Key Insights and Clinical Pearls in the Identification and Management of Cirrhosis and Its Complications.

Cirrhosis is a prevalent, chronic condition with an asymptomatic compensated phase, in which patients may feel well, and a decompensated phase that begins with the onset of complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding). Because patients with cirrhosis may appear healthy with normal liver enzymes, alkaline phosphatase, and serum bilirubin levels, awareness of clinical signals is important. For example, patients with thrombocytopenia should be evaluated for chronic liver disease and cirrhosis.

Adherence in Hepatitis C Virus Treatment: What We Know.

Although therapy with direct-acting antiviral (DAA) agents achieves high hepatitis C virus (HCV) cure rates and is forgiving of missed doses, certain patient populations, such as people who inject drugs (PWID), are often denied therapy because of a perceived high risk of nonadherence. However, a relationship between adherence to DAAs for various patient populations and efficacy has not been well defined. The lack of a standardized method for evaluating adherence complicates making comparisons between studies, making it difficult to develop and implement novel measures that may improve adherent behavior.

Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity.

Study Design: Retrospective review of prospectively collected data.

Objective: To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD).

Background: Spine, hip, and knee pathologies often overlap in ASD patients.

Cholangiocarcinoma Surveillance Recommendations in Patients with Primary Sclerosing Cholangitis.

Cholangiocarcinoma (CCA) is a deadly complication observed in the setting of primary sclerosing cholangitis (PSC). When symptoms develop and CCA is diagnosed, it is usually at an advanced stage. Median survival is less than 12 months.

The Case for Operative Efficiency in Adult Spinal Deformity Surgery: Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient-Reported Outcomes.

Study Design: Retrospective review of prospectively collected data.

Objective: To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes.

Background: It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes.

Commentary on: "Septal Advancement Flap" by Ferriera: Caudal Septal Extension Graft, Columellar Strut, or the New Septal Advancement Flap.

The septal advancement flap is introduced as a new technique to support the nasal base in preservation rhinoplasty. The SAF is a septal flap composed of the caudal septum in continuity with the high strip incision used in dorsal preservation. The technique is supported with a strut of cartilage between the medial crura.

Structural Approach to Secondary Repair of the Unilateral Cleft Lip Nasal Deformity.

Management of the unilateral cleft lip nasal deformity is complex because of the underlying significant asymmetry of the lower lateral cartilages and soft tissues of the nasal base. Suturing and grafting techniques may leave the patient with residual asymmetries of the nasal tip and nostrils. Some of this residual asymmetry may be attributable in part to the anchoring effect of the vestibular skin attachments to the lower lateral cartilages.

Auricular Composite Graft Survival in Rhinoplasty.

Auricular composite grafts can be used in rhinoplasty to correct defects of the internal nasal valve, ala, vestibule, sill, and external nose. The objective of this study was to measure the auricular composite graft (ACG) survival rate and patient-reported outcome with Nasal Obstruction Symptom Evaluation (NOSE) score among patients undergoing rhinoplasty. A retrospective chart review was performed of all patients who underwent rhinoplasty with ACGs from 2002 to 2019 by the senior author.

Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities.

Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries.

My First Twenty Rhinoplasties Using Dorsal Preservation Techniques.

Dorsal preservation involves eliminating the dorsal hump by performing reduction while preserving the patient's natural dorsal anatomy. This can involve surface manipulation or foundational techniques or a combination of both. When surgeons begin performing dorsal preservation, there are important factors to consider to avoid complications.

Subdorsal Cantilever Graft: Indications and Technique.

The subdorsal cantilever graft (SDCG) is a costal cartilage graft that is positioned below the nasal dorsum to control the position of the nasal bones and middle nasal vault. SDCG type A is used to raise the middle nasal vault and caudal nasal bones to correct the saddle nose deformity. SDCG type B can be used to raise the entire dorsum of the nose (radix, bony vault, and middle vault) in the ethnic augmentation rhinoplasty patient.

Building Programs to Eradicate Toxoplasmosis Part I: Introduction and Overview.

Purpose Of Review: Review building of programs to eliminate infections.

Recent Findings: Morbidity and mortality from toxoplasmosis led to programs in USA, Panama, and Colombia to facilitate understanding, treatment, prevention, and regional resources, incorporating student work.

Summary: Studies foundational for building recent, regional approaches/programs are reviewed.

Subdorsal Cantilever Graft for Elevating the Dorsum in Ethnic Rhinoplasty.

Augmentation of the nasal dorsum is frequently required in the ethnic rhinoplasty patient to create a narrowing effect and to balance the upper two thirds of the nose with the desired increase in tip projection. The subdorsal cantilever graft (SDCG) provides a method to elevate the nasal dorsum to complement the increase in nasal tip projection. SDCG type A is situated below the bony dorsum and acts to raise the dorsum with limited elevation of the radix.

Structural Preservation Rhinoplasty: A Hybrid Approach.

Structural preservation rhinoplasty merges two popular philosophies of rhinoplasty-structure rhinoplasty and preservation rhinoplasty-in an effort to maximize patient outcomes, aesthetics, and function. This allows the surgeon to both preserve the favorable attributes of the nose, and also to structure the nasal tip and dorsum with grafts to maximize contour and support. The concept of dorsal preservation is to preserve favorable dorsal aesthetic lines without the creation of an "open roof.