MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'article'. Sat, 03 Sep 2011 01:54:03 +0100 http://www.medworm.com/index.php?rid=5181868&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FFhL12-nPJZg%2Fkids-and-boxing.html I can’t say I am a fan of boxing, but I can appreciate the discipline required both mentally and physically.  The American Academy of Pediatrics has recently (full reference below, free access) issued a policy statement on participation of children and adolescents in the sport of boxing (bold emphasis is mine). Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. B... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5181868 Thu, 01 Sep 2011 11:15:00 +0100 5181868 http://www.medworm.com/index.php?rid=5159141&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fmtqu7Chctl0%2Fpressure-treatment-of-auricular-keloids.html I have written of keloid treatment (general, not site specific) previously.  I have always tried to include pressure treatment as part of the plan when treating keloids of the ear lobe.   This pressure treatment came in the form of pressure earrings  -- clip-on, disc-shaped.  The recent article (full reference below) in the Archives of Facial Plastic Surgery journal introduces a new pressure device which looks like it will work better than what has been available (photo credit)  and as can be seen in this photo the upper ear can be treated with pressure which has not been possible with the clip earrings. (photo credit)   These devices were custom made which makes them more expensive than off-the-shelve pressure earrings and may make them difficult to... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5159141 Thu, 25 Aug 2011 14:13:47 +0100 5159141 http://www.medworm.com/index.php?rid=5130797&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FTQ5qdYe8uKQ%2Fmanagement-of-latex-allergic-surgical.html In conclusion, we believe that a sensible balance requires a mix of latex and synthetic gloves.           REFERENCES Recognition and Management of the Latex-Allergic Patient in the Ambulatory Plastic Surgical Suite;  Deborah Accetta and Kevin J. Kelly; Aesthetic Surgery Journal July 2011 31: 560-565, first published on June 1, 2011 doi:10.1177/1090820X11411580 Latex Medical Gloves: Time for a Reappraisal; Palosuo T, Antoniadou I, Gottrup F, Phillips P; Int Arch Allergy Immunol 2011;156:234-246 (DOI: 10.1159/000323892) (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5130797 Mon, 15 Aug 2011 11:15:00 +0100 5130797 http://www.medworm.com/index.php?rid=5107571&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FKQpYUu2tK7w%2Freview-of-nsaids-effects-side-effects.html Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away.  It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working.  I can’t take Aleve due to the severe esophagitis it induces.  I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis. BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA.  The rheumatologist was impressed with the swelling, pain, and ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5107571 Mon, 08 Aug 2011 11:15:01 +0100 5107571 http://www.medworm.com/index.php?rid=5096282&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F00YvPBcMlds%2Ftiming-of-radiotherapy-in-implant-based.html This study demonstrated that a higher total failure rate affects breast reconstructions that undergo irradiation during tissue expansion. For this reason, we suggest that if tissue expansion can be performed during postoperative chemotherapy, chest wall irradiation should be delivered on permanent implants. The second surgical step can be scheduled 3 weeks after the end of chemotherapy, and the irradiation should not begin more than 3 weeks later. Patients whose need for radiotherapy is not known preoperatively can, in this way, improve their surgical outcome.         REFERENCES Outcome of Different Timings of Radiotherapy in Implant-Based Breast Reconstructions; Nava, Maurizio B.; Pennati, Angela E.; Lozza, Laura; Spano, Andrea; Zambetti, Milvia; Catanuto, Giuseppe; P... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5096282 Thu, 04 Aug 2011 11:15:00 +0100 5096282 http://www.medworm.com/index.php?rid=5086233&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fnif0Us-_iWY%2Fis-prophylactic-mastectomy-worth-it.html There is a recent article which asks this question (full reference below).  I think it is a question which must be answered on an individual basis.   For someone like me, the answer would be no.  I have no family history or personal history of breast cancer.  I have small, more dense than fatty breast, but have always had normal mammograms.  I have never had any lesions which needed biopsy. For an individual woman with a strong family history of breast cancer (especially genetically proven, BRCA1 and BRCA2) and a person history of breast cancer (ie right mastectomy for lobular carcinoma), then it is easy to say “Yes, a prophylactic left mastectomy would be worth it for you.” In between these two examples is the gray area, and this article doesn’t nece... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5086233 Mon, 01 Aug 2011 11:15:00 +0100 5086233 http://www.medworm.com/index.php?rid=5077768&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F29%2Fdbs-for-depression-still-mixed-results%2F Deep brain stimulation (DBS) is a treatment long used for Parkinson’s disease. But in the past decade, some researchers have also examined its use for the treatment of severe clinical depression. Severe major depression is a serious problem in society, because some studies estimate that up to 30 percent of those who attempt to be treated for it find they have “treatment resistant” depression — that is, traditional treatments simply don’t work very well. Deep brain stimulation has mixed results. As we reported on back in February, a long-term followup of 20 patients found an average response rate to DBS of 64 percent. Not shabby, but also not the hopeful, guaranteed cure it was once held out to be. Maiken Scott, the behavioral health reporter for Philadelphia... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5077768 Fri, 29 Jul 2011 15:39:07 +0100 5077768 http://www.medworm.com/index.php?rid=5077731&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fj6kzAUAU-nY%2Fmore-on-implant-related-alcl-of-breast.html This article notes (as did the recent FDA report) most investigations performed to date suggest an association between breast implants and primary ALCL of the breast.  The specifics regarding this relationship remain poorly defined. A review of all reported cases of implant-related primary ALCL of the breast demonstrates no obvious correlation with implant fill type (silicone vs. saline), surface morphology (smooth vs. textured), implant position (subpectoral vs. subglandular), or indication for implant placement (cosmetic vs. reconstructive). The FDA notes (bold emphasis is mine): ALCL is a very rare condition; when it occurs, it has been most often identified in patients undergoing implant revision operations for late onset, persistent seroma. Because it is so rare and most often ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5077731 Thu, 28 Jul 2011 11:15:00 +0100 5077731 http://www.medworm.com/index.php?rid=5069512&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FNjprUN1f394%2Fmodification-of-square-face.html Recently an article in the Archives of Facial Plastic Surgery (full reference below) led to a Reuters news by Genevra Pittman:  Face too square? There's a surgery for that The journal article is from China where the surgical procedure to modify a square face to a more oval face is done much more commonly than in the United States.  The Reuters article includes quotes from two U.S. surgeons:  Dr. Jeffrey Spiegel, chief of facial plastic and reconstructive surgery at the Boston University School of Medicine, and Dr. Ross Clevens, a cosmetic surgeon in Melbourne, Florida. Spiegel states he does the procedure described in the Archives article two to four times each week.  Clevens states “he doesn't treat many male patients who want a more "feminine" face shape.�... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5069512 Wed, 27 Jul 2011 11:15:00 +0100 5069512 http://www.medworm.com/index.php?rid=5062275&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FjCwOqt0SsuA%2Fshould-langers-lines-be-used-for.html An old PRS journal article came to my attention recently thanks to a tweet by @prsjournal: “Most Emailed Article Langer's Lines: To Use or Not to Use: Thirty-six differently named guidelines have develope... http://bit.ly/mPR6v1” [I’m not sure the time frame involved in the “most emailed.” Not sure if it’s for the day, the week, etc.] – The tweeted article (first full reference below) is a short one and I would recommend it to young plastic surgeons and students. A state of tension exists naturally in skin. For instance, wounded skin will gape, becoming elliptical instead of round. The first to notice this skin property was Dupuytren. In 1834, he encountered a corpse of a man who had stabbed himself with a round-tipped awl. Dupuytren noticed these stab wounds were elliptic... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5062275 Mon, 25 Jul 2011 11:15:00 +0100 5062275 http://www.medworm.com/index.php?rid=5050660&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FdQCEqkSTXr0%2F2-stage-ear-reconstruction-article.html There is a nice article on a 2-stage ear reconstruction for microtia (full reference below) in the current issue (May/June 2011) of the Archives of Facial Plastic  Surgery journal. I am in awe of the surgeons who can carve the 3-dimensional cartilage framework fabricated in the first stage.  This is not something I mastered but continue to read to learn (while referring this patients to others). In the article, Yanyong Zhao, MD  and colleagues describe the 2-stage procedure they used to reconstruct the ears of 68 patients (ages ranged from 5 to 17 years).  The surgeries were done  between January 1, 2006, to December 31, 2008. Forty-eight patients were boys, and 20 were girls. Unilateral microtia was present in 66 patients and bilateral microtia was present in 2 pa... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5050660 Mon, 18 Jul 2011 11:16:00 +0100 5050660 http://www.medworm.com/index.php?rid=5028380&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FwB0sSuEhj5Y%2Flaser-treatment-of-stretch-marks.html Stretch marks (striae distensae) are common.  They represent linear dermal scars accompanied by epidermal atrophy.  Stretch marks aren’t a significant medical problem, but can be a source of significant emotional distress. There are many treatments available, ranging from therapy applied to the skin, laser therapy, and even more invasive surgical methods. Unfortunately, stretch marks remain a tricky problem to target, in which no established treatment exists. A recent article in the  May issue of the Aesthetic Surgery Journal (full reference below) discusses the use of fractional nonablative laser treatment for stretch marks. Dr. Francesca de Angelis and colleagues conducted a clinical study involving 51 patients with striae, three male and 48 female,  who were treate... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5028380 Mon, 11 Jul 2011 11:15:00 +0100 5028380 http://www.medworm.com/index.php?rid=5008262&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F7kYcZDwBvws%2Fis-personalizing-mammogram-screening.html I read the LA Times article by Shari Roan, Study urges more individual mammogram guidelines, with interest.  As Roan notes, guidelines to date have mainly focused on a woman’s age and not her other risks factors. The American Cancer Society recommends that healthy women undergo screening mammograms every one to two years beginning at age 40 regardless of risk factors. In 2009, the U.S. Preventive Services Task Force recommended a different schedule which urged the inclusion of an individual’s personal risks:  screening for women ages 40 to 49 should be based on individual risk factors and women ages 50 to 74 should be screened every two years. Monday, a paper was published in the Annals of Internal Medicine (full reference below) which argues for a more personalized approach ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=5008262 Wed, 06 Jul 2011 11:15:01 +0100 5008262 http://www.medworm.com/index.php?rid=4992820&cid=t_106950_122_f&fid=37835&url=http%3A%2F%2Fwww.iqscorner.com%2F2011%2F07%2Flaw-review-article-maroney-2011-on.html The following has been added to the ICDP Law Review Article blogroll.Maroney, T. A. (2011). ADOLESCENT BRAIN SCIENCE AFTER GRAHAM V. FLORIDA. Notre Dame Law Review, 86(2), 765-793.- iPost using BlogPress from my Kevin McGrew's iPadintelligence intelligence testing Atkins cases ICDP blog psychology school psychology neuropsychology forensic psychology criminal psychology criminal justice death penalty capital punishment ABA IQ tests IQ scores adaptive behavior AAIDD mental retardation intellectual disability Graham v Florida adolescent brain science neuroscience and law Generated by: Tag Generator (Source: Intelligent Insights on Intelligence Theories and Tests (aka IQ's Corner)) Intelligent Insights on Intelligence Theories and Tests (aka IQ's Corner) blogs http://www.medworm.com/rss/comments.php?id=4992820 Fri, 01 Jul 2011 19:00:00 +0100 4992820 http://www.medworm.com/index.php?rid=4975922&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fi4DC0FCg59M%2Fideal-dressing-for-stsg-donor-site.html In the 2009 review (2nd reference below),  Voineskos and colleagues did a literature review of skin graft donor-site dressings.  They noted that although there is no clear evidence that moist dressings are any better overall when compared with dry dressings,  there is evidence that moist dressings tend to be less painful than dry dressings. Donor sites take an average of 7 to 21 days to heal, depending on their size, location, and the patient's health status.  This latest study (first article referenced below) compared Aquacel and a modified (perforated) polyurethane dressing modified (MPD).  The study is a prospective randomized double-blind clinical trial which included 50 adult patients.  The authors state (bold emphasis is mine): The ideal dressing sh... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4975922 Mon, 27 Jun 2011 11:15:00 +0100 4975922 http://www.medworm.com/index.php?rid=4968542&cid=t_106950_105_f&fid=36987&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FIvorKovicMd%2F%7E3%2Fv_fF9FquzRA%2F Just recently my colleague and I have published two research papers. I am very proud of the first one titled “Mobile phone in the Chain of Survival”, which was published after a lot of research in the Resuscitation journal. This short paper gives an overview of vast possibilities possessed by mobile phones to be of assistance in medical emergencies. It represents a continuation of my work with CPR mobile applications. I have also now published a video of the lecture I gave during the Resuscitation 2010 congress about the same subject. You can watch my 10 minute lecture here, and read our paper at the Resuscitation website. The second paper we wrote appeared in the Croatian journal Lijecnicki Vjesnik (in English this would be something like Physician’s Newsletter). It i... Ivor Kovic, M.D. blogs http://www.medworm.com/rss/comments.php?id=4968542 Sat, 25 Jun 2011 09:54:12 +0100 4968542 http://www.medworm.com/index.php?rid=4960104&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FeU1BDyv8MXk%2Fdoes-negative-pressure-promote-wound.html There was a recent EurekAlert which caught my attention:  No healing in a vacuum.  Negative-pressure wound therapy probably does not promote healing. This is the conclusion of Frank Peinemann and Stefan Sauerland's meta-analysis in the current edition of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108[22]: 381-9). The press release actually contained a link to a pdf file of the article (full reference and link below). Negative-pressure wound therapy (NPWT), also known as vacuum assisted closure,  involves covering the wound with an an airtight film and an adjustable negative pressure is applied using an electronically controlled pump.  The vacuum or negative pressure drains wound exudate.   NPWT is used for chronic persistent wounds and com... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4960104 Thu, 23 Jun 2011 11:15:00 +0100 4960104 http://www.medworm.com/index.php?rid=4960103&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FwY8k1WyQzA4%2Fdysport-or-botox-for-crows-feet.html A new study published online in Archives of Facial Plastic Surgery suggests Dysport (abobotulinumtoxinA) is better for treating Crow’s feet than Botox (onabotulinumtoxinA). Let’s look at the study which only had 90 patients, all older than 18 years of age (mean age 54½, 77 women), were enrolled in a randomized, double-blind, split-face study. The authors include this history of both products: ….in 2002, the FDA approved Botox Cosmetic (onabotulinumtoxinA) (Allergan Inc, Irvine, California) for the treatment of corrugator-mediated glabellar lines. Concurrently, another botulinum toxin type A product manufactured by Medicis Aesthetics (Scottsdale, Arizona), Dysport (abobotulinumtoxinA), had been used in other countries since 1991. It was approved for cosmetic use in Europe in 200... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4960103 Thu, 23 Jun 2011 01:58:13 +0100 4960103 http://www.medworm.com/index.php?rid=4934277&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FzJNDoYh9Ovk%2Fimpact-of-obesity-on-breast-surgery.html Obesity is an ever increasing presence in today’s world.  Thirty-four percent of U.S. adults are now estimated to be obese (BMI>30), up from just 15% three decades ago. Obesity increases the risk of complications in many medical/surgical situations which has pushed some Ob-Gyns in Florida to refuse to care for pregnant women over a certain weight. Martin A. Makary, MD and colleagues designed a study to measure the impact on complication rates in obese patients presenting for a set of elective breast procedures. The PRS journal article referenced below has been published online ahead of print and looks at the impact obesity has on breast surgery complication. The researchers used claims data from seven Blue Cross and Blue Shield Plans covering individuals with employer-provided co... