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There is significant variation in treatment parameters when treating the infraorbital region. Thorough knowledge of these pertinent factors, choice of the optimal filling material, and proper understanding of the anatomy of this unforgiving region will contribute to a safe, effective, and natural result. We aim to conduct a systematic review of published literature related to soft tissue fillers of the tear trough and infraorbital region. A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. The Medical Subject Headings (MeSH) terms used were "tear trough" OR "infraorbital" AND "dermal filler" OR "hyaluronic acid" OR "poly-L-lactic acid" OR "calcium hydroxyapatite" OR "Restylane" OR "Radiesse" OR "Perlane" OR "Juvéderm" OR "Belotero." Different combinations of these key terms were used. The initial search identified 526 articles. Six additional articles were identified through references. Two-hundred twenty-five duplicates were removed. A total of 307 studies were screened by title and abstract and 258 studies were eliminated based on inclusion and exclusion criteria. Forty-nine articles underwent full-text review. The final analysis included 23 articles. Patient satisfaction was high, and duration of effect ranged from 8 to 12 months. Restylane was most commonly used. Injection technique varied, but generally involved placing filler pre-periosteally, deep to orbicularis oculi muscle, anterior to the inferior orbital rim via serial puncture or retrograde linear threading with a 30-gauge needle. Topical anesthetic was most commonly used. Side effects were generally mild and included bruising, edema, blue-gray dyschromia, and contour irregularities. Nonsurgical correction of the tear trough deformity with soft tissue filler is a minimally invasive procedure with excellent patient satisfaction with long-lasting effects. It is essential to have a fundamental understanding of the relevant anatomy and ideal injection technique to provide excellent patient outcomes and prevent serious complications.
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Técnicas Cosméticas , Preenchedores Dérmicos , Envelhecimento da Pele , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/uso terapêutico , Pálpebras/cirurgia , Humanos , RejuvenescimentoRESUMO
BACKGROUND: Rheumatoid arthritis patients are at increased risk for periprosthetic joint infection after arthroplasty. The reason is multifactorial. Nasal colonization with Staphylococcus aureus is a modifiable risk factor; carriage rates in RA patients are unknown. The goal of this study is to determine the S aureus nasal carriage rates of RA patients on biologics, RA patients on traditional disease-modifying anti-rheumatic drugs (DMARDs), and osteoarthritis. METHODS: Consecutive patients with RA on biologics (±DMARDs), RA on non-biologic DMARDs, or OA were prospectively enrolled from April 2017 to May 2018. One hundred twenty-three patients were determined necessary per group to show a difference in carriage rates. Patients underwent a nasal swab and answered questions to identify additional risk factors. S aureus positive swabs were further categorized using spa typing. Logistic regression evaluated the association with S aureus colonization between the groups after controlling for known risk factors. RESULTS: RA patients on biologics, 70% of whom were on DMARDs, had statistically significant increase in S aureus colonization (37%) compared to RA on DMARDs alone (24%), or OA (20%) (P = .01 overall). After controlling for glucocorticoids, antibiotic use, recent hospitalization, and diabetes, RA on biologics had a significant increased risk of S aureus nasal colonization (Odds ratio 1.80, 95% confidence interval 1.00-3.22, P = .047). CONCLUSION: S aureus colonization risk was increased for RA on biologics compared to RA not on biologics and OA. Nasal S aureus carriage increases the risk of surgical site infection; this modifiable risk factor should be addressed prior to total joint arthroplasty for this higher risk patient group.
