Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK

PURPOSE

The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK).

METHODS

Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases.

RESULTS

IFS appears 2.33 days (±1.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 μm ± 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid.

CONCLUSIONS

IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

Introduction

Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents.

Materials and methods

This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 19972015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening.

Results

A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of non-union. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain.

Conclusion

Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Mitral annular disjunction and myxomatous mitral valve disease in a dog

Mitral annular disjunction (MAD) has been defined as a structural abnormality with separation between the posterior leaflet of the mitral valve and the left atrial wall. It is commonly associated with myxomatous mitral valve disease (MMVD), mitral valve prolapse (MVP), ventricular arrhythmias, and sudden cardiac death in humans, but has not been described in veterinary medicine despite the high prevalence of MMVD in the canine population. The echocardiographic findings in a Chihuahua with MAD, MMVD, and MVP are described. Diagnostic methods and criteria are reviewed and adapted.

Improving the Performance of Paper-Based Dipole Antennas by Electromagnetic Flux Concentration

One of the essential issues in modern advanced materials science is to design and manufacture flexible devices, in particular in the framework of the Internet of Things (IoT), to improve integration into applications. An antenna is an essential component of wireless communication modules and, in addition to flexibility, compact dimensions, printability, low cost, and environmentally friendlier production strategies, also represent relevant functional challenges. Concerning the antenna's performance, the optimization of the reflection coefficient and maximum range remain the key goals. In this context, this work reports on screen-printed paper@Ag-based antennas and optimizes their functional properties, with improvements in the reflection coefficient (S₁₁) from -8 to -56 dB and maximum transmission range from 208 to 256 m, with the introduction of a PVA-Fe₃O₄@Ag magnetoactive layer into the antenna's structure. The incorporated magnetic nanostructures allow the optimization of the functional features of antennas with possible applications ranging from broadband arrays to portable wireless devices. In parallel, the use of printing technologies and sustainable materials represents a step toward more sustainable electronics.

Thin and hypokinetic myocardial segments in cats with cardiomyopathy

INTRODUCTION/OBJECTIVES

Thin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS).

ANIMALS

Eighty client-owned cats.

MATERIALS AND METHODS

Retrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death.

RESULTS

Mean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8-6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6-1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07-180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8-7.7 mm) vs. 1.9 mm (95% CI 1.5-2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83-223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring.

CONCLUSIONS

Cats with THyMS had advanced cardiomyopathy and a poor prognosis.

Direct cost analysis of genetic testing for CYP2C19*2 and *3 loss of function variants in percutaneous coronary intervention patients

Background/Introduction

Patients with CYP2C19*2 or *3 loss of function (LOF) variants who undergo percutaneous coronary intervention (PCI) have an increased risk of ischemic events when treated with clopidogrel.

Purpose

A subgroup of patients who were included in the TAILOR-PCI trial were also enrolled in this study to determine if a genotype-guided (GG) approach based on CYP2C19*2 or *3 LOF variants is cost-effective.

Methods

Patients were randomized to the conventional therapy group with clopidogrel and to the GG group who underwent point of care genotype testing for CYP2C19*2 or *3 LOF variants. In the GG group, therapy was based on genotype results. Those identified as LOF carriers were prescribed ticagrelor while non-carriers were prescribed clopidogrel.

Results

There were no significant differences in direct medical costs between the conventional therapy group and GG group (mean $19,747 versus $20,682, p=0.11), however total costs were significantly greater in the GG group which was primarily driven by the outpatient cost of ticagrelor. Furthermore, there was no significant cost difference between ticagrelor treated LOF carriers and clopidogrel treated non-carriers.

Conclusion

These findings suggest that a GG approach with point of care testing for CYP2C19*2 or *3 LOF variants in patients undergoing PCI may be a cost-effective practice.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): NIH grants

NAV3 is a genetic determinant of myocardial recovery in dilated cardiomyopathy and attenuates cardiac fibrosis

Background

A genome-wide association study (GWAS) assessing change in left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM), a surrogate marker of morbidity and mortality in heart failure (HF), had not been performed previously and could provide insight into novel biological pathways that could lead to the development of new drugs that might target myocardial recovery. The presence and extent of cardiac fibrosis in DCM is independently associated with myocardial recovery and cardiovascular mortality.