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4934277 Thu, 16 Jun 2011 11:16:00 +0100 4934277 http://www.medworm.com/index.php?rid=4921494&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FLbN0qYHjpi8%2Fadvances-in-surgical-treatment-of.html In conclusion: In conclusion, free gracilis transfer for smile reanimation in children carries an acceptable failure rate, significantly improves smiling, and seems to improve QOL with respect to facial function. It should be a cornerstone intervention in the appropriately counseled patient and family. Because it carries a lower failure rate than a similar cohort of adult patients, there is no need to wait until patients reach adulthood to offer dynamic reanimation. Early facial reanimation provides the advantage of permitting children to express themselves nonverbally through smiling and may in fact lead to fewer negative social consequences as they interact with peers.         REFERENCES 1.  Free Gracilis Transfer for Smile in Children:  The Massachusetts... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4921494 Thu, 09 Jun 2011 11:15:00 +0100 4921494 http://www.medworm.com/index.php?rid=4893519&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F_m6dJYYTCV0%2Frecovery-of-sensation-post-facial.html Discussion: Pathways of Sensory Recovery after Face Transplantation; Chong, Tae; Plastic & Reconstr Surgery 127(5):1890-1891, May 2011; doi: 10.1097/PRS.0b013e31820e88c9 ASPR Press Release, May 9, 2011:  Sensation Recovers to 'Near-Normal' After Face Transplant, Study Finds Setting Goals, Rehabilitating After Brain Injury; NPR, May 16, 2011 (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4893519 Wed, 01 Jun 2011 11:20:00 +0100 4893519 http://www.medworm.com/index.php?rid=4862610&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fc5PLtjyXfLs%2Ftransaxillary-breast-augmentation-and.html I’m not a huge fan of transaxillary breast augmentation (TABA).  One of the major selling points for the transaxillary approach is the lack of scars on the breasts.  As a woman living in the south, my arm pits are much more likely to be seen in public than my breasts.  As a surgeon, I also know that when revisions need to be done (capsule issues, etc) most recommend using an inframammary approach so why not just start there.  In my opinion, all women with implants will have a repeat surgery at some point in the future – implant failure (deflation, rupture) being a given. I admit I had not thought about how the incision might interfere with future sentinel lymph node assessment prior to this article (full reference below). Dr. Ana Claudia Weck Roxo, Rio de Janeiro S... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4862610 Wed, 25 May 2011 11:11:00 +0100 4862610 http://www.medworm.com/index.php?rid=4841554&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FfHkmS_t5G1U%2Fnonmelanoma-skin-cancer-in-ibd-patients.html I stumbled across this review article (first full reference below) earlier this week.   Skin cancer is the most common form of cancer in the United States.  Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems (such as inflammatory bowel disease patients on immunosuppressive therapy).  According to the National Cancer Institute (NCI), in there were more than one million new cases of nonmelanoma skin cancers (NMSC) in the United States in 2010.  There were less than 1,000 NMSC deaths during the same time. NMSC includes  squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).   Both occur more frequently on sunlight-exposed areas such as the head and neck. BCC is far more c... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4841554 Thu, 19 May 2011 11:15:00 +0100 4841554 http://www.medworm.com/index.php?rid=4789308&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fu4R23934B3k%2Fwomen-dont-regret-prophylactic.html I was alerted to the presentation at the American Society of Breast Surgeons meeting (first reference below) by Judy Boughey, MD by @MedicalNews’ tweet: ASBS: Prophylactic Mastectomy Good Even Years Later (CME/CE) http://bit.ly/kMCsdr Boughey and colleagues note that previous researchers using cross-sectional surveys have found that the majority of women are satisfied with their decision to have contralateral prophylactic mastectomy (CPM) one to several years after the procedure. Their study chose to look at the consistency of satisfaction and changes in adverse effects in the same women with longer term follow-up. To do this, they surveyed a previously established cohort of women with unilateral breast cancer who had contralateral prophylactic mastectomy at the Mayo Clinic between 19... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4789308 Thu, 05 May 2011 11:15:00 +0100 4789308 http://www.medworm.com/index.php?rid=4789307&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F4BRJYvjPPxA%2Fliposuction-and-redistribution-of-fat.html This article does more definitively define the answer to where it will be placed. The study enrolled 32 healthy women (mean age 36) with disproportionate fat depots (lower abdomen, hips, or thighs) were enrolled and then randomly placed into either a small-volume liposuction group (n = 14, mean BMI: 24 ± 2 kg/m2) or control (n=18, mean BMI: 25 ± 2).  Participants agreed not to make lifestyle changes while enrolled. Baseline body composition measurements included dual-energy X-ray absorptiometry (DXA) (a priori primary outcome), abdominal/limb circumferences, subcutaneous skinfold thickness, and magnetic resonance imaging (MRI) (torso/thighs). The surgery group had their liposuction within 2-4 weeks of the baseline measurement.  Identical measurements were repeated at 6 weeks,... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4789307 Wed, 04 May 2011 11:15:00 +0100 4789307 http://www.medworm.com/index.php?rid=4762790&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FsTvgmOO2MPE%2Fscreening-prior-to-cosmetic-breast.html This article from November 2009 (full reference below)  reviews this topic.  Note this survey was done prior to the release of the new USPSTF guideline recommendations for screening mammograms the same month.   I wonder if a new survey would have different outcomes. The article reports on a study which looked at breast cancer screening practices of American plastic surgeons (self-reported) and the degree to which those practices adhere to the American Cancer Society guidelines. The study was conducted using an online survey of the members of the American Society of Plastic Surgeons over a 5 month period (January 2008 to May 2008). The 20 multiple-choice questions were designed to assess physician practice composition and familiarity with American Cancer Society guideli... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4762790 Thu, 28 Apr 2011 11:15:00 +0100 4762790 http://www.medworm.com/index.php?rid=4758777&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FjQVLZDeG5Ww%2Fadvances-in-nipple-sparing-mastectomy.html There is a very nice review article of the advances in nipple-sparing mastectomy surgery in the March 2011 issue of the Aesthetic Surgery Journal (full reference below). Dr. Patrick Maxwell and colleagues includes some history of nipple-sparing mastectomy (NSM): NSM was attempted in the 1980s but never gained popularity owing to the controversies surrounding oncological safety. Now, better technologies for preoperative staging and assessment of lesion distance from the NAC, along with an increased understanding of the anatomy of the breast ducts with relation to the nipple, are encouraging a return to the concept. One of the key publications that renewed and increased enthusiasm for this technique was the multicenter publication of 192 patients undergoing NSM with only four recurrences, ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4758777 Wed, 27 Apr 2011 11:14:00 +0100 4758777 http://www.medworm.com/index.php?rid=4747636&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F_YOLfQGE8RA%2Fmore-on-link-between-breast-implants.html I have written about this previously.  ALCL and Breast Implants – an article review (March 9, 2011) ALCL and Breast Implants (January 31, 2011) Breast Implants and Lymphoma Risk (June 29, 2009)   A quick review:  In January, the Food and Drug Administration (FDA) released a safety alert warning of the possible association of acute large cell lymphoma (ALCL) with breast implants. After the Plastic Surgery Societies got through being defensive, they did the right thing  reviewed the literature (4th reference below) and the Plastic Surgery Foundation and the Aesthetic Surgery Education and Research Foundation commissioned RAND to conduct an exhaustive review of the medical literature and organize a panel of medical experts to evaluate the evidence for a potential link ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4747636 Mon, 25 Apr 2011 11:15:00 +0100 4747636 http://www.medworm.com/index.php?rid=4734158&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F5rtsPwMhdGc%2Fmore-on-hand-and-face-transplantation.html Conclusions: Although the risk of donor-derived cytomegalovirus is acceptable in life-saving solid organ transplantation, for face transplantation patients, the scenario is different. When the authors' team performed the first nearly total face/maxilla transplantation (December of 2008), there was little known regarding the consequences of cytomegalovirus-related donor transmission in face transplantation. Therefore, the authors now recommend that all candidates be fully informed as to the risks of cytomegalovirus/infectious transmission and that aggressive viral, bacterial, and fungal prophylaxis be instituted.   As with the young women who would give a year of life for a perfect body, it is a question for the individual (I am coming to believe) to decide.  But for them to deci... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4734158 Thu, 21 Apr 2011 11:15:00 +0100 4734158 http://www.medworm.com/index.php?rid=4723904&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FpI5s4UDLMiw%2Ftopical-treatment-of-hypertensive-leg.html An interesting little article in the April issue of the Archives of Dermatology (full reference below) by Senet and colleagues on the treatment of hypertensive leg ulcers with platelet-derived growth factor-BB.  Interesting, in that, it reported a negative outcome or lack of superiority for one treatment over another. First, what is a hypertensive leg ulcer (HLR)? According to the Graves and colleagues (second article referenced below), Martorell, a Spanish cardiologist (1906-1984) first noticed the relationship between hypertension and alterations in arterioles and leg ulcers in 1945.  Martorell called these ulcers hypertonic or hypertensive ulcers of the legs and published the first 4 cases.  Originally, Martorell described the following diagnostic criteria: a) Ulcer lo... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4723904 Mon, 18 Apr 2011 11:15:00 +0100 4723904 http://www.medworm.com/index.php?rid=4684411&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FLCI_zXgVpv8%2Fangry-face-syndrome.html I must say when I first read the title of this article (full reference below) I thought it was a joke. Apparently, I was just unaware this syndrome exist. The authors state, “The finding of frontal bossing, deep radix, straight nasal dorsum, and an over projection of the nasal tip constitutes the angry face syndrome.” (photo credit, from article) The authors note, “When the syndrome components of frontal bossing, a deep radix, and nasal tip projection are present but include a significant nasal dorsal hump (instead of a straight dorsum), the angry face syndrome does not apply. Somehow the dorsal hump negates the message of anger to the observer.” Their solution is a rhinoplasty with attention to a major radix augmentation graft and substantial reduction of the nasal tip projec... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4684411 Wed, 06 Apr 2011 14:20:36 +0100 4684411 http://www.medworm.com/index.php?rid=4676851&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F9ykXCwYywiM%2Fdecision-making-in-severe-lower-leg.html About the time I was reading the journal article on decision-making process for patients with severe lower leg trauma (full reference below), @sospokesaroj shared news article via twitter:  Nine-year-old loses leg while saving little sister’s life. Another news article on the accident notes Surgeons worked on Anaiah from 1 p.m. to midnight on Friday, Davis says, to try and save a shattered left leg. On Saturday the leg was amputated. The brute force of the accident also broke Anaiah’s right leg, fractured her neck, damaged her spleen and destroyed one kidney. Which brings me back to the journal article which is a qualitative analysis of patient preferences for amputation or reconstruction. Twenty patients with type IIIB or IIIC open tibial fractures participated in the study. ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4676851 Mon, 04 Apr 2011 11:15:00 +0100 4676851 http://www.medworm.com/index.php?rid=4664215&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FK0pL3nzOhuA%2Ffat-grafting-to-breast-and-oncologic.html This study investigated an orthotopic model of breast cancer in which human breast cancer cells were implanted into the mammary fat pad of immunodeficient animals, followed by placement of a human fat graft (with or without noncultured supplemental cells) immediately adjacent to the mammary fat pad containing the nascent tumor. The study found no increase in tumor growth with either an estrogen receptor-positive or an estrogen receptor-negative human breast cancer line. This is consistent with the absence of evidence for increased cancer risk in the many reports of fat grafting for breast reconstruction and augmentation. However, at this time, the number of patients with prolonged follow-up is only approximately 1000 and appropriate caution in proceeding is indicated. ……….In the cl... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4664215 Thu, 31 Mar 2011 11:15:00 +0100 4664215 http://www.medworm.com/index.php?rid=4605862&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FK8nBbeJubaQ%2Flasting-gift.html This study suggests that there is an additional benefit as a protection for the family. Just leaving decisions up to the family may well be counterproductive and make it harder on the family, not easier." I and my siblings can attest to the lasting gift our mother gave us.  There is a peace in knowing we followed her wishes when she had the massive intra-operative stroke which ended her life. She repeatedly over the years told us what she wanted and what she didn’t want.  We are able to discuss it without feeling morbid.  My husband is not. My dear husband finds it uncomfortable when I want to tell him what my wishes are when the time comes for tough choices.  I tell my siblings and hope they will help him (and me) when the time comes. I don’t know what his wi... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4605862 Thu, 17 Mar 2011 11:15:00 +0100 4605862 http://www.medworm.com/index.php?rid=4570577&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FGrGJsphU9pE%2Feconomics-of-limb-salvage-in-diabetes.html Discussion: The Economics of Limb Salvage in Diabetes; Driver, Vickie R.; Yao, Min; Plastic & Reconstructive Surgery. 127():296S-297S, January 2011; doi: 10.1097/PRS.0b013e318203a47c (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4570577 Thu, 10 Mar 2011 12:21:00 +0100 4570577 http://www.medworm.com/index.php?rid=4527759&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FcTLG5-Lp0Gs%2Fare-patients-making-good-decisions.html The objective of the study was to “measure women's knowledge about reconstruction and to evaluate the degree to which treatments reflected patients' goals and preferences.” Their conclusion (bold emphasis is mine): Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients' goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making. Granted the study was small, but it left me wondering if we the medical community fails to educate these women.   The study involved a cross-sectional survey of early-stage breast cancer survivors from four university medic... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4527759 Mon, 28 Feb 2011 12:15:00 +0100 4527759 http://www.medworm.com/index.php?rid=4522144&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F25%2Fbest-of-our-blogs-february-25-2011%2F This article looks at different types of narcissism (even healthy ones) and provides information that may make you rethink the way you perceive narcissists. (Source: World of Psychology) World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4522144 Sat, 26 Feb 2011 02:18:48 +0100 4522144 http://www.medworm.com/index.php?rid=4522087&cid=t_106950_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F_HJ3m2AeitY%2F This report provides crucial practical drafting guidance for exercising the states’ constitutional authority. In essence, it recommends that state legislators draft their Article V applications and delegate commissions with an eye to targeting specific subject matters, while still giving state delegates a meaningful level of deliberative independence to ensure that the amendments convention can serve its consensus-building and problem-solving purpose. The key is to regard an amendments convention as a modern-day “task force”—a representative body that is limited to a specific agenda but expected to exercise judgment on accomplishing that agenda. For the previous two papers, and other materials regarding amendment conventions, see Goldwater's invaluable Artivle V resource page. How ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4522087 Fri, 25 Feb 2011 19:09:06 +0100 4522087 http://www.medworm.com/index.php?rid=4517200&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fcc8fbeQ__8g%2Fbreast-cancer-oncogene-znf703.html Much of gene research is over my head, but the discovery of a new breast cancer oncogene, ZNF703, is exciting.  It appears to have been discovered by two independent research groups (references below) and published alongside one another in the same journal EMBO Molecular Medicine today this past week. The only other breast oncogene that I am aware of is Her2 which has been very helpful in identifying which patients are most likely to respond to Herceptin.  This greatly helps in tailoring therapy to the individual. The first group of researcher scientists used ‘microarray technology’ which allows large numbers of tissue samples to be tested simultaneously, picking up subtle differences in gene activity between normal cells and cancer cells. The researchers had already identi... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4517200 Thu, 24 Feb 2011 12:14:00 +0100 4517200 http://www.medworm.com/index.php?rid=4482810&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FVf2QT5L7LSI%2Fphotography-in-medicine.html Fellow blogger Sterile Eye recently did a post on the historical use of mirrors in photos of wounded soldiers.  At the time I was reading an article in the journal Advances in Skin & Wound Care (full reference below) on wound photography. Photography, not only in wound care, but in many areas of medicine/surgery (before and after photos, changes in hemangiomas, etc) is important.  As the article points out, if more than one person is to be responsible for taking these photos it is equally important that practice standards be implemented and adhered to. The authors created a wound photography performance checklist to ensure consistency.   In addition to the patient’s name, wound evaluator’s name, and date, here are a few (not all) of the critical items on the che... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4482810 Wed, 16 Feb 2011 12:15:00 +0100 4482810 http://www.medworm.com/index.php?rid=4459996&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FckXdzzWRCo0%2Fhow-to-block-and-tackle-face.html For medical students, residents, or anyone wanting a review, the March 1998 article by Dr. Barry Zide (first full reference below) is a great place to begin.  The article reviews the anatomy of each nerve, the areas of anesthesia obtained by each block, and gives instructions and tips for each of eight facial nerve blocks.   The article, also, has some nice photos. 1.  Infraorbital Nerve Zide’s preferred technique is the transcutaneous nasolabial approach. This approach has a point of injection medial to the upper nasolabial groove a few millimeters lateral to the alar groove. The injection point for the infraorbital nerve is in the center of the small triangle lateral to the alar rim and medial to the nasolabial fold. With your left index finger on the infraorbital... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4459996 Thu, 10 Feb 2011 12:14:00 +0100 4459996 http://www.medworm.com/index.php?rid=4436736&cid=t_106950_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FYLO-_XEBUf0%2F By Ilya ShapiroThose of us who are upset at how "constitutional law" has gotten far away from the text of the Constitution have more options than just hoping the judiciary tosses us an occasional bone and otherwise writing law review articles and op-eds.  We can also amend the Constitution! Indeed, the Framers provided a method of constitutional amendment that is easy to understand (if not to execute, at least not since the New Deal Congress and FDR began de facto amending the Constitution without bothering to amend it de jure).  Article V says that an amendment can be sent to the states for ratification upon approval by two thirds of both houses of Congress.  In the alternative, two thirds of the state legislatures can call for an amending convention.  Either way, the resulting prop... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4436736 Fri, 04 Feb 2011 04:41:14 +0100 4436736 http://www.medworm.com/index.php?rid=4433126&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FmNkq4owqbC8%2Fnutrition-and-wound-healing.html Nutrition, or rather the new USDA Dietary Guidelines, have been in the news this week.  It seem apropos to take not of a recent article in the supplement to the January issue of the Plastic and Reconstructive Surgery Journal discussing nutrition and wound healing (full reference below). The article presents an update on new developments in the field of nutrition and wound healing, not an exhaustive review of the field. As the authors point out “most operations in well-nourished patients are successful, with uncomplicated healing responses, even if nutritional intake is absent or curtailed for 7 to 10 days.”   It’s the patient with trauma, cancer, chronic illnesses, mal-absorption issues where this is most important. First and foremost, the nutritional assessment should... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4433126 Thu, 03 Feb 2011 12:15:00 +0100 4433126 http://www.medworm.com/index.php?rid=4429044&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FK7QQyGjK-iI%2Fclosure-of-facial-mohs-defects.html It is very likely there will never be a complete consensus on the best or correct way to close defects left by Mohs’ surgical excision of skin cancers on the face.  Which is best?  Direct linear closure.  Local flap. Skin graft. In my opinion, it comes down to multiple factors but perhaps the most important are:   Where on the face is the defect?  How lax is the surrounding skin?  The authors of the recent Plastic & Reconstructive Surgery Journal article on the topic (full reference below) write in their introduction in favor of direct closure (the first step in the reconstructive ladder): This first step on the reconstructive ladder is often overlooked in favor of more intricate local flap options. If performed properly, direct linear closure r... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4429044 Wed, 02 Feb 2011 12:19:00 +0100 4429044 http://www.medworm.com/index.php?rid=4405762&cid=t_106950_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FWk_iIYBXFic%2F By Ilya ShapiroI am pleased to pass on word from our friends at the Institute for Justice that they have established a new Center for Judicial Engagement.  The center is dedicated to reinvigorating the judicial branch to stand up and perform its constitutional role instead of showing the deference so many courts now give to the political branches of state and federal government. As much lip service that has been paid to the bogeyman of “judicial activism,” the reality is that the courts have been all-too-reluctant to sacrifice constitutional questions to acquiesce to the supposed wisdom of political actors.  Veteran IJ lawyer and friend of Cato Clark Neily will be heading the center, and had this to say about its mission: We need judges to judge.  What we see too often now is judges... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4405762 Thu, 27 Jan 2011 04:38:45 +0100 4405762 http://www.medworm.com/index.php?rid=4399560&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FtVdI1tBW4Tk%2Fuspstf-breast-screening-guidelines.html The question continues as to when breast screening should begin.  The current pushback comes from radiologists Dr. Mark Helvie of the University of Michigan Health System and colleague Dr. Edward Hendrick of the University of Colorado. The two researchers have published an article (full reference below) in the February issue of the American Journal of Roentgenology questioning the U.S. advisory panel’s breast cancer screening guidelines and suggesting the panel ignored scientific evidence that more frequent mammograms save lives. For the article, the two conducted a review of the risk models used by the U.S. Preventive Services Task Force (USPSTF) to issue controversial breast screening guidelines in 2009.  They used Cancer Intervention and Surveillance Modeling Network modeli... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4399560 Wed, 26 Jan 2011 18:51:00 +0100 4399560 http://www.medworm.com/index.php?rid=4343190&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F9g42C0vUOy8%2Fprophylactic-antibiotics-in-aesthetic.html There is a very nice review of this topic in the Nov/Dec 2010 issue of the Aesthetic Surgery Journal (full reference below). While we want to prevent surgical site infections (SSIs), we don’t want to over utilize antibiotics.   Consequences of which include:   Clostridium difficile infections [CDI] and development of resistant organisms. The authors note that currently no national guidelines for antibiotic prophylaxis in aesthetic surgery although they do for cardiac, colorectal, neurosurgical, and orthopedic procedures.  “In fact, studies examining the impact of prophylactic antibiotics have produced contradictory results.” So what should we do: Until randomized controlled trials examining the efficacy of prophylactic antibiotics in aesthetic surgery are... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4343190 Thu, 13 Jan 2011 12:15:00 +0100 4343190 http://www.medworm.com/index.php?rid=4337995&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F8bIayPpR7Yc%2Fpropranolol-treatment-for-infantile.html The Plastic and Reconstructive Surgery Journal article from 2009 (second reference below) spurred Will J. M. Holmes, M.R.C.S and colleagues to write a letter to the journal noting their experience with propranolol in the treatment of infantile hemangiomas. Holmes cited two articles (references 3 and 4 below) which report the efficacy of of β-blockers in the treatment of hemangioma. As part of a larger study, we have used propranolol in a total of 15 patients. So far, we have observed signs of rapid involution of hemangioma within the first week of treatment in all patients. The response rate is faster than those we have seen when corticosteroids are used. In addition to stopping the proliferation of hemangiomas, propranolol also causes rapid involution within a short period. We now o... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4337995 Wed, 12 Jan 2011 12:14:00 +0100 4337995 http://www.medworm.com/index.php?rid=4318365&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FspOFl_UG6Vs%2Fnew-mrsa-treatment-guidelines.html I learned of this thanks to a tweet from @OFPC: New #MRSA guidelines for the treatment of staph infections http://goo.gl/NQ3xZ #medicine MRSA (methicillin-resistant staphylococcus aureus) infections continue to be a growing public health issue, both hospital-acquired and community-acquired.  These guidelines come from the Infectious Diseases Society of America (IDSA).  The article is a 38 page document (pdf file, full reference below); the last 10 pages are supporting references. The major performance measures are: 1. The management of all MRSA infections should include identification, elimination and/or debridement of the primary source and other sites of infection when possible (eg, drainage of abscesses, removal of central venous catheters, and debridement of osteomyel... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4318365 Thu, 06 Jan 2011 12:14:00 +0100 4318365 http://www.medworm.com/index.php?rid=4298665&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FiXnZzb-4qy8%2Fsurgical-treatments-for-breast-cancer.html Upper extremity lymphedema for breast cancer survivors can be a major source of morbidity. Historically, the reported incidence in breast cancer survivors after axillary lymph node dissection has ranged from 9 to 41%. Even with sentinel node biopsy, the reported incidence of upper limb lymphedema remains at 4 to 10%. Lymphedema after surgery may occur immediately but most often appears after a latent period of weeks or months. Common lymphedema symptoms are increased volume and weight of the limb and increased skin tension. Conservative therapy (complex decongestive treatment) should be the initial treatment when lymphedema is suspected or present. This includes skin care, compression garments, exercise therapy, and manual lymph drainage. An article in the December issue of the Plastic a... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4298665 Wed, 29 Dec 2010 12:16:00 +0100 4298665 http://www.medworm.com/index.php?rid=4265829&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fa1A_feWYn2A%2Fbreast-augmentation-geographical.html This article (full reference below, free access) came to my attention via MDLinx.  It was interesting to read.  The conclusion verified my expectations rather than surprised me. The authors conducted a retrospective review of patient demographics and implant information from three university settings:  Kelowna (British Columbia, Canada), Loma Linda (California, USA), and Temple (Texas, USA).  Each cohort included 100 consecutive breast augmentation cases. Characteristic analyzed included age, height, weight, BME, parity, and average implant volume.  When considering the 300 as one cohort, the average age was 34 years with a height of 163 cm (5’4”), weight of 58.1 (127.8 lb) and parity of 1.7 .  The average implant size was 370 ml. When considered separate... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4265829 Wed, 15 Dec 2010 12:17:00 +0100 4265829 http://www.medworm.com/index.php?rid=4253191&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FygT5ieihk4Q%2Fdrug-abuse-in-plastic-surgery-patients.html This article seeks to impart clinical savvy regarding verbal and non-verbal cues of the seven most commonly abused drugs by detailing their pharmacology, clinical manifestations, screening and management, thus enabling plastic surgeons to provide prompt and appropriate treatment when encountering complications related to these drugs. I would recommend this article be read by more than just plastic surgeons.  It will either educate you or simply be a good review.  I’m not as good at picking drug abuse up as say Gruntdoc or Movin Meat or White Coat, so I found it worth my time. To begin: The typical urine drug screen (UDS) is based upon federal guidelines established by the Substance Abuse and Mental health Services Administration, or SAMHSA. This drug screen is referred to ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4253191 Mon, 13 Dec 2010 12:17:00 +0100 4253191 http://www.medworm.com/index.php?rid=4241752&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FNVOoknPDUQQ%2Fgynecomastia-is-pathologic-examination.html Most medical centers routinely perform or require that breast tissue be sent to pathology for histologic examination.  The authors of the article (referenced below) question whether this is useful when the breast tissue excised comes from an adolescent male with gynecomastia considering the benign nature of the condition. Furthermore, the authors point out male breast cancer is rare and when it does occur it is most often in older males, not adolescent males. In 2009, there were an estimated 1,910 new cases and 440 deaths related to male breast cancer, accounting for just 0.25% and 0.15% of all new cases of cancer and cancer deaths for males in the entire United States, respectively, with historical cohorts demonstrating that the peak incidence of male breast cancer occurs at approx... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4241752 Wed, 08 Dec 2010 12:14:01 +0100 4241752 http://www.medworm.com/index.php?rid=4238070&cid=t_106950_133_f&fid=35124&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Faspergerwoman%2F%7E3%2FuolZ97tU-14%2Fhttpwwwtheatlanticcommagazinearchive201.html Someone has sent me the link to this article, it's about the first person ever to be diagnosed with autism. See the blogpost on top of this page! Very very interesting. Thanks for sharing this article! You know who you are ;-) (Source: The Art of Being Asperger Woman) The Art of Being Asperger Woman blogs http://www.medworm.com/rss/comments.php?id=4238070 Tue, 07 Dec 2010 10:03:00 +0100 4238070 http://www.medworm.com/index.php?rid=4233219&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FOSMoEUN-H14%2Fdorsal-hand-coverage-refinements.html We present our hand in greeting for a hand shake. Our hands are visible when keyboarding or talking on the phone. We hold hands with our loved ones. We want our hands to both work/function and be aesthetically pleasing. Function must come first with a severe injury, but the authors of the first article referenced below correctly note “with high success rates, flap survival should no longer be the sole criterion in judging success in dorsal hand and wrist reconstruction.” In an attempt to determine the best flap for dorsal hand coverage in terms of aesthetic appearance, donor-site morbidity, and minimization of revision surgery, the authors conducted a retrospective review of all free flaps for dorsal hand and wrist coverage from 2002 to 2008 was performed. Flaps were divided into four... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4233219 Mon, 06 Dec 2010 12:16:00 +0100 4233219 http://www.medworm.com/index.php?rid=4207323&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FxncQr-EVPqU%2Fsuture-material-and-skin-irritation.html I have written about Suture Allergy vs Suture Reactivity so was very interested in this new article accepted for publication in the journal of Plastic and Reconstructive Surgery (online ahead of publication).  The article comes from researchers in Greece who chose to use digital image analysis to evaluate the erythema  associated with tissue reaction to suture material.  The sutures evaluated were polydioxanone (PDS II(R), Ethicon, Sint-Stevens-Woluwe, Belgium), polypropylene blue (Polypropylene(R), Assut Sutures, Ascheberg-Herbern, Germany), polyamide 6 (Ethilon(R), Ethicon, Neuchatel, Switzerland), metallic clips (APPOSETM, ULC Tyco, Hampshire, UK), and polyglactin (Vicryl Rapid(R), Ethicon, Norderstedt, Germany). Digital photos of 100 patients(70 females, 30 males; all... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4207323 Mon, 29 Nov 2010 12:15:00 +0100 4207323 http://www.medworm.com/index.php?rid=4197121&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fgl8QOo-bTL8%2Fl-brachioplasty-article-review.html With the increase number of patients receiving weight-loss surgery, there is has been an increase in those asking for procedures to remove the remaining excess skin such as panniculectomy, abdominoplasty, lower body lift, brachioplasty (arm lifts), and thigh lifts. The scars involved in brachioplasty surgery are not a good trade-off if there is minimal skin excess or looseness.  These individuals are better served by upper arm exercises to increase the muscle mass. Brachioplasty (arm lift) is defined as the removal of excess skin and subcutaneous tissue to reshape the upper arm (axilla to elbow). (photo credit) The L-brachioplasty described in the Hurwitz article from the July/August 2010 issue of the Aesthetic Surgery Journal addresses significant excess upper arm skin and the exce... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4197121 Wed, 24 Nov 2010 12:14:00 +0100 4197121 http://www.medworm.com/index.php?rid=4525092&cid=t_106950_129_f&fid=27216&url=http%3A%2F%2Flifewithadhd.com%2Fadhd%2Fthree-highly-rated-positive-parenting-tips-which-are-guaranteed-to-make-your-life-easy.php Are you currently struggling to balance your family obligations along with all of your other obligations? If this leads you to possess behavior difficulties with your children, the next 3 positive parenting tips ought to significantly aid your circumstances. Simply, a couple of fast ideas before we get started. We realize that being a parent could be the most difficult position on the planet. That is certainly not in question. These, or just about any ideas or support you get from this guide or it’s sources, have this specific issue in mind![I:http://lifewithadhd.com/wp-content/uploads/2010/11/PaulDonahue8.jpg] The very first positive parenting tip to hold in mind is in the case when a kid does not conduct himself or herself in a manner that you approve of, you must question your sel... Life With ADHD blogs http://www.medworm.com/rss/comments.php?id=4525092 Fri, 12 Nov 2010 00:00:00 +0100 4525092 http://www.medworm.com/index.php?rid=4151851&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FCORY66xs_5U%2Flongevity-of-smas-face-lift.html Discussion: Longevity of SMAS Facial Rejuvenation and Support; Lambros, V.; Stuzin, J. M.; Plastic & Reconstructive Surgery. 126(1):238-239, July 2010; doi: 10.1097/PRS.0b013e3181dab6f3 The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Friel, M.T.; Shaw, R. E.; Trovato, M. J.; Owsley, J. Q.; Plastic & Reconstructive Surgery. 126(1):245-257, July 2010; doi: 10.1097/PRS.0b013e3181dbc2f0 Discussion: The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Pusic, A.L.; Klassen, A. F.; Scott, A. M.; Cano, Stefan J.; Plastic & Reconstructive Surgery. 126(1):258-260, July 2010; doi: 10.1097/PRS.0b013e3181dbba19 (So... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4151851 Wed, 10 Nov 2010 11:10:00 +0100 4151851 http://www.medworm.com/index.php?rid=4142785&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FVEd4PPsksjU%2Fstem-cells.html The October issue of the Plastic and Reconstructive Surgery Journal has a nice review article of stem cells (bold emphasis is mine).  The article gives an overview of current advancements in the field of stem cell research, as well as perspectives for future clinical applications. Stem cells are defined by their capacity to both self-renew and differentiate into multiple cell lines. Traditionally, they have been divided into two main groups based on their potential to differentiate. Pluripotent stem cells (embryonic) can differentiate into every cell of the body, whereas multipotent stem cells (adult) can differentiate into multiple, but not all, cell lineages. In addition to the traditional stem cell classification, a new class of stem cells has recently been described—induced ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4142785 Mon, 08 Nov 2010 11:14:00 +0100 4142785 http://www.medworm.com/index.php?rid=4105738&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F17jhYgvC3tw%2Fteam-work.html There’s an article in the Oct 20, 2010 issue of the Journal of the American Medical Association (JAMA) which discusses surgical team training and team work in the operating room. Most surgeons have crews or individuals in the operating rooms they prefer to work along side.  Things just go smoother.  We work more as a team, more as one. Why?  Personalities.  Communication styles that work well together.  Skills that compliment.  Each person knows and does their job, not trying to do someone else’s.  Each knowing that even the smallest task is important to the whole. Ideally, we could create teams like this at all times in the operating room.  In reality, its not so easy.  Change in personnel happens.  Team members get sick, so there is g... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4105738 Mon, 25 Oct 2010 11:13:00 +0100 4105738 http://www.medworm.com/index.php?rid=4065405&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FCADL_03SVqA%2Fforeign-bodies-in-skin.html I recently read a nice review article on the topic:  Diagnosis and Management of Foreign Bodies in the Skin.   Most humans at one time or another will have an experience with a foreign body – splinters, thorns, broken glass, etc. Physicians see the worst ones.  The ones that aren’t easily removed or only partially removed. The history of the injury is always the starting place.   It is important to know when (recent, days or weeks ago), where (home, farmyard, ocean, etc), how (sharp object, fist to mouth, blunt object), and if known the possible foreign body (splinter, fish spine, teeth, glass). Remember fragments of the foreign body can be left in the wound even if you or the patient think it was removed.  Check to make sure the “needle” is compl... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4065405 Thu, 14 Oct 2010 11:13:00 +0100 4065405 http://www.medworm.com/index.php?rid=4036705&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FMWJ2DuHQqvs%2Fliposuction-overview.html I use the form of liposuction commonly called traditional though it is more accurately called superwet suction-assisted liposuction (SAL).   Why don’t I use ultrasound or laser assisted?  Cost mainly.  I find it difficult to purchase all the latest and greatest equipment.  I find it difficult to ask the hospitals/surgery centers I work at to do the same when I’m not sure I can guarantee them patients numbers needed to recoup the costs. Superwet SAL has worked well for me and my patients.  I have found that the greatest improvements to liposuction since it’s introduction by Illouz in the 1980s have been the addition of the wetting technique and the improvement in cannula size (specifically much smaller ones available than the early years). I have been tra... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4036705 Wed, 06 Oct 2010 11:15:00 +0100 4036705 http://www.medworm.com/index.php?rid=4018206&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FGO5Y5iHWu58%2Fpostoperative-management-of-cmc-joint.html I haven’t seen or treated any wrist dislocation injuries since my hand surgery fellowship, but still read an article regarding their treatment every now and then. I stumbled across this one (full reference below) via MDLinx. The full article is available for free online. The authors of the article note in their literature search that most multiple carpometacarpal (wrist) fracture/dislocation injuries are due to motor vehicle accidents. They were unable to find any large studies of multiple CMC dislocations. One of the “largest” had only 10 patients. Multiple CMC dislocations are uncommon and occur from high-energy trauma. Treatment of these injuries require operative fixation. The reduced fractures/dislocations are stabilized using K-wires which remain in place for 6-8 weeks. Prolon... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4018206 Thu, 30 Sep 2010 11:15:00 +0100 4018206 http://www.medworm.com/index.php?rid=4013241&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FTdGM33xbHSI%2Fcomparison-of-repair-incisions-for.html Discussion: Comparison of Three Incisions to Repair Complete Unilateral Cleft Lip; Wolfe, S. Anthony; Plastic & Reconstructive Surgery. 125(4):1217-1219, April 2010; doi: 10.1097/PRS.0b013e3181d45017 Unilateral Cleft Lip Repair; eMedicine article, June 19, 2009; Pravin K Patel, MD, Raja Ramaswamy, MS,  Mitchell F Grasseschi, MD, David E Morris, MD (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=4013241 Wed, 29 Sep 2010 11:14:00 +0100 4013241 http://www.medworm.com/index.php?rid=4013103&cid=t_106950_86_f&fid=38272&url=http%3A%2F%2Flaikaspoetnik.wordpress.com%2F2010%2F09%2F29%2Fa-filter-for-finding-all-studies-on-animal-experimentation-in-pubmed%2F For  an introduction to search filters you can first read this post. Most people searching PubMed try to get rid of publications about animals. But basic scientists and lab animal technicians just want to find those animal studies. PubMed has built-in filters for that: the limits. There is a limit  for “humans” and a limit for “animals”. [...] (Source: Laika's MedLibLog) Laika's MedLibLog blogs http://www.medworm.com/rss/comments.php?id=4013103 Tue, 28 Sep 2010 22:38:42 +0100 4013103 http://www.medworm.com/index.php?rid=4003293&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F09%2F27%2F10-challenges-for-parents-with-chronic-illness%2F In the Parents Magazine article, “Mommy Isn’t Feeling Well Today,” Sarah Mahoney interviews many experts: professionals, parents who have chronic illness and sometimes, as in my case, people who are both. I was honored to be among them. The article is impressive in how it covers many of the challenges parents face every day rearing their children while their health is seriously compromised. Below, I summarize the article’s most salient points and add my comments: 1. “Handling chronic illness is about learning to live in balance,” said Rosalind Doran, Psy.D. Many of us learn the hard way that if we don’t pay attention to what and how much we do in all spheres of our lives we can quickly over-do. The result is the same as when the tires on our car a... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4003293 Mon, 27 Sep 2010 14:50:47 +0100 4003293 http://www.medworm.com/index.php?rid=3993986&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F73nJiEZ2a1M%2Fcost-of-hand-transplantation.html Discussion: An Economic Analysis of Hand Transplantation in the United States; Concannon, Matthew J.; Plastic & Reconstructive Surgery. 125(2):599-600, February 2010.; doi: 10.1097/PRS.0b013e3181c831e5 Hand transplantation not cost-effective; AAOS Now, January 2010 Issue; Peter Pollack Hand Transplantation; Brown University Biomed Course Info (2001); accessed September 15, 2010 (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3993986 Wed, 22 Sep 2010 11:14:00 +0100 3993986 http://www.medworm.com/index.php?rid=3972937&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FAjKF4s-9uyw%2Ftreatment-of-common-congenital-hand.html This article and the companion videos are worth your time.     REFERENCES Treatment of Common Congenital Hand Conditions; Oda, Takashi; Pushman, Allison G.; Chung, Kevin C.; Plastic & Reconstructive Surgery. 126(3):121e-133e, September 2010. Treatment of Common Congenital Hand Conditions - Video 1 - Syndactyly release with proximal-based dorsal rectangular flap Treatment of Common Congenital Hand Conditions Video 2 - Ablation of the radial thumb and ligament reconstruction Treatment of Common Congenital Hand Conditions - Video 3 - Pollicization of the index finger (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3972937 Wed, 15 Sep 2010 11:15:00 +0100 3972937 http://www.medworm.com/index.php?rid=3965474&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FDfsQzRaiJUQ%2Flocal-wound-care-for-malignant-and.html Wounds in palliative care patients may be related to their underlying malignancy or to skin breakdown (poor nutrition, advanced age, poor perfusion, etc).  Wounds and associated skin changes that develop in palliative patients are generally considered as nonhealable.  Therefore, the goal is refocused in an attempt to reduce emotional distress to patients and their families as well as reduction of  local physical wound issues.  The article defines these issues using the mnemonic HOPES:    Hemorrhage, Odor, Pain, Exudate, and Superficial infection. The article reminds us that malignant wounds (due to cutaneous mets) have been estimated to affect 5% to 19% of patients with metastatic disease.  The chest, breasts, and the head and neck, followed by the ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3965474 Mon, 13 Sep 2010 11:12:00 +0100 3965474 http://www.medworm.com/index.php?rid=3946526&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FoNcEKo-XpLw%2Fscar-scales-and-measuring-devices.html In clinical practice, scars are most often evaluated simply by the patient and surgeon’s subjective assessments of color (redness, traumatic tattooing, faded since last assessment, etc) and physical qualities (adherent, depressed, flat, raised, texture, etc).   The patient may comment that the scar is painful or itchy.  Some objective measurements such as length and width can easily be made and compared over time.  Thickness is a bit trickier to easily measure without specialized tools. I recently stumbled over a review article of the scales and measuring devices used for scar assessment on Medscape (full reference below).  Most, I admit, I have never seen or used as I am not an academic plastic surgeon.  The article is a nice review.  While it may hel... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3946526 Wed, 08 Sep 2010 11:14:00 +0100 3946526 http://www.medworm.com/index.php?rid=3938369&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F9M-vzOfctqk%2Ftopical-silicone-gel-for-burn-scars.html I have read the studies the promote the use of silicone sheets for scar treatment.  I know the claims Mederma and other silicone gel scar treatments make.  What do I tell my patients?  “It doesn’t matter what you use.  It matters that you use it.  Mederma is non-scented and less greasy than Vit E or cocoa butter.  If that will entice you into doing your dailyscar massage, then use it.” For most scars, I will stand by the above.  Burn scar are characterized by an increasing occurrence of redness, thickness, stiffness, pain, and itching, and a disturbance in pigmentation and surface roughness.   So when I saw there was a new study looking at the use of silicone gel in the treatment of burn scars, I read it (full reference below). Burn scars... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3938369 Mon, 06 Sep 2010 11:20:00 +0100 3938369 http://www.medworm.com/index.php?rid=3924930&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FK0X-mHTco20%2Finfected-or-exposed-breast-prosthesis.html Discussion: Management of the Infected or Exposed Breast Prosthesis: A Single Surgeon's 15-Year Experience with 69 Patients; Hammond, Dennis C.; Plast Reconstr Surg.125(4):1085-1086, April 2010; doi: 10.1097/PRS.0b013e3181d18289 The infected or exposed breast implant: Management and treatment strategies; Spear SL, Howard MA, Boehmler JH, Ducic I, Low M, Abbruzzesse MR.;  Plast Reconstr Surg. 2004;113:1634–1644. (Source: Suture for a Living) Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3924930 Wed, 01 Sep 2010 11:18:00 +0100 3924930 http://www.medworm.com/index.php?rid=3885379&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FV3IymbFlsRQ%2Fprimary-breast-abscess-risk-factors.html A recent article in the July issue of the Journal of the American College of Surgeons (full reference below) looked at the risk factors for developing a breast abscess. It is a case control study of 68 patients with a primary breast abscess. Several (36/68) developed a recurrence as defined by the need for repeated drainage within 6 months. They found Univariate analysis indicated that smoking (odds ratio [OR] 8.0 [95% CI 3.4 to 19.4]), obesity (OR 3.6 [95% CI 1.5 to 9.2]), diabetes mellitus (OR 5.7 [95% CI 1.1 to 54.9]), and nipple piercing (OR 10.2 [95% CI 1.3 to 454.4]) were significant risk factors for development of primary breast abscess. Recurrent breast abscess occurred in 36 (53%) patients. Multivariate logistic regression identified significant OR for an increase in recurre... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3885379 Thu, 19 Aug 2010 11:15:00 +0100 3885379 http://www.medworm.com/index.php?rid=3868773&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FImQW612Rv_g%2Flimberg-flap-in-treatment-of-pilonidal.html MDLinx has once again pointed me to an article I might never have seen.  This one is in the journal Surgery Today and deals with the treatment of pilonidal sinus disease using one of two type of Limberg flap:  the classic and the modified. Pilonidal sinus disease (PSD) occurs in the cleavage between the buttocks.  The diagnosis of a pilonidal sinus is made by identifying the epithelialized follicle opening (the sinus). The name pilonidal taken from the Latin, meaning literally 'nest of hairs'. The onset of PNS is rare both before puberty and after the age of 40. Males are affected more frequently than females. It is also common in obese people and those with thick, stiff body hair. The article does a good review of the management of PSD which remains controversial. There is ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3868773 Mon, 16 Aug 2010 11:12:00 +0100 3868773 http://www.medworm.com/index.php?rid=3858196&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fv4OeCzsX_Nk%2Fapproaches-for-managing-bias.html This article was written more for Family Medicine physicians, but all of us can benefit from self-assessment of potential biases that might affect our judgment. It was also written with the potential bias towards the obese patient in mind, but the article could have been written with any“fill in the blank” bias as the topic. The article points out that bias among physicians tends to “be implicit rather than explicit because of social pressure for healthcare providers to show tolerance and cultural sensitivity.” So how do we guard against implicit bias? Some evidence suggests that motivated individuals who are made aware of their personal implicit biases can mentally alter them. One way of developing such awareness is to take the Implicit Association Test , a brief, online, in... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3858196 Wed, 11 Aug 2010 11:05:00 +0100 3858196 http://www.medworm.com/index.php?rid=3822954&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Frmh_rXaUjd4%2Fcultural-practices-affecting-skin.html I learned of this article (full reference below) via a tweet from @MDLinx last week Cultural practices affecting the skin of children: Current Opinion in Pediatrics http://bit.ly/dbKdNJ #GM #mdlinx Thanks to friends I was able to obtain a pdf copy of the article which I would recommend to anyone who see children (pediatricians, family doctors, ER doctors, dermatologists, plastic surgeons, nurses, etc).  The article reviews cultural practices that present with dermatologic manifestations in the pediatric population.  Most of us have had minimal exposure to these cultural practices.  This can lead to misunderstandings, misdiagnosis, and (unfounded) child abuse accusations.  