Determinants of patient satisfaction with ultrasound-assisted liposuction

Background: Liposuction is one of the most common aesthetic procedures and a number of options are available to practitioners in terms of surgical technique. One of those options is ultrasound-assisted liposuction (UAL), which has garnered considerable attention in the literature and from patients themselves. Because the role of ultrasound in body sculpting is continuing to increase over time, the authors believe that a comprehensive assessment of patient satisfaction after the procedure is essential. Currently, there are very few reports in the literature examining patient satisfaction with UAL, and to the authors' knowledge, no reports in the literature have successfully outlined the determinants and predictors of long-term satisfaction with the procedure. Objective: The authors examine the correlates and predictors of patient satisfaction after UAL. Methods: The authors conducted a prospective cross-sectional study on 609 consecutive patients who underwent UAL from 2002 to 2008. One hundred and sixty (54) out of 300 patients with whom the authors could make contact agreed to answer a standardized questionnaire regarding their overall satisfaction. Results: Nearly 80 of the patients were completely or mostly satisfied with UAL. Seventy-five percent reported that they had or would recommend UAL to others. Women (P =.009), patients who did not gain weight after their UAL procedure (P <.001), patients who were content with their body appearance (P <.001), patients whose dress sizes decreased after UAL (P =.001), and patients with confidence in their body (P <.001) showed statistically significant higher rates of satisfaction with UAL. Among these correlates, confidence in body (odds ratio OR = 24.4; 95% confidence interval CI: 6.8-83.3) and contentment with body appearance (OR = 5.5; 95% CI: 1.5-19.4) were found to be reliable independent predictors of patient satisfaction. Conclusion: Most patients were satisfied with UAL, but certain patient responses were more highly correlated with overall satisfaction than others and therefore can be considered predictors of long-term patient satisfaction with this procedure. The results of this study may provide plastic surgeons with valuable clues that can enhance preoperative planning and therefore enable further improvement of patients' satisfaction with UAL. © 2010 The American Society for Aesthetic Plastic Surgery, Inc

Urine macrophage migration inhibitory factor in pediatric systemic lupus erythematosus

We reported a series of ten patients with lupus nephritis (five patients in the relapse phase and five in the remission phase) and measured the macrophage migration inhibitory factor (MIF), an important pro-inflammatory cytokine with probable role in the pathogenesis of many inflammatory diseases, in their urine samples. MIF/creatinine (Cr) ratio directly correlated with disease activity and it does not have any significant difference between inactive disease and normal ones. We found that the urine MIF/Cr ratio not only differentiates active disease from inactive disease and normal ones but also correlates with the activity indices of renal pathology. © Clinical Rheumatology 2007

Measuring the Physiologic Properties of Oral Lesions Receiving Fractionated Photodynamic Therapy

Photodynamic therapy (PDT) can treat superficial, early‐stage disease with minimal damage to underlying tissues and without cumulative dose‐limiting toxicity. Treatment efficacy is affected by disease physiologic properties, but these properties are not routinely measured. We assessed diffuse reflectance spectroscopy (DRS) for the noninvasive, contact measurement of tissue hemoglobin oxygen saturation (StO2) and total hemoglobin concentration ([tHb]) in the premalignant or superficial microinvasive oral lesions of patients treated with 5‐aminolevulinic acid (ALA)‐PDT. Patients were enrolled on a Phase 1 study of ALA‐PDT that evaluated fluences of 50, 100, 150 or 200 J cm−2 delivered at 100 mW cm−2. To test the feasibility of incorporating DRS measurements within the illumination period, studies were performed in patients who received fractionated (two‐part) illumination that included a dark interval of 90–180 s. Using DRS, tissue oxygenation at different depths within the lesion could also be assessed. DRS could be performed concurrently with contact measurements of photosensitizer levels by fluorescence spectroscopy, but a separate noncontact fluorescence spectroscopy system provided continuous assessment of photobleaching during illumination to greater tissue depths. Results establish that the integration of DRS into PDT of early‐stage oral disease is feasible, and motivates further studies to evaluate its predictive and dosimetric value.Diffuse reflectance spectroscopy with a contact probe was employed as part of a fluorescence and reflectance spectroscopy system to measure the tissue hemoglobin oxygen saturation and hemoglobin content of lesions of premalignant or early microinvasive cancer of the oral cavity. Studies demonstrate the feasibility of incorporating these measurements into treatment with fractionated (two‐part) photodynamic therapy (PDT) using 5‐aminolevulinic acid. Patient‐specific differences in physiologic parameters were detectable at baseline and at times during and after PDT. Photobleaching of photosensitizer was measured by its fluorescence. Results establish the utility of rationally designed spectroscopy probes toward personalized dosimetry in PDT of oral disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113767/1/php12475.pd

Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations

<p>Abstract</p> <p>Background</p> <p>Mandibular reconstruction by means of fibula transplants is the standard therapy for severe bone loss after subtotal mandibulectomy. Venous failure still represents the most common complication in free flap surgery. We present the injection of heparine into the arterial pedicle as modification of the revising both anastomoses in these cases and illustrate the application with a clinical case example.</p> <p>Methods</p> <p>Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color.</p> <p>Results</p> <p>The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis.</p> <p>Conclusion</p> <p>Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.</p

Anatomic MR Imaging and Functional Diffusion Tensor Imaging of Peripheral Nerve Tumors and Tumorlike Conditions

ABSTRACT BACKGROUND AND PURPOSE: A number of benign and malignant peripheral nerve tumor and tumorlike conditions produce similar imaging features on conventional anatomic MR imaging. Functional MR imaging using DTI can increment the diagnostic performance in differentiation of these lesions. Our aim was to evaluate the role of 3T anatomic MR imaging and DTI in the characterization of peripheral nerve tumor and tumorlike conditions

The Evaluation of Cystosonography accuracy in diagnosis of Vesicoureteral Reflux in children

Background: Vesicoureteral reflux (VUR) affects approximately 1% of children. It is a risk factor for acute pyelonephritis. Reflux has been identified in 30-50% of children following urinary tract infection. Reflux nephropathy is one of the causes of hypertension and end stage renal disease in children. The primary diagnostic procedure for evaluation of VUR in children is fluoroscopic voiding cystography (VCUG) and radionuclide cystography (RNC). Many investigators have used voiding urosonography (VUS) for the diagnosis of reflux in an effort to eliminate the radiation exposure especially during follow-up period. Methods: We analyzed 25 children with suspected VUR who underwent RNC and VUS concurrently in Labbafi Nejad Hospital in Tehran. Reflux was diagnosed in 8 patients by RNC and in 9 patients by VUS. One case with reflux in RNC was not detected by VUS, and 2 cases with reflux in VUS were not detected by RNC. Findings: The diagnosis of reflux by these two procedures (RNC and VUS) was comparable (p=0.000, r=0.728). In addition, grades of reflux reported by these procedures were also comparable (p=0.000, r=0.724). We considered RNC as the method of choice for reflux diagnosis. The specifity of VUS was 88% and its sensitivity 87%. Accuracy of this imaging was 88% (PPV=77%, NPV=94%). Conclusions: These results showed that VUS is a valuable procedure in follow-up and screening of patients with vesicoureteral reflux

The story continues: persistence of life themes in old age

Survivors of a longitudinal study over the age of 80 years were asked whether they saw their lives in terms of story and whether they agreed with our assessment of its present major themes. Two-thirds of the initial sample of 43 people affirmed that their life story was a coherent one in which past and present were connected. Relationships, particularly within the family, were the major source of linkage. One-quarter of the sample, predominantly female members, perceived neither story nor connections but they were not necessarily dissatisfied with their present lives. Detailed case studies were subsequently composed on the identity processes shown by each person, and their conclusions discussed with the 28 remaining participants two to three years later. The most evident continuing life theme for both men and women was one oriented to the family. Maintenance of independence and own home were also emphasised. The application of McAdams' story model of identity is discussed in relationship to two cases. Implications for research and practice are discussed, including opportunities for older people to construct and present the story of their lives to others

