Septum-based nasal tip plasty : A comparative study between septal extension graft and double-layered conchal cartilage extension graft.

Background: Septal extension graft is currently the most commonly used primary and secondary rhinoplasty technique in Asia because it provides maximal tip projection and rotational controllability. We designed this study to compare the tip projection amount and rotational controllability of the tip support between the septal extension graft based on the L-strut septum and double-layered conchal cartilage graft based on the full septum at the nasal tip.

Method: A total 27 consecutive patients who underwent nasal tip plasty with the septal extension graft or double-layered conchal cartilage graft for purely esthetic reasons between March 2014 and July 2016. The nasal tip projection and columellar labial angle in preoperative (T0), immediate postoperative (T1, average 2 weeks after the operation), and postoperative (T2, on average 7 months after the operation) was analyzed with clinical photography

Result: 14 patients (Group A) received septal extension graft whereas 13 patients (Group B) received double-layered conchal cartilage graft. 61% and 74% changes in tip projection ratio were immediately achieved and was maintained after surgery for Groups A and B, respectively (T2-T0/T1-T0; p = 0.722 for Group A and B). Therefore, the relapse ratio of this technique was 39% and 26% for Groups A and B.

Conclusion: This comparative study between the septal extension graft and double-layered conchal cartilage graft showed that both nasal tip plasties are similar in terms of stability. Considering the fact that the double-layered conchal cartilage graft could preserve septal support, this technique could become an effective and safe alternative option for rhinoplasty.

(C)2017American Society of Plastic Surgeons

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Minimally Invasive Laparoscopic Dissected – Deep Inferior Epigastric Artery Perforator Flap (MILD-DIEP): An Anatomic Feasibility Study and a First Clinical Case.

SUMMARY: The deep inferior epigastric perforator (DIEP) flap is a workhorse of breast reconstruction. Risks of herniation derive from violation of the rectus abdominis muscle anterior rectus sheath (ARS) and might be reduced by Minimally Invasive Laparoscopic Dissection (MILD) of the deep inferior epigastric vessels. We performed a feasibility study on five anatomical subjects and performed a secondary right breast reconstruction on a 67 year-old woman. A 30[degrees] laparoscope was used with laparoscopy ports inset to preserve the flap. Blunt preperitoneal dissection followed by CO2 insufflation allowed the deep inferior epigastric (DIE) pedicle to be dissected and clip-sectioned. The ARS was opened around the perforating vessels, and the flap was anastomosed on the internal mammary vessels. Length of incision in the ARS was compared between laparoscopic and conventional approaches. The mean incision length in the ARS was 3 cm versus 12 cm in the classic approach. Average duration of laparoscopic flap harvest was 50 minutes, including a mean of 30 minutes for DIE dissection. Adhesions led to a 1 cm peritoneal laceration in our first anatomical subject. There were no pre- or post-operative complications in the clinical case. The clinical procedure duration was 8h15 minutes with the ARS incision reduced from the conventional 12 cm to 5 cm. Flap ischemia lasted 50 minutes. The patient was discharged on postoperative day 5. This anatomic study and first successful laparoscopic assisted DIEP flap harvest prove that reduced trauma to the anterior rectus sheath is feasible and promising.

(C)2017American Society of Plastic Surgeons

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22 Cases of BIA-ALCL: Awareness and Outcome Tracking from the Italian Ministry of Health.

Background: To date, 359 cases of anaplastic large cell lymphoma in women with breast implants (BIA-ALCL) worldwide have been reported out of more than 10 million implanted patients but Health Care Authorities suspect this is a possible underestimation and the limited number of cases makes it difficult to clarify its etiology. The General Directorate of Medical Devices and Pharmaceutical Services of the Italian Ministry of Health (IMoH) has examined and studied the Italian BIA-ALCL cases, and the aim of this study is to report on the knowledge and experience gained on this new emerging disease.

Patients and Methods: An official document has been diffused by the IMoH to all the Italian medical associations, aiming at encouraging all physicians to notify each BIA-ALCL case through the compilation of a specific on-line form. A retrospective study has been performed on the notified BIA-ALCL cases collected in the IMoH’s database named DISPOVIGILANCE.

