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Cordero JJ, Alaniz L, Kalavacherla S, Tholpady SS, Chu MW. Trends of Medicare Reimbursement Rates for Gender-Affirming Surgery Procedures. Ann Plast Surg 2024; 92:S366-S370. [PMID: 38689421 DOI: 10.1097/sap.0000000000003799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Awareness of Medicare reimbursement is important for gender-affirming surgeons who treat transgender patients with Medicare. In 2014, Medicare began to provide coverage for medically necessary transition-related surgery. The purpose of this study was to analyze trends in Medicare reimbursement rates for gender-affirming surgery procedures from 2014 to 2022. METHODS The Medicare Physician Fee Schedule Look-Up Tool provided by the Centers for Medicare and Medicaid Services was used, and the Current Procedural Terminology codes for 43 gender-affirming surgery services were obtained. Monetary units, conversion factors, relative value units (RVUs) for work, facility, and malpractice costs for 30 transmasculine and 13 transfeminine procedures were analyzed. Descriptive statistics were performed to account for inflation and to determine the relative differences between 2014 and 2022. RESULTS For all gender-affirming surgery procedures covered by Medicare, the average relative difference of monetary units decreased by 2.99% between 2014 and 2022. On average, there was a 3.97% decrease of work-based RVU charges for transmasculine procedures and a 1.73% decrease of work-based RVU charges for transfeminine procedures. After adjusting for inflation, the average relative difference of monetary units for all gender-affirming surgery procedures decreased by 23.42% between 2014 and 2022. CONCLUSIONS Reimbursement rates for gender-affirming surgery procedures covered under Medicare have decreased over the observed period, and trends in reimbursement rates have not kept up with consumer price index inflation. Gender-affirming surgeons should be conscious of these changes in reimbursement rates and advocate for fairer compensation to promote medical care among an underserved population.
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Affiliation(s)
- Justin J Cordero
- From the School of Medicine, University of California Riverside, Riverside
| | | | | | - Sunil S Tholpady
- Division of Plastic and Reconstructive Surgery, Indiana University, Indianapolis, IN
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2
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Cordero JJ, Eidelson S, Alaniz L, Lucich E, Cook JA, Tholpady SS, Chu MW. Defining Preferred Esthetics of the Ideal Phallus via Crowdsource Survey. Urology 2024; 186:63-68. [PMID: 38350549 DOI: 10.1016/j.urology.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To describe phalloplasty subunits and determine the preferred crowdsourced esthetics. Esthetic ideals are often used to guide reconstruction, and there has been an increase in the number of gender-affirming surgeries and reconstructive phalloplasties performed. However, there is a paucity of literature describing ideal phalloplasty esthetics. METHODS Phallus esthetic subunits were defined, and a split testing-based survey was used. Subjects were solicited via Craigslist, Amazon Mechanical Turk, and Reddit and distributed among health care co-workers. Computer-generated images with variable ratios of glans, corona, and shaft were provided and respondents were asked to select the most esthetically pleasing photo. Demographic information was gathered. Univariate and multivariate regression were performed. RESULTS A total of 1029 people responded to the survey request and 909 people (88.3%) completed the entire survey. There were 440 respondents who self-identified as male, 334 female, 92 transgender male, and 25 transgender female. The health care field was the profession for 55.4%. Health care providers had 65.3% higher odds of preferring the longer shaft length-to-width ratio, 30.3% less odds of preferring a bilateral taper of the glans, and 48.4% less odds of preferring an angulated shaft compared to non-health care providers (P = .006, P = .021, P <.001, respectively). When compared to males, transgender females were more than 13 times likely to prefer an angulated glans corona junction (P = .008). CONCLUSION The ideal phallic esthetic varies by individual, and there were statistically significant preferences across age, education, health care status, gender, and sexual orientation. This study can serve as a guide on phalloplasties for patients and gender-affirming surgeons.
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Affiliation(s)
- Justin J Cordero
- University of California Riverside, School of Medicine, Riverside, CA
| | - Sarah Eidelson
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, CA
| | - Leonardo Alaniz
- University of California Irvine, School of Medicine, Irvine, CA
| | - Elizabeth Lucich
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Julia A Cook
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Sunil S Tholpady
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN; Division of Plastic & Reconstructive Surgery, R.L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN
| | - Michael W Chu
- University of Southern California, Division of Plastic & Reconstructive Surgery, Los Angeles, CA; Department of Plastic & Reconstructive Surgery, Kaiser Permanente Medical Center, Los Angeles, CA.
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3
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Nguyen N, Doan L, Jiang F, Chu MW, Liu YY, Francis SH, Kim H, Lee JC. Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications. J Plast Reconstr Aesthet Surg 2024; 93:30-35. [PMID: 38631083 DOI: 10.1016/j.bjps.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND To date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery. METHODS A retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission. RESULTS Of 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively). CONCLUSION Ambulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.
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Affiliation(s)
- Nghiem Nguyen
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA
| | - Leandra Doan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA
| | - Fang Jiang
- Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Michael W Chu
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Yuan Y Liu
- Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Stacey H Francis
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Holly Kim
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - James C Lee
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
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4
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Chiang CC, Lee HC, Lin SC, Qu D, Chu MW, Chen CD, Chien CL, Huang SY. Unequivocal Identification of Spin-Triplet and Spin-Singlet Superconductors with Upper Critical Field and Flux Quantization. Phys Rev Lett 2023; 131:236003. [PMID: 38134800 DOI: 10.1103/physrevlett.131.236003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023]
Abstract
Spin-triplet superconductors play central roles in Majorana physics and quantum computing but are difficult to identify. We show the methods of kink-point upper critical field and flux quantization in superconducting rings can unequivocally identify spin-singlet, spin-triplet in centrosymmetric superconductors, and singlet-triplet admixture in noncentrosymmetric superconductors, as realized in γ-BiPd, β-Bi_{2}Pd, and α-BiPd, respectively. Our findings are essential for identifying triplet superconductors and exploring their quantum properties.
