Early emergency department discharge for intermediate heart score patients presenting for chest pain.

Study Objective: The use of the HEART score to risk stratify patients for short-term major adverse cardiac events in the emergency department (ED) setting is well established. Although discharge to home for low-risk HEART score patients is widely accepted as safe practice, there are limited outcomes data on moderate-risk HEART score patients discharged to home. We investigated the safety of discharging moderate-risk HEART score patients to home from the ED with established early cardiology follow-up.

Parathyroid hormone-driven algorithms after thyroid surgery: Not one-size-fits-all.

Background: Underreported variation in parathyroid hormone (PTH) assays exists. Using quality improvement methods, we aimed to develop an institution-specific PTH-based protocol to predict hypocalcemia after thyroidectomy.

Methods: We retrospectively reviewed patients who underwent total/completion thyroidectomy.

Achieving Aesthetic Results in the Umbilical Float Mini-Abdominoplasty: Patient Selection and Surgical Technique.

Background: The umbilical float mini-abdominoplasty has been criticized for low final umbilicus position and umbilical distortion. The authors believe that in the properly selected patient and with proper technique, the umbilical float can achieve superior aesthetic results in a subset of patients.

Methods: A retrospective review was performed of all umbilical floats performed by two surgeons (B.

IL-13 is produced by tumor cells in breast implant-associated anaplastic large cell lymphoma: implications for pathogenesis.

More than 500 women worldwide have developed a CD30+ T-cell lymphoma around breast implants, strongly suggesting a cause-and-effect relationship, and designated as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The mechanism of lymphomagenesis is unknown. Recently, a bacterial biofilm containing gram-negative bacilli was discovered on the surface of breast implants associated with ALCL.

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation.

Objectives: Atrial fibrillation (AFib) is the most common dysrhythmia in the United States. Patients seen in the emergency department (ED) in rapid AFib are often started on intravenous rate-controlling agents and admitted for several days. Although underlying and triggering illnesses must be addressed, AFib, intrinsically, is rarely life-threatening and can often be safely managed in an outpatient setting.

Characterization of retentive capacity of the subpericranial pocket in cochlear implants with and without a pedestal.

Objectives/hypothesis: To quantify the retentive capacity (RC) of the subpericranial pocket (SpP) in children undergoing cochlear implantation (CI) and measure improvements in RC with the addition of a pedestal to the device base. Retention of a CI in an SpP relies on the integrity of surrounding tissues to determine device position and resist movement from external forces. We hypothesize that device position can be controlled and resistance to movement can be improved with placement of a small pedestal on the base of the CI receiver stimulator.

Influence of preoperative velar closing ratio and lateral wall movement on outcomes of Furlow palatoplasty for velopharyngeal incompetence.

Currently, there is no consensus regarding how to determine the optimal surgical procedure for a patient with velopharyngeal incompetence (VPI) post-primary palate repair. The purpose of the present study was to assess the effect of preoperative velar closing ratio (VCR) and lateral wall movement (LWM) on nasal emission and hypernasality after Furlow double-opposing Z-plasty. A retrospective analysis involving patients with VPI post-primary palatoplasty whose VPI was treated with double-opposing Z-plasty by a single surgeon was performed.

Reversal of skin aging with topical retinoids.

Topical skin care and its place in plastic surgery today are often overlooked by clinicians formulating a plan for facial rejuvenation. Not only is it important to consider topical skin care as part of comprehensive care, but clinicians should also be educated with the data available in today's literature. This review aims to familiarize the reader with the biological processes of skin aging and evidence-based clinical outcomes afforded by various topical therapies.

Contractility of sphincter pharyngoplasty: Relevance to speech outcomes.

Background: Sphincter pharyngoplasty has demonstrated time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). However, controversy surrounding the contractility of the transposed muscles persists. Completely unaddressed in the literature is whether the dynamism of the sphincter affects speech outcomes.

The Science and Theory behind Facial Aging.

The etiology of age-related facial changes has many layers. Multiple theories have been presented over the past 50-100 years with an evolution of understanding regarding facial changes related to skin, soft tissue, muscle, and bone. This special topic will provide an overview of the current literature and evidence and theories of facial changes of the skeleton, soft tissues, and skin over time.

Impact of cleft palate type on the incidence of acquired cholesteatoma.

Objectives: The objectives of this study were to determine the incidence of acquired cholesteatoma in children with congenital cleft palate, and to determine the impact of various cleft palate types (cleft lip and palate, cleft palate alone, submucous cleft palate) on the development of acquired cholesteatoma.

Materials And Methods: This is a retrospective cohort study spanning a 25-year period from 1981 to 2005. The Cleft Palate Registry at the Hospital for Sick Children in Toronto, Canada was cross-referenced with the hospital's surgical pathology database to identify all children with cleft palate and acquired cholesteatoma.