The article points out that the 2000 Census counted approximately 28 million first-generation ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3822954 Wed, 04 Aug 2010 11:01:00 +0100 3822954 http://www.medworm.com/index.php?rid=3798598&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FIez--F56cF0%2Fhidradenitis-suppurativa.html The July issue of the journal Advances in Skin & Wound Care has a CME review article on the chronic, relapsing skin condition known as hidradenitis suppurativa (HS).  I have given the full article reference below. When I see patients with this condition, it is because they have already progressed past the first clinical stage into either the second or third stage.  It is due to their family doctor or internist deciding perhaps they are in need of surgery. HS is not a skin condition anyone wants to have.  Robin in her 365 Project:  365 Days with Cushing’s Disease has discussed living with the condition: Hidradenitis suppurativa.... I'm lucky.  Mine is "mild" compared to most.  Nonetheless, it's no fun.  In 1985, I saw a doctor becaus... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3798598 Wed, 28 Jul 2010 11:16:00 +0100 3798598 http://www.medworm.com/index.php?rid=3790749&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F07%2F26%2F20-years-of-the-americans-with-disabilities-act%2F Twenty years ago, George W. Bush signed into law the Americans with Disabilities Act (ADA), a broad civil rights law that forbids discrimination based on any kind of disability — physical or mental. It gives similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964. Some see it as a broad government boondoggle, but it’s the law that makes a simple thing like a curb cut a federal mandate because local governments just didn’t care about the people within their communities who live with a physical or mental disability. Navigating a crosswalk seems like such a simple thing for most of us. But try it in a wheelchair when the curbs don’t have ramps and suddenly it becomes an opportunity to be hit by a car. More importantly, ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3790749 Tue, 27 Jul 2010 01:35:39 +0100 3790749 http://www.medworm.com/index.php?rid=3780394&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FFbe1k8ipKLQ%2Frecent-breast-cancer-news-articles.html Interesting news recently related to breast cancer.  Original journal articles are listed in the references below. First topic -- 'Cancer risk' for house-proud women – Associated Press Houseproud women who like to keep their homes clean and fragrant may be at greater risk of breast cancer, research has suggested. Household cleaners may double risk of breast cancer – Telegraph.co.uk Women who regularly use household cleaners and air fresheners are at double the risk of developing breast cancer than those who never use the products.   If you take the time to look at the study done by Dr Julia Brody, from the Silent Spring Institute, and colleagues which was published in the July issue of the Journal of Environmental Health you do find it suggests there is a link. However... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3780394 Thu, 22 Jul 2010 11:16:00 +0100 3780394 http://www.medworm.com/index.php?rid=3757902&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FXrmda-RsLFI%2Fasian-dermatologic-patient-article.html I ran across this article on Medscape (full reference below):  The Asian Dermatologic Patient: Review of Common Pigmentary Disorders and Cutaneous Diseases.  It is originally from the American Journal of Clinical Dermatology. The vast majority of my patients are Caucasian and African American, but over the years there has been an increase in Asian and Latino.  So when I see an article like this, I read it, even though it is not in depth as it adds to my knowledge. The Asian patient ….., photodamage in the form of pigmentary disorders is common. Melasma, freckles, and lentigines are the epidermal disorders commonly seen, whilst nevus of Ota and acquired bilateral nevus of Ota-like macules are common dermal pigmentary disorders. Post-inflammatory hyperpigmentation (PIH) oc... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3757902 Thu, 15 Jul 2010 11:15:01 +0100 3757902 http://www.medworm.com/index.php?rid=3753861&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F12g0gkFQEpQ%2Fusing-botox-in-combination-with-other.html Recently I read and completed a nice CME article on Medscape (first reference below).  It focused on the consensus panel’s (second reference, from first article and not read by me) recommendations.  As Botox and Dysport are used more often, it is becoming more common for them to be used in combination with other treatments (ie Laser resurfacing, fillers, and surgery).  It was nice to see a consensus regarding how to approach multimodal treatment with BoNTA.  Treatment Recommendations Botox+ Injectable fillers BoNTA and injectable fillers can be administered the same day or separate days. However, it may be preferable to inject the first agent, wait until effects are clinically evident, and then follow up with second agent as needed. Upper face: Typical to inject... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3753861 Wed, 14 Jul 2010 11:11:00 +0100 3753861 http://www.medworm.com/index.php?rid=3733112&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FiZvQT5uMB30%2Fadherence-to-surgical-care-improvement.html An article in the June 23/30 issue of JAMA features an analysis of the reported adherence to Surgical Care Improvement Project measures (SCIPs) and the reduction of postoperative infections. There are 9 publicly reported SCIP measures, 6 of which focus on postoperative infection prevention. INF-1: patients who received prophylactic antibiotics within 1 hour prior to surgical incision (2 hours if receiving vancomycin). INF-2: patients who received prophylactic antibiotics recommended for their specific surgical procedure. INF-3: patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time (48 hours for coronary artery bypass graft surgery or other cardiac surgery). INF-4: cardiac surgery patients with controlled 6 AM postoperative blood... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3733112 Wed, 07 Jul 2010 11:31:00 +0100 3733112 http://www.medworm.com/index.php?rid=3718440&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FNfO4FsNlnkc%2Fblepharoplasty-complications-article.html There is a really nice article in the March 2010 issue of the Journal of Plastic and Reconstructive Surgery which reviews complications of blepharoplasty surgery (full reference below). It is an article worthy of your time if you perform this surgery. The article divides the complication into time periods which they occur: early (first week), intermediate (1-6 weeks), and late (after 6 weeks). Here is a list of the complications listed and discussed. The information included in my post does not cover all that is covered in the journal article as it is not meant to take the place of the article. Early Postoperative Period (first week) Vision Loss The most feared complication of blepharoplasty is permanent visual loss. The most common cause is retrobulbar hemorrhage, although other causes... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3718440 Thu, 01 Jul 2010 11:01:00 +0100 3718440 http://www.medworm.com/index.php?rid=3706713&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F294XYX2fwoA%2Fpre-hospital-surgical-prep.html The June 2010 issue of the Surgical Products magazine has an article by Amanda McGowan focusing on the prep in preventing surgical site infections – Preventing SSI: It Starts in the Prep.   What really caught my attention was the pre-hospital prep described for one hospital.  Currently, (as most of my patients exhibit good hygiene) I haven’t begun anything more than taking a shower (with basic soap), washing their hair, and brushing their teeth pre-op.  My SSI rate is less than 0.5% over 20 years.  The bold is my emphasis. As Beth Beck, director of infection prevention and control/employee health at Springhill Medical Center in Mobile, AL, explains, her facility follows specific steps in the prep process to help reduce infection risk. “We ask the surgeons to ha... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3706713 Mon, 28 Jun 2010 11:01:00 +0100 3706713 http://www.medworm.com/index.php?rid=3679796&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F06%2F20%2Fin-celebration-of-fathers-2010%2F Happy Father’s Day! Dads sometimes get a bum rap as simple bread winners who occasionally are called upon to wield a hammer to hang a picture. They play ball (or, more likely, video games) with the kids, and leave the heavy lifting of child rearing and such to the moms. But fathers are, of course, so much more. They teach us about the wisdom of consideration, courage and honor. They know it is better to command respect than fear, to cultivate friendships rather than enemies, and to find something you love to do, and then build your career around it. Perhaps they aren’t always as “involved” in things as moms seem to be, but they so often seem to provide the rock of stability in a family that is often under-appreciated. Dads are increasingly feeling just as stressed ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3679796 Sun, 20 Jun 2010 11:52:17 +0100 3679796 http://www.medworm.com/index.php?rid=3656839&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F06%2F13%2Four-brains-on-technology%2F Is technology taking over our lives? Or do some people just make choices with regard to choosing technology over interacting with their family and friends? I don’t believe that “technology” can take over our lives — unless we choose to let it. So it was with interest that I saw a lengthy article written over at the New York Times, “Hooked on Gadgets, and Paying a Mental Price.” I was going to comment earlier on the article, thinking it was going to be this thoughtful, in-depth look at how technology is impacting people’s lives for both the positive and negative. Instead, it appeared to be some sort of story revolving around a guy called Kord Campbell and his family. Kord apparently has a hard time prioritizing things in his life — to the poin... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3656839 Sun, 13 Jun 2010 10:21:44 +0100 3656839 http://www.medworm.com/index.php?rid=3648568&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FR7njCO0GXSo%2Fmelanoma-of-nail-matrix.html Two recent articles in the Archives of Dermatology serve as a reminder that melanoma may occur under the finger nail in the nail matrix. The first one (full references for both below) used slides and prepared information from 12 cases to “test” dermatologist. Here is one of the examples given in the paper: Nevus. A, Clinical features; B, nail plate dermoscopy; C, intraoperative dermoscopy. ABCDEF rule information: A (age, 35 years), C (change in band at 2 years; it became enlarged or darker), D (digit, third finger, right hand), and F (no family or personal history of melanoma) Only 46-55% made the correct diagnosis of nail matrix melanoma in situ in this study. The level of expertise did not statistically influence the correct diagnosis. Early diagnosis of melanoma of the nail u... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3648568 Thu, 10 Jun 2010 11:01:00 +0100 3648568 http://www.medworm.com/index.php?rid=3633618&cid=t_106950_147_f&fid=39202&url=http%3A%2F%2Fnicolaziady.wordpress.com%2F2010%2F06%2F05%2Fhow-a-good-title-description-can-make-or-break-your-sem-submission%2F I read a great article on SEOmoz blog about an interesting case study regarding social media submissions. The article talks about an interesting subject topic. The piece was  not created for social sharing but the author saw the potential for great link bait. Read the full article “How a Good Title and Description Can Make or Break Your Social Media Submission” ::  http://bit.ly/dgS6B7 (Source: Nicola Ziady) Nicola Ziady blogs http://www.medworm.com/rss/comments.php?id=3633618 Sun, 06 Jun 2010 03:47:34 +0100 3633618 http://www.medworm.com/index.php?rid=3614646&cid=t_106950_132_f&fid=35006&url=http%3A%2F%2Fnsaunders.wordpress.com%2F2010%2F05%2F31%2Fdata-fail%2F Unique, yet identical to each other Filed under: humour, publications Tagged: article, fail, journals (Source: What You're Doing Is Rather Desperate) What You're Doing Is Rather Desperate blogs http://www.medworm.com/rss/comments.php?id=3614646 Mon, 31 May 2010 06:40:01 +0100 3614646 http://www.medworm.com/index.php?rid=3560282&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F05%2F13%2F10-ways-to-find-new-motivation%2F How often do you lament, “If only I were more motivated, I could get so much done and be successful”? For many of us, motivation seems hard to find. Whenever a tough project pops up or we have to do something we’ve been dreading — whether it’s stripping the wallpaper in the bedroom or collecting the year’s receipts at tax time — our motivation vanishes. Here’s an excerpt from my recent article on how to find it, keep it, and overcome the most common roadblocks along the way. 1. Assess your values. Consider whether the task at hand aligns with your values, Maynard said. To figure out your values, she suggested asking, “How do you want to see yourself in the world today?” Another way to think of this is to mull over what accomplishing the task would give you “tha... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3560282 Thu, 13 May 2010 10:05:36 +0100 3560282 http://www.medworm.com/index.php?rid=3482935&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F04%2F19%2Fpolice-training-helps-treatment-of-mentally-ill%2F This article talks about a situation that happened in Utah where a man who apparently had bipolar disorder was Tasered twice, and died: The findings could add clout to a claim made in a federal lawsuit filed this month by the family of Brian Cardall, who died in June after a Hurricane police officer twice deployed a Taser on Cardall as he suffered a bipolar episode on a southern Utah highway. Filed by Cardall’s widow, children and parents, the lawsuit alleges Hurricane police declined to send officers to the training for at least eight years, which they claim played a role in Cardall’s death. The lawsuit says Hurricane Police Chief Lynn Excell failed to adequately train his officers by not sending them to attend the mental health training, in which dozens of police agencies ac... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3482935 Mon, 19 Apr 2010 13:14:14 +0100 3482935 http://www.medworm.com/index.php?rid=3471817&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FvYYLI8TmECg%2Fcapsular-contracture.html In this study, no cases of Baker grade 3 or 4 capsular contractures were reported. Ventura and Marcello retrospectively analyzed 100 patients who had received primary breast enlargement with textured implants positioned in the subfascial compartment and found that only two patients (2 percent) experienced Baker grade 2 capsular contractures. Finally, in a retrospective multicenter study of more than 500 patients, Gutowski et al. found that the use of subglandular positioning of the prosthesis increased the risk of capsular contractures by almost eight times. It is a nice review of the literature which points out the short comings of our knowledge. Although it is apparent from the articles studied in this review that a great deal of progress has been made over the past few decades to... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3471817 Thu, 15 Apr 2010 11:01:00 +0100 3471817 http://www.medworm.com/index.php?rid=3448891&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F2rTmHoXFGM4%2Fevidence-or-lack-thereof-behind.html This article (first reference below) in the February issue of the Aesthetic Surgery Journal is a review of the evidence behind retinoids in cosmeceutical products.  It turns out there isn’t much. First, let’s begin with some definitions: Retinoids include Vitamin A and its derivatives which may be either natural or synthetic. Cosmeceutical products are formulations which are not classified as prescription medications.  Retinoids which are prescription medications include tretinoin, isotretinoin, alitretinoin, tazarotene, and adapalene.  Because they are classified as prescription medications, these do not qualify as cosmeceuticals. This is an important distinction as there is a large body of evidence to support tretinoin in the treatment of photoaging.  This articl... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3448891 Thu, 08 Apr 2010 11:01:00 +0100 3448891 http://www.medworm.com/index.php?rid=3424910&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F03%2F30%2Fbest-of-our-blogs-march-30-2010%2F There’s just a few days left in March and we’re heading straight for the spring season! Some of you may be busy preparing for Easter weekend while others are in the thick of spring break. Whatever you’re doing, we hope you’ll stop by and see what’s buzzing over at our blogs this week. I’ve scoured our blogs to find the best, most popular posts so that you can quickly click through and find your favorite ones. Happy Hunting! And make sure to come back later in the week for another round of, “Best of Our Blogs.” Music Education Helps Kids Brains With Sound Stimuli (Family Mental Health) – Music isn’t just all fun and games. Did you know it actually helps with communication skills? Hard to believe that all that noise in a music class... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3424910 Tue, 30 Mar 2010 18:06:42 +0100 3424910 http://www.medworm.com/index.php?rid=3390788&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FcPvC445lHD4%2Fwhen-and-how-to-perform-biopsy-on.html Super nice article on in the March 2010 issue of Advances in Skin & Wound Care (full reference below) on a very important topic. Most of us may know when a biopsy should be done of a chronic wound, but most of us are not trained in how to do one. Different areas of the chronic wound are best biopsied depending on the suspected diagnosis. The article clearly lists the indications and contraindications for a wound biopsy. This is probably the most important question for healthcare professionals dealing with wound care. Benefits of biopsy in a wound can be divided into 3 groups that reflect the 3 main causes of wounds in general: 1. to diagnose the etiology of a wound (wound edge), 2. to rule out malignancy (wound edge), and 3. to obtain tissue for bacterial quantitative culture or ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3390788 Mon, 22 Mar 2010 11:01:00 +0100 3390788 http://www.medworm.com/index.php?rid=3350428&cid=t_106950_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2F3693%2F A new independent, international dental journal, Dental Hypotheses, will soon hit the web and the press. Like many dentistry publications, this journal will provide peer-reviewed articles for the professional dental community. However, Editors-In-Chief Edward F. Rossomando (Director of the Biodontics® Program at the University of Connecticut School of Dental Medicine., United States) and Jafar Kolahi (Torabinejad Research Center, Isfahan University of Medical Sciences,Isfahan, Iran, Islamic Republic) and their editorial team seek submissions about controversial and out-of-the-ordinary issues. For example, nano-dentistry, biodontics, dental specialties, community dental health, and the economy of dentistry are ideal topics for submission. Dental Hypotheses is not supported by any instituti... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=3350428 Wed, 10 Mar 2010 14:17:16 +0100 3350428 http://www.medworm.com/index.php?rid=3350307&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FRxs1hCkTfUk%2Fpreventing-peripheral-neuropathy-in.html This article comes from my medical school (UAMS).  The full reference is given below.  This topic is important to me because it relates to nutritional status of these patients who may present to my office for excess skin excision procedures, etc. You may wish to read my related post from September 2008: Nutritional Deficiency of Post-Bariatric Surgery Body Contouring Patients: What Every Plastic Surgeon Should Know -- An Article Review   Here is part of the opinion statement from Dr. Rudnicki  published online: Given the ever-increasing problem of obesity, it is not surprising that the number of patients who undergo bariatric surgery continues to rise. …………. Ideally, one would like to prevent these neuropathies, but there is no consensus of opinion as to wha... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3350307 Wed, 10 Mar 2010 12:01:00 +0100 3350307 http://www.medworm.com/index.php?rid=3342677&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FcnkcbeI9OaQ%2Fpossible-implant-rupture-is-mri-useful.html This article (full reference below) reports a retrospective review study devised to “evaluate its utility in diagnosing ruptured silicone implants in the setting of capsular contracture and to correlate the preoperative assessment of implant integrity with or without magnetic resonance imaging with operative findings.” The study involved 171 patients with capsular contractures with a total of 319 capsulectomies.  Preoperative MRIs was done on 160 implants, whereas the remaining 159 were evaluated using only physical examination and/or mammography. The authors then analyzed postoperative results  to determine the sensitivity, specificity, and accuracy of preoperative MRI in comparison with clinical and/or mammography evaluation alone. They found that while the MRI was occasion... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3342677 Mon, 08 Mar 2010 12:01:00 +0100 3342677 http://www.medworm.com/index.php?rid=3326997&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fn4ykCg3Rzwo%2Flaser-treatments-of-tattoos-article.html This study’s conclusions might provide general guidance for optimizing lightening therapy.   The authors make it clear that this is an initial study which will require further exploration.  This said, their study suggest: The studies herein demonstrate that the selection of adequate laser variables guarantees the selective elimination of tattoo pigments in vivo, even using a density of energy significantly lower than those usually reported in the literature. We found that under the present conditions, fluences of 0.7 to 1.6 J/cm2 were effective in the removal of tattoos compared with fluences of 9.0 to 12.0 J/cm2 commonly reported in the literature. In addition, the tattoo removal process in the present case required shorter therapy sessions and spacing between sessions... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3326997 Wed, 03 Mar 2010 12:01:00 +0100 3326997 http://www.medworm.com/index.php?rid=3302352&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FENFuHRSVxrM%2Fcutaneous-metastatic-carcinoma-article.html Most of us will never see skin metastases from carcinoma in our clinical practices as they are relatively uncommon.  It is estimated that 2% to 9% of patients with internal malignancy may develop cutaneous metastasis.  Often these will herald the diagnosis of the internal malignancy.  The short article in the Advances in Skin & Wound Care Journal on this topic is a review (full reference below) of the topic.  It comes out of the University of Calabar Teaching Hospital, Calabar, Nigeria.  The authors had six patients with histological diagnosis of cutaneous metastatic carcinoma between 2000 to 2006.   These patients were part of a wider study of cutaneous malignancy. The variables analyzed were age, sex, site of cutaneous metastasis, clinical presenta... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3302352 Wed, 24 Feb 2010 12:01:00 +0100 3302352 http://www.medworm.com/index.php?rid=3294624&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FEGqa3w58KkU%2Fcare-of-pressure-ulcers-in-palliative.html I’d like to recommend this article (full reference below) to anyone involved in the care of palliative care patients, as well as anyone who does wound care.  It is a thoughtful and well written consensus paper from the National Pressure Ulcer Advisory Panel. The article begins by pointing out the difference in goals between palliative care patients and the usual patients with pressure ulcers (PrU). Usual care of a PrU is designed to promote healing; however, healing or closing the ulcer in patients receiving palliative care is often improbable. Therefore, the focus of care is better directed to reduce or eliminate pain, odor, and infection and allow for an environment that can promote ulcer closure, as well as improve self-image to help prevent social isolation.   There is a... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3294624 Mon, 22 Feb 2010 12:01:00 +0100 3294624 http://www.medworm.com/index.php?rid=3283561&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FrDFrXoP2PQg%2Fshortened-radiation-treatment-for.html An interesting article in the February 11 issue of of the New England Journal of Medicine (full reference below) looking at the effects of shorten regimens of radiation therapy in conjunction with breast conservation surgery in treatment of breast cancer. Conventional radiation therapy is a 5-week regimen.  It is estimated up to 30% of women who are recommended to receive radiation therapy as part of their treatment for breast cancer may avoid it due to inconvenience and cost. Researchers have begun to look at using shorter regimens, and are finding that the 10-year recurrence rates and cosmetic outcomes for breast cancer patients are similar. Dr. Tim Whelan, a professor of oncology of the Michael G. DeGroote School of Medicine at McMaster University, and colleagues compared an inten... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3283561 Thu, 18 Feb 2010 12:01:00 +0100 3283561 http://www.medworm.com/index.php?rid=3272927&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F1RuDCg-fUEE%2Fnew-treatment-for-crps.html In this study, the pain relief lasted on average five weeks. The editors of the Annuals make the point I want to stress: Because the study is so small, it is difficult to know whether these results apply to most other patients with CRPS. Also, the small number of patients increases the possibility that chance may affect the results. For now, the cornerstone in the treatment of RSD / CRPS remains normal use of the affected part as much as possible. This is done through education, pain control, and physical therapy. (photo credit) For more information check this eMedicine article and this website (RSD Foundation). You will also find a nice video animation on the RSD Foundation site that shows how an injury might trigger RSD / CRPS.       SOURCES: Intravenous Immunoglob... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3272927 Mon, 15 Feb 2010 12:01:00 +0100 3272927 http://www.medworm.com/index.php?rid=3243842&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F02%2F05%2Fnewsweek-do-antidepressants-work-for-many-people-yes%2F I admire Newsweek writer Sharon Begley’s work … especially when she explains ways we can try to rewire our brain. But I found last week’s cover story irresponsible. If, for no other reason, than its title and subtitle: “The Depressing News About Antidepressants: Studies Suggest That the Popular Drugs Are No More Effective Than a Placebo. In Fact, They May Be Worse.” Then I may as well kill myself. That’s how I would have read the article four years ago, before I started questioning all the information available today on mood disorders and drug treatment, before I started working with a physician from Johns Hopkins who could help me tease out the hope from articles like this, so I wasn’t tempted to take my life upon reading there was no way out of ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3243842 Fri, 05 Feb 2010 12:39:19 +0100 3243842 http://www.medworm.com/index.php?rid=3216616&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fp3umCMXW_3k%2Fget-up-and-move.html Last week, researchers  at the Swedish School of Sport and Health Sciences published an editorial online in the British Journal of Sports Medicine, warning us of the dangers of prolonged sitting. Dr. Elin Ekblom-Bak and colleagues note the benefits of regular physical activity for several major health diseases is clear and unanimous, but warn that recent studies suggest that prolonged bouts of sitting time and lack of whole-body muscular movement can undo some of the benefits even for someone who is considered “in shape.” The editorial mentions a study published last year that tracked more than 17,000 Canadians for about a dozen years. Peter Katzmarzyk  and colleagues found people who sat more had a higher death risk, independently of whether or not they exercised. Our bod... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3216616 Thu, 28 Jan 2010 12:01:00 +0100 3216616 http://www.medworm.com/index.php?rid=3212357&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FgF2zAXs4Xzo%2Fus-diagnosis-of-closed-tendon-injuries.html I found the article on using ultrasound to diagnosis closed flexor tendon injuries interesting.  I  still rely on history and physical exam to make the diagnosis, but can see how the use of ultrasound (US) could be useful particularly in children. The article is a retrospective audit of the accuracy of US in diagnosing closed flexor tendon ruptures and ruptures following recent flexor tendon repair in 80 patients between January 2001 and December 2006.  The accuracy of US was found to be higher than clinical examination alone (95% vs. 79%, Z = 2.00, p = 0.03). US findings were 100% accurate when imaging was undertaken between 1 and 7 days following injury, but only 88% accurate when undertaken on the same day as injury and 85.7% accurate when performed after 1 week (X 2 = 6... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3212357 Wed, 27 Jan 2010 12:01:00 +0100 3212357 http://www.medworm.com/index.php?rid=3201760&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F01%2F23%2Fchange-your-password%2F Humans are creatures of habit. We eat the same foods at the same times nearly every day. Cereal for breakfast, a sandwich for lunch, maybe we change it up for dinner. Look at us, we’re living on the edge! But because humans are so predictable, we’re also pretty lousy at protecting ourselves from the pitfalls of predictability. We tend to choose things like passwords based upon easily-memorized components — the word “password” or some combination of characters that a 4-year old would pick (abc or 123). So as a public service, I have to mention a study released last week of 32 million breached password accounts. You’d like to think that people aren’t really that obvious. And you’d be wrong. If your password is one of the below, please change it... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3201760 Sat, 23 Jan 2010 21:47:53 +0100 3201760 http://www.medworm.com/index.php?rid=3193753&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FKSiNN0fFZmw%2Fbreast-focused-microwave-thermotherapy.html I noticed this AP article, Microwave heat, chemotherapy combine to shrink breast cancer tumors, reduce mastectomies, in the health news earlier this week with this claim: A University of Oklahoma researcher has found that microwave heat treatment combined with chemotherapy actually kills large breast cancer tumors and could reduce the need for mastectomies by nearly 90 percent. I would love for this to turn out to be true, having begun medical school when Halsted mastectomies were still the standard of care.  Preoperative focused microwave thermotherapy (FMT) is the focus of multi-institutional clinical studies from OU, the Massachusetts Institute of Technology, the Los Angeles Biomedical Research Institute, the Comprehensive Breast Center of Florida and St. Joseph's Hospital in ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3193753 Thu, 21 Jan 2010 12:01:00 +0100 3193753 http://www.medworm.com/index.php?rid=3189177&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FhVIHBuMdKxw%2Fstandardized-care-protocol-for.html It has been a while since I’ve had a patient with postoperative alcohol withdrawal.  I can still recall my first exposure to this problem as a 3rd year medical student at the Veteran’s Hospital.  It was my first clinical rotation – surgery service at the VA. Browsing the CME articles on the JAMA website, I came across the article (full reference below):  Improved Outcomes in Patients With Head and Neck Cancer Using a Standardized Care Protocol for Postoperative Alcohol Withdrawal.  For me it was a nice review of the problem with updates on current drug use/protocol. Their protocol is based on three distinct clusters of symptoms characterize alcohol withdrawal syndrome (AWS). Type A symptoms represent central nervous system (CNS) excitation and include anxiety, dys... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3189177 Wed, 20 Jan 2010 12:01:00 +0100 3189177 http://www.medworm.com/index.php?rid=3182200&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F4Cm9ATEZq80%2Fhistologic-relationship-of-preauricular.html There is a nice article in the journal Archives of  Otolaryngology-- Head Neck Surgery (first reference below) which examines the relationship of preauricular sinuses to auricular cartilage.  (photo credit) Preauricular sinuses are a congenital malformation of the preauricular soft tissues.   They can be both sporadic and inherited. They are bilateral in approximately 25% to 50% of patients. When bilateral, the sinuses are more likely to be inherited in an autosomal dominant pattern with reduced penetrance and variable expression.  Although the true prevalence is not well established, preauricular sinuses are thought to occur most commonly in black populations. The incidence of preauricular sinuses has been estimated to be 0.1% to 0.9% in Europe and the United Sta... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3182200 Mon, 18 Jan 2010 12:01:00 +0100 3182200 http://www.medworm.com/index.php?rid=3146006&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fx-C70I3K2gQ%2Fneurotoxins-dysport-and-botox.html Medscape has a nice CME article on neurotoxins, Dysport® and Botox® Cosmetic. Dysport is abobotulinumtoxinA. Botox Cosmetic is onabotulinumtoxinA. Dr Monheit begins with the interesting history of botulinum toxin. 1895: Clostridium bacterium identified 1940s: BoNT-A purified (Schantz and colleagues) 1950s: BoNT-A mechanism of action elucidated 1970s: BoNT-A investigated as a treatment for strabismus (Dr. Alan B. Scott) 1979 Botulinum neurotoxin type A was approved by the FDA [US Food and Drug Administration] and became a registered mechanism for use in ophthalmology. It was called Oculinum at first. 1987: Dr. Jean Carruthers notices effect on the glabella when treating patients with BoNT-A for blepharospasm. 1989: Botox approved by FDA for the treatment fo strabismus and blepha... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3146006 Wed, 06 Jan 2010 12:01:00 +0100 3146006 http://www.medworm.com/index.php?rid=3139066&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FmjLF41sO5_w%2Fclinical-and-radiographic-poland.html The authors of the recent Aesthetic Surgery Journal article (full reference below) have proposed a new classification of Poland Syndrome based on both clinical and radiographic presentation (CRPS). Using their CRPS classification, they present an algorithm for planning surgical treatment. The article begins with a review of Poland Syndrome: Classically, it consists of a combination of unilateral aplasia of the sternocostal portion of the pectoralis major muscle (PMM) and hypoplasia of the ipsilateral hand, with syndactyly and synbrachydactyly. The reported incidence of Poland Syndrome (PS) is one in 30,000 live births. Male-to-female ratio is 3:1. The right side is affected twice as often as the left. The etiology of PS is still unknown, but recently a vascular hypothesis suggests hypo... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3139066 Mon, 04 Jan 2010 12:01:00 +0100 3139066 http://www.medworm.com/index.php?rid=3129521&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FFABRPOVI97Q%2Fappearance-is-function-of-face.html I noticed this article title on MDLinx, then went to the Journal of Plastic and Reconstruction website to read the full article.  The abstract is free to read, the full article requires a subscription. The study was prompted by the authors noticing third party insurers increasingly deny coverage to patients with post traumatic and congenital facial deformities.  This denial is often cited as due to the deformities not being seen as "functional" problems.  The authors cite the recent facial transplants patients as having demonstrated  that the severely deformed are willing to undergo potentially life-threatening surgery and extended chemotherapy in an attempt in look normal. The authors also noted that very little research exists which objectively documents app... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3129521 Wed, 30 Dec 2009 12:01:00 +0100 3129521 http://www.medworm.com/index.php?rid=3118900&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F6Jm-85Jx-mQ%2Fhand-rejuvenation.html I took this photo when my mom was in the hospital earlier this year. My hand looks like I wash dishes for a living. Her hand shows many of the spots that come with age and sun exposure: actinic keratosis, liver spots, etc. There is a decent article that gives an overview of hand rejuvenation in the Sept/October issue of the Aesthetic Surgery Journal. The epidermis thins as we age. Lentigines, actinic keratoses and seborrheic keratoses, general dyschromia, and textural roughness appear. Capillary fragility may make bruising common. Fat atrophy may make tendons and bony prominences more noticeable and the veins appear to bulge. The article goes through the available treatments: chemical peels, vein sclerotherapy, fillers, laser therapy, intense pulsed light (IPL) therapy, fractional skin ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3118900 Thu, 24 Dec 2009 12:01:00 +0100 3118900 http://www.medworm.com/index.php?rid=3115111&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FWNP33xL8fSk%2Fwhen-does-death-start.html H/T to @ctsinclair and @doclake  for the link to this December 16th NY Times article.  If you haven’t read it, it is worth the time, especially if you have any interest in this topic. When does death start? from NYT http://bit.ly/8xGXjL The article, "When does death start?",  was written by Darshak Sanghavi, the chief of pediatric cardiology at the University of Massachusetts Medical School, is Slate’s health care columnist and the author of “A Map of the Child: A Pediatrician’s Tour of the Body.” The article uses the story of Amanda to discuss “brain death” and “death after cardiac arrest”  in conjunction with organ procurement.   No organs can be procured until a person has been declared dead (the so-called dead-donor rule).&#1... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3115111 Wed, 23 Dec 2009 12:01:00 +0100 3115111 http://www.medworm.com/index.php?rid=3111464&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F12%2F21%2Fmanaging-childrens-expectations-during-a-holiday-recession%2F This will not be a great Christmas for many families, due to another holiday season with the economy still in shambles. That is, if you believe that Christmas should be measured in the amount of gifts you give (or receive). And while most of us wouldn’t say we believe the number of gifts we give to our children is important, many still rely on quantity acting as some sort of indicator of parental worthiness. Psych Central writers have written before on this topic, doing Christmas on a budget and providing answers to people who believe simplifying during the holidays is just not possible. It is. And you should always set a budget for gift purchases every year (for all occasions, not just Christmas). “But what if that budget this year is smaller than in years past? Won’t m... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3111464 Mon, 21 Dec 2009 18:00:22 +0100 3111464 http://www.medworm.com/index.php?rid=3096886&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FcYz-w2C_u0Q%2Fchest-wall-contouring-in-female-to-male.html I’ve been in solo practice for 19 years. I’m getting ready to do my first female-to-male (FTM) chest wall contouring. [Yes, I told the patient he was my first FTM though not my first mastectomy.] I recalled having seen the fifth referenced article below and used it’s bibliography to find other articles which gave me nice tips on the “male” chest.  Here is the algorithm I scanned in from the fifth article. In the normal female mastectomy, the inframammary fold is maintained. In the FTM chest-wall contouring mastectomy it is not. In the 5th article, it is explicitly pointed out: “The inframammary fold is always released, and this is an especially important maneuver for patients with large breasts.” Also, Regardless of the technique chosen, we feel it is extremely importa... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3096886 Thu, 17 Dec 2009 12:01:00 +0100 3096886 http://www.medworm.com/index.php?rid=3084805&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FIvdaqrFtBMw%2Fskin-cancer-more-than-skin-deep-article.html It’s winter so why think about skin cancer?   One of the major risk factors is UVA and UVB rays from sun exposure which is much more common in the summer.  Tanning beds never cease being used, regardless of season and may even be used more in the winter than summer. There is never a wrong season to be reminded of the prevalence of skin cancer or the risk factors for skin cancer or ways to prevent skin cancer. Having read this short article (full reference below) in the “throw away” December issue of the journal Advances in Skin & Wound Care it seemed a good time to again discuss skin cancer.  The article is a good overview of skin cancer which is the most common carcinoma in the United States.  The article quotes statistics from the American Cancer Societ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3084805 Mon, 14 Dec 2009 12:01:00 +0100 3084805 http://www.medworm.com/index.php?rid=3075535&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FrejFJ5OLE9w%2Fmicrocystic-lymphatic-malformations-of.html I stumbled across this article while previewing JAMA & Archives CME articles (full reference below). The article gives an overview of lymphatic malformations, noting that both sexes are equally affected, and there is no predilection for any race. Lymphatic malformations are vascular malformations with an unknown cause. They are estimated to make up 6% of all benign soft-tissue tumors in children. While they may be rare, 50% of all lymphatic malformations are already obvious at the time of birth. Most (90%) are diagnosed by the end of the second year of life owing to clinical symptoms. About 60% of all lymphatic malformations are found in the head and neck region. Regarding the mouth, the tongue is most commonly affected. When the malformations occur in the tongue, the symptoms may i... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3075535 Thu, 10 Dec 2009 12:01:01 +0100 3075535 http://www.medworm.com/index.php?rid=3067071&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FN1v5-VbBgbc%2Ftechnical-and-anatomical-aspects-of.html The stated objective of the article (full reference below) is simply to “discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant.” I think they did an excellent job. As you may recall, Cleveland Clinic did it’s first face transplant in December 9, 2008. It was a combined face and maxilla transplant done as a salvage operation. The patient was a 46-year-old woman with a history of a gunshot wound to the midface who had had 23 major reconstructive procedures prior to the face transplant. (photo credit) The article includes some nice photos and illustrations along with an abbreviated list of the major anatomical deficits, preoperative planning, the... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3067071 Mon, 07 Dec 2009 20:40:08 +0100 3067071 http://www.medworm.com/index.php?rid=3052164&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F4PmjGXyJgbc%2Fcase-report-of-cystosarcoma-phyllodes.html Flipping through my current copy of The Journal of the Arkansas Medical Society, I was surprised to see this case report (full reference below) of a 30.8 pound cystosarcoma phyllodes of the breast. The accompanying photos are impressive. Many questions filled my head – Why did the woman wait so long to seek care? How did she manage to physically do her daily chores on the farm? How did she manage to find clothing to wear? I scanned this photo in from the article. The patient’s history is as follows: A 54-year-old self-employed cattle farmer first noticed a small tumor in her left breast at age 19. Over time, the tumor grew from the size of a small pea to a massive size. Finally, family members convinced the patient to seek medical attention. …. Also, there was no family hist... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3052164 Thu, 03 Dec 2009 12:01:00 +0100 3052164 http://www.medworm.com/index.php?rid=3026705&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FwtZa_o1xges%2Fperistomal-skin-complications-and.html There is a very nice review article in the “throw away” journal Advances in Skin & Wound Care (full reference below) which discusses the causes and management of peristomal skin complications.  The photo (credit) to the right shows normal, healthy skin around a stoma. Peristomal complications are one of the most challenging aspects of living with ostomies.  The purpose of this review article was stated to be “to illustrate practical approaches to prevent and treat common peristomal skin conditions.” The authors propose the use of the mnemonic MINDS to help clinicians remember and be mindful of the potential causes of peristomal skin problems: M:  Mechanical trauma from the ostomy equipment and skin stripping I:     Infection (bacterial an... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3026705 Wed, 25 Nov 2009 12:01:00 +0100 3026705 http://www.medworm.com/index.php?rid=3019026&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fquv06ZJj3r4%2Fabdominal-wall-reconstruction-article.html This article from the November issue of the Archives of Surgery Journal looks at using the “components separation” procedure to repair the defects. The article authors begin by point out the lack of consensus on the best method of abdominal wall closure. For primary repair, recurrence rates range from 24% to 54%, with seemingly high recurrence rates after mesh (24%) and suture (43%) repairs.  Although mesh repairs have led to improved recurrence rates overall, synthetic mesh repair is associated with various morbidities.  They correctly point out the one of the main problems with comparing outcomes in abdominal wall reconstruction is the “lack of a common starting point for patients.” In other words, midline hernias can be of various sizes, and patients differ in age... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=3019026 Mon, 23 Nov 2009 12:01:00 +0100 3019026 http://www.medworm.com/index.php?rid=2984831&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FXftkxgiQVV0%2Fprevalence-of-persistent-pain-following.html Conclusions Based on the results of our study together with previously reported findings, chronic pain after breast cancer surgery and adjuvant therapy may predominantly be characterized as a neuropathic pain state and probably related to intraoperative injury of the intercostal-brachial nerve. In accordance with these findings, preliminary observations with nerve-sparing techniques may suggest such approaches to reduce the risk of developing a chronic neuropathic pain state. ……… So far, analgesic and other interventions with paravertebral blocks, topical capsaicin, gabapentin and local anesthetics, N-methyl-D-aspartate–receptor antagonists,  or glucocorticoids may suggest certain benefits, but large-scale studies including well-characterized relevant subpopulations are req... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2984831 Thu, 12 Nov 2009 12:01:00 +0100 2984831 http://www.medworm.com/index.php?rid=2958889&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FIqMwt4Dgnr8%2Fasps-news-on-breast-reductions.html The ASPS News Brief section has two updates listed related to breast reductions regarding papers presented at last week’s American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference which I wasn’t able to attend.  According to ASPS statistics, nearly 89,000 breast reductions were performed in 2008, up 5 percent since 2000. The first one is a pilot study conducted to “determine the extent to which reduction mammaplasty surgery produces a change in biomechanical stress of the spine and level of disability in women with macromastia.”  In the study,  eleven women (ages 27 to 71 yrs, mean age 44.18) who had been determined to need breast reduction surgery, participated in a biomechanical analysis/task that involved lifting a 5 lb. weight and responded t... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2958889 Wed, 04 Nov 2009 11:01:00 +0100 2958889 http://www.medworm.com/index.php?rid=2828235&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FdOlcRatiekc%2Ftreatment-of-nasal-fxs-article-review.html Nasal fractures are extremely common.  Deciding which technique to use for a given nasal fracture can be challenging.  The recent article (full reference below) in the Arch Facial Plastic  Surgery does a very nice job of condensing down the treatment of nasal fractures into a logical approach. They start with the classification of nasal fractures (photo credit) Type I, “simple straight” --  unilateral or bilateral displaced fracture without resulting midline deviation. Type II, “simple deviated” – unilateral or bilateral displaced fracture with resulting midline deviation. Type III, “comminution of nasal bones”  -- bilateral nasal bone comminution and crooked septum with preservation of midline septal support; septum does not interfere ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2828235 Thu, 24 Sep 2009 11:01:00 +0100 2828235 http://www.medworm.com/index.php?rid=2772538&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F4oDMV76iR_Q%2Fhypercoagulability-as-cause-for-flap.html This article discusses the failures due to undiagnosed coagulopathies the patient may bring into the mix.  The authors presented four cases.  Unfortunately sometimes the first presentation of coagulopathy might be microvascular complications of the free flap. The authors noted that all fours of their cases were similar intraoperatively: Intraoperative findings that were common to these failed anastomoses were as follows: 1. The arterial anastomosis does not flash when the clamp is removed; it requires manipulation. 2. The arterial anastomosis goes down quickly (within 1 hour), before the rest of the procedure is completed. 3. The vessels, particularly the recipient flap vessels, are flaccid. 4. Topical agents such as papaverine and lidocaine do not appear to resolve the pe... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2772538 Mon, 07 Sep 2009 11:01:00 +0100 2772538 http://www.medworm.com/index.php?rid=2768815&cid=t_106950_136_f&fid=36070&url=http%3A%2F%2Fnetwork.nature.com%2Fpeople%2Fbasanta%2Fblog%2F2009%2F09%2F04%2Fthe-role-of-transforming-growth-factor-beta-mediated-tumor-stroma-interactions-in-prostate-cancer-progression-an-integrative-approach Can biologists and mathematicians accomplish more together than working separately? My answer to that question has always been a resounding yes but today I am backing up that statement with a piece of research: the result of a collaboration involving mathematicians and biologists (and a pathologist) in Tampa, Nashville and Houston. Basanta, D., Strand, D., Lukner, R., Franco, O., Cliffel, D., Ayala, G., Hayward, S., & Anderson, A. (2009). The Role of Transforming Growth Factor- -Mediated Tumor-Stroma Interactions in Prostate Cancer Progression: An Integrative Approach Cancer Research, 69 (17), 7111-7120 DOI: 10.1158/0008-5472.CAN-08-3957 The paper, of which I am one of the authors, studies the role of stromal-tumour interactions in prostate cancer progression. It introduces a computat... Cancerevo: Evolution and cancer blogs http://www.medworm.com/rss/comments.php?id=2768815 Fri, 04 Sep 2009 22:27:13 +0100 2768815 http://www.medworm.com/index.php?rid=2757788&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F_A703yn3Efw%2Fradiation-therapy-and-breast.html This article attempted to review the most recent literature on breast reconstruction in patients receiving postmastectomy radiation therapy.  They did a nice job. To find articles for review, we performed a search of the MEDLINE database for studies of radiation therapy and breast reconstruction. We then read the reference lists of the identified articles to find additional articles for review. Studies were included if most patients were treated after 1985 and the mean follow-up period was more than 1 year. Forty-nine articles were reviewed. Just from the headings in the article you can get a sense of the complexities of this topic: Indications for Postmastectomy Radiation Therapy: Consensus and Controversies Design of Postmastectomy Radiation Therapy: Consensus, Controversies, ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2757788 Wed, 02 Sep 2009 11:01:00 +0100 2757788 http://www.medworm.com/index.php?rid=2727145&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F8mWqYFeUN9M%2Fmastectomy-flap-necrosis-article-review.html This study (full reference below) comes out of Memorial Sloan-Kettering Cancer Center.  Flap necrosis following mastectomy and reconstruction using a tissue expander has always concerned me.  I will never (due to the size of my practice) have the numbers they have or experience.  They state their purpose as The purpose of this study was to assess the outcomes of our approach to mastectomy flap necrosis and to establish an algorithm that may be useful to other surgeons faced with this complication. They were able to use the “prospectively maintained database” of all patients treated at Memorial Sloan-Kettering Cancer Center to identify patients with documented mastectomy flap necrosis following immediate tissue expander placement between January of 1995 and March of 20... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2727145 Mon, 24 Aug 2009 11:01:00 +0100 2727145 http://www.medworm.com/index.php?rid=2712141&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FypAT_Zz4KXE%2Fweight-lifting-good-for-breast-cancer.html Historically, we healthcare providers have cautioned breast cancer patients to avoid weight training after a mastectomy and or axillary dissection.  We often use 15 lbs as a guideline for a save weight to lift using the arm on the mastectomy side.  A new study suggests this advice turns out to be misguided. The study has been published in the August 13 issue of the New England Journal of Medicine.  It is a small study, but the results do challenge our current reluctance to allow lymphedema patients to weight-lift. Kathryn Schmitz, PhD, MPH and colleagues enrolled 141  breast cancer survivors with lymphedema.   The enrollees were then placed into two groups.  One was assigned to a weight-lifting group who lifted twice-weekly for 13 weeks.  The other g... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2712141 Wed, 19 Aug 2009 11:01:00 +0100 2712141 http://www.medworm.com/index.php?rid=2705153&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FkAuDRhAqcLg%2Fshould-excised-mastectomy-scars-be.html Surgeons are commonly faced with the question of whether or not a surgical specimen should be submitted for histologic analysis. Routine histologic examination of clinically unsuspected mastectomy scars that are excised during secondary corrective surgery is considered good practice, but in this era of cost containment in medicine should it be done?  Locoregional recurrence of breast cancer following mastectomy occurs mainly in the first 3 to 5 years at an incidence rate of  3 to 7%.    That risk after breast-conserving therapy is 1.5 to 2 % per year, stabilizing around 10 to 20 % at 10 to 15 years.  The first reference article below involved a retrospective review of 433 patients with a history of breast cancer whose mastectomy or breast-conserving surgery ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2705153 Mon, 17 Aug 2009 11:01:00 +0100 2705153 http://www.medworm.com/index.php?rid=2695396&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FD_F5FTVWoLU%2Fasps-task-force-updates-position-on-fat.html CONCLUSIONS Clinical Applications Based on a review of the current literature and a lack of strong data, the Task Force cannot make specific recommendations for the clinical use of fat grafts. Although fat grafts may be considered for use in the breast and other sites, the specific techniques of graft harvesting, preparation, and injection are not standardized. The results therefore may vary depending on the surgeon’s technique and experience with the procedure. Although there are little data to provide evidence for long-term safety and efficacy of fat grafting, the reported complications suggest that there are associated risks. Regarding fat grafting to the breast, there are no reports suggesting an increased risk of malignancy associated with fat grafting. There is a potential ris... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2695396 Thu, 13 Aug 2009 11:01:00 +0100 2695396 http://www.medworm.com/index.php?rid=2691528&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FwwKa9bScEqs%2Finternal-us-technique-treats.html This was suppose to simply be an article review. I was intrigued by the potential of using ultrasound (US) to damage the sweat glands when I read this article in the August issue of Cosmetic Surgery Times. I even went back and read the Aesthetic Plastic Surgery Journal article referenced, but I have gotten sidetracked by this photo. It troubles me. See how it is labeled an intra-operative photo? Notice the surgeon is wearing what appears to be a large jeweled ring under her sterile glove. Who wears jewelry in the OR??? That’s not proper sterile technique! Intra-operative photo shows application of internal ultrasound therapy to damage the sweat glands. (Photo credit: Sharon Giese, M.D., F.A.C.S.) In the article Dr. Giese states the procedure uses the heat energy of the ultrasound li... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2691528 Wed, 12 Aug 2009 11:01:00 +0100 2691528 http://www.medworm.com/index.php?rid=2670774&cid=t_106950_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FrDOfY7S-O3M%2F Passed with scant deliberation amid a stock market panic, the Sarbanes-Oxley Act of 2002 vastly expanded the federal government’s role in regulating corporate governance and the accounting industry. As part of that effort, Congress created a new agency to “audit the auditors.” Known as the Public Company Accounting Oversight Board, the agency has broad rulemaking and enforcement powers to set accounting standards, investigate accounting firms, punish criminal violations, and make whatever rules “may be necessary or appropriate in the public interest or for the protection of investors.” Remarkably, the PCAOB (pronounced “peek-a-boo”) also has the power to fund its own budget by levying taxes on publicly traded companies. Despite giving the PCAOB all this po... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2670774 Tue, 04 Aug 2009 18:48:05 +0100 2670774 http://www.medworm.com/index.php?rid=2653789&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fnp8cHp3VuVE%2Fraynauds-phenomenon-of-nipple.html This article would have been off my radar had it not been for the interaction on twitter. jeffreyleow RT @paulinechen: Camera Phones [patients taking pics] helps doctor make rare diagnosis http://3.ly/CXr (via @EllenRichter) Granted I am not generally asked about nipple pain in pregnant women.  Those questions tend to go to folk like TBTAM or ER’s Mom.  The article describes a case report of a 25 yo woman in her 2nd trimester with “frequent episodes of extreme bilateral nipple pain. A typical episode lasted between 5 and 15 minutes and was so painful as to bring her to tears.” The article discusses Raynaud’s phenomenon of the nipple and share these photos (credit) taken with a camera phone with us.  The text with the photo: Vasospasm of the arterioles manifest... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2653789 Thu, 30 Jul 2009 11:01:00 +0100 2653789 http://www.medworm.com/index.php?rid=2616710&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FLgbhxhxzn2w%2Fimpact-of-partial-breast-reconstruction.html I wanted to share this article (1st reference below) with you.  I feel it is important as we continue to improve the treatment of breast cancer.  Our surgical treatments can change the surveillance. The authors begin their article by pointing out breast conservation therapy has grown in popularity and scope.  In saving the majority of the breast tissue, some of the reconstructive procedures significantly alter the architecture of the breasts.  How does this affect surveillance postoperatively?  The article’s stated purpose was to look at this question. The purpose of this review was to evaluate long-term postoperative cancer surveillance techniques in a group of patients with breast cancer who underwent partial breast reconstruction using reduction techniques. ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2616710 Mon, 20 Jul 2009 11:01:00 +0100 2616710 http://www.medworm.com/index.php?rid=2594451&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FVsMJMg7pP3I%2Fover-diagnosis-of-breast-cancers.html Are breast cancers over-diagnosed?  If so, how often?  Those are the questions looked at by the systematic review of incidence reported data/articles done by Karsten Juhl Jørgensen & colleagues.  Their results are published online in the June 9th issue of the British Medical Journal.   Their review shows an estimated 52% over-diagnosis of breast cancer. The researchers’ objective was to estimate the extent of over-diagnosis.  Screening for breast cancer is meant to detect lethal cancers earlier.  Unfortunately it also detects harmless ones that will not cause death or symptoms. As it is not possible to distinguish between lethal and harmless cancers, all detected cancers are treated. Over-diagnosis and overtreatment are therefore inevitable. They ... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2594451 Mon, 13 Jul 2009 11:01:00 +0100 2594451 http://www.medworm.com/index.php?rid=2584216&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F07%2F08%2Fmichael-jacksons-brain-and-the-false-narrative%2F Since the news media seems to be unable to tear itself away from the Michael Jackson story, we learn about every fascinating detail about his life, and his death. Including the details of standard autopsy procedures, as though they were new or bizarre. The latest, of course, is that Michael Jackson’s body is being buried without his brain. But this is not unusual in an autopsy where the cause of death isn’t certain and the brain is suspected to carry some clues. The brain needs to harden, in order to perform the later slicing needed in the autopsy procedure: It involves removing the brain from the skull and leaving it to soak in a diluted mixture of formaldehyde and water called formalin. This soaking process usually takes four weeks and the brain genuinely does harden. Vaug... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2584216 Wed, 08 Jul 2009 13:24:00 +0100 2584216 http://www.medworm.com/index.php?rid=2572952&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FdKQ5t_E2qm8%2Fpreventing-and-treating-skin-tears.html If you work with elderly patients, then you have probably seen “skin tears.”  There is a nice basic article (see full reference below) on the topic that recently crossed my desk.  I’d like to share some of the information with you. (photo credit) In considering the mechanism of skin tears, I love the way Dr Salcido (2nd reference below) puts it.  His paper explanation could be useful in explaining the problem to patients. I will consider the etiologic factors associated with the development of skin tears through these 2 subdivisions:  pathomechanical & pathophysiological. The French term la melodie de la peau de papier ("the melody of the little piece of paper") is useful to describe both the mechanical (human machine interface) and the pathophy... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2572952 Mon, 06 Jul 2009 11:01:00 +0100 2572952 http://www.medworm.com/index.php?rid=2572999&cid=t_106950_125_f&fid=38161&url=http%3A%2F%2Fwww.dentalheroes.com%2F10-dental-care-posts-read-week%2F I don’t know about you, but some days I feel like there’s just not enough time to read through all of the e-mails, tweets, rss feeds that we receive. On the off chance that I do have time, I undoubtedly spend a great deal of it wading through less than worthy information. Since I’m sure you don’t like your time being wasted either, I’ve decided to add a new weekly feature to Dental Heroes. Each week I’m going to feature a list of the top 10 dental-related blog posts or articles I’ve read for that week. Here’s the top 10 for this week: 1) At Home Tooth Whiteners Differ in Effectiveness (Consumer Reports) 2) As rating sites grow, doctors voice concerns (azcentral.com) 3) New treatment for receding gums (medicalnewstoday.com) 4) Nanotechnolog... Dental Heroes blogs http://www.medworm.com/rss/comments.php?id=2572999 Mon, 06 Jul 2009 05:37:11 +0100 2572999 http://www.medworm.com/index.php?rid=2561272&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FSBw3zeFTz10%2Finfections-after-face-lifts.html When you read articles at sites like MedScape or MedPage Today, you are often referred to other articles of interest.  That’s how I came across this one on the MedPage Today site.   I went there to read the one on “Sinus Infections Cause Toxic Shock Syndrome in Children”.  Both are interesting articles, but I want to discuss the article referenced below that was discussed on MedPage Today. The topic is postoperative infections in face lift surgery.  The stated objective of the article: To determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA)-positive surgical site infections after face-lift surgery and to discuss the screening, prevention, and treatment of such infections. MRSA infections are never a good thing, but as a postoperat... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2561272 Wed, 01 Jul 2009 11:01:01 +0100 2561272 http://www.medworm.com/index.php?rid=2553057&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F2Q94C6M3OmA%2Fbreast-implants-and-lymphoma-risk.html This article was published in the March issue of the Plastic and Reconstructive Surgery Journal. The article is the summary of a literature review using PubMed to review the evidence from all epidemiologic cohort studies of cancer incidence among women with cosmetic breast implants that include results on the incidence of non-Hodgkin's lymphoma, with specific attention to lymphomas arising in the breast. The review was prompted by the article from The Netherlands (second reference below) which suggested an association of breast implants with anaplastic large T-cell lymphoma. Primary breast lymphoma is a rare malignancy. Most of them are of B-cell origin. It is important for anecdotal reports not to alarm providers or patients. This review article found only five long-term cohort studies w... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2553057 Mon, 29 Jun 2009 11:01:03 +0100 2553057 http://www.medworm.com/index.php?rid=2523070&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F7rIKVJqih5k%2Fsurgical-glove-perforation-and-risk-of.html H/T to ACP Internist for bringing this article to my attention (see full reference below). It's best not to get holes in one's surgical gloves in the middle of a procedure, as this leads to a higher risk of infection for the patient, the Archives of Surgery reports in a study about the effect of ripped gloves. …… Which is, perhaps, why the surgeons put on the gloves in the first place? For me, I found nothing new in this article.  Yes, surgeons wear gloves to both protect the patient and him/herself.  Gloves are part of the universal precautions.  It is well known that the risk of getting a hole in one’s glove increases with the length of the surgery (especially when over 2 hours) or when dealing with spiked bone fragments.  The authors of the article felt the... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2523070 Wed, 24 Jun 2009 11:01:08 +0100 2523070 http://www.medworm.com/index.php?rid=2523657&cid=t_106950_136_f&fid=36070&url=http%3A%2F%2Fnetwork.nature.com%2Fpeople%2Fbasanta%2Fblog%2F2009%2F06%2F22%2Fcooperation-and-cancer I have been neglecting this blog for the last few weeks due to work (why do I have the feeling that this might be one of the most common excuses in the blogsphere??). Part of that work involved hypothethising whether cells in a tumour cooperate, and if they do, how does that happen and what are the implications (from the therapeutical point of view and otherwise). Although discussed in this blog before (here, here,here, here and here), I know that cooperation is not an entirely uncontroversial topic. The idea of cells competing or cooperating is, admittedly, a problematic one if it results in anthropomorphism. What is the meaning of cells in a tumour cooperating? Does it mean that they sit down and discuss possible alliances? do they sign contracts to make sure that the cooperation can be ... Cancerevo: Evolution and cancer blogs http://www.medworm.com/rss/comments.php?id=2523657 Mon, 22 Jun 2009 04:05:31 +0100 2523657 http://www.medworm.com/index.php?rid=2523065&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2F8r17Ujp-CxM%2Ftopical-fluorouracil-for-photoaging.html The authors of the article referenced below looked at the use of topical fluorouracil and it’s affects on improving photoaging in skin.  Topical fluorouracil (5FU) has become a standard treatment of actinic keratoses (AKs).  For treatment of AKs it is applied to the skin once or twice daily for 2-4 weeks.  It produces significant and predictable irritation and inflammation.  When the skin is healed there is always a decrease in the number of AKs.  A “side benefit” of the AK treatment in many patients was improved skin (smoother, more even color, and a decrease in fine wrinkles).  This improvement appears to come from the wound-healing response of the skin.  The authors end the article with this observation: Evidence is accumulating that even mini... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2523065 Thu, 18 Jun 2009 12:57:50 +0100 2523065 http://www.medworm.com/index.php?rid=2458164&cid=t_106950_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F06%2F06%2F7-good-reasons-to-cry-your-eyes-out%2F New York Times reporter Benedict Carey referred to tears in a recent piece as “emotional perspiration.” Given that I sweat a lot and hate deodorant, I suppose it makes sense that I weep often. But I’m not going to apologize for that, because after a good cry, I always feel cleansed, like my heart and mind just rubbed each other’s backs in a warm bath. In his intriguing article, “The Miracle of Tears” , from which I’ve lifted some of the research for this post, author Jerry Bergman writes: “Tears are just one of many miracles which work so well that we taken them for granted every day.” Here, then, are seven ways tears and the phenomenon we call “crying” heal us physiologically, psychologically, and spiritually. 1. Tears hel... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2458164 Sat, 06 Jun 2009 11:10:33 +0100 2458164 http://www.medworm.com/index.php?rid=2405286&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2Fx7LTxFpeLj8%2Fdermatitis-and-eczema-article-review.html Being a plastic surgeon, I have a great interest in the skin and no I don’t see or treat much dermatitis as the primary physician.  Patients do occasionally ask me about patches / rashes they have.  It’s always nice to be up on the topic and to know when it’s important to make sure they see a dermatologist. The article listed below is a nice, simple  review of conditions that fall into the eczema / dermatitis categories.  The article discusses atopic dermatitis (AD), nummular (coin-shaped)eczema,  contact dermatitis, and stasis dermatitis.  It is not a deep article on the subject, but did include some nice reminders and tips.   The article points out that allergic dermatitis is not uncommon in patients with chronic wounds.  They site an article... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2405286 Mon, 11 May 2009 11:01:00 +0100 2405286 http://www.medworm.com/index.php?rid=2376110&cid=t_106950_106_f&fid=36682&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSutureForALiving%2F%7E3%2FgJtdVVplTcg%2Fmelanoma-skin-screening-is-important.html I’m all for finding skin cancer early.  It makes treatment so much more simple and effective.  This is reinforced in the recent article by Alan C. Geller, of the Boston University School of Public Health, and colleagues in the April issue of  Archives of Dermatology.  The study shows that routine screening for melanoma can lead to a 50% increase in detection of small back-of-body lesions.  These lesions on the back are ones that are often missed by the patients themselves. The study surveyed 227 men ≥40 within three months of melanoma diagnosis.   They found that more than half (59%) had not received a full-body physical examination by a physician prior to diagnosis of melanoma.   Melanoma can present anywhere on the body, but in men the ba... Suture for a Living blogs http://www.medworm.com/rss/comments.php?id=2376110 Wed, 29 Apr 2009 11:01:00 +0100 2376110