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Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Portador Sadio/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/microbiologia , Terapia Biológica , Portador Sadio/microbiologia , Testes Diagnósticos de Rotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/microbiologia , Osteoartrite/cirurgia , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologiaRESUMO
The diagnosis of venous thromboembolism is difficult in the postoperative setting because signs such as hypoxemia, leg pain, and swelling are so common. CTPA can also detect subsegmental PE (SSPE), of which the clinical significance has been widely debated. Clinical decision rules (CDR), such as the Wells and PISA 2, have been developed to identify symptomatic patients at low risk for PE who could forgo imaging. We performed this study in order to (1) compare the performance of the Wells and PISA 2 CDR in orthopedic patients; (2) compare CDR scores in patients with subsegmental PE (SSPE) versus larger clots; and (3) identify variables that improve performance of the Wells in orthopedic patients. This retrospective cohort study included all orthopedic surgery patients that underwent computerized tomographic pulmonary angiography at a single institution from 1/1/13 to 12/31/14 and had data to calculate both Wells and PISA 2 scores. CDR sensitivity, specificity and c-statistics were calculated. Multivariable logistic regression was used to identify variables that improved CDR performance. 402 patients were included in the study. The Wells rule (cutoff > 4) had sensitivity 74% and specificity 45%. PISA 2 (cutoff 0.6) had sensitivity 90% and specificity 11%. The Wells performed better than PISA 2: c-statistic 0.60 vs. 0.50; p = 0.007. The mean Wells score was 5.20 ± 1.68 for patients with SSPE and 5.41 ± 1.86 for patients with larger clots. Adding the variables prior smoking and varicose veins improved the performance of the Wells rule (c-statistic 0.66 vs. 0.60, p = 0.008). The Wells rule (cutoff > 4) performs better than PISA 2 in orthopedic patients. Neither can distinguish patients with SSPE from those with larger clots. Although adding past smoking and varicose veins to the Wells improves its performance, this requires validation in other populations.
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Angiografia por Tomografia Computadorizada/normas , Técnicas de Apoio para a Decisão , Procedimentos Ortopédicos/efeitos adversos , Embolia Pulmonar/diagnóstico , Adulto , Idoso , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fumar , Varizes , Adulto JovemRESUMO
Infection and extrusion of hardware are known complications of hypoglossal nerve stimulation surgery. We present a unique case of an extruded hardware lead successfully managed with reimplantation without need for explantation and new device placement. The topic will be discussed in context of the body of literature related to extruded medical device management. Laryngoscope, 133:2821-2822, 2023.
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Terapia por Estimulação Elétrica , Nervo Hipoglosso , Humanos , Nervo Hipoglosso/cirurgia , Reimplante , Remoção de Dispositivo , ReoperaçãoRESUMO
INTRODUCTION: The risk of adverse events, specifically avascular necrosis (AVN), associated with corticosteroid use is not well reported. The aim of this study was to evaluate the prevalence of AVN among patients with prior oral corticosteroid administration. METHODS: An institutional database query recognized 113,734 adult patients with oral corticosteroid administration between January 2006 and May 2017. A temporal query performed on this cohort determined that 789 had a diagnosis of AVN following oral corticosteroids. A retrospective review was performed on this cohort. Data collected included demographics, comorbidities, date of initial oral corticosteroid exposure, and time to diagnosis of AVN. Records without radiographic confirmation of AVN were excluded from analysis. Patients with cumulative lifetime dosages greater than 10,000 mg prednisone were excluded from analysis. RESULTS: A total of 789 patients with oral corticosteroid use prior to diagnosis of AVN were identified. Five hundred and seventy-two patients were excluded due to insufficient documentation of oral corticosteroid dosage, no radiographic evidence supporting the diagnosis of AVN, insufficient data confirming the temporal relationship between oral corticosteroids and AVN, and/or a cumulative dosing of >10,000 mg prednisone. This left 217 patients included in the analysis. The mean duration of use prior to diagnosis of AVN was 219 (± 374) days, and mean cumulative dose was 3314 (± 2908) mg prednisone equivalents. Mean time between diagnosis of AVN and onset of pathologic fracture was 379 (± 1046) days. CONCLUSION: For patients receiving low cumulative doses of oral corticosteroids, corticosteroids pose a small risk of development of AVN. More studies are required to better characterize risk.
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Corticosteroides , Osteonecrose , Corticosteroides/efeitos adversos , Adulto , Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico , Osteonecrose/epidemiologia , Prednisona/efeitos adversos , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVES: To investigate and identify the concerns and opinions expressed in both parental and provider posts on social media about ankyloglossia. METHODS: In this study, posts on Twitter between 1/1/2008 and 12/31/2018 were collected using search terms and hashtags specific to pediatric ankyloglossia. The search terms included a primary phrase to indicate ankyloglossia along with a pediatric identifier. Tweets that met inclusion criteria were analyzed qualitatively via conventional content analysis. After all tweets were categorized, descriptive statistics were completed to determine frequency of each theme. RESULTS: In total, 5951 tweets were retrieved. Parents authored 982 (16.5%) of tweets, and 782 (13.1%) were by providers. The remaining 4187 tweets did not fit criteria for either the parent or provider groups. Amongst parents, the most common themes mentioned were feeding problems (309 tweets [32.4%]), followed by lip tie (215 [22.5%]), anxiety or emotion (207 [21.7%]), and maternal breastfeeding complications (127 [13.3%]). The number of tweets about ankyloglossia and frenotomy in 2018 had increased by 2395% since 2009. Amongst providers, 215 tweets were judged by the coders to provide an opinion on ankyloglossia, of which 94.4% had a pro-frenotomy sentiment. When a specialty was identified, tweets were most often by dentists (250 [31.9%]), followed by lactation consultants and International Board Certified Lactation Consultants (IBCLCs) (157 [29.7%]) and non-otolaryngologist physicians (79 [10.1%]). Otolaryngologists accounted for 8.7% (68 tweets) of posts about ankyloglossia. CONCLUSION: Our findings demonstrate the spectrum of opinions that exist among both parents and providers about ankyloglossia. This can aid in shared-decision making by enabling the counseling provider to guide recommendations based on medical evidence with the understanding that there is a large amount of non-scientific information and opinions disseminated that may be shaping decisions.