Purpose

To identify the biological relevance of genetic targets that are associated with change in LVEF in patients with DCM.

Methods

A GWAS was performed using DNA from 686 patients with recent onset DCM who were on standard HF therapy using change in LVEF at a median of 6 months after initial diagnosis. Cultured human cardiac fibroblasts (HCFs) were used as an in vitro model to study the functional and biological relevance of the gene target identified in the GWAS. Specifically, HCFs were transfected with siRNA by using the Lipofectamine™ RNAiMAX Transfection Reagent for gene knockdown (KD). RNA-seq was performed using the Illumina TruSeq protocol with expression analysis conducted with the EdgeR package. Ingenuity Pathway Analysis was used.

Results

A single-nucleotide polymorphism, rs11105445(G&gt;A), mapping to the neuron navigator 3 (NAV3) gene (rs11105445, p=2.37E-07; beta 2.74±0.53) was associated with improvement in LVEF. We performed a phenome-wide association study using data from the UK Biobank and demonstrated that genetic variation in NAV3 was significantly associated with HF mortality (p=3.2E-28), highlighting the potential importance of this gene in HF. Using GTEx data we demonstrated that in LV tissue the minor allele A was associated with ↓NAV3 expression (p=0.03) suggesting that ↓NAV3 expression might be associated with improvement in LVEF. We demonstrated that NAV3 KD significantly ↓TGF-β1 mediated HCF transdifferentiation into myofibroblasts, ↓α-smooth muscle actin (ACTA2) and ↓collagen I (COL1A1), therefore NAV3 KD was anti-fibrotic (see Figure 1), 1a. HCFs treated by vehicle/TGF-β1 after KD of NAV3/ctrl, and ACTA2 and COL1A1 were analyzed by qPCR; 1b. Representative immunofluorescence staining for α-SMA (in green), RNA-seq after NAV3 KD followed by pathway analysis suggested that NAV3 exerted its effect by regulating cell cycle related proteins (Figure 2), 2a. Volcano plot shows significant differentially expressed genes identified by RNA-seq analysis (down-regulated in blue, up-regulated in red); 2b. NAV3 KD significantly increased expression of cell cycle related proteins, which was validated by Western blot.

Conclusions

Decreased expression of NAV3 is associated with myocardial recovery in DCM, most likely due to its anti-fibrotic effect via direct regulation of cell cycle proteins. The role of NAV3 as a novel therapeutic target in DCM needs to be explored.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Mayo Clinic Center for Individualized MedicineMayo Clinic Department of Cardiovascular Medicine

C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS

Aims

The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.

Methods and Results

We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR.

Conclusions

In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.

Greener Solvent-Based Processing of Magnetoelectric Nanocomposites

Polymer-based magnetoelectric (ME) nanocomposites are an enabling material technology for a wide range of applications in the area of digitalization strategies. Due to its highest piezoelectric response among polymers, poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE) is the piezoelectric matrix most used in polymer-based ME materials with over 80% of the total reports, with the resulting composites typically processed from solutions with N,N-dimethylformamide (DMF), a toxic solvent. Nevertheless, environmentally friendlier approaches and sustainable technologies are increasingly being required. This work demonstrates that P(VDF-TrFE)/Co₂Fe₂O₄ nanocomposites can be successfully prepared from solution using three different environmentally friendlier solvents: dimethyl sulfoxide (DMSO), N,N'-dimethylpropyleneurea (DMPU), and triethyl phosphate (TEP) with different dipole moments. It is shown that the prepared composite films, with a maximum ME voltage coefficient of 35 mV cm^-1 Oe^-1 and a maximum sensitivity of 2.2 mV T^-1, are suitable for applications, highlighting the path for a new generation of more sustainable ME sensors.