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Affiliation(s)
- C C Chiang
- Department of Physics, National Taiwan University, Taipei 10617, Taiwan
- Willian H. Miller III Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - H C Lee
- Department of Physics, National Taiwan University, Taipei 10617, Taiwan
| | - S C Lin
- Center for Condensed Matter Sciences, National Taiwan University, Taipei 10617, Taiwan
| | - D Qu
- Center for Condensed Matter Sciences, National Taiwan University, Taipei 10617, Taiwan
- Center of Atomic Initiatives for New Materials, National Taiwan University, Taipei 10617, Taiwan
| | - M W Chu
- Center for Condensed Matter Sciences, National Taiwan University, Taipei 10617, Taiwan
- Center of Atomic Initiatives for New Materials, National Taiwan University, Taipei 10617, Taiwan
| | - C D Chen
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - C L Chien
- Department of Physics, National Taiwan University, Taipei 10617, Taiwan
- Willian H. Miller III Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - S Y Huang
- Department of Physics, National Taiwan University, Taipei 10617, Taiwan
- Center of Atomic Initiatives for New Materials, National Taiwan University, Taipei 10617, Taiwan
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Cordero JJ, Eidelson S, Frediani T, Shakoori P, Carré AL, Klausmeyer MA, Chu MW. The Top 100 Cited Articles in the Microsurgical Treatment for Lymphedema. J Reconstr Microsurg 2023; 39:559-564. [PMID: 36564050 DOI: 10.1055/a-2003-7795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence-based medicine uses the current best evidence for decisions about patient care. Lymphedema is a chronic debilitating medical condition caused by a dysfunctional lymphatic system. This study analyzes the most cited articles, including the levels of evidence, for the surgical treatment of lymphedema. METHODS The Web of Science Sci-Expanded Index was utilized to search for surgical treatment of lymphedema. Articles were examined by three independent reviewers and the top 100 articles were determined. The corresponding author, citation count, publication year, topic, study design, level of evidence, journal, country, and institution were analyzed. RESULTS Since 1970, the top 100 articles have been cited 7,300 times. The average citation count was 68 and standard deviation was 55. The majority was case series (71), followed by retrospective cohort (8), prospective cohort (7), retrospective case-control (5), and randomized controlled trials (2). Based on the "Level of Evidence Pyramid," 71 articles were level IV, 13 articles were level III, and 9 articles were level II. On the Grading of Recommendations Assessment, Development, and Evaluation Scale, there were 71 articles with "very low," 20 articles with "low," and 2 articles with "moderate" quality of evidence. CONCLUSION The top 100 cited articles were mostly case series and lacked high levels of evidence. Most studies are retrospective case series with short-term outcomes. However, low level evidence for new surgical procedures is to be expected. Current trends suggest the treatment and understanding of lymphedema will continue to improve.
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Affiliation(s)
- Justin J Cordero
- School of Medicine, University of California Riverside, Riverside, California
| | - Sarah Eidelson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Tanner Frediani
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Pasha Shakoori
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - A Lyonel Carré
- Department of Plastic & Reconstructive Surgery, City of Hope, Duarte, California
| | - Melissa A Klausmeyer
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
- Department of Plastic and Reconstructive Surgery, Kaiser Permanente Medical Group, Los Angeles, California
| | - Michael W Chu
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
- Department of Plastic and Reconstructive Surgery, Kaiser Permanente Medical Group, Los Angeles, California
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Abstract
Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.
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Affiliation(s)
- Sarah E. Sasor
- Indiana University, Indianapolis,
USA,Sarah E. Sasor, Division of Plastic Surgery,
Department of Surgery, Indiana University, 545 Barnhill Drive, EH 232,
Indianapolis, IN 46202, USA.
| | | | | | | | - Adam C. Cohen
- Richard L. Roudebush VA Medical Center,
Indianapolis, IN, USA
| | - William A. Wooden
- Indiana University, Indianapolis,
USA,Richard L. Roudebush VA Medical Center,
Indianapolis, IN, USA
| | - Sunil S. Tholpady
- Indiana University, Indianapolis,
USA,Richard L. Roudebush VA Medical Center,
Indianapolis, IN, USA
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Hage A, Giambruno V, Jones P, Chu MW, Fox S, Teefy P, Lavi S, Bainbridge D, Harle C, Iglesias I, Dobkowski W, Kiaii B. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis With Long-Term Follow-up. J Am Heart Assoc 2019; 8:e014204. [PMID: 31826727 PMCID: PMC6951054 DOI: 10.1161/jaha.119.014204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
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Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Vincenzo Giambruno
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Philip Jones
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Michael W Chu
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Stephanie Fox
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Patrick Teefy
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Shahar Lavi
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Christopher Harle
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Woijtecj Dobkowski
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
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8
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Sasor SE, Cook JA, Loewenstein SN, Wooden WA, Cohen AC, Chu MW, Tholpady SS. Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer. JAMA Surg 2019; 154:179-181. [PMID: 30422253 DOI: 10.1001/jamasurg.2018.3534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah E Sasor
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Julia A Cook
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Scott N Loewenstein
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - William A Wooden
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Adam C Cohen
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Michael W Chu
- Department of Plastic and Reconstructive Surgery, Kaiser Permanente, Los Angeles, California
| | - Sunil S Tholpady
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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9
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Sasor SE, Soleimani T, Chu MW, Cook JA, Nicksic PJ, Tholpady SS. Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases. J Wound Care 2019; 27:S4-S8. [PMID: 29334018 DOI: 10.12968/jowc.2018.27.sup1.s4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis. This condition has clinical features analogous to infectious processes and must be quickly diagnosed to be properly treated. The purpose of this study was to characterise relevant clinical features associated with pyoderma gangrenosum based on a large inpatient cohort. METHOD The National Inpatient Sample (US) was used to identify patients with the diagnosis of pyoderma gangrenosum using ICD-9 diagnosis code 686.01, during the years 2008-2010. Data was collected on demographics, associated diagnoses, treatments and outcomes. Data analysis was performed using SAS 9.3 software. RESULTS A total of 2,273 adult patients were identified with pyoderma gangrenosum. Mean age was 56 years; 66.4% were female; 71.1% were Caucasian. Pyoderma gangrenosum was the primary diagnosis in 22.6% of patients, followed by cellulitis (9.4%), inflammatory bowel disease (IBD) (6.9%), wound/ulcer (5.4%), sepsis (4.7%), and postoperative infection/complication (2.7%). The most common procedures performed were wound debridement (5.3%), skin biopsy (5.1%), esophagogastroduodenoscopy (2%), large bowel biopsy (1.9%), and incision and drainage (1.1%). A total of 74 patients (3.2%) died during hospitalisation. CONCLUSION Pyoderma gangrenosum is a serious skin condition, frequently associated with systemic disease, and often confused with other skin pathergies. Pyoderma gangrenosum should be considered when evaluating patients with ulcers, wounds, and post-operative complications. A high index of suspicion is necessary for early and accurate diagnosis and prompt treatment.
