were determined.

A Cosmetic Regimen Formulated to Address the Multi-Modal Pathogenesis of Rosacea Demonstrates Efficacy for Treating Facial Redness and Skin's Appearance.

BACKGROUND: The treatment of rosacea is complicated as there are multiple pathogenic factors in play resulting in a myriad of clinical signs and symptoms including facial redness. OBJECTIVE: The primary objective was to evaluate the efficacy and tolerability of a non-prescription anti-redness regimen in patients with rosacea. METHODS: Thirty subjects with rosacea-induced facial erythema were enrolled in this single site, monadic study. The test regimen consisted of a treatment serum, redness-reducing moisturizer, and sunscreen. The test products are formulated with ingredients curated to address the multifactorial pathogenesis of facial redness. Investigator and subject self-assessment for efficacy and tolerability were performed at baseline, weeks 4 and 8. Non-invasive assessments for facial redness and skin hydration were conducted at all time points. RESULTS: Investigator grading showed significant improvement in facial redness of 21% at week 4 and 32% at week 8. Skin's appearance improved as early as 4 weeks while at 8 weeks there was statistically significant improvement in fine lines 15%, radiance/brightness 37%, tactile roughness 44%, visual roughness 41%, and 26% in overall appearance. Non-invasive assessments showed statistically significant improvement in skin hydration of 28% at week 4 and facial redness of 21% by week 8. No tolerability issues were identified by the investigator. CONCLUSION: Patients with rosacea often turn to over-the-counter products to reduce facial redness and improve skin's appearance. In this study, a cosmetic skincare regimen designed to reduce facial redness demonstrated efficacy and tolerability in subjects with rosacea. J Drugs Dermatol. 2024;23(9):757-763. doi:10.36849/JDD.8460.

Comparison of facial skin ageing in healthy Asian and Caucasian females quantified by in vivo line-field confocal optical coherence tomography 3D imaging.

BACKGROUND: Quantitative biomarkers of facial skin aging were investigated in 109 healthy Asian female volunteers, aged 20 to 70 years. MATERIALS AND METHODS: In vivo 3D Line-field Confocal Optical Coherence Tomography (LC-OCT) imaging, enhanced by Artificial Intelligence (AI)-based quantification algorithms, was utilized to compute various metrics, including stratum corneum thickness (SC), viable epidermal (VE) thickness, and Dermal-Epidermal Junction (DEJ) undulation along with cellular metrics for the temple, cheekbone, and mandible. RESULTS: Comparison with data from a cohort of healthy Caucasian volunteers revealed similarities in the variations of stratum corneum and viable epidermis layers, as well as cellular shape and size with age in both ethnic groups. However, specific findings emerged, such as larger, more heterogeneous nuclei in both layers, demonstrated by an increase in nuclei volume and their standard deviation, and increased network atypia, all showing significant age-related variations. Caucasian females exhibited a flatter and more homogeneous epidermis, evidenced by a decreased standard deviation of the number of layers, and a less dense cellular network with fewer cells per layer, indicated by a decrease in cell surface density. CONCLUSION: Ethnicity-wise comparisons highlighted distinct biological features specific to each population. Asian individuals showed significantly higher DEJ undulation, higher compactness, and lower cell network atypia compared to their Caucasian counterparts across age groups. Differences in stratum corneum and viable epidermal thickness on the cheekbone were also significant. LC-OCT 3D imaging provides valuable insights into the aging process in different populations and underscores inherent biological differences between Caucasian and Asian female volunteers.

Sulfated Chinese yam polysaccharide exert anti-inflammatory potential via MAPK/NF-κB signaling pathways in a co-culture system and LPS-induced acute inflammatory mice model.

Our previous study has demonstrated that sulfated Chinese yam polysaccharide (SCYP) can improve immunomodulatory activity in Raw 264.7 cells. However, its anti-inflammatory is little known. In this study, the anti-inflammatory effects of SCYP were systematically investigated via the Lipopolysaccharides (LPS)-induced Raw264.7 cell model, Caco-2/Raw264.7 co-culture system, and acute inflammation mice model. The results suggested SCYP promoted the cell proliferation and have no toxicity in Raw264.7 and Caco-2 cells at the concentration of 200 µg/mL. Moreover, when treated with SCYP, the production of pro-inflammatory cytokines (interleukin [IL]-1ß, IL-6, and tumor necrosis factor-α) reduced significantly in Raw264.7 via the MAPK/NF-κB pathway. In the Caco-2/Raw264.7 co-cultured system, SCYP could regulate inflammation reaction by improving intestinal barrier, which might prevent systemic inflammation. Further, systemic inflammation was alleviated by SCYP in LPS-induced acute inflammation mice through MAPK/NF-κB pathway. PRACTICAL APPLICATION: These results supported that SCYP may be used as an anti-inflammation agent in the functional food field.

