Adam D. Glener

A Population-Based Exploration of the Social Implications Associated with Cleft Lip and/or Palate

Background: Clefts of the lip and/or palate (CL/P) carry a social stigma that often causes psychosocial stress. The purpose of this study was to consider the association of cleft phenotype and age with self-reported aspects of psychosocial stress. Methods: Children with nonsyndromic CL/P and unaffected children born between 1997 and 2003 were identified through the North Carolina Birth Defects Monitoring Program and North Carolina birth records, respectively. The psychosocial concerns of children with CL/P were assessed via a 29-question subset of a larger survey. Responses were analyzed according to school age and cleft phenotype (cleft lip with/without cleft alveolus, CL ± A; cleft palate only, CP; or cleft lip with cleft palate, CL + P). Results: Surveys were returned for 176 children with CL/P and 333 unaffected children. When compared with unaffected children, responses differed for CL ± A in 4/29 questions, for CP in 7/29 questions, and for CL + P in 8/29 questions (P < 0.05). When stratified by school age, children with CL/P in elementary, middle, and high school differed from unaffected children by 1/29, 7/29, and 2/29 questions, respectively. Middle school–aged children with CL/P were more affected by aesthetic concerns, bullying, and difficulties with friendship, and social interaction. Children with CL + P reported more severe aesthetic-related concerns than children with CL ± A or CP but experienced similar speech-related distress as children with CP only. Conclusion: Social implications associated with CL/P are most pronounced during middle school, and less so during elementary and high school. This information identifies areas of social improvement aimed at reducing the stigma of CL/P.

Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

Table of contentsA1 Effects of enhanced recovery pathways on renal functionCharles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy J. Miller, Stuart A. GrantA2 Economic outcomes of enhanced recovery after surgery (ERAS)Jeffrey HuangA3 What does eating, drinking and mobilizing after enhanced recovery surgery really mean?Kirstie McPherson, Sanjiv Patel, Su Cheen Ng, Denise Veelo, Bart Geerts, Monty MythenA4 Intra-operative fluid monitoring practicesSu Cheen Ng, Mark Foulger, Tim Collins, Kirstie McPherson, Michael MythenA5 Development of an integrated perioperative medicine care pathwayMark Edwards, Denny Levett, Tristan Chapman, Imogen Fecher – Jones, Julian Smith, John Knight, Michael GrocottA6 Cardiopulmonary exercise testing for collaborative decision making prior to major hepatobiliary surgeryMark Edwards, Thomas Sharp, Sandy Jack, Tom Armstrong, John Primrose, Michael Grocott, Denny LevettA7 Effect of an enhanced recovery program on length of stay for microvascular breast reconstruction patientsAdam B. King, Kye Higdon, Melissa Bellomy, Sandy An, Paul St. Jacques, Jon Wanderer, Matthew McEvoyA8 Addressing readmissions associated with an enhanced recovery pathway for colorectal surgeryAnne C. Fabrizio, Michael C. Grant, Deborah Hobson, Jonathan Efron, Susan Gearhart, Bashar Safar, Sandy Fang, Christopher Wu, Elizabeth WickA9 The Manchester surgical outcomes project: prevalence of pre operative anaemia and peri operative red cell transfusion ratesLeanne Darwin, John MooreA10 Preliminary results from a pilot study utilizing ears protocol in living donor nephrectomyAparna Rege, Jayanth Reddy, William Irish, Ahmad Zaaroura, Elizabeth Flores Vera, Deepak Vikraman, Todd Brennan, Debra Sudan, Kadiyala RavindraA11 Enhanced recovery after surgery: the role of the pathway coordinatorDeborah WatsonA12 Hospitalization costs for patients undergoing orthopedic surgery treated with intravenous acetaminophen (IV-APAP) + IV opioids or IV opioids alone for postoperative painManasee V. Shah, Brett A. Maiese, Michael T. Eaddy, Orsolya Lunacsek, An Pham, George J. WanA13 Development of an app for quality improvement in enhanced recoveryKirstie McPherson, Thomas Keen, Monty MythenA14 A clinical rotation in enhanced recovery pathways and evidence based perioperative medicine for medical studentsAlexander B Stone, Christopher L. Wu, Elizabeth C. WickA15 Enhanced recovery after surgery (ERAS) implementation in abdominal based free flap breast reconstructionRachel A. Anolik, Adam Glener, Thomas J. Hopkins, Scott T. Hollenbeck, Julie K. Marosky ThackerA16 How the implementation of an enhanced recovery after surgery (ERAS) protocol can improve outcomes for patients undergoing cystectomyTracey Hong, Andrea Bisaillon, Peter Black, Alan So, Associate Professor, Kelly MaysonA17 Use of an app to improve patient engagement with enhanced recovery pathwaysKirstie McPherson, Thomas Keen, Monty MythenA18 Effect of an enhanced recovery after surgery pathway for living donor nephrectomy patientsAdam B. King, Rachel Forbes, Brad Koss, Tracy McGrane, Warren S. Sandberg, Jonathan Wanderer, Matthew McEvoyA19 Introduction and implementation of an enhanced recovery program to a general surgery practice in a community hospitalPatrick Shanahan, John Rohan, Desirée Chappell, Carrie ChesherA20 “Get fit” for surgery: benefits of a prehabilitation clinic for an enhanced recovery program for colorectal surgical patientsSusan VanderBeek, Rebekah KellyA21 Evaluation of gastrointestinal complications following radical cystectomy using enhanced recovery protocolSiamak Daneshmand, Soroush T. Bazargani, Hamed Ahmadi, Gus Miranda, Jie Cai, Anne K. Schuckman, Hooman DjaladatA22 Impact of a novel diabetic management protocol for carbohydrate loaded patients within an orthopedic ERAS protocolVolz L, Milby JA23 Institution of a patient blood management program to decrease blood transfusions in elective knee and hip arthroplastyOpeyemi Popoola, Tanisha Reid, Luciana Mullan, Mehrdad Rafizadeh, Richard Pitera