Results: Research on DISPOVIGILANCE gives back a list of 22 Italian BIA-ALCL cases. The patients’ mean age was 49.6 years (range 30 -71). The average time to the onset of the symptoms was 6.8 years (range 1-22). The average time to the diagnosis was 7.8 years (range 4 -22). The estimated incidence of the Italian BIA-ALCL cases related to 2015 is 2.8 per 100.000 patients.

Conclusions: The BIA-ALCL pathogenesis remains unknown. The Italian Ministry of Health, together with scientific associations and other Competent Authorities worldwide, is working on the BIA-ALCL issue to increase awareness and knowledge of this disease by healthcare professionals.

(C)2017American Society of Plastic Surgeons

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The Expanded Use of Auto-augmentation Techniques in Oncoplastic Breast Surgery.

Background: Auto-augmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects and women with smaller breasts. The purpose of this report is to describe the use of auto-augmentation techniques in OR and compare the results with traditional OR.

Methods: We queried a prospectively maintained database of all women who underwent partial mastectomy and OR between 1994 and October 2015. The auto-augmentation techniques were defined as 1) extended primary nipple auto-augmentation pedicle, and 2) primary nipple pedicle and secondary auto-augmentation pedicle. Comparisons were made to a control oncoplastic group.

Results: There were a total of 333 patients, 222 patients (67.7%) without auto-augmentation and 111 patients (33%) with auto-augmentation. Fifty-one patients had extended auto-augmentation pedicle, and 60 patients with a secondary auto-augmentation pedicle. Biopsy weight was smallest in the extended pedicle group (136 grams) and largest in the regular oncoplastic group (235 grams, p=0.017). Superomedial was the most common extended pedicle and lateral being the most common location. Inferorolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5% in the regular oncoplastic group, 19.6% in the extended pedicle group, and 20% in the secondary pedicle group.

Conclusions: Auto-augmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects especially in smaller breasts. Auto-augmentation can be done safely without increase risk of complications, broadening the indications for breast conservation therapy.

(C)2017American Society of Plastic Surgeons

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Effects of Percutaneous Coronary Intervention on Viable Myocardium and Heart Function of Diabetic Patients With Chronic Total Occlusion

imageObjective: The aim of this study was to compare the effects of percutaneous coronary intervention (PCI) on coronary chronic total occlusion patients with (DM) or without (NDM) diabetes mellitus.

Methods: A total of 78 patients were divided into DM group and NDM group according to whether the patient has DM. The results of PCI were analyzed using quantitative coronary analysis. In addition, all the patients underwent 99mTc-MIBI (methoxyisobutylisonitrile) single-photon emission computed tomography (SPECT) and ultrasonic cardiogram in the first week and the sixth month after PCI to evaluate PCI results. During the 6-month follow-up, major adverse cardiac event (MACE) was recorded and analyzed as well.

Results: The first and second classes of collateral circulation between the 2 groups have significant differences (P

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Usefulness of a Low Tube Voltage: Knowledge-Based Iterative Model Reconstruction Algorithm for Computed Tomography Venography

imageObjectives: The objective of this study was to evaluate the use of 80-kVp scans with knowledge-based iterative model reconstruction (IMR) for computed tomography venography (CTV).

Methods: This prospective study received institutional review board approval; a previous informed consent was obtained from all participants. We enrolled 30 patients with suspected deep venous thrombosis or pulmonary embolism who were to undergo 80-kVp CTV studies. The images were reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and IMR. The venous attenuation, image noise, and contrast-to-noise ratio at the iliac, femoral, and popliteal veins were compared on FBP, HIR, and IMR images. We performed qualitative image analysis (image noise, image contrast, image sharpness, streak artifacts, and overall image quality) of the 3 reconstruction methods and measured their reconstruction times.

Results: There was no significant difference in venous attenuation among the 3 reconstruction methods (P > 0.05). On IMR images, the image noise was lowest at all 3 venous locations, and the contrast-to-noise ratio was highest. Qualitative evaluation scores were also highest for IMR images. The reconstruction time for FBP, HIR, and IMR imaging was 25.4 ± 1.9 seconds, 43.3 ± 3.3 seconds, and 78.7 ± 6.0 seconds, respectively.

Conclusions: At clinically acceptable reconstruction times, 80-kVp CTV using the IMR technique yielded better qualitative and quantitative image quality than HIR and FBP.

