Daniel D. Im

Social media use and impact on plastic surgery practice.

Background: Social media platforms have revolutionized the way human beings communicate, yet there is little evidence describing how the plastic surgery community has adopted social media. In this article, the authors evaluate current trends in social media use by practicing plastic surgeons. Methods: An anonymous survey on the use of social media was distributed to members of the American Society of Plastic Surgeons. Prevalent patterns of social media implementation were elucidated. Results: One-half of respondents were regular social media users. Reasons for using social media included the beliefs that incorporation of social media into medical practice is inevitable (56.7 percent), that they are an effective marketing tool (52.1 percent), and that they provide a forum for patient education (49 percent). Surgeons with a primarily aesthetic surgery practice were more likely to use social media. Most respondents (64.6 percent) stated that social media had no effect on their practice, whereas 33.8 percent reported a positive impact and 1.5 percent reported a negative impact. Conclusions: This study depicts current patterns of social media use by plastic surgeons, including motivations driving its implementation and impressions on its impact. Many feel that social media are an effective marketing tool that generates increased exposure and referrals. A small number of surgeons have experienced negative repercussions from social media involvement. Our study reveals the presence of a void. There is a definite interest among those surveyed in developing best practice standards and oversight to ensure ethical use of social media platforms throughout the plastic surgery community. Continuing discussion regarding these matters should be ongoing as our experience with social media in plastic surgery evolves.

Inferior turbinoplasty during cosmetic rhinoplasty: techniques and trends.

BackgroundThe sheer number of accepted inferior turbinoplasty techniques emphasizes the fact that there is no general agreement on which approach yields optimal results, nor are there data available that describes prevalent techniques in turbinate surgery among plastic surgeons. ObjectiveThe aim of this study was to identify practice patterns among plastic surgeons who perform inferior turbinoplasty during rhinoplasty. MethodsMembers of the American Society of Plastic Surgeons were invited to participate in an anonymous, Internet-based survey containing questions related to personal preferences and outcomes in inferior turbinate surgery. ResultsA total of 534 members of the American Society of Plastic Surgeons participated in the survey. Most (71.7%) trained in an independent plastic surgery program with prerequisite training in general surgery. More than half (50.6%) had more than 20 years of operative experience; only 15.2% reported performing greater than 40 rhinoplasties per year. The 5 most preferred inferior turbinate reduction techniques were outfracture of the turbinates (49.1%), partial turbinectomy (33.3%), submucous reduction via electrocautery (25.3%), submucous resection (23.6%), and electrocautery (22.5%). Fewer than 10% of the respondents reported the use of newer techniques such as radiofrequency thermal ablation (5.6%), use of the microdebrider (2.2%), laser cautery (1.1%), or cryosurgery (0.6%). Mucosal crusting and desiccation were the most frequently reported complications. ConclusionsThe results of this survey provide insights into the current preferences in inferior turbinate reduction surgery. Plastic surgeons are performing more conventional methods of turbinate reduction rather than taking advantage of the many of the more novel technology-driven methods.

Teasing in younger and older children with microtia before and after ear reconstruction

Abstract This study prospectively measured teasing and emotional adjustment before and after ear reconstruction in younger and older children with microtia. Participants with isolated microtia (n = 28) were divided into two groups by age at surgery, with a younger group aged 3–5 years (n = 13) with a mean age of 4.0 (0.71) years at the time of surgery and an older group aged 6–10 years old (n = 15) with a mean age of 7.87 (1.30) years. Children and their parents were interviewed preoperatively and a year after surgery about teasing and emotions about their ear(s). Teasing began between the ages of 2.4–4.8 years. A third of the younger group and all of the older group reported preoperative teasing. Before surgery, the older group reported higher rates of negative emotions about their ear(s) and teasing was correlated for all ages with feeling sad, worried, and mad about their ear(s). After surgery, teasing and negative emotions significantly decreased with increased happiness about their ear(s). Postoperative teasing was correlated with trying to hide their ear(s). There were significant interactions from before to after surgery based on surgery age for frequency of teasing, sadness, and feeling mad, with the older group showing relatively greater change postoperatively. Teasing and negative emotions about their ear(s) decreased for all ages after surgery, with a potential protective factor seen in younger surgery age.

Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair.

Clinical and basic experimental approaches to pediatric acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within 7 days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9 to 9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation, and surfactant regulation have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long-term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long-term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute, and long-term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis.

Hypersegmented Neutrophils in an Adolescent Male With Heatstroke.