Injury incidence and burden during senior inter-provincial field hockey tournaments

Background

Field hockey is an Olympic sport played internationally and in which South Africa is a participating nation. It also has its own world cup. Few injury studies have been published on South African field hockey. Research efforts should increase within the sport to ensure safe participation and mitigate the inherent injury risks.

Objectives

The objective of the study was to attend the male and female inter-provincial field hockey tournaments in South Africa and determine the incidence of injury and burden of acquired sport injuries (time-loss and medical attention).

Methods

A quantitative, descriptive, longitudinal study, including 133 females and 139 males, was conducted. Participants completed baseline questionnaires prior to the tournament and post-match questionnaires detailing injuries during the tournament.

Results

The recorded injuries were 77.9 (females) and 99.5 (males) per 1 000 player match hours. Medical attention was 51.9 (females) and 70.3 (males) injuries per 1 000 player match hours. The result for time-loss injuries was 4.3 (females) and 7.5 (males) injuries per 1 000 player match hours.

Discussion

The study found high incidence rates of all injuries and medical attention injuries; however, the incidence of time-loss injuries was low in comparison to existing literature. Comparing current results to existing literature is challenging due to the heterogeneity of methodologies and injury definitions in field hockey research.

Conclusion

This was the largest observational study in field hockey conducted in South Africa. The international sporting body should establish a consensus for future research and the South African Hockey Association explore long-term surveillance in South Africa to mimic similar national codes.

Magnetic materials: a journey from finding north to an exciting printed future

The potential implications/applications of printing technologies are being recognized worldwide across different disciplines and industries. Printed magnetoactive smart materials, whose physical properties can be changed by the application of external magnetic fields, are an exclusive class of smart materials that are highly valuable due to their magnetically activated smart and/or multifunctional response. Such smart behavior allows, among others, high speed and low-cost wireless activation, fast response, and high controllability with no relevant limitations in design, shape, or dimensions. Nevertheless, the printing of magnetoactive materials is still in its infancy, and the design apparatus, the material set, and the fabrication procedures are far from their optimum features. Thus, this review presents the main concepts that allow interconnecting printing technologies with magnetoactive materials by discussing the advantages and disadvantages of this joint field, trying to highlight the scientific obstacles that still limit a wider application of these materials nowadays. Additionally, it discusses how these limitations could be overcome, together with an outlook of the remaining challenges in the emerging digitalization, Internet of Things, and Industry 4.0 paradigms. Finally, as magnetoactive materials will play a leading role in energy generation and management, the magnetic-based Green Deal is also addressed.

International Microsurgery Club Webinar Series-Bridging the Knowledge Gap during the COVID-19 Pandemic

PURPOSE

 The impact of the coronavirus disease 2019 (COVID-19) outbreak shut down most conferences. To minimalize the influence, virtual meetings sprang up subsequently. International Microsurgery Club (IMC), as one of the largest professionals-only online microsurgery education groups worldwide, began to host regular weekend webinars during the pandemic to fill the knowledge gap. This study aims to discuss how webinars have fundamentally changed the way knowledge is delivered and exchanged.

METHODS

 From February 29, 2020 to March 14, 2021, 103 IMC webinars were reviewed and analyzed in detail to determine the use, benefit, and effect. A comparison between webinars hosted by the different societies was made as well. A questionnaire survey focusing on attendees' behavior, attitude, and using habit about webinars was also made.

RESULTS

 As for the 103 IMC webinar events, the peak participants were 112.3 people in average. The members requesting to join IMC abruptly increased during the pandemic, and the group activity increased dramatically. From the questionnaire (n = 68), the satisfaction level was high (8.88 ± 1.18/10). The respondents were most satisfied with the good quality of the speakers (73.5%). Not only hosts our webinar series but IMC also serves as the platform that welcomes webinars from other societies to share their information. In September 2020, International Microsurgery Webinar League was established via the significant webinar hosts, with more than 300 recorded webinar talks connected successfully.

CONCLUSION

 As the knowledge revolution driven by COVID-19 will continue, IMC will keep playing an essential role in exploring new and emerging opportunities to improve knowledge dissemination worldwide beyond the space-time boundary.