Abstract 22: An Analysis of Bleeding Complications in Plastic Surgery

CONCLUSION: The CRISPR/Cas9 method targeted to a highly conserved sequence of fgfr1a introduced a diverse array of mutagenized alleles providing the opportunity to investigate suture development in correlation with new pathologic alleles. These mutations are heritable and despite the high sequence homology among genes encoding Fgf receptors, no off-target mutations have been identified to date. Initial characterization of identified alleles will focus on embryonic stages to assess the effect of mutation on Fgf signaling target genes. This analysis will be complemented by histology of zebrafish head to assess the cranial suture development and maintenance of juvenile and adult animals.

Post-Surgical Relapse in Metopic Synostosis and Limitations of the Interfrontal Angle as an Outcome Measure

Background: The interfrontal angle (IFA) has been utilized as a surrogate for morphologic assessment of the anterior cranial region in metopic synostosis with success in characterizing presenting severity. Its utility as an outcome measure has not been assessed similarly. In this study, we aimed to determine whether meaningful information relative to shape, and relapse in particular, could be assessed using the IFA. Methods: Patients with operatively treated isolated metopic synostosis were identified and included based on the availability of “previously obtained” low-dose computerized tomography (CT) scans at (1) preoperative and 2 postoperative (2) postoperative day-3 and (3) 1 year time points. Relapse was calculated as the percentage of the operatively induced change in IFA that was retained after the first postoperative year. Results: After exclusionary criteria, 19 patients were identified. The mean IFA values at the 3 time points were 119.3° (±9.8), 139.6° (±6.3), and 135.3° (±7.1), chronologically. Of the 19 patients, 14 (73.7%) experienced relapse, with this subgroup averaging 62.4% retention of their surgical change after 1 year. Increased preoperative severity and delayed age at surgical intervention were concurrently associated with an increased occurrence of relapse (P = 0.011). Another model utilizes preoperative IFA to predict the change in IFA that would accompany surgery on a case-by-case basis (P < 0.0001). Conclusions: (1) Fronto-orbital advancement offers immediate correction in the frontal bandeau. (2) Surgical impact, using fronto-orbital advancement, can be predicted using preoperative severity. (3) A component of postoperative relapse occurs within the frontal bandeau and is detectable at 1 year via the IFA. Exclusively, the IFA cannot characterize holistic postoperative relapse due to its inherent anatomical constraints; this supports the cessation of routine postoperative computerized tomography scans for determining outcomes.

Median Nerve Compression by Radial Head Osteophyte

Congenital radial head dislocations are rare, and presentation with late complications is even less common. We present a case of a patient who presented with symptoms and findings of proximal median nerve compression secondary to large osteophytes associated with untreated congenital radial head dislocations.