The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis.

INTRODUCTION: The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings. OBJECTIVES: To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital. DESIGN: A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management. FINDINGS: Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre. DISCUSSION: Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision. CONCLUSION: This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.

Bilateral reduction mammoplasty following breast cancer: A case-control study.

PURPOSE: Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed. METHODS: A matched case-control study with patients serving as their own control (treated breast cancer breasts were 'cases', healthy breasts were 'controls') was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions. RESULTS: Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%). CONCLUSIONS: Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.

OBJECTIF: De nombreuses femmes subissent une réduction mammaire bilatérale après une lumpectomie et des radiations pour traiter un cancer du sein causé par une hypertrophie mammaire. L'issue de ces patientes, axée sur les complications et la nécessité de procéder à des opérations supplémentaires, est analysée. MÉTHODOLOGIE: Les chercheurs ont mené une étude cas-témoins appariée auprès de patientes étant elles-mêmes leur propre sujet témoin (le sein traité contre le cancer était le « cas ¼ et le sein non atteint, le « témoin ¼). Ils ont repéré les patientes au moyen des dossiers hospitaliers de 1980 à 2007. Ils ont inclus les patientes traitées par lumpectomie et radiation qui ont subi une réduction mammaire bilatérale par la suite. Ils ont assemblé les données relatives à la démographie, aux antécédents médicaux et aux complications périopératoires et postopératoires. Les issues mesurées étaient les hématomes ou les séromes, le retard de guérison de la plaie, l'infection, les problèmes du complexe mamelon-aréole, la cicatrisation, l'asymétrie et la nécessité de procéder à d'autres opérations. Les variables continues sont déclarées sous forme de moyenne ± ÉT, et les variables catégoriques, sous forme de proportions. RÉSULTATS: Chez les neuf patientes incluses dans l'étude, les chercheurs ont remarqué un retard de guérison de la plaie dans 22 % des cas et des infections de la plaie dans 66,7 % des cas, dont 22,2 % de deuxième infection. Une patiente a présenté une perte partielle du complexe mamelon-aréole sur le sein ayant subi des radiations. On observait des cicatrices anormales sur 33,3 % des seins traités, et une asymétrie postopératoire chez 77,8 % des patientes. Trois patientes ont subi des opérations supplémentaires (33,3%). CONCLUSIONS: D'après les résultats de la présente étude, les femmes ayant des antécédents de cancer du sein traitées par lumpectomie et radiation présentent une plus forte occurrence de complications postopératoires après une réduction mammaire bilatérale. Les patientes doivent être informées de ces risques potentiels et ont besoin d'un suivi postopératoire attentif. Une étude prospective multicentrique comportant un nombre suffisant de sujets s'impose pour tirer des conclusions définitives.

The use of economic evaluation in hand surgery.

This article explains the concepts of an economic evaluation relevant to evidence-based hand surgery. Cost-effectiveness analysis in hand surgery is increasingly important as health care resources become scarce in most jurisdictions. Hand surgeons need to incorporate the "manager of health care system" competency in their daily practice. Hand surgery literature may claim that "a novel hand technique" is more cost-effective than a prevailing one; it is important that hand surgeons and other users of clinical research appraise such innovation claims before adopting them in their practices. Clinical researchers can use the methodological principles described here for their cost-effectiveness analysis.

Incidence of capsular contracture in silicone versus saline cosmetic augmentation mammoplasty: A meta-analysis.

INTRODUCTION: Capsular contracture after augmentation mammoplasty occurs at a rate of 15% to 45%. The purpose of the present study was to determine the effect of implant core type (silicone versus saline) on the rate of capsular contracture in augmentation mammoplasty. METHODS: A systematic review was conducted through a search of three electronic databases. Two reviewers independently scanned titles yielded by the search and identified potentially relevant papers. Inter-reviewer variability and the scientific quality of the articles were assessed. Meta-analysis was performed. RESULTS: Eighty-eight titles of potential relevance were selected from the 393 articles yielded by the search. Inter-rater agreement for selection of potentially relevant articles was 84% (kappa=0.54). Four comparative studies were included in the analysis. Scientific quality scores of the included studies ranged from 5 of 14 to 9 of 14. Three of the four studies reported a higher rate of capsular contracture in patients with silicone implants. A combined odds ratio calculated on two of the studies found a 2.25-fold increased risk of capsular contracture in patients who received silicone implants. Eight series of patients who received cohesive gel silicone implants reported rates of capsular contracture from 0% to 13.6%. CONCLUSIONS: Higher rates of capsular contracture were found in patients who received silicone implants when compared with those who received saline implants. However, the scientific quality of the comparative studies to date on this subject is poor. Recent series evaluating cohesive gel implants report relatively low rates of capsular contracture. A randomized controlled trial comparing rates of capsular contracture in cohesive gel and saline implants is recommended.

The lysosomal transport of prosaposin requires the conditional interaction of its highly conserved d domain with sphingomyelin.

Lysosomal prosaposin (65 kDa) is a nonenzymic protein that is transported to the lysosomes in a mannose 6-phosphate-independent manner. Selective deletion of the functional domains of prosaposin indicates that the D domain and the carboxyl-terminal region are necessary for its transport to the lysosomes. Inhibitors of sphingolipid biosynthesis, such as fumonisin B(1) (FB(1)) and tricyclodecan-9-yl xanthate potassium salt (D609), also interfere with the trafficking of prosaposin to lysosomes. In this study, we examine sphingomyelin as a direct candidate for the trafficking of prosaposin. Chinese hamster ovary and COS-7 cells overexpressing prosaposin or an albumin/prosaposin construct were incubated with these inhibitors, treated with sphingolipids, and then immunostained. Sphingomyelin restored the immunostaining in lysosomes in both FB(1)- and D609-treated cells and ceramide reestablished the immunostaining in FB(1)-treated cells only. D-Threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol (PDMP), which inhibits glycosphingolipids, had no effect on the immunostaining pattern. To determine whether sphingomyelin has the same effect on the transport of endogenous prosaposin, testicular explants were treated with FB(1) and D609. Sphingomyelin restored prosaposin immunogold labeling in the lysosomes of FB(1)- and D609-treated Sertoli cells, whereas ceramide restored the label in FB(1) treatment only. Albumin linked to the D and COOH-terminal domains of prosaposin was used as a dominant negative competitor. The construct blocked the targeting of prosaposin and induced accumulation of membrane in the lysosomes, demonstrating that the construct uses the same transport pathway as endogenous prosaposin. In conclusion, our results showed that sphingomyelin, the D domain, and its adjacent COOH-terminal region play a crucial role in the transport of prosaposin to lysosomes. Although the precise nature of this lipid-protein interaction is not well established, it is proposed that sphingomyelin microdomains (lipid rafts) are part of a mechanism ensuring correct intercellular trafficking of prosaposin.