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Affiliation(s)
- Sarah E Sasor
- Indiana University School of Medicine, Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine Indianapolis, IN, US
| | - Tahereh Soleimani
- Michigan State University College of Human Medicine, Department of Surgery, East Lansing, MI, US
| | - Michael W Chu
- Kaiser Permanente, Division of Plastic and Reconstructive Surgery, Los Angeles, CA, US
| | - Julia A Cook
- Indiana University School of Medicine, Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine Indianapolis, IN, US
| | - Peter J Nicksic
- Indiana University School of Medicine, Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine Indianapolis, IN, US
| | - Sunil S Tholpady
- Indiana University School of Medicine, Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine Indianapolis, IN, US; Division of Plastic and Reconstructive Surgery, R.L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, US
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10
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Evans TA, Sasor S, Duquette S, Chu MW, Munshi I, Soleimani T, Tholpady SS. Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers. JAMA Surg 2019; 153:183-184. [PMID: 29141070 DOI: 10.1001/jamasurg.2017.3163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tyler A Evans
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah Sasor
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Michael W Chu
- Department of Surgery, R. L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Imtiaz Munshi
- R. L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Tahereh Soleimani
- Department of Surgery, R. L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Sunil S Tholpady
- Department of Surgery, R. L. Roudebush VA Medical Center, Indianapolis, Indiana
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11
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Chauhan R, Munger BN, Chu MW, Munshi I, Cohen AC, Wooden WA, Tholpady SS. Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer. JAMA Surg 2019; 153:390-392. [PMID: 29261825 DOI: 10.1001/jamasurg.2017.5073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ruvi Chauhan
- Indiana University School of Medicine, Indianapolis
| | | | - Michael W Chu
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Imtiaz Munshi
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Adam C Cohen
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - William A Wooden
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Sunil S Tholpady
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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12
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Cook JA, Sasor SE, Tholpady SS, Chu MW, Momeni A. Complexity of health news reporting on breast implant-associated anaplastic large cell lymphoma. Breast J 2018; 25:163-165. [PMID: 30592350 DOI: 10.1111/tbj.13189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Julia A Cook
- Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah E Sasor
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sunil S Tholpady
- Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael W Chu
- Plastic & Surgery, Kaiser Permanente, University of Southern California, Los Angeles, California
| | - Arash Momeni
- Plastic & Reconstructive Surgery, Stanford University Medical Center, Stanford, California
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13
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Tholpady SS, Cohen AC, Chu MW. Age and Treatment of Nonmelanoma Skin Cancer-Reply. JAMA Surg 2018; 153:867-868. [PMID: 29955823 DOI: 10.1001/jamasurg.2018.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sunil S Tholpady
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Adam C Cohen
- Department of Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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Sasor SE, Cook JA, Duquette SP, Loewenstein SN, Gallagher S, Tholpady SS, Chu MW, Koniaris LG. Scholarly activity in academic plastic surgery: the gender difference. J Surg Res 2018; 229:332-336. [DOI: 10.1016/j.jss.2018.04.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/01/2018] [Accepted: 04/13/2018] [Indexed: 11/16/2022]
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Abstract
BACKGROUND The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites. METHODS An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Index, Gunning Fog Score, Automated Readability Index, and Coleman-Liau Index. A 2-tailed z test was used to compare means. RESULTS Seventy-six institutions with both plastic and orthopedic surgery training programs were identified; 42 had educational material available online. The average readability for all hand-related information was at the 11.92 grade reading level. Information regarding de Quervain tenosynovitis had the highest grade level for all plastic surgery procedures (13.45). Hand arthritis had the highest grade level for all orthopedic surgery procedures (12.82). Ganglion cysts had the lowest grade level for both plastic and orthopedic surgery (10.15 and 11.01, respectively; P = .12). Carpal tunnel release was the most commonly described procedure overall. There were no differences in text complexity among geographic regions. CONCLUSIONS Online patient resources for common hand ailments are too complex for the average patient to understand. Efforts should be made to provide materials at the recommended sixth-grade reading level to improve patient education and improve the physician-patient relationship.
