Radix's Importance for Plastic Surgeons: A Descriptive Cross-Sectional Study.

Background: Considering the importance of the nose in the beauty of the face, accurate and systematic three-dimensional nasal analysis of the nose before the procedure is essential. The radix, and so the nasofrontal and nasofacial angles, play an essential role in forming an aesthetically pleasing nose because they influence the length and projection of the nose. We aimed to measure information about the pre-operative radix position in our region. Method: Pre-operative images were taken from our cases in the profile view. A checklist including radix location and projection, nasofrontal angle, and nasofacial angle were extracted from these images. Results: Overall, 200 (100 males and 100 females) cases were enrolled. Thirty-two male cases and 48 females had abnormal radix position. Radix projection were normal in only 36 male cases and 18 females. The mean nasofrontal angle in the male and female groups was 119.2 and 128.2 respectively. The mean nasofacial angle was 29.8 in the female groups and 32.6 in the male group. Conclusion: The reality of the current society of Iranian patients can be very different from the predictions of surgeons and can be far away from the statistics mentioned in western books. We tried to notify surgeons to thoroughly examine the patients prior to surgical operation by measuring parameters such as projection and position of the radix and nasofrontal and nasofacial angles.

Preoperative Eyelid and Eyebrow Asymmetry: A Potential Pre-Operation Inform Consent Option: A Descriptive Cross-Sectional Study.

Background: We aimed to determine the prevalence of pre-existing asymmetry in our patients and investigate the impact of age and sex on upper facial asymmetry. Methods: We collected images from 155 patients who were undergoing upper eyelid blepharoplasty and MRD1 (marginal reflex distance 1), TPS (tarsal plate show), and BFS (brow fat span) measurements were extracted by ImageJ software. The relationship between asymmetry and age and gender was assessed by comparing the mean differences of these metrics. A generalized linear model (GLM) was used to compare the outcomes of the study. P-value < 0.05 was considered significantly different in all tests. Results: Pre-operative asymmetry was present in 112 (72%) patients. Among the cases, 61 (39%), 40 (26%), and 24 (15.5%) patients had more than 1mm of asymmetry in BFS, TPS, and MRD1, respectively. Males under 50 years old had the most asymmetry in the preorbital area. Comparing men under 50 years old with the other groups showed that the mean ± SD of absolute differences of TPS was significantly higher in this group (all P< 0.00), but pairwise comparison for MRD1 and BFS indicated no significant correlation between age, gender, and the mean asymmetry of these parameters (overall test P = 0.70 for MDR1 and P = 0.45 for BFS). Conclusion: Most patients have asymmetry before surgery without being aware of it. Awareness of this asymmetry and the relationship between facial asymmetry and age and gender is essential to prevent dissatisfaction due to the probable post-operative asymmetry and unrealistic expectations.

Duodenojejunostomy following failed gastrojejunostomy in superior mesenteric artery syndrome: A case report.

INTRODUCTION: Superior mesenteric artery (SMA) syndrome is a rare duodenal-vascular anatomic disorder leading to external compression on the duodenum. The first step of treatment usually is conservative, and in the case of failure, surgical management is the treatment choice. Treatment success with duodenojejunostomy after failure in gastrojejunostomy can show the uniqueness of this article. CASE PRESENTATION: A 14-year-old boy came to our hospital with a complaint of epigastric pain, nausea, bilious vomiting, and weight loss since 6 months ago. Conservation therapy and laparotomic Braun anastomosis and gastrojejunostomy was performed due to the SMA syndrome diagnosis 2.5 months before the admission. At our hospital, an alteration of gastrojejunostomy by duodenojejunostomy employing a diamond-shaped anastomosis between the third portion of the duodenum (D3) and a part of jejunum that was placed 15 cm away from the ligament Treitz was done. A significantly dilated stomach and the first three parts of the duodenum were observed during the procedure. After the second surgical intervention, the general condition of the patient dramatically improved. CLINICAL DISCUSSION: Conservative treatment, including nasogastric tube decompression, postural changes, and nutritional support with hyperalimentation, has a variable success rate. However, in some cases, surgery may be necessary. Surgeons prefer laparoscopic duodenojejunostomy due to its outstanding success rate, ranging from 80 % to 100 %. But, in some case reports it is suggested that gastrojejunostomy could be done in cases with severe duodenal dilation instead of duodenojejunostomy. The initial gastrojejunostomy failed because of ongoing symptoms, which was finally revised with a duodenojejunostomy. CONCLUSION: It is suggested to use duodenojejunostomy after failure of gastrojejunostomy or it can be employed as the first surgical option even in cases with severe dilation. Because it is a more efficient correction with fewer complications than gastrojejunostomy.

A Giant Frontal Sinus Mucocele in an Opium Addict Patient: A Case Report.