A 14-year-old male presented to the hospital after syncope during football practice on a hot summer day. On examination, temperature was 40.41C (104.71F) and heart rate was 180 beats per minute. He was unresponsive, intubated, and cooled in the pediatric intensive care unit. Laboratory values revealed acute kidney injury and ischemic hepatitis. Complete blood count showed a white blood cell count of 17!10/L, hemoglobin of 14.8 g/L, platelet count of 395!10/L, and mean corpuscular volume of 83.8 fL (normal, 81.4 to 91.9 fL). Peripheral blood smear showed hypersegmented neutrophils with “botryoid” nuclei (Supplemental Fig. 1 Supplemental Digital Content 1, http://links.lww.com/JPHO/A98). Hypersegmented neutrophils are classically seen with folate (vitamin B9) orcobalamin (vitamin B12) deficiency. These morphologic changes of the neutrophil nucleus occur due to impaired DNA synthesis from inadequate substrate or impaired replication from a toxin or medication effect. Arrest of nuclear maturation, impaired cell division, and unbalanced cell growth results in characteristic large cells with immature nuclei with relative cytoplasmic maturity. Red blood cell macrocytosis often accompanies hypersegmented neutrophils and can be seen in hypothyroidism, alcohol abuse, uremia, and myelodysplastic syndromes. Hypersegmented neutrophils without red blood cell macrocytosis, as in our patient, has been described in patients with hyperthermia, uremia, and concurrent megaloblastic and microcytic anemia from combined folate and/ or cobalamin deficiency along with iron deficiency or thalassemia. As the finding of hypersegmented neutrophils preceeds macrocytosis, neutrophil hypersegmentation without macrocytosismay represent early cobalamin and folate deficiency.1 The term “botryoid” refers to nuclei that appear like a cluster of grapes around a stem.2 Botryoid nuclei have been described in patients with hyperthermia due to cocaine and methamphetamine use,3 malignant hyperthermia, neuroleptic malignant syndrome,4 and autoimmune disorders such as rheumatoid arthritis, psoriatic arthritis, and systemic sclerosis.5 In comparison, the multilobed nuclei in cobalamin and folate deficiency appear disorganized. The pathogenesis of botryoid nuclei in hyperthermia has not been clearly elucidated. Hyperthermia may activate the intrinsic signaling pathway that initiates apoptosis since pyknosis, nuclear condensation in the setting of irreversible cell death, is seen in neutrophils in response to hyperthermia.6 In addition, microtubular decomposition may play a role.7 In vitro experiments have shown that radially segmented neutrophils are induced by applying heat.8 Botryoid changes in >50% of neutrophils on a peripheral blood smear may be sufficient to diagnose heatstroke.2 Fewer than 50% botryoid neutrophils is suggestive of heatstroke. Clinicians should be aware that hyperthermia can cause hypersegmented neutrophils so as to avoid unnecessary evaluations for other etiologies. Our patient’s mental status and renal function improved with cooling and intravenous fluids. He was extubated on the first day of hospitalization. Subsequent peripheral blood smears showed resolution of hypersegmented neutrophils by the second hospital day. He was discharged home after 3 days without any complications.

Early Familial Experiences With Microtia: Psychosocial Implications for Pediatric Providers

This study focuses on early experiences of families with a child with microtia to better inform their ongoing care by pediatric providers. Parents and children (n = 62; mean age of 6.9 ± 3.9 years) with isolated microtia participated in semistructured interviews in Spanish (66.1%) or English (33.9%). Qualitative analysis of responses used open coding to identify themes. Parents reported stressful informing experiences of the diagnosis with multiple negative emotions. Parents and children generally reported not understanding microtia etiology, while some families identified medical, religious, and folk explanations. Parental coping included learning about surgeries, normalization, perspective taking, and support from family, providers, religion, and others with microtia. Family communication centered on surgery and reassurance. Pediatricians of children with microtia need to understand families’ formative psychosocial experiences to better promote positive family adjustment through clarifying misinformation, educating families about available treatment options, modeling acceptance, psychosocial screening, and providing resources.

A 12-Year-Old Boy With Dyspnea, Hypertension, Hematuria, and Proteinuria

Case: A 12-year-old boy presented to the emergency department with progressive dyspnea for 1 week and bilateral periorbital edema for 1 day. On review of systems, he reported an upper respiratory tract infection 1 week before the onset of dyspnea. A review of vital signs showed a temperature of 99.8°F (37.7°C), heart rate of 99 beats/min, blood pressure of 167/117 mm Hg, respiratory rate of 22 breaths/min, and oxygen saturation of 99% on room air. In addition to periorbital edema, the patient appeared to have worsening dyspnea when he was placed supine. The patient’s admission laboratory values revealed the following: sodium, 142 mmol/L; potassium, 4.4 mmol/L; chloride, 112 mmol/L; bicarbonate, 20 mmol/L; blood urea nitrogen, 11 mg/dL; creatinine, 0.63 mg/dL; and a normal complete blood cell count except for a hemoglobin level of 9.8 g/dL. Urinalysis with microscopy showed trace amounts of blood with 6 to 10 red blood cells (RBCs) per high-power field and 100 mg/dL of protein. Chest radiograph revealed pulmonary edema (Fig 1). FIGURE 1 Chest radiograph showing pulmonary vascular congestion. Question: What is the significance of hematuria and proteinuria in this patient with hypertension and pulmonary edema? Discussion: Hematuria and proteinuria, along with hypertension, are highly suggestive of glomerulonephritis (GN).1 Assessment of RBC morphology may help determine whether hematuria is glomerular or nonglomerular in origin. Intact urinary RBCs suggest an anatomic urinary tract lesion or trauma, whereas dysmorphic RBCs and RBC casts suggest glomerular hematuria. A fresh urine specimen should be analyzed under the microscope promptly because RBC casts disintegrate within 1 hour of voiding. In patients with suspected GN, the amount of proteinuria should be quantified to assess the severity of GN. Nephrotic-range proteinuria in children is defined as >40 mg/m2 per hour, >3 g/1.73 m2/day, or >50 mg/kg per day of …

171A: THREE DIMENSIONAL POLY-LACTIDE-GLYCOLIC ACID (PLGA) AND TYPE I COLLAGEN SCAFFOLDS EXERT AN OPPOSITE EFFECT ON OSTEOGENISIS IN HUMAN AND MOUSE OSTEOBLASTS

Introduction: Joint surfaces injuries arise from repetitive or traumatic high impact loading and are a common and potentially debilitating problem. Repair strategies focus on the creation of scar tissue, which is biomechanically inferior to articular cartilage. Previous studies have demonstrated the ability of tissue-engineered cartilage to bond to articular cartilage; however the ability to bond to subchondral bone is uncharacterized. The goal of this study is to characterize the bond formed between native cartilage, engineered cartilage and subchondral bone using histology and biomechanical testing.