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Affiliation(s)
- Julia A. Cook
- Indiana University, Indianapolis,
USA,Julia A. Cook, Division of Plastic &
Reconstructive Surgery, Indiana University School of Medicine, Indiana
University, 545 Barnhill Drive #232, Indianapolis, IN 46202, USA.
| | | | - Sunil S. Tholpady
- Indiana University, Indianapolis,
USA,Richard L. Roudebush VA Medical Center,
Indianapolis, IN, USA
| | | | - Michael W. Chu
- Indiana University, Indianapolis,
USA,Richard L. Roudebush VA Medical Center,
Indianapolis, IN, USA
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Giambruno V, Jones P, Khaliel F, Chu MW, Teefy P, Sridhar K, Cucchietti C, Barnfield R, Kiaii B. Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting. Ann Thorac Surg 2018; 105:1330-1335. [DOI: 10.1016/j.athoracsur.2017.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 10/03/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema. The omental donor site is advantageous for its copious soft tissue, well-defined collateral circulation, and large number of available nodes, without the risk of iatrogenic lymphedema. The purpose of this study is to define the anatomy of the omental flap in the context of vascularized lymph node harvest. METHODS Consecutive abdominal computed tomography angiography (CTA) images performed at a single institution over a 1-year period were reviewed. Right gastroepiploic artery (RGEA) length, artery caliber, lymph node size, and lymph node location in relation to the artery were recorded. A two-tailed Z-test was used to compare means. A Gaussian Mixture Model confirmed by normalized entropy criterion was used to calculate three-dimensional lymph node cluster locations along the RGEA. RESULTS In total, 156 CTA images met inclusion criteria. The RGEA caliber at its origin was significantly larger in males compared with females (p < 0.001). An average of 3.1 (1.7) lymph nodes were present per patient. There was no significant gender difference in the number of lymph nodes identified. Average lymph node size was significantly larger in males (4.9 [1.9] × 3.3 [0.6] mm in males vs. 4.5 [1.5] × 3.1 [0.5] mm in females; p < 0.001). Three distinct anatomical variations of the RGEA course were noted, each with a distinct lymph node clustering pattern. Total lymph node number and size did not differ among anatomical subgroups. CONCLUSION The omentum is a reliable lymph node donor site with consistent anatomy. This study serves as an aid in preoperative planning for vascularized lymph node transfer using the omental flap.
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Affiliation(s)
- Julia A Cook
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah E Sasor
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunil S Tholpady
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Division of Plastic and Reconstructive Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - Michael W Chu
- Division of Plastic and Reconstructive Surgery, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
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Um KJ, Mcclure GR, Belley-Cote EP, Gupta S, Bouhout I, Lortie H, Alraddadi H, Alsagheir A, Bossard M, Mcintyre WF, Lengyel A, Eikelboom JW, Ouzounian M, Chu MW, Parry D, El-Hamamsy I, Whitlock RP. Hemodynamic outcomes of the Ross procedure versus other aortic valve replacement: a systematic review and meta-analysis. J Cardiovasc Surg 2018; 59:462-470. [DOI: 10.23736/s0021-9509.18.10255-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Sasor SE, Evans TA, Cook JA, Lucich EA, Wooden WA, Tholpady SS, Chu MW. Assessing the Necessity of Stopping Antithrombotic Agents Before Wide-Awake Hand Surgery. JAMA Surg 2018; 153:284-285. [PMID: 29188281 DOI: 10.1001/jamasurg.2017.3927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah E. Sasor
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Tyler A. Evans
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Julia A. Cook
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Elizabeth A. Lucich
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - William A. Wooden
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Sunil S. Tholpady
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Michael W. Chu
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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Cook JA, Tholpady SS, Momeni A, Chu MW. Response to "Letter to the editor: Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis", Madada-Nyakauru, et al. J Plast Reconstr Aesthet Surg 2018; 71:938-939. [PMID: 29483056 DOI: 10.1016/j.bjps.2018.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Julia A Cook
- Indiana University School of Medicine, Division of Plastic & Reconstructive Surgery, Indianapolis, IN, USA
| | - Sunil S Tholpady
- Indiana University School of Medicine, Division of Plastic & Reconstructive Surgery, Indianapolis, IN, USA; R.L. Roudebush Veterans Administration Medical Center, Division of Plastic & Reconstructive Surgery, Indianapolis, IN, USA
| | - Arash Momeni
- Stanford University, Division of Plastic & Reconstructive Surgery, Stanford, CA, USA
| | - Michael W Chu
- Kaiser Permanente Medical Group, Department of Plastic & Reconstructive Surgery, Los Angeles, CA, USA.
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21
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Giambruno V, Chu MW, Fox S, Swinamer SA, Rayman R, Markova Z, Barnfield R, Cooper M, Boyd DW, Menkis A, Kiaii B. Robotic-assisted coronary artery bypass surgery: an 18-year single-centre experience. Int J Med Robot 2018; 14:e1891. [PMID: 29349908 DOI: 10.1002/rcs.1891] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/06/2017] [Accepted: 12/13/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Minimally invasive robot-assisted direct coronary artery bypass (RADCAB) has emerged as a feasible minimally invasive surgical technique for revascularization that might offer several potential advantages over conventional approaches. We present our 18-year experience in RADCAB. METHODS Between February 1998 and February 2016, 605 patients underwent RADCAB. Patients underwent post-procedural selective graft patency assessment using cardiac catheterization. RESULTS The mortality rate was 0.3%. The rate of conversion to sternotomy for any cause was reduced from 16.0% of the first 200 cases to 6.9% of the last 405 patients. The patency rate of the LITA-to-LAD anastomosis was 97.4%. Surgical re-exploration for bleeding occurred in 1.8% of patients, and the transfusion rate was 9.2%. Average ICU stay was 1.2 ± 1.4 days, and average hospital stay was 4.8 ± 2.9 days. CONCLUSIONS Robot-assisted coronary artery bypass grafting is safe, feasible and it seems to represent an effective alternative to traditional coronary artery bypass grafting in selected patients.
