Nicholas Kim

Preoperative assessment preferences and reported reoperation rates for size change in primary breast augmentation: a survey of ASPS members.

Background: The purpose of this study was to determine the current preferences of plastic surgeons regarding preoperative assessment and their effect on clinical outcome in primary breast augmentation. Methods: An eight-question online survey was sent to members of the American Society of Plastic Surgeons. Data collected online were analyzed using Students t test or Pearsons chi-square test. A value of p < 0.05 was considered statistically significant. Results: The response rate was 20.1 percent (604 respondents). Breast base diameter [n = 286 (47.4 percent)] was ranked the most important consideration vital in choosing implants. Most surgeons chose to reeducate their patients to resolve a conflict between their patients implant size request and the surgeons clinical judgment [n = 385 (63.7 percent)], whereas 151 (25 percent) would proceed anyway. Those surgeons who chose reeducation ranked breast base diameter as a vital consideration significantly higher than those who would accommodate their patients (2.03 ± 1.41 versus 2.31 ± 1.41; p = 0.041). Similarly, surgeons who reeducated their patients ranked implant volume as the vital consideration significantly lower than those who accommodated their patients (2.90 ± 1.67 versus 2.44 ± 1.47; p = 0.002). Regarding size change, 332 surgeons (55 percent) reported their rate was 5 percent or less, whereas 272 (45 percent) reported it was greater than 5 percent. Surgeons who reported a 5 percent or less rate ranked implant volume significantly lower than those with reoperation rates greater than 5 percent (2.93 ± 1.71 versus 2.55 ± 1.53; p = 0.004). Conclusions: Breast base diameter and implant volume were the two most important considerations in choosing an implant for breast augmentation. Reported reoperation rates for size change were significantly lower for surgeons who regarded breast base diameter as more vital than those who valued implant volume more.

Preoperative Stone Attenuation Value Predicts Success After Shock Wave Lithotripsy in Children

PURPOSE We determined whether stone attenuation can predict stone fragmentation after shock wave lithotripsy in the pediatric population. Previous studies show that preoperative attenuation in HU on noncontrast computerized tomography predicts shock wave lithotripsy success. To our knowledge study of this parameter in the pediatric population has been lacking to date. MATERIALS AND METHODS We performed a multi-institutional review of the records of 53 pediatric patients 1 to 18 years old who underwent shock wave lithotripsy for 3.8 to 36.0 mm renal calculi. Stone size, average skin-to-stone distance and attenuation value were determined by bone windows on preoperative noncontrast computerized tomography. Success was defined as radiographically stone-free status at 2 to 12-week followup after a single lithotripsy session without the need for further sessions or ancillary procedures. RESULTS After lithotripsy 33 patients (62%) were stone-free and 20 had incomplete fragmentation or required additional procedures. Mean ± SD stone attenuation in successfully treated patients vs those with incomplete fragmentation was 710 ± 294 vs 994 ± 379 HU (p = 0.007). Logistical regression analysis revealed that only attenuation in HU was a significant predictor of success. When patients were stratified into 2 groups (less than 1,000 and 1,000 HU or greater), the shock wave lithotripsy success rate was 77% and 33%, respectively (p <0.003). CONCLUSIONS Stone attenuation less than 1,000 HU is a significant predictor of shock wave lithotripsy success in the pediatric population. This finding suggests that attenuation values have a similar predictive value in the pediatric population as that previously reported in the adult population.

Stone Size is Only Independent Predictor of Shock Wave Lithotripsy Success in Children: A Community Experience

PURPOSE We determined whether age, gender, body mass index, number of stones, stone location or total stone diameter could independently predict stone-free rates after extracorporeal shock wave lithotripsy in children. MATERIALS AND METHODS We reviewed 149 patients 3 to 17 years old undergoing shock wave lithotripsy between 2001 and 2008. Cases were retrieved from a regional shock wave lithotripsy database. Variables analyzed included age, gender, body mass index, number of shocks delivered, stone location, number of stones and total stone diameter. Stone-free status on followup imaging at 2 weeks to 3 months was considered a successful outcome. RESULTS Of 149 patients 32 had multiple stones. After shock wave lithotripsy 106 patients (71%) were stone-free, 12 (8%) required a repeat procedure and 31 (21%) had residual fragments. Number of stones per patient ranged from 1 to 18 (mean +/- SD 2.14 +/- 2.60). Mean +/- SD number of stones was 1.87 +/- 2.42 in successfully treated patients and 2.81 +/- 2.92 in those with treatment failure (p = 0.065). Total stone diameter ranged from 2 to 90 mm (mean +/- SD 14.03 +/- 16.68). Mean total stone diameter was 11.1 +/- 13.4 mm in successfully treated patients and 21.3 +/- 21.4 mm in those with treatment failure (p <0.005). CONCLUSIONS To our knowledge we present the first multi-institutional cohort study in children demonstrating no significant relationship between successful outcome and patient age, gender, body mass index, stone location or number of stones. Only total stone diameter independently predicted shock wave lithotripsy success.

