Nosocomial transmission of necrotising fasciitis organisms from prepartum patient to healthcare worker.

Necrotising fasciitis is an aggressive skin and soft tissue infection requiring urgent surgical treatment, resuscitative efforts and intensive care management. We herein present a case of necrotising fasciitis with nosocomial transmission of causative organisms from patient to healthcare worker. Bacterial transmission from human to human despite personal protective equipment is quite rare, and with limited reports in the literature. The patient was also prepartum, representing to our knowledge, one of only a handful of cases of prepartum necrotising fasciitis. Recommendations to avoid healthcare worker transmission include wearing Association of the Advancement of Medical Instrumentation level 4 gowns during debridement, as well as eye protection and changing scrubs and showering between cases.

Do Adolescents with Gynecomastia Require Routine Evaluation by Endocrinology?

BACKGROUND: Primary evidence for the role of endocrinologic investigations in patients with adolescent gynecomastia is lacking in the current literature. The objective of this study was to assess the yield of endocrinologic investigations in the evaluation of adolescent gynecomastia to inform current practice for this common condition. METHODS: A 26-year retrospective review was conducted. Data collection included patients with gynecomastia presenting to endocrinology at a quaternary children's hospital with a catchment area of 1 million. Clinical metrics, endocrinologic results, treatments, and costs were reviewed. RESULTS: One hundred ninety-seven patients met inclusion criteria. Ninety-eight (50 percent) were overweight or obese and 29 (15 percent) had a positive family history. The median age at onset was 11.5 years; 25 cases (13 percent) were prepubertal. A total of 15 patients (7.6 percent) were diagnosed with secondary gynecomastia (10 related to exogenous substance use). Endocrine investigations were performed in 173 patients (87 percent), with positive findings in three cases (1.7 percent). One hundred one patients were observed, with a median age at resolution of 14.6 years; 86 patients underwent surgery at a median age of 16.5 years. The case-cost of endocrine evaluation was $389. CONCLUSIONS: Endocrinologic workup identified secondary gynecomastia in 7.6 percent of patients, of which only 1.7 percent were evident on blood work. This workup is associated with an avoidable case-cost burden to the health care system and largely unnecessary testing for the child. Because a majority of secondary gynecomastia cases (67 percent) were drug-induced, we do not suggest routine endocrinology workup, as it adds little value. The authors' data suggest that referral for surgery is warranted if gynecomastia persists beyond 16 years of age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons.

BACKGROUND: Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. METHODS: An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery. RESULTS: The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements. CONCLUSIONS: The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.

HISTORIQUE: Certains prétendent que la spécialité de la chirurgie plastique subit un changement d'identité. Remis en question par des facteurs comme la concurrence croissante sur le marché de l'esthétique et le recul du remboursement des interventions reconstructives, de nombreux chirurgiens plasticiens américains se tournent vers une pratique de chirurgie esthétique. La présente étude portait sur le profil de pratique des chirurgiens plasticiens canadiens, jusqu'alors inconnu, afin de déterminer la combinaison entre la reconstruction et l'esthétique ainsi que les facteurs qui influent sur le type de pratique, de manière à d'établir si le Canada connaît une évolution similaire. MÉTHODOLOGIE: Les auteurs ont distribué un sondage virtuel anonyme au sujet des profils de pratique aux 352 chirurgiens plasticiens canadiens détenteurs d'une adresse de courriel auprès de la Société canadienne des chirurgiens plasticiens ou de la Société canadienne de chirurgie plastique et esthétique. RÉSULTATS: Le taux de réponse au sondage s'élevait à 34 % (120 réponses), dont 75 % avaient une pratique en reconstruction et 25 % en esthétique. Les chirurgiens reconstructeurs avaient une dette d'études plus élevée après leur formation, consacraient plus de temps aux appels d'urgence, aux tâches universitaires et à l'enseignement et, lorsqu'ils choisissaient leur type de pratique, étaient davantage influencés par les perspectives universitaires et moins par des calculs financiers et non financiers. Pour ce qui est des similarités entre les groupes, soulignons le nombre d'heures travaillées par semaine, les réalisations universitaires et le désir d'effectuer les interventions qu'ils préféraient. CONCLUSIONS: Le domaine de la chirurgie reconstructive semble prospère au Canada. Le passage d'une pratique de reconstruction à une pratique esthétique est courant, mais par rapport à leurs collègues américains, une plus forte proportion de chirurgiens plasticiens canadiens maintient une pratique reconstructive. Les différences et les similarités entre les chirurgiens plasticiens reconstructeurs et esthétiques sont exposées.