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Affiliation(s)
- Vincenzo Giambruno
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W Chu
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Fox
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stuart A Swinamer
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Reiza Rayman
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Zarina Markova
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Rebecca Barnfield
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Mitchell Cooper
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas W Boyd
- Division of Cardiac Surgery, University of California Davis, Sacramento, California, USA
| | - Alan Menkis
- Division of Cardiac Surgery, Saint Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Bob Kiaii
- Division of cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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Kugar MA, Cohen AC, Wooden W, Tholpady SS, Chu MW. The readability of psychosocial wellness patient resources: improving surgical outcomes. J Surg Res 2017; 218:43-48. [PMID: 28985876 DOI: 10.1016/j.jss.2017.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Meredith A Kugar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam C Cohen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - William Wooden
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Division of Plastic and Reconstructive Surgery, Department of Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - Sunil S Tholpady
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Division of Plastic and Reconstructive Surgery, Department of Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - Michael W Chu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Division of Plastic and Reconstructive Surgery, Department of Surgery, R.L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana.
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Cook JA, Sasor SE, Deldar R, Poh M, Momeni A, Gallagher S, Tholpady SS, Chu MW. Complexity of online gender confirmation resources surpass patient literacy. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1347545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Julia A. Cook
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah E. Sasor
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Romina Deldar
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Poh
- Department of Plastic & Reconstructive Surgery, Kaiser Permanente Medical Group, Los Angeles, CA, USA
| | - Arash Momeni
- Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Sidhbh Gallagher
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunil S. Tholpady
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Plastic & Reconstructive Surgery, R. L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Michael W. Chu
- Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Plastic & Reconstructive Surgery, R. L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
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Chang CS, Chu MW, Nelson JA, Basta M, Gerety P, Kanchwala SK, Wu LC. Complications and Cost Analysis of Intraoperative Arterial Complications in Head and Neck Free Flap Reconstruction. J Reconstr Microsurg 2017; 33:318-327. [PMID: 28236793 DOI: 10.1055/s-0037-1598618] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. Methods A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without. Postoperative outcomes and costs were analyzed to determine factors associated with microvascular arterial complications. A regression analysis was performed to control for confounders. Results Total 438 head and neck free flaps were performed, with 24 (5.5%) having intraoperative arterial complications. Patient groups and flap survival between the two groups were similar. Free flaps with arterial issues had higher rates of unplanned reoperations (p < 0.001), emergent take-backs (p = 0.034), and major surgical (p = 0.002) and respiratory (p = 0.036) complications. The overall cost of reconstruction was nearly double in patients with arterial issues (p = 0.001). Regression analysis revealed that African American race (OR = 5.5, p < 0.009), use of vasopressors (OR = 6.0, p = 0.024), end-to-side venous anastomosis (OR = 4.0, p = 0.009), and use of internal fixation hardware (OR =3.5, p = 0.013) were significantly associated with arterial complications. Conclusion Intraoperative arterial complications may impact complications and overall cost of free flap head and neck reconstruction. Although some factors are nonmodifiable or unavoidable, microsurgeons should nonetheless be aware of the risk association. We recommend optimizing preoperative comorbidities and avoiding use of vasopressors in head and neck free flap cases to the extent possible.
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Affiliation(s)
- Catherine S Chang
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael W Chu
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marten Basta
- Division of Plastic and Reconstructive Surgery, Brown University, Providence, Rhode Island
| | - Patrick Gerety
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Suhail K Kanchwala
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liza C Wu
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.
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Affiliation(s)
- Zrria L White
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Dr., Suite 1100, Norfolk, VA 23507.
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Cook JA, Tholpady SS, Momeni A, Chu MW. Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis. J Plast Reconstr Aesthet Surg 2016; 69:1340-8. [DOI: 10.1016/j.bjps.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
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Lee JT, Suh JD, Carrau RL, Chu MW, Chiu AG. Endoscopic Denker's approach for resection of lesions involving the anteroinferior maxillary sinus and infratemporal fossa. Laryngoscope 2016; 127:556-560. [PMID: 27640815 DOI: 10.1002/lary.26237] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Michael W Chu
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona Medical Center, Tucson, Arizona, U.S.A
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona Medical Center, Tucson, Arizona, U.S.A
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Chu MW, Soleimani T, Evans TA, Fernandez SI, Spera L, Klene C, Zarzaur BL, Tholpady SS. C-spine injury and mandibular fractures: lifesaver broken in two spots. J Surg Res 2016; 206:386-390. [PMID: 27884333 DOI: 10.1016/j.jss.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/14/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trauma is a leading cause of injury and mortality and may involve mandibular fractures and cervical spine injuries. Manipulation of the spine during trauma protocols and operative treatment has the potential to cause serious spinal cord injuries. The purpose of this study was to identify risk factors associated with cervical spine injury (CSI) in patients with mandibular fractures. METHODS The National Trauma Databank (2007-2010) was used to identify patients with mandibular fractures. RESULTS A total of 59,028 patients were identified and separated into adult and pediatric cohorts. There were 50,711 adults (86%) and 8317 children (14%). There were statistically significant lower rates of associated CSI in pediatric patients than adults (3.5% versus 7.3%, P < 0.01). Predictors of associated CSI in mandible fractures for both adults and children were older age, lower Glasgow Coma Scale, thoracic injuries, firearm or motor vehicle accident mechanisms, and symphyseal fractures. In the pediatric cohort, body, ramus, and subcondylar fractures were significantly associated with CSI. In adults, female gender, and upper extremity, abdominopelvic, and head injuries were also significantly associated with CSI. CONCLUSIONS Multiple mandibular fractures were inversely correlated with CSI. One possibility is that energy dissipation in the mandible with multiple fractures is protective of the C-spine leading to fewer fractures. Children and adults had different associations in the pattern of mandible fractures concomitant with CSI. This has implications in management, imaging, and workup of trauma patients.