Clinical impact of acquired risk factors in TTN-mediated dilated cardiomyopathy

Background/Introduction

Truncating variants in TTN-encoded titin (TTNtvs) underlie ∼25% of familial dilated cardiomyopathy (DCM) cases. In addition, TTNtvs are over-represented in alcoholic, peripartum, and chemotherapy-induced CM suggesting that risk factors may play a substantive role in the penetrance and expressivity of TTN-mediated DCM.

Purpose

To determine the prevalence and clinical impact of risk factors for TTN-mediated DCM within a single center cohort of unrelated patients with pathogenic (P)/likely pathogenic (LP) TTNtvs.

Methods

In this retrospective study, an institutionally developed natural language processing algorithm was used to identify all TTNtv-positive patients evaluated clinically between 01/2012 and 12/2019. Each TTNtv was then mapped to the TTN reference sequence (NM_133378.4) and classified according to a strict interpretation of the 2015 American College of Medical Genetics and Genomics (ACMG) guidelines. After exclusion of individuals with complex congenital heart disease, ischemic heart disease, and those without ACMG P/LP TTNtvs, available medical records were reviewed for risk factors such as long-term heavy alcohol consumption (&gt;80 grams/day), cardiotoxic chemotherapy exposure, morbid obesity (body mass index &gt;40), biopsy/imaging-confirmed myocarditis, peripartum/tachycardia-mediated CM, and valvular heart disease.

Results

Overall, 33 ACMG P/LP TTNtv-positive patients were identified (40% female; mean age at presentation 45±16 years; mean LVEF at presentation 38%±17%). Of note, 17/33 (52%) presented with heart failure (HF) and 4/33 (12%) presented with sustained ventricular arrhythmias (VAs). The remaining 12 (36%) TTNtv-positive patients presented with incidentally detected asymptomatic left ventricular systolic dysfunction (n=9) or as a result of genetic cascade screening (n=3). In comparison to TTNtv-positive patients with non-HF presentations, those with HF had worse left ventricular function (mean LVEF: 26% ± 11% vs 51% ±12%; p&lt;0.001) and were more likely to have ≥1 risk factor [11/17 (65%) vs 4/16 (25%); p=0.04]. Unexpectedly, the 7 TTNtv-positive patients that presented with (n=4) or subsequently developed (n=3) sustained VAs were younger at the time of presentation (34±13 years vs 48±15 years; p=0.04) and displayed a similar degree of left ventricular dysfunction to those without sustained VAs (mean LVEF: 42% ± 17% vs 36% ± 17%; p=ns). Interestingly, the only risk factor over-represented amongst those with sustained VAs was bileaflet mitral valve prolapse [3/7 (43%) vs 0/26 (0%); p=0.006].

Conclusion

The majority of TTNtv-positive patients (14/23; 61%) with a history of HF and/or sustained VAs possessed ≥1 acquired risk factor providing further evidence that gene-environment interaction(s) exert a crucial role in the manifestation of TTN-mediated disease.

Funding Acknowledgement

Type of funding source: None

Utilization of cardiac MRI for the assessment of suspected rejection with negative biopsy in heart transplant recipients

Background

Heart transplant (HTx) patients can develop graft dysfunction (GD) without biopsy evidence of cell or antibody mediated rejection. Cardiac MRI (CMR) can detect inflammatory or infiltrative causes of cardiomyopathy however CMR findings in HTx recipients with GD have not been previously described.

Purpose

We sought to identify CMR characteristics of HTx patients with GD, and evaluate its additive value in its diagnosis and prognosis.

Methods

CMR has been performed routinely to evaluate GD at our institutions. There were 37 HTx recipients who presented with acute decline in left ventricular ejection fraction (LVEF) of &lt;50% and &gt;10% from baseline, with no biopsy evidence of rejection between 2007 and 2018. Coronary angiogram with IVUS was done to rule out allograft vasculopathy. Treatment of GD was per discretion of the treating clinician. Responders were defined as those with LVEF improvement &gt;10% at 180 days or greater post-presentation. LV and RV indices, the presence and pattern of late gadolinium enhancement (LGE) were determined by CMR.

