National Patterns in Surgical Management of Syndactyly: A Review of 956 Cases

Purpose: Being one of the most common congenital hand malformations, syndactyly is repaired by orthopedic, plastic, and fellowship-trained general surgeons. Limited multi-institutional outcomes analyses regarding incidence, timing, and type of repair exist. Methods: All syndactyly cases performed over a 5-year period from 2012-2016 were isolated from the National Surgical Quality Improvement Program Pediatric database. Patient demographics, surgical factors, perioperative outcomes, and risk factors were analyzed using χ², Fisher exact, and t-test analysis. Results: A total of 956 patients who underwent syndactyly repair were identified. Most cases were simple syndactyly with nearly even case distribution among plastic and orthopedic surgeons. Most patients were men and Caucasian. Mean age at the time of surgery was 2.6 years. Most cases were performed as outpatient surgery. Patients of plastic surgeons had significantly more airway abnormalities and shorter operative times. Patients with complex syndactyly had significantly more ventilator dependence, tracheostomy, and comorbidities when compared with those with simple syndactyly. Cases with complex syndactyly also had longer operative times and a higher rate of superficial surgical site infections. Conclusions: Syndactyly repair is a safe procedure with few major or minor reconstructive complications regardless of the surgical specialty or syndactyly type. Patients with complex syndactyly have significantly more preoperative comorbidities with comparable outcomes. orthopedic surgeons have significantly longer operative times than plastic surgeons, likely due to caring for increased number of patients with complex syndactyly.

The impact of body mass index on reduction mammaplasty: a multicenter analysis of 2492 patients

BACKGROUND

Reduction mammaplasty is commonly performed in women who are considered obese by the body mass index (BMI) classification of the World Health Organization.

OBJECTIVES

The authors compare complication rates among breast reduction patients, stratified by BMI, across multiple institutions.

METHODS

A retrospective analysis was performed of all reduction mammaplasties in the database of the National Surgical Quality Improvement Program for 2006 through 2010. Demographic, comorbidity, and BMI data were collected. Data on medical and surgical complications, reoperation, and mortality were collected through 30 days postsurgery.

RESULTS

Of 2492 patients, 55% were considered obese (BMI >30). The overall rate of surgical complications was 4.0%, increasing from 2.4% for BMI <25 to 7.1% for BMI >45 (P = .006), with an adjusted odds ratio of 2.97 for BMI >45 versus BMI <25. The most common surgical complication was superficial surgical site infection; it was found in 2.9% of patients, increasing from 2.1% for BMI <25 to 5.1% for BMI >45 (P = .03). The medical complication rate was 0.6%, and the reoperation rate was 2.1%. There were no deaths. A maximal point analysis showed that BMI ≥39 was associated with a significantly higher complication rate, with an odds ratio of 2.38.

CONCLUSIONS

Reduction mammaplasty is a safe surgical procedure, even when performed on obese patients. However, patients with higher BMI have a greater risk of surgical site complications. This risk should be discussed preoperatively with obese patients.

Calcium-sensing receptor abrogates secretagogue- induced increases in intestinal net fluid secretion by enhancing cyclic nucleotide destruction

The calcium-sensing receptor (CaSR) provides a fundamental mechanism for diverse cells to detect and respond to modulations in the ionic and nutrient compositions of their extracellular milieu. The roles for this receptor are largely unknown in the intestinal tract, where epithelial cells are normally exposed to large variations in extracellular solutes. Here, we show that colonic CaSR signaling stimulates the degradation of cyclic nucleotides by phosphodiesterases and describe the ability of receptor activation to reverse the fluid and electrolyte secretory actions of cAMP- and cGMP-generating secretagogues, including cholera toxin and heat stable Escherichia coli enterotoxin STa. Our results suggest a paradigm for regulation of intestinal fluid transport where fine tuning is accomplished by the counterbalancing effects of solute activation of the CaSR on neuronal and hormonal secretagogue actions. The reversal of cholera toxin- and STa endotoxin-induced fluid secretion by a small-molecule CaSR agonist suggests that these compounds may provide a unique therapy for secretory diarrheas.