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Affiliation(s)
- Michael W Chu
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Tahereh Soleimani
- Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Tyler A Evans
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah I Fernandez
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leigh Spera
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carrie Klene
- Department of Oromaxillofacial Surgery, Indiana School of Dentistry, Indianapolis, Indiana
| | - Ben L Zarzaur
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunil S Tholpady
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, R.L. Roudebush VA Medical Center, Indianapolis, Indiana.
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Yin H, Akawi O, Fox SA, Li F, O'Neil C, Wong J, Arpino JM, Balint B, Watson A, Guo LR, Quantz MA, Nagpal AD, Kiaii B, Chu MW, Pickering JG. Abstract 504: Telomere-based Assessment of Biological Age in Patients with Advanced Vascular Disease. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Ascertaining the biological age of patients with advanced vascular disease could advance risk assessment and management. The extent to which telomeres shorten in leukocytes could be a marker of biological age because it reflects the accumulation of replication stresses imposed on leukocyte progenitors. However, because of wide, genetic variability in leukocyte telomere length (TL), a single leukocyte TL measurement does not reliably indicate telomere shortening.
Hypothesis:
We hypothesized that the difference in length of telomeres in “non-replicating” muscle-rich tissue and that of circulating leukocytes provides a patient-specific index of telomere shortening in patients with advanced vascular disease.
Methods:
TL in leukocytes, skeletal muscle, and right atrial cardiac muscle were measured from 134 patients undergoing coronary or thoracic aortic surgery, using quantitative polymerase chain reaction. Relationships between leukocyte TL or the muscle-leukocyte TL difference (ΔTL) and early post-operative outcomes were tested using Cox proportional hazard and binary logistic regression analyses.
Results:
Telomeres in cardiac muscle and skeletal muscle were significantly longer than those in leukocytes (p<0.001) but with synchrony among these measures in an individual (p<0.001). Leukocyte TL and skeletal muscle TL inversely correlated with chronological age (p<0.001) however cardiac muscle TL did not (p=0.283). There was no relationship between leukocyte TL and either the post-operative length of stay in the intensive care unit (ICU) or major complications. However, cardiac-leukocyte ΔTL was associated with length of ICU stay (hazard ratio 1.26, p=0.043) and post-operative complications (odds ratio 3.03, p=0.029).
Conclusions:
Right atrium-leukocyte ΔTL provides an index of telomere shortening and may inform outcomes in patients with advanced vascular disease. This two-component telomere measurement may reflect the biological age of individuals with chronic vascular disease.
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Affiliation(s)
- Hao Yin
- Dept of Medicine, Robarts Rsch Institute, Western Univ, London, Canada
| | - Oula Akawi
- Dept of Medicine, Robarts Rsch Institute, Western Univ, London, Canada
| | - Stephanie A Fox
- Dept of Surgery, London Health Sciences Cntr, Western Univ, London, Canada
| | - Fuyan Li
- Dept of Medicine, Robarts Rsch Institute, Western Univ, London, Canada
| | - Caroline O'Neil
- Dept of Medicine, Robarts Rsch Institute, Western Univ, London, Canada
| | - Jorge Wong
- Dept of Medicine, London Health Sciences Cntr, Western Univ, London, Canada
| | | | - Brittany Balint
- Dept of Med Biophyics, Robarts Rsch Institute, Western Univ, London, Canada
| | - Alanna Watson
- Dept of Biochemistry, Robarts Rsch Institute, Western Univ, London, Canada
| | - L. Ray Guo
- Dept of Surgery, London Health Sciences Cntr, Western Univ, London, Canada
| | - MacKenzie A Quantz
- Dept of Surgery, London Health Sciences Cntr, Western Univ, London, Canada
| | - A. Dave Nagpal
- Dept of Surgery, London Health Sciences Cntr, Western Univ, London, Canada
| | - Bob Kiaii
- Dept of Surgery, London Health Sciences Cntr, Western Univ, London, Canada
| | - Michael W Chu
- Dept of Medicine, London Health Sciences Cntr, Western Univ, London, Canada
| | - J. Geoffrey Pickering
- Dept of Medicine, Med Biophysics, Biochemistry, Robarts Rsch Institute, London Health Sciences Cntr, Western Univ, London, Canada
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McClure RS, Ouzounian M, Boodhwani M, El-Hamamsy I, Chu MW, Pozeg Z, Dagenais F, Appoo JJ. The Immediate Cause of Death After Surgical Repair of Acute Type A Aortic Dissection: Evidence From the Canadian Thoracic Aortic Collaborative. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2015.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chu MW, Barr JS, Hill JB, Weichman KE, Karp NS, Levine JP. Late-Start Days Increase Total Operative Time in Microvascular Breast Reconstruction. J Reconstr Microsurg 2015; 31:401-6. [PMID: 25826441 DOI: 10.1055/s-0035-1548740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prolonged operative time has been associated with increased postoperative complications and higher costs. Many academic centers have a designated day for didactics that cause cases to start 1 hour later. The purpose of this study is to analyze the late-start effect of microvascular breast reconstructions on operative duration. METHODS A retrospective review was performed on all patients who underwent abdomina-based free flap breast reconstruction from 2007 to 2011 and analyzed by those who had surgery on late-start versus normal-start days. Patient demographics, average operative time, postoperative complications, and individual surgeon effects were analyzed. A Student t-test was used to compare operative times with statistical significance set at p < 0.05. A multivariate regression analysis was performed to control for potential confounders. RESULTS A total of 272 patients underwent 461 free flap breast reconstructions. Twenty-one cases were performed on late-start days and 251 cases were performed on normal-start days. Patient demographics and complications were not statistically different between the groups. The average operative time for all reconstructions was 434.3 minutes. The average operative times were significantly longer for late-start days, 517.6 versus 427.3 minutes (p = 0.002). This was true for both unilateral and bilateral reconstructions (432.8 vs. 350.9 minutes, p = 0.05; 551.5 vs. 461.2 minutes, p = 0.007). There were no differences in perioperative complications and multivariate regression showed no statistically significant relationship of confounders to duration of surgery. CONCLUSION Starting cases 1 hour later can increase operative times. Although outcomes were not affected, we recommend avoiding lengthy procedures on late-start days.