Timing of Laser Intervention on Facial Scars: A 3D Imaging and Scar Scale Analysis in a Retrospective Study.

OBJECTIVES: Scars resulting from injuries or surgical procedures often present both physical and aesthetic challenges. Recent studies have indicated promising results in improving postoperative scar outcomes through the combined use of specific laser technologies. Nevertheless, there remains a crucial need for further exploration to ascertain the optimal timing for initiating such treatments. METHODS: In this retrospective investigation, a cohort of 47 adult patients who did not require hospitalization was analyzed. These patients were divided into two distinct groups: Group A, which received intervention beginning 2 weeks after their respective operations, and Group B, which commenced intervention 4 weeks postoperation. Each group underwent a comprehensive treatment protocol consisting of five laser sessions. Initially, patients underwent three sessions of V-beam pulsed-dye laser (PDL) therapy followed by two sessions of ablative fractional CO2 laser (AFL) therapy. Evaluation of outcomes was conducted using advanced imaging techniques such as Antera 3D imaging, in conjunction with established scar assessment tools including the Vancouver Scar Scale (VSS) and the University of North Carolina "4P" Scar Scale (UNC4P). RESULTS: All patients successfully completed the full course of five treatment sessions, with no dropouts and no reported adverse events. Baseline cosmetic assessments of scars were equivalent across both groups. In Group A, the mean VSS scores decreased from 7.04 before treatment to 5.29 at 3 months posttreatment and further to 4.33 at 6 months posttreatment. Meanwhile, in Group B, scores decreased from 7.52 to 6.83 at 3 months and 6.17 at 6 months. There were no statistically significant differences in baseline VSS scores between the two groups (p = 0.34). At both the 3- and 6-month follow-up points, mean VSS scores were significantly lower in Group A compared to Group B (p < 0.05). Similar trends were observed in UNC4P scores. Statistically significant differences were noted across all time points (baseline, 3 months, and 6 months posttreatment) for both VSS and UNC4P scores (p < 0.05). Subset analysis revealed greater improvements in texture and depression volume at 3 months posttreatment, while improvements in depression area, depth, elevation variation, and area were more pronounced at the 6-month mark. CONCLUSIONS: Early intervention using the combined 595-nm pulse dye laser and CO2 ablative fractional laser (AFL) 2- and 4-weeks post-surgery proves to be an effective and safe method for improving scar outcomes, particularly for facial surgical scars when treatment starts 2 weeks after surgery. However, further research is needed to refine our understanding and address potential study limitations.

Facial Artery Perforator Flap for Perioral and Perinasal Oncologic Defect Reconstruction: Surgical Technique and Postoperative Outcomes.

INTRODUCTION: Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management. METHODS: We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (n = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups. RESULTS: The mean histological tumor defect area was 331 mm2. During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, p = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, p = 0.04). CONCLUSION: Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.

Positive Impact of UV Photography on Individual Sun Protection: A Swiss Feasibility Study.

Objectives: This study evaluates the feasibility and impact of conveying personalized sun protection message supported by a UV photograph of the face in Switzerland. Methods: 440 adults from 14 private and public sites associated with high sun exposure received a skin cancer prevention intervention composed of a facial UV-filtered photograph and individual counselling by a trained registered nurse. Pre-/post intervention surveys assessed sun protection of participants, their skin cancer risk and reasons for behavioural change. Results: The range of facial UV spots' count per individual was very broad (0-590) and mainly determined by phototype, followed by age. Three months after the intervention, 61% of participants positively changed their sun protection habit both during leisure and at work. Use of all sun protection means increased. No factor could be specifically associated to that propension for change. The individualized message was perceived as the main motivation for change. Conclusion: Personalized sun protection messages supported by a facial UV photograph led to significant favourable behavioural change in a highly sun-exposed population of adults.