Hypochondriasis: the patient's perspective

OBJECTIVE

The purpose of this investigation was to learn how patients with hypochondriasis view their physicians and medical care.

METHOD

To accomplish this, we identified 20 patients with DSM-III-R hypochondriasis and 26 nonhypochondriacal patients from a general medicine clinic. Using a semistructured interview, we obtained information from patients about their recent health problems and medical care. The investigators then reviewed transcribed interviews and assigned comments to a series of categories.

RESULTS

Hypochondriacal and non-hypochondriacal patients made equal numbers of positive comments, but hypochondriacal patients made significantly more negative comments about physicians' professional characteristics, characteristics of the patients themselves and total negative comments. Many viewed physicians they had seen as unskilled and uncaring. They indicated that, in many instances, their relationships with physicians had suffered from poor communication and collaboration.

CONCLUSION

Since successful management of patients with hypochondriasis rests upon positive relationships, ways must be found to improve the frustrating and costly situation that currently exists.

Neuroleptic malignant syndrome: an overview

Neuroleptic Malignant Syndrome (NMS) is a specific, potentially lethal disorder related to the usage of dopamine antagonists. The four clinical hallmarks associated with this syndrome are 1) hyperthermia, 2) muscle rigidity, 3) mental status changes, and 4) autonomic instability. NMS has been estimated to occur in 0.02% to 3.23% of patients receiving dopamine antagonist therapy. The wide range of incidence is probably related to the variability in diagnostic criteria, survey techniques, and patient populations. Although the incidence of NMS is rare, the inherent mortality for patients developing NMS is significant. Fortunately, the mortality has gone from 25% before 1984 to 11.6% thereafter. This is probably related to greater awareness of the syndrome by the physician with early diagnosis and treatment and also to the advent of newer therapeutic modalities. Current methods of treatment include withdrawal of the dopamine antagonist, control of the hyperpyrexia, administration of a dopamine agonist, and the administration of dantrolene. Electroconvulsive therapy has been advocated in patients unresponsive to the above therapies. The reinstitution of dopamine antagonist therapy after an episode of NMS is possible. Specific protocols are available and are currently under revision by researchers. The current data indicate that the risk of a recurrence of NMS is about 30% if the protocol is followed.

The endogenous inhibitor of protein kinase-C in the rat ovary is a protein phosphatase

Calcium- and lipid-dependent protein kinase (PKC) activity in the ovary of the pseudopregnant rat is masked by an endogenous inhibitor of PKC. These studies were undertaken to examine the mechanism of action of the endogenous inhibitor of PKC in the rat ovary. The addition of the phosphatase inhibitors calyculin-A (0.09 nM), microcystin-LR (6.4 nM), and okadaic acid (10 nM) resulted in the loss of PKC inhibitory activity and an increase in basal PKC activity in rat ovarian cytosol. In phosphatase assays, significant dephosphorylation of histone-III-S or myelin basic protein that had been phosphorylated by PKC occurred within 4 min after the addition of ovarian cytosol from the pseudopregnant rat. This dephosphorylation was prevented from the pseudopregnant rat. This dephosphorylation was prevented by the addition of calyculin-A (0.73 nM) and was removed by fractionation of ovarian cytosol on diethylaminoethyl cellulose. No inhibition of PKC activity was observed when the PKC-specific peptides AcMBP-(4-14) and [Ser25]PKC-(19-31) were used as the substrate for phosphorylation. In addition, rat ovarian cytosol did not exhibit phosphatase activity when the peptide AcMBP-(4-14) was used as the substrate. Addition of ovarian cytosol resulted in dephosphorylation of phosphorylase-alpha phosphorylated by phosphorylase kinase, but not dephosphorylation of histone-II-A or histone-VIII-S phosphorylated by PKA. The data suggest that the endogenous inhibitor of PKC in the rat ovary is a protein phosphatase.