Mucocele is a benign soft tissue mass that could occur in all accessory glands. Mucocele can also occur in paranasal sinuses. It is mostly placed in the frontal sinus and barely grows larger than 1.5 centimeters(cm). Based on the affected site, it could cause facial pain and headache. Analgesics like opioids could relieve and potentially make patients ignore the headache and cause giant frontal mucocele. This article discusses a patient with giant frontal sinus mucocele (7×8×8 cm) and opium addiction that presented with severe and intolerable pain. A 32 yr old man came to Rajaee Trauma Hospital, Shiraz, Iran with a severe headache and a large swelling of the face frontal region that developed gradually. In physical examination, the mass was non-tender, non-pulsatile, and free from the overlying normal skin. Computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated a frontal sinus mucocele. The operation was planned, and the patient was discharged after two days. Subsequently, the 6-month follow-up of the patient was normal. Two different hypotheses are declared in this article. First, the potential role of opium addiction as a risk factor for giant mucoceles was noted, then the analgesic non-responsiveness of sinus mucoceles was described. The latter hypothesis is more likely. So, we should consider that if the patient had an analgesic-resistant headache, one differential diagnosis could be sinus mucocele. Moreover, the pos sible psychological effect of addiction on discounting face beauty was acknowledged.

A pediatric case series of catastrophic gastrointestinal complications of posttransplant lymphoproliferative disease with increasing incidence, high association with coronavirus disease 2019, higher mortality, and a plea for early endoscopy to prevent late fatal outcome.

BACKGROUND: Posttransplant lymphoproliferative disorder is one of the most severe complications after transplantation, caused by uncontrolled proliferation of Epstein-Barr virus-positive B-cells in the setting of chronic immunosuppression. As one of the biggest transplant centers worldwide, we observed a potential increase in the number of patients with posttransplant lymphoproliferative disorder presenting with gastrointestinal symptoms in 1 year, during the coronavirus disease 2019 pandemic. There is limited information about dysregulation of the immune system following coronavirus disease 2019 infection, which may lead to Epstein-Barr virus reactivation in Epstein-Barr virus-positive B-cells and development of posttransplant lymphoproliferative disorder. Furthermore, there is no consensus in literature on a modality that can help in early diagnosis of posttransplant lymphoproliferative disorder with nonspecific gastrointestinal presentations before late and fatal complications occur. CASE PRESENTATION: Our case series includes five Iranian (Persian) patients, three female (2, 2.5, and 5 years old) and two male (2 and 2.5 years old), who developed gastrointestinal posttransplant lymphoproliferative disorder after liver transplantation. All of our patients were on a similar immunosuppressant regimen and had similar Epstein-Barr virus serologic status (seronegative at time of transplantation but seropositive at time of posttransplant lymphoproliferative disorder diagnosis). Four patients had either a positive coronavirus disease 2019 polymerase chain reaction test or exposure within the family. Although all of our patients presented with nonspecific gastrointestinal symptoms, four patients developed late posttransplant lymphoproliferative disorder complications such as bowel perforation and obstruction. All five patients with gastrointestinal posttransplant lymphoproliferative disorder received chemotherapy, but only two survived and currently are continuing the therapy. In one of the surviving patients, prompt endoscopic investigation resulted in early diagnosis of posttransplant lymphoproliferative disorder and a better outcome. CONCLUSION: Since 80% of our patients had exposure to coronavirus, a potential relationship might be suggested between the two. Furthermore, as we witnessed in one case, urgent endoscopic investigation in immunocompromised patients presenting with gastrointestinal symptoms can improve the clinical outcomes and therefore should be considered for early diagnosis of posttransplant lymphoproliferative disorder.

Evaluation of Clinical Manifestations, Pattern of Involvement, and Surgical Outcomes in Patients with Post Covid-19 Head and Neck Mucormycosis Infection among Patients Admitted To Namazi Hospital, Shiraz, Iran (2021-2022).

Background: COVID-19, caused by SARS-CoV-2, is a global pandemic that particularly affects immunocompromised individuals, leading to secondary bacterial and fungal infections. Mucormycosis, caused by Mucorales fungi, is a severe infection primarily affecting immunocompromised individuals. The COVID-19 pandemic has seen a surge in mucormycosis cases worldwide, with India experiencing a significant increase. Various factors, including diabetes mellitus, contribute to the risk of mucormycosis. This study investigated head and neck mucormycosis in patients with prior COVID-19 infection. Methods: Data from 45 patients were analyzed, with diabetes being the most common risk factor. Visual symptoms, ethmoid bone involvement, and orbital bone involvement were also identified as significant factors. Results: The COVID-19 pandemic has led to an increase in mucormycosis cases, particularly in the head and neck region, with high mortality. Successful management involves addressing underlying factors, surgical debridement, and antifungal therapy. Conclusion: Timely debridement reduces morbidity and mortality.

Hydroxychloroquine Therapy Led to the Diagnosis of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in an Elderly Patient with COVID-19 Involvement: A Case Report and Review of the Literature.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common RBC abnormality, affecting 400 million people globally. Neonatal jaundice, hemolytic anemia, icteric skin, dark urine, and fever are usually the primary signs of this condition, which is generally diagnosed between the ages of infancy and 16 years old. Therefore, its first manifestation in old age is an unexpected phenomenon. Here, we present the case of a 70-year-old man with no past medical history of G6PD deficiency that was admitted to our hospital due to COVID-19 infection and developed acute hemolytic anemia while receiving hydroxychloroquine (HCQ) medication for COVID-19-related pneumonia.