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Affiliation(s)
- Michael W Chu
- Division of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason S Barr
- Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York
| | - J Bradford Hill
- Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York
| | - Katie E Weichman
- Division of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Nolan S Karp
- Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York
| | - Jamie P Levine
- Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York
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Camuglia AC, Syed J, Garg P, Kiaii B, Chu MW, Jones PM, Bainbridge D, Teefy PJ. Invasively assessed coronary flow dynamics improve following relief of aortic stenosis with transcatheter aortic valve implantation. J Am Coll Cardiol 2013; 63:1808-9. [PMID: 24370439 DOI: 10.1016/j.jacc.2013.11.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony C Camuglia
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Jaffer Syed
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Pallav Garg
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Bob Kiaii
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Michael W Chu
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Philip M Jones
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Daniel Bainbridge
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada
| | - Patrick J Teefy
- London Health Sciences Centre and University of Western Ontario, London, Ontario, Canada.
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Akawi O, Yin H, Fox SA, Li F, O'Neil C, Wong J, Chase L, Arpino G, Guo L, Quantz M, Watson A, Chu MW, Pickering J. Telomere Dynamics in Patients Undergoing Cardiac Surgery. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Chu MW. Reply: To PMID 22365023. Ann Thorac Surg 2013; 95:1511. [PMID: 23522229 DOI: 10.1016/j.athoracsur.2013.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/07/2013] [Accepted: 01/28/2013] [Indexed: 11/16/2022]
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Abstract
Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.
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Affiliation(s)
- Michael W. Chu
- Institute of Reconstructive Plastic Surgery, New York
University School of Medicine, New York City
| | - Alice Werner
- Department of Pathology and Anatomy, Eastern Virginia
Medical School, Norfolk
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Chu MW, Werner A, Moody-Antonio SA. Juvenile xanthogranuloma of the tympanic membrane: a case report. Ear Nose Throat J 2012; 91:364-368. [PMID: 22996708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.
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Affiliation(s)
- Michael W Chu
- Institute of Reconstructive Plastic Surgery, New York University School of Medicine, New York City, NY, USA
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Abstract
Defects of the nasal dorsum or sidewall can result from trauma, congenital lesions, extirpation of neoplasms, or iatrogenic injuries. Simple techniques are often used to reconstruct defects in this area with excellent outcomes. Complex defects require more sophisticated techniques including multilayer closures using pedicled flaps or free tissue transfer. This review discusses key anatomic and functional principles and techniques to assist in planning for reconstruction of nasal dorsum and sidewall defects from any cause.
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Affiliation(s)
- Michael W Chu
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Norfolk, VA 23507, USA
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Abstract
Carcinoid tumors are rare, indolent, neuroendocrine tumors that are most commonly found in the gastrointestinal tract and lungs. They occasionally develop in the head and neck, either as a primary tumor or, more commonly, as a metastasis. The most common sites of head and neck carcinoids are the larynx and middle ear. Only a few cases of carcinoid in the nasal cavity and paranasal sinuses have been reported. We describe a case of primary typical carcinoid of the frontal sinus in a 61-year-old man, and we review the clinical, imaging, surgical, and histochemical findings in this case. The patient was treated with endoscopic resection. A subsequent workup for metastatic and occult primary disease was negative, confirming that the frontal sinus was the primary source. At follow-up 12 months postoperatively, the patient remained without disease. To the best of our knowledge, this is the first report of a primary typical carcinoid tumor originating in the frontal sinus.
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Affiliation(s)
- Michael W. Chu
- From the Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Daniel W. Karakla
- From the Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Marc Silverberg
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Va
| | - Joseph K. Han
- From the Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Va
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Murkin J, Young B, Granton J, Falter F, Chu MW. In Response. Anesth Analg 2010. [DOI: 10.1213/ane.0b013e3181e29162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
OBJECTIVE To review the experience and outcomes of a novel use of botulinum toxin type A (BtxA) in the treatment of chronic cough. DESIGN Retrospective case series. SETTING Academic referral center. PATIENTS A total of 438 patients were diagnosed as having laryngeal spasm and chronic cough, and 6 were documented as having chronic cough treated with BtxA injections. Two patients were excluded from the study because of a history of tracheostomy or concurrent laryngeal and voice dysfunction. INTERVENTION Electromyography-guided BtxA injections of the thyroarytenoid muscles. MAIN OUTCOME MEASURES Patient demographics (age and sex), voice-related quality-of-life scores, postprocedure complications, number of BtxA units used, number and length of treatments, and voice outcomes are reviewed. RESULTS Three of the 4 patients (75%) were women, and the mean patient age was 55.6 years (range, 38-64 years). All patients had significant relief of cough after BtxA injection, with complete resolution after a median of 7 injections (range, 4-16), using a mean dose of 4.0 U (range, 1.0-10.0 U) per treatment session for a mean duration of 25.7 months (range, 7.2-42.9 months). CONCLUSIONS To our knowledge, this is the first reported series in the literature of the use of BtxA in the treatment of chronic cough in adults. In this small case series, we report a neuropathic model for chronic cough caused by neuroplastic changes and laryngeal hyperactivity as an explanation for the effectiveness of BtxA treatment. Further research and long-term follow-up are warranted, but BtxA is effective in directly decreasing laryngeal hypertonicity and possibly reducing neurogenic inflammation and neuropeptide-mediated cough. Botulinum toxin type A can be considered for the treatment of chronic cough refractory to other medical therapies.
