The Canadian Society for Aesthetic Plastic Surgery 40th Annual Meeting: September 20 & 21, 2013, Vancouver,British Columbia

After studying the anatomy of 10 fresh cadavers, we developed a technique for the treatment of the cervical area during face lifts. We called this technique PLATYSMA-SUSPENSION and PLATYSMA-PEXY rather than plication. This technique consists of suspending the free edge of the platysma muscle and fixing it to a resistant tissue close to the earlobe (Loré’s fascia or temporo-parotid fascia). The anterior triangle of the neck was well defined and there was no need to undermine the platysma muscle because of a perfect sliding plane between the platysma and sternocleidomastoid muscles. This technique is both simple and effective. It generates long-lasting results, without the inconveniences or complications associated with other techniques.

MATERIALS AND METHODS:

Ten fresh cadavers (ie, 20 hemifaces) were subjected to the proposed technique. They were photographed and filmed at all stages.Ten more cadavers were dissected to study the submental area and we discovered that the best way to recreate the cervico mental angle and to rebuild the floor of the mouth is to use a digastric corset so that we could rebuild the retaining ligaments between the platysma/digastric and mylohyoïd muscles.More than 100 patients were operated by the senior author; they underwent platysma-suspension and platysma-pexy of the fascia described by Loré; associated in difficult necks (Knize 3 and 4 necks) with the digastric corset. The patients were followed-up for a minimum of 12 months.

CONCLUSION:

PLATYSMA-SUSPENSION and PLATYSMA-PEXY in the fascia described by Loré is an extremely long-lasting and effective technique in cervical lifting. It generates impressive results, even in the most inferior portion of the neck. It redefines the entire anterior triangle, especially the sternocleidomastoid muscle and the mandibular contours. Furthermore, PLATYSMA-SUSPENSION minimizes the risk of nerve injury and hematoma by preventing deep and unnecessary dissections because the superficial cervical fascia has a perfect sliding plane between the platysma and the deepest structures of the neck.In difficult necks, we do associate a digastric corset using a submental incision.Pre-op botulinum toxin injections appears to be of great interest leaving the muscle at rest during the post-operative phase.

• Can J Plast Surg. 2013 Winter; 21(4): 253–255.
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• 2: Facial Palsy: Lengthening Temporalis Myoplasty and Smile Reanimation

Can J Plast Surg. 2013 Winter; 21(4): 253.

2: Facial Palsy: Lengthening Temporalis Myoplasty and Smile Reanimation

D LabbéAuthor information Copyright and License information DisclaimerCaen, FranceCopyright ©2013 Canadian Society of Plastic Surgeons. All rights reserved     

An unexpected cause of cardiac arrest during laparoscopy in an infant with supravalvar aortic stenosis

Patients with congenital supravalvar aortic stenosis (SVAS) with associated biventricular outflow tract obstruction and coronary artery abnormalities have a tenuous myocardial oxygen supply/demand relationship. They are at increased risk of acute myocardial ischemia and sudden death, especially during anesthesia. Furthermore, resuscitation during cardiac arrest is frequently unsuccessful. We report a case of perioperative cardiac arrest due to an unexpected cause in a 2 month old with SVAS during a laparoscopic Nissen fundoplication.     

Age- and gender-related differences in cortical geometry and microstructure: Improved sensitivity by regional analysis