Prenatal counseling's effect on rates of neonatal intensive care admission for feeding problems cleft lip/palate infants.

Prenatal counseling and feeding instruction is standard at our institution for parents of cleft lip and palate patients. We studied this intervention's effect on Neonatal Intensive Care Unit (NICU) admission solely for feeding. Ten percent (2/20) of patients whose parents received counseling were admitted to the NICU for feeding issues alone compared to 21% (5/24) of the non-counseling group.

Toward engineering functional organ modules by additive manufacturing.

Tissue engineering is emerging as a possible alternative to methods aimed at alleviating the growing demand for replacement tissues and organs. A major pillar of most tissue engineering approaches is the scaffold, a biocompatible network of synthetic or natural polymers, which serves as an extracellular matrix mimic for cells. When the scaffold is seeded with cells it is supposed to provide the appropriate biomechanical and biochemical conditions for cell proliferation and eventual tissue formation.

Exploring the relationship between head anatomy and cochlear implant stability in children.

In our experience, surgical outcomes in children have been excellent with a low complication rate. Our aim in this study was to better understand what aspects of our current surgical technique have been successful with a view to retain those that are beneficial as we proceed with implantation of future devices. Because the receiver-stimulator and overlying skin flap may be more vulnerable to damage in children than adults, we concentrated on issues related to the positioning and security of this part of the implant on the head.

Chorda tympani nerve function in children: relationship to otitis media and body mass index.

Objective/hypothesis: A relationship between acute otitis media and elevated body mass index has recently been reported. Intriguingly, it was postulated that this relationship may result from altered chorda tympani nerve function impacting taste sensation and eating habits. We sought to test this directly by measuring chorda tympani nerve function in children with and without a previous history of acute otitis media and to determine the relationship to body mass index.

Fine tuning lipoaspirate viability for fat grafting.

Background: The efficient harvest of abundant viable adipocytes for grafting is of considerable interest. Hand aspiration, low-g-force, short-duration centrifugation, and harvest of the lower sublayer of fat centrifugate maximize viable adiopocytes, but this process is cumbersome with conventional equipment. The Lipose Corporation (Greenwich, Conn.

Unilateral frontosphenoidal craniosynostosis with achondroplasia: a case report.

Isolated, premature fusion of the frontosphenoidal suture is rare. This report describes an unusual combination of frontosphenoidal craniosynostosis and achondroplasia. Although craniosynostosis is known to occur in allelic conditions such as thanatophoric dysplasia, craniosynostosis in individuals with achondroplasia is exceedingly rare.

The inability of B-type natriuretic protein to predict short-term risk of death or myocardial infarction in non-heart-failure patients with marginally increased troponin levels.

Study Objective: We want to know whether a low B-type natriuretic peptide (BNP) level, obtained shortly after presentation and independent of information provided by other clinical findings and laboratory tests, would affect management decisions for emergency department (ED) patients with nondiagnostic troponin levels. Previous studies have generally been retrospective or inclusive of patients with heart failure.

Methods: We prospectively studied patients evaluated for possible acute coronary syndromes who had nondiagnostic levels of serum troponin, nondiagnostic ECGs, and no clinical heart failure within 4 hours of presentation.

Adenoid involvement in velopharyngeal closure in children with cleft palate.

Objective: To assess the role of the adenoid pad in velopharyngeal (VP) closure.

Design: A retrospective review of patients with cleft palate (CP) who underwent nasendoscopy and multiview videofluoroscopy during evaluation for VP insufficiency (VPI) from January 2006 to March 2008.

Patients: Thirty-two consecutive patients were identified.

Splinting after carpal tunnel release: current practice, scientific evidence, and trends.

Background: Postoperative splinting is common after carpal tunnel release, despite a lack of scientific evidence supporting its value. The purpose of this study was to characterize postoperative splinting regimens among hand surgeons and to identify trends in splint use after this procedure.

Methods: Questionnaires were mailed to members of the American Society for Surgery of the Hand.

Predictors and outcomes of emergency department visits within 30 days following percutaneous coronary intervention.

Our objective was to determine the frequency and predictive factors for cardiac-related emergency department (ED) encounters within 30 days after percutaneous coronary intervention (PCI). The data source was an electronic database of 2,731 patients who had PCI from 2002 to 2004. Almost all underwent stent placement.

Investigation of connective tissue attachments to the cervical spinal dura mater.

The connective tissue attachments to the cervical spinal dura mater originating from the ligamentum nuchae (LN) and rectus capitis posterior minor (RCPM) muscle were evaluated in 30 cadaveric spines. Magnetic resonance images (MRIs) were correlated with the attachments in four cadaveric specimens. Attachments from the LN to the RCPM were also identified.