Airway management for patients with tracheal stenosis and severe scar contracture of the face and neck via bronchoscopy: a case report.

Both anaesthesiologists and surgeons experience challenges in managing airway stenosis and scar contracture in the face and neck. Herein, we report the case of a 38-year-old woman (BMI 23.1 kg/m2, third-degree burns covering 40% of her body, an American Society of Anaesthesiologists physical status III) with an unusual case of airway constriction. This patient had a predictable difficult airway (mouth opening of 2 cm, bilateral nostril scar hyperplasia, Mallampatti score III, scarring of the head and neck, and severe tracheal stenosis). Tracheal stenosis measuring 5.5 mm in width as observed 8 cm below the glottis, and the bronchoscope could not pass through it. After two failed attempts at laryngeal mask insertion, we decided to instead insert a custom-made tracheal tube under the guidance of a fiberoptic bronchoscope. The operation was successful, and the patient was transferred to the intensive care unit (ICU).

Utilization of facial fat grafting augmented reality guidance system in facial soft tissue defect reconstruction.

BACKGROUND: Successfully restoring facial contours continues to pose a significant challenge for surgeons. This study aims to utilize head-mounted display-based augmented reality (AR) navigation technology for facial soft tissue defect reconstruction and to evaluate its accuracy and effectiveness, exploring its feasibility in craniofacial surgery. METHODS: Hololens 2 was utilized to construct the AR guidance system for facial fat grafting. Twenty artificial cases with facial soft tissue defects were randomly assigned to Group A and Group B, undergoing filling surgeries with the AR guidance system and conventional methods, respectively. All postoperative three-dimensional models were superimposed onto virtual plans to evaluate the accuracy of the system versus conventional filling methods. Additionally, procedure completion time was recorded to assess system efficiency relative to conventional methods. RESULTS: The error in facial soft tissue defect reconstruction assisted by the system in Group A was 2.09 ± 0.56 mm, significantly lower than the 3.23 ± 1.15 mm observed with conventional methods in Group B (p < 0.05). Additionally, the time required for facial defect filling reconstruction using the system in Group A was 25.45 ± 2.58 min, markedly shorter than the 37.05 ± 3.34 min needed with conventional methods in Group B (p < 0.05). CONCLUSION: The visual navigation offered by the fat grafting AR guidance system presents obvious advantages in facial soft tissue defect reconstruction, facilitating enhanced precision and efficiency in these filling procedures.

Pharmacologic and Other Noninvasive Treatments of the Aging Face: A Review of the Current Evidence.

SUMMARY: Aging of the face is the result of the interrelation of three-dimensional changes occurring over time among the 5 different layers of the face and its associated structures. Knowledge regarding the causes of these changes and identification of new key anatomic structures have helped elucidate one of the most complex areas of the human body. This has resulted in the introduction of pharmacologic agents to help stop, mitigate, or counteract signs of aging and restore the youthful appearance of the face. The authors performed a systematic search of the literature to review the current highest-level evidence of facial antiaging pharmacologic agents. Pharmacologic and minimally invasive antiaging treatments can target different components of facial aging and continue to evolve. With continuous research efforts, traditional treatments, such as botulinum toxin type A, injectable fillers, and chemical peels, are emerging in newer, more effective formulations, with longer lasting clinical results. However, for soft-tissue descent and facial volume loss, surgery remains the standard treatment. An adequate understanding of the three-dimensional process of facial aging over time (the fourth dimension), facial anatomy, and the pharmacologic properties of antiaging/rejuvenation agents are the sine qua non of facial antiaging treatment. The specific modality should be tailored to patient characteristics, preferences, and goals.

Unilateral acute cataract after facial aesthetic procedure: a case report.

Aging and face sagging have many causes, and various techniques are used for treatment, including noninvasive procedures, such as focused ultrasound, which uses the principle of collagen regeneration by coagulative necrosis of the dermis layers using radiofrequency, but this procedure has complications. We reported a case of a 54-year-old female patient who complained of poor visual acuity in her right eye three days after a focused ultrasound facial aesthetic procedure, with the best visual acuity of 20/60. Biomicroscopy of the right eye revealed an acute cataract with three points of fibrosis extending from the posterior to the anterior capsule. The patient underwent phacoemulsification surgery with visual rehabilitation and improved vision of 20/20. We hypothesized that the occurrence of acute cataract was related to the inappropriate use of focused ultrasound.