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Anquiloglossia , Mídias Sociais , Aleitamento Materno , Criança , Feminino , Humanos , Freio Lingual , PaisRESUMO
Blue Rubber Bleb Nevus Syndrome (BRBNS), also known as Bean Syndrome, is a rare condition characterized by vascular ectasias that typically present systemically. Most diagnoses are made in early childhood due to cutaneous lesions in Caucasians with familial inheritance. Treatment is usually patient centered due to the wide variance in clinical presentation of the disease. Here, we present a case of BRBNS in a 65-year-old African-American patient with episodic gastrointestinal (GI) bleeding with no previous history. This case emphasizes the need for a higher clinical suspicion of the disease in patients with recurrent GI bleeding.
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A 55-year-old immunocompetent male presented with new-onset seizures and acute respiratory failure requiring intubation and a stay in the medical intensive care unit. Magnetic Resonance Imaging (MRI) of the brain revealed ring-enhancing lesions, and Computed Tomography (CT) chest showed ground-glass opacity. The patient underwent craniotomy and bronchoscopy, followed by culture of the purulent aspirate from lesions in the brain and bronchoalveolar lavage (BAL). After extensive infectious workup, the patient was diagnosed with a Nocardia farcinica brain abscess plus underlying pulmonary alveolar proteinosis (PAP). Based on a recommendation from an infectious disease expert, the patient was treated with trimethoprim-sulfamethoxazole (TMP/SMX). This case highlights the importance of understanding that, though rare, infections such as nocardiosis can present in immunocompetent patients and cause severe morbidity.
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Unfortunately, the original version of this article [1] contained an error.
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BACKGROUND: Umingmakstrongylus pallikuukensis and Varestrongylus eleguneniensis are two potentially pathogenic lungworms of caribou and muskoxen in the Canadian Arctic. These parasites are currently undergoing northward range expansion at differential rates. It is hypothesized that their invasion and spread to the Canadian Arctic Archipelago are in part driven by climate warming. However, very little is known regarding their physiological ecology, limiting our ability to parameterize ecological models to test these hypotheses and make meaningful predictions. In this study, the developmental parameters of V. eleguneniensis inside a gastropod intermediate host were determined and freezing survival of U. pallikuukensis and V. eleguneniensis were compared. METHODS: Slug intermediate hosts, Deroceras laeve, were collected from their natural habitat and experimentally infected with first-stage larvae (L1) of V. eleguneniensis. Development of L1 to third-stage larvae (L3) in D. laeve was studied at constant temperature treatments from 8.5 to 24 °C. To determine freezing survival, freshly collected L1 of both parasite species were held in water at subzero temperatures from -10 to -80 °C, and the number of L1 surviving were counted at 2, 7, 30, 90 and 180 days. RESULTS: The lower threshold temperature (T0) below which the larvae of V. eleguneniensis did not develop into L3 was 9.54 °C and the degree-days required for development (DD) was 171.25. Both U. pallikuukensis and V. eleguneniensis showed remarkable freeze tolerance: more than 80% of L1 survived across all temperatures and durations. Larval survival decreased with freezing duration but did not differ between the two species. CONCLUSION: Both U. pallikuukensis and V. eleguneniensis have high freezing survival that allows them to survive severe Arctic winters. The higher T0 and DD of V. eleguneniensis compared to U. pallikuukensis may contribute to the comparatively slower range expansion of the former. Our study advances knowledge of Arctic parasitology and provides ecological and physiological data that can be useful for parameterizing ecological models.