ObjectiveWhile the importance of cortical structure quantification is increasingly underscored by recent literature, conventional analysis techniques obscure potentially important regional variations in cortical structure. The objective of this study was to characterize the spatial variability in cortical geometry and microstructure at the distal radius and tibia using high resolution peripheral quantitative computed tomography (HR-pQCT). We show that spatially-resolved analysis is able to identify cortical sub-regions with increased sensitivity to the effects of gender and aging.MethodsHR-pQCT scans of 146 volunteers (92 female/54 male) spanning a wide range of ages (20–78 years) were analyzed. For each subject, radius and tibia scans were obtained using a clinical HR-pQCT system. Measures describing geometry (cortical bone thickness (Ct.Th)), microstructure (porosity (Ct.Po), pore diameter (Ct.Po.Dm), and pore size heterogeneity (Ct.Po.Dm SD)), and cortical bone density were calculated from the image data. Biomechanical parameters describing load and stress distribution were calculated using linear finite element analysis. Cortical quadrants were defined based on anatomic axes to quantify regional parameter variation. Subjects were categorized by gender, and age, and menopausal status for analysis.ResultsSignificant regional variation was found in all geometric and microstructural parameters in both the radius and tibia. In general, the radius showed more pronounced and significant variations in all parameters as compared with the tibia. At both sites, Ct.Po displayed the greatest regional variations. Correlation coefficients for Ct.Po and Ct.Th with respect to load and stress distribution provided evidence of an association between regional cortical structure and biomechanics in the tibia. Comparing women to men, differences in Ct.Po were most pronounced in the anterior quadrant of the radius (36% lower in women (p < 0.01)) and the posterior quadrant of the tibia (27% lower in women (p < 0.01)). Comparing elderly to young women, differences in Ct.Po were most pronounced in the lateral quadrant of the radius (328% higher in elderly women (p < 0.001)) and the anterior quadrant of the tibia (433% higher in elderly women (p < 0.001)). Comparing elderly to young men, the most pronounced age differences were found in the anterior radius (205% higher in elderly men, (p < 0.001)) and the anterior tibia (190% higher in elderly men (p < 0.01)). All subregional Ct.Po differences provided greater sensitivity to gender and age effects than those based on the global means.ConclusionThese results show significant regional variation in all geometric and microarchitectural parameters studied in both the radius and tibia. Quantification of region-specific parameters provided increased sensitivity in the analysis of age- and gender-related differences, in many cases providing statistically significant differentiation of groups where conventional global analysis failed to detect differences. These results suggest that regional analysis may be important in studies of disease and therapeutic effects, particularly where microstructural parameters based on global analyses have thus far failed to identify a response in bone quality.     

Medicaid and privately financed orthodontic patients have similar occlusal and psychosocial outcomes

Objective: This study compares occlusal and psychosocial outcomes from comprehensive orthodontic treatment in Medicaid (MC) and privately financed (private pay, PP) patients. Methods: Two cohorts received comprehensive orthodontics: MC (n = 66); PP (n = 60). A calibrated, blinded examiner scored dental casts at baseline (pretreatment, T1) and after completing 2 years of treatment (posttreatment, T2) using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome, and Need (ICON). The prevalence of patients in the validated ICON categories for treatment need, complexity, and improvement were calculated. Questionnaires to assess body image (BI) and expectations/experiences were administered. Occlusal measures at T2 were compared after adjustment for baseline characteristics. Psychosocial measures were compared between and within groups. Occlusal and psychosocial associations were evaluated. Results: MC was 1.3 years younger (P < 0.001) and had worse malocclusions at baseline (PAR 32 versus 25; P < 0.001); (ICON 64 versus 56; P = 0.06). After adjustment for age and initial severity, estimated average differences between groups at T2 (MC‐PP) were slight: 1.5 [95 percent confidence interval (CI) ?2.9, 5.9] and 2.4 (95 percent CI ?4.4, 8.9) for PAR and ICON, respectively. More PP completed treatment under 2 years (85 percent versus 62 percent; P = 0.03). At baseline, both groups needed treatment, but MC malocclusions were more complex (P = 0.05). At T2, both groups were acceptable and there were no differences in ICON improvement categories. Group differences in psychosocial measures and associations between psychosocial and occlusal measures were evident in the “teeth” domain but weak or lacking elsewhere. Conclusions: Occlusal and psychosocial outcomes from orthodontics in MC and PP were comparable, despite worse MC malocclusions at baseline.     

Nonsuicidal self-injury disorder: Clinician and expert ratings

Nonsuicidal self-injury (NSSI) is a growing clinical and public health problem that affects individuals from all age groups, most prominently young adults. NSSI involves numerous methods and functions. NSSI has long been associated with borderline personality disorder (BPD), and in fact, it is only referenced among the diagnostic criteria of BPD in the DSM-IV-TR. However, recent studies have provided strong evidence that NSSI occurs outside of BPD. For these reasons, a diagnosis of nonsuicidal self-injury is included in DSM-5 Section-III as a condition that requires further study. The primary purpose of the present study was to identify whether the proposed DSM-5 NSSI criteria adequately reflect the symptoms of a prototypic individual who engages in self-injury. Clinicians in private practice and expert NSSI researchers (n=119) were asked to describe their familiarity and agreement with the proposed DSM-5 NSSI criteria, as well as the degree to which each proposed criterion is a prototypic symptom. Overall, most participants reported that the proposed DSM-5 criteria for NSSI accurately captured the behavior of the prototypic self-injurer. The results of this study provide incremental support for the proposed DSM-5 NSSI diagnostic criteria.     

Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health

Objective

A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes.

Method

This study on the findings of the technical expert panel.

Results

Videoconferencing and standard telephone technologies to deliver psychotherapy have been well validated. Web-based interventions have shown efficacy across a broad range of mental health outcomes. Social media such as online support groups have produced disappointing outcomes when used alone. Mobile technologies have received limited attention for mental health outcomes. Virtual reality has shown good efficacy for anxiety and pediatric disorders. Serious gaming has received little work in mental health.

Conclusion

Research focused on understanding reach, adherence, barriers and cost is recommended. Improvements in the collection, storage, analysis and visualization of big data will be required. New theoretical models and evaluation strategies will be required. Finally, for BITs to have a public health impact, research on implementation and application to prevention is required.     

Estimating the prevalence of drinking problems among physicians

Objective

Surveys assessing alcohol use among physicians have most commonly employed the Alcohol Use Disorders Identification Test (AUDIT) or the AUDIT-C, the most common short version of the AUDIT. As with other screeners, prevalence estimation is dependent on the accuracy of the test as well as choice of the cutoff value. The aim of the current study is to derive more precise prevalence estimates of alcohol problems in physicians by correcting for false-positive and false-negative results.

Method

In the context of a survey, the AUDIT was sent out via email or standard postal service to all 2484 physicians in Salzburg, Austria. A total of 456 physicians participated. A published correction formula was used to estimate the real prevalence of alcohol use problems.

Results

Applying a cutoff of 5 points for the AUDIT-C, 15.7% of female and 37.7% of male physicians screened positive. Use of a correction based on general population data and the sensitivity and specificity of the AUDIT-C resulted in much lower prevalence rates: 4.0% for female and 9.5% for male physicians. Using the full AUDIT, 19.6% of the female physicians and 48% of the male physicians were screened positive. Using the correction, the estimated prevalence rates for females and males were 6.3% and 15.5%, respectively.

Conclusions

Our findings demonstrate that uncorrected screening results may markedly overestimate the prevalence of physicians drinking problems.     

Muscle and nerve biopsies: Techniques for the neurologist and neurosurgeon

Objective

Muscle and nerve biopsies are commonly performed procedures for the diagnosis of neuromuscular disorders. Neurologists and neurosurgeons are often consulted to perform these procedures in clinical practice. We provide guidelines in the performance of muscle and nerve biopsies.

Methods

We describe the technique for performance of muscle and nerve biopsy, and review the relevant literature.

Results

The quadriceps muscle is the most typical biopsy site for most myopathies, whereas the sural nerve is the most common nerve biopsy site for most peripheral neuropathies. Other sites may be utilized depending upon the pattern of symptoms or the differential diagnosis. Motor nerves may be sampled in the setting of motor neuron disease, for example. We advocate the use of conduit repair to allow for sensory or motor recovery to occur following nerve biopsy.

Conclusion

The muscle biopsy and nerve biopsy may be performed with high yield, low morbidity, and rare complications.     

Immunologic privilege in the central nervous system and the blood–brain barrier

The brain is in many ways an immunologically and pharmacologically privileged site. The blood–brain barrier (BBB) of the cerebrovascular endothelium and its participation in the complex structure of the neurovascular unit (NVU) restrict access of immune cells and immune mediators to the central nervous system (CNS). In pathologic conditions, very well-organized immunologic responses can develop within the CNS, raising important questions about the real nature and the intrinsic and extrinsic regulation of this immune privilege. We assess the interactions of immune cells and immune mediators with the BBB and NVU in neurologic disease, cerebrovascular disease, and intracerebral tumors. The goals of this review are to outline key scientific advances and the status of the science central to both the neuroinflammation and CNS barriers fields, and highlight the opportunities and priorities in advancing brain barriers research in the context of the larger immunology and neuroscience disciplines. This review article was developed from reports presented at the 2011 Annual Blood-Brain Barrier Consortium Meeting.