Self and identity in advanced old age: validation of theory through longitudinal case analysis

Case studies drawn from a 20-year longitudinal study of aging were examined for the support they provide to two theoretical viewpoints on the self in later life: one focusing on management of self-esteem, the other on development of identity as story. The five cases selected for scrutiny represented diverse trajectories of self-esteem. They furnished ample illustrations of certain key aspects of both theories, including assimilative processes of coping, depression related to absence of accommodation, maintenance of life story themes, and life review processes. They did not, however, give strong support to the dichotomy, drawn within both theoretical models, between younger and older old age. Examples of accommodation, disengagement, and self-transcendence, hypothesized to typify advanced old age, were relatively few in number and emerged only toward the very end of life. It is argued that examination of prototypical cases provides a useful approach to validating and developing theory. A conclusion drawn from this study is that more analysis should be carried out on the lives of persons who exemplify the theoretically ideal characteristics of advanced old age

Short-term and long-term effects of slow graft function on graft survival in pediatric live donor renal transplantation

SGF generally has early and long-term consequences for allograft survival. Limited studies have been performed on SGF and its complications in pediatric renal transplantation. Therefore, 230 children who received transplants between 1985 and 2005 in Labafi Nejad hospital were included in this study. SGF was defined if the serum creatinine level increased, remained unchanged, or decreased by <10 per day immediately after surgery during three consecutive days in the first week after transplantation. The children were divided into two groups: 183 children in group A (non-SGF) and 47 patients in group B (SGF). The impact of SGF on renal function within the first year, long-term graft survival and post-transplantation complications were analyzed and compared using logistic regression model and Kaplan-Meier survival analysis. The incidence of graft failure at the end of follow-up period was significantly more common in SGF group (53.2 vs. 22.4, p < 0.001). The median survival time was 140.25 (s.e.m. = 19.35) months in group A (non-SGF) and 60 (s.e.m. = 17.90) months in group B (SGF) (p < 0.001). The graft survival rate was 94.9, 91.9, 83.9, 79.2, and 72 at one, three, five, seven, and twelve yr after transplantation in children without SGF vs. 75.6, 53.2, 47.2, 40 at one, three, five, and seven yr after transplantation in patients with SGF. The results of our study showed that slow graft function could remarkably affect graft survival and worsen both short-term and long-term transplantation outcomes. Thus, the prevention of SGF is one of the most important issues in graft survival improvement. © 2009 John Wiley & Sons A/S

Kidney transplantation in children with posterior urethral valves

There is controversy about the outcome of renal transplantation in patients with PUV. The objective of this study was to analyze the outcome of renal transplantation in children with PUV. Fifteen patients had a history of PUV as the etiology of their ESRD. Forty-five patients comprised a control group without lower urinary tract anomalies. Mean age and follow-up duration were not significantly different between the case and the control group (p = 0.1). The immunosuppressive protocol and the year of transplantation were similar in these two groups (p = 0.2, 0.4, respectively). Among patients with PUV, 37.5 had acute rejection; and 56.2 had chronic rejection. Among the controls, 22.2 had acute rejection and 28.8 had chronic rejection. None of these differences was significant. Mean survival time was seven yr in affected patients and 6.2 yr in the control group (p = 0.9). Among patients with PUV, the rate of graft survival in the first year after transplantation was 95; and those in the third, fifth, and seventh yr, 91, 65, and 50, respectively. For the controls, the graft survival was 83 at one yr; 80 at three yr; 71 at five yr; and 60 at seven yr after transplantation (p = 0.9). Conclusively, this study showed that a history of PUV had no effect on graft function. Graft survival was not different among these patients compared with patients free of these anomalies. We also showed that urological complications were few in these patients. © 2008 Blackwell Munksgaard