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Computed Tomography Pulmonary Angiogram Dynamic Parameter Correlation With Pulmonary Pressure and Pulmonary Hypertension Etiologies

imageObjective: Pulmonary hypertension (PH) is caused by etiologies that differ in pathophysiology. Patients with undiagnosed PH may have a computed tomography pulmonary angiography (CTPA) scan during workup. Static measurements on computed tomography correlate with PH; however, dynamic parameters have received less attention. We studied the correlation between CTPA dynamic parameters and PH and assessed whether these parameters differ among PH etiologies. We also propose a method for PH screening.

Methods: Patients who underwent right-heart catheterization and CTPA within 45 days of each other were included. Charts were reviewed for presence and etiology of PH. The time it took to reach the CTPA trigger threshold during bolus tracking (TT) was recorded and compared with pulmonary pressure measured on pulmonary artery catheterization. The correlation between TT values and pulmonary pressure was studied, as well as the sensitivity and specificity of TT for PH.

Results: Twenty-seven patients with 28 examinations were included. A significant correlation was found between pulmonary pressure and TT, as well as TT and right ventricular decreased function, P

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Sternal Development and Variations and Anomalies in Patients With Microtia: Evaluation Using 3-Dimensional Computed Tomography

imageObjective: The objectives of this study were to evaluate sternal development and variations in patients with microtia and to identify the incidence of congenital sternal anomalies and then to investigate the interaction between microtia and sternal anomalies.

Methods: A total of 212 consecutive patients received a preoperative 3-dimensional chest computed tomography. A retrospective study was performed with the clinical and imaging data from November 2014 to July 2015. Descriptive statistics, analysis of variance, Spearman analysis, χ2 test, and Fisher χ2 test were performed for statistics analysis.

Results: We evaluated the ossification centers and developmental variations in the manubrium and body, as well as the xiphoid process, manubriosternal and sternoxiphoidal fusion, and sternal anomalies. Significant variations were observed from person to person. Sternal foramen was detected in 6 male patients (2.8%). All foramina were located in the inferior part of the body. Sternal cleft was observed in 4 cases (1.9%), of which 2 were accompanied by a foramen in the distal part of the sternum.

Conclusions: The development of the different components of the sternum is a process with wide variation among patients with microtia. A different distribution of mesosternal types I to II among our population age range was found, and the incidence of sternal foramina was lower in patients with microtia.

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Evaluation and Minimization of the Pseudohepatic Anisotropy Artifact in Liver Intravoxel Incoherent Motion

imagePurpose: The aim of this study was to evaluate the effect of the pseudohepatic anisotropy artifact on liver intravoxel incoherent motion (IVIM) metrics and whether the use of multiple gradient directions in the IVIM acquisition minimizes the artifact.

Materials and Methods: Multiple breath-holding and forced shallow free-breathing IVIM scans were performed on 8 healthy volunteers using 1 and 6 gradient directions. Cluster analysis was carried out to separate motion-contaminated parenchyma from liver parenchyma and vessels. Nonlinear motion analysis was also performed to look for a possible link between IVIM metrics and nonlinear liver motion.

Results: On the basis of the resulted clusters, motion-contaminated parenchyma is often noted in the left liver lobe, where the prominent pseudohepatic artifact has previously been identified. A significant reduction in outliers was obtained with the acquisition of 6 noncoplanar gradient directions and when using forced shallow free-breathing.

Conclusion: The pseudohepatic anisotropy artifact can be minimized when using multiple diffusion-encoding gradient directions and forced free-breathing during IVIM acquisition.

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Assessing Synovitis and Bone Erosion With Apparent Diffusion Coefficient in Early Stage of Rheumatoid Arthritis

imagePurpose: The aim of this study was to assess the value of apparent diffusion coefficient (ADC) in distinguishing synovitis from joint fluid and bone erosion from cysts.

Methods: Twenty-eight patients with suspected rheumatoid arthritis underwent diffusion-weighted imaging and pre– and post–contrast-enhanced magnetic resonance imaging. The mean ADC values were compared between synovitis and joint effusion and between bone erosion and cyst.

Results: Mean ADC value of synovitis was significantly lower than that of the joint effusion (2.6 ± 0.37 × 10−3 vs 1.63 ± 0.37 × 10−3 mm2/s, P

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