Anconeus Epitrochlearis Muscle Associated With Cubital Tunnel Syndrome: A Case Series:

Background: Cubital tunnel syndrome is a common compressive neuropathy of the upper extremity. The anconeus epitrochlearis muscle is an unusual but occasional contributor. We review our experience with this anomalous muscle in elbows with cubital tunnel syndrome. Methods: We retrospectively reviewed charts of 13 patients noted to have an anconeus epitrochlearis muscle associated with cubital tunnel syndrome. Results: Ten patients had unilateral ulnar neuropathy supported by nerve conduction studies. Three had bilateral cubital tunnel syndrome symptoms with 1 of those having normal nerve conduction studies for both elbows. Eight elbows were treated with myotomy of the anconeus epitrochlearis muscle and submuscular transposition of the ulnar nerve. The other 8 elbows were treated with myotomy of the anconeus epitrochlearis muscle and in situ decompression of the ulnar nerve only. All but 1 patient had either clinical resolution or improvement of symptoms at follow-up ranging from 2 weeks to 1 year after surgery. The 1 patient who had persistent symptoms had received myotomy and in situ decompression of the ulnar nerve only. Conclusions: An anomalous anconeus epitrochlearis occasionally results in compression of the ulnar nerve but is usually an incidental finding. Its contribution to compression neuropathy can be tested intraoperatively by passively ranging the elbow while observing the change in vector and tension of its muscle fibers over the ulnar nerve. Regardless of findings, we recommend myotomy of the muscle and in situ decompression of the ulnar nerve. Submuscular transposition of the ulnar nerve may be necessary if there is subluxation.

Nontoxic Three-Part Combination Local Wound Therapy to Eradicate Carbapenem-Resistant Klebsiella pneumoniae.

ABSTRACT This case report describes eradication of carbapenem-resistant Klebsiella pneumoniae from an ischial pressure injury in a patient who underwent a 3-week course of nontoxic three-part combination local wound therapy. With this therapy, providers prevented systemic spread of this multidrug-resistant pathogen and avoided the nephrotoxicity associated with conventional triple antibiotic therapy.

Current trends in chaperone use by plastic and reconstructive surgeons

PurposeThere is a paucity of literature regarding the use of chaperones by surgeons when examining patients. Use of a chaperone not only makes the patient comfortable but also potentially protects the surgeon from perceived misconduct. This is especially true for plastic surgeons who examine sensitive areas commonly. The purpose of this study was to determine the current trends in chaperone use by plastic surgeons when examining patients. Materials and MethodsA 23-question online survey was sent to all members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student t test and Pearson &khgr;2 test. A P < 0.05 was considered significant. ResultsOf the 4990 surgeons polled, 830 (16.6%) responded to some or all of the questions (707 [85%] male; 117 [14%] female). The overall chaperone use by plastic surgeons during all examinations of patients was 30%. This rate increased up to 60% while examining sensitive areas. Male surgeons reported a higher frequency of chaperone use than female surgeons (P < 0.001). Cosmetic surgeons had a higher rate of chaperone use compared to reconstructive surgeons (P = 0.001). Similarly, surgeons who had been in practice for more than 20 years reported a higher rate of chaperone use compared to surgeons in practice for less than 20 years (P = 0.032). Sixty-one (7.6%; 56 male and 5 female) surgeons reported being accused of inappropriate behavior by patients, of whom 49 (80%) did not have a chaperone present. There was no significant difference among male and female surgeons in rates of being accused of inappropriate behavior (7.9% vs 4.2%, P = 0.19). ConclusionsThere was a higher rate of chaperone use by male plastic surgeons, surgeons with more than 20 years experience, and cosmetic surgeons. Despite the difference in chaperone use between the sexes, both had similar rates of being accused of inappropriate behavior during examinations by patients, and although these incidents were quite low, most had no chaperone present during those examinations.