Results

There were 34% females and mean age at transplant was 49±13 years. Median time from HTx to GD was 1.2 years. Presenting symptoms were heart failure (n=25), cardiogenic shock (n=1) and 11 patients were asymptomatic. Mean LVEF at presentation was 37±12% and donor specific antibodies were detected in 38% patients. Most patients were treated with steroid bolus (n=29), and/or plasmapheresis (n=23). There were no major changes made in immunosuppression in 6 patients. Delayed enhancement MRI was performed with standard inversion-recovery (IR) gradient echo sequences, between 5 and 20 minutes after institutional-standard protocol administration of IV gadolinium contrast. Biventricular LGE was present in 18/37 (49%) patients with GD and was more prevalent in responders (57%, 13 of 23) than non-responders (35%, 5 of 14), although not statistically significant (p=0.21). There were two patterns of LGE noted: 1) Diffuse epicardial (10 patients out which 9 were responders) and 2) Patchy pattern with non-specific distribution (8 patients out of which 4 were responders). Myocardial edema by triple IR sequencing was seen in 6 patients, all having diffuse epicardial pattern of enhancement matching the delayed enhancement pattern. When comparing different treatment groups, among those treated for GD (n=31), 12 of 21 (57%) responders had LGE and 4 of 10 (40%) non-responders had LGE (p=0.37), a pattern similar to the broader population. Among those not treated for GD (n=6), 1 of 2 responders had LGE and 1 of 4 non-responders had LGE (p=0.5).

Conclusion

CMR identified inflammation as a potential cause of GD in approximately 50% of HTx patients. There are 2 distinct patterns of LGE observed in GD, diffuse epicardial (56%) and patchy (44%). Although the presence of LGE in itself is not associated with myocardial recovery, 90% of patients with a diffuse epicardial pattern have recovery of GD.

Funding Acknowledgement

Type of funding source: None

ACCIDENTAL FINDING OF SYNCHRONOUS BILATERAL DUCTAL CARCINOMA IN SITU IN A YOUNG MAN REFERRED TO MASTECTOMY DUE TO GYNECOMASTIA - AND WHAT IF LIPOSUCTION HAVE BEEN USED? CASE REPORT

Breast male cancer is a rare condition. We report a case of a synchronous bilateral ductal carcinoma in situ (DCIS) which developed in a 26-year-old man with long-standing gynecomastia. He underwent bilateral subcutaneous mastectomy. Histology revealed bilateral pure DCIS. There was no identifiable causative factor for the development of bilateral DCIS, and there was no family history of the disease. No other treatment was required, and after 18 months there were no signs of local recurrence. This case highlights the importance of staying vigilant regarding the presence of malignancy in normally benign conditions. Liposuction has become a very useful technique for gynecomastia correction, however, there is a risk of dissemination of an unknown malignant tumor. In atypical cases, en bloc surgical excision should be performed.

A Five-Year Retrospective Cohort Study Analyzing Factors Influencing Complications after Nasal Trauma

The purpose of this study was to assess the outcomes of patients with nasal trauma during a long period of time and determine factors predisposing to complications after nasal trauma treatment. A retrospective cohort study was conducted that included all patients who were attended for a nasal trauma between January and December 2010. In 2015, the charts were retrospectively reviewed and the patients were prospectively followed up looking for outcomes after treatment of nasal trauma. A univariate analysis between complications and risk factors was performed and a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A total of 220 consecutive patients with nasal trauma were included in the study. The mean follow-up was 44.3 ± 10.3 months (3-67) with 10% of lost patients. The most important factors determining complications after nasal trauma treatment were male gender, acute septal injury, chronic septal deviation, displaced or comminuted fractures in the radiologic study, and late nasal reduction surgery. A decision-making algorithm is proposed based on the fact that nasal bone fracture is not a minor problem and that closed nasal bone reduction is not the treatment of choice for all patients with nasal trauma.