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Affiliation(s)
- Michael W Chu
- Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
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Chu MW, Wadsworth JT. Analysis of Outcomes and Complications of a New Microvascular Head and Neck Reconstruction Program: Review of 155 Cases. Laryngoscope 2009. [DOI: 10.1002/lary.20332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Payne DM, Pavan Koka H, Karanicolas PJ, Chu MW, Dave Nagpal A, Briel M, Schünemann HJ, Lonn EM. Hemodynamic Performance of Stentless Versus Stented Valves: A Systematic Review and Meta-Analysis. J Card Surg 2008; 23:556-64. [DOI: 10.1111/j.1540-8191.2008.00705.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Asthma is a dynamic and complex inflammatory disease. Recent research suggests that it is a manifestation of a systemic disorder of the entire respiratory system including both upper and lower airways. The diagnosis of asthma can be made based on clinical history, physical findings, and pulmonary function tests such as spirometry. In children, spirometry may be difficult; therefore, diurnal changes in peak expiratory flow rate can be used instead to assist in the diagnosis of asthma. Increasing the use of objective pulmonary measures will help better identify and monitor treatment of lower respiratory inflammatory disease.
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Affiliation(s)
- Michael W Chu
- Division of Rhinology & Endoscopic Sinus and Skull Base Surgery, Department of Otolaryngology & Head and Neck Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 510, Norfolk, VA 23507, USA
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Rudnick EF, Sismanis A, Dodson KM, Chu MW, Mitchell RB. In Reference to Orbital Sequelae of Rhinosinusitis After Cochlear Implantation in Children. Laryngoscope 2007. [DOI: 10.1097/mlg.0b013e318065aa53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES The objectives of this retrospective case review were to describe orbital complications in children after cochlear implantation, to define rhinosinusitis as a possible preoperative risk factor, and to suggest a possible pathophysiological mechanism for this previously unreported occurrence. METHODS Records of children undergoing cochlear implantation over a 7-year period at a tertiary academic medical center were reviewed. Four children who experienced postoperative orbital sequelae were identified. We describe the demographics, clinical course, and radiologic findings in these children. RESULTS The records of 91 children who underwent cochlear implantation were reviewed. The mean age was 6.0 years (range, 0.9-16.9 years). Forty-nine children (54%) were female and 51 (56%) were white. Four children developed postoperative orbital complications on the ipsilateral side to implantation. Orbital complications were characterized by periorbital edema and preseptal cellulitis necessitating prolonged hospitalization in all four children (mean length of stay, 3.3 days). Each child's orbital complication resolved with medical therapy that included intravenous antibiotics and nasal saline. Temporal bone images before implantation showed evidence of rhinosinusitis in all four cases. Of 76 available preoperative scans from the unaffected children, only 11 (14%) studies showed evidence of rhinosinusitis. CONCLUSIONS Children with preoperative radiologic evidence of rhinosinusitis may be at risk of orbital sequelae after cochlear implantation. Positioning of the patient during surgery, length of surgery, and minor trauma to the lamina papyracea during drilling of the mastoid may be important etiologic factors. A careful review of medical history and computed tomography imaging before implantation may identify at-risk children.
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Affiliation(s)
- Emily F Rudnick
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
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Novick RJ, Chu MW. Attitude toward and application of off-pump coronary artery bypass after continuing education retraining. J Thorac Cardiovasc Surg 2006; 131:14-5. [PMID: 16399287 DOI: 10.1016/j.jtcvs.2005.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 08/29/2005] [Indexed: 10/25/2022]
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Abstract
Extension of metastatic hepatocellular carcinoma into the right atrium is exceedingly rare and has a very poor prognosis. We report a case of successful surgical excision of hepatic tumor extension into the right atrium that was causing hemodynamic compromise.
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Affiliation(s)
- M W Chu
- Division of Cardiovascular and Thoracic Surgery, Regina General Hospital, Saskatchewan, Canada
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Abstract
PURPOSE We studied the effect of horizontal transposition of the vertical rectus muscles on incyclotropia and excyclotropia in terms of the amount of correction obtained and the stability of the outcome. METHOD Preoperative measurements for cyclotropia were compared in 11 patients with measurements during the immediate postoperative period and last follow-up. Excyclotropia was treated with nasal transposition of the inferior rectus muscle and incyclotropia with nasal transposition of the superior rectus muscle, to which we added temporal transposition to the inferior rectus muscle in one patient to enhance the effect. RESULTS Fusion in all gaze positions was restored in six patients and functional improvement occurred in five. The average effect of horizontal transposition of one vertical rectus muscle for cyclotropia was a correction of 7 degrees in primary position and of 11 degrees in depression. This effect remained stable after a mean follow-up of 17 months, and additional improvement occurred in one patient. One patient developed a hypertropia, eliminated by an additional operation, in the treated eye. CONCLUSIONS For excyclotropia, nasal transposition of the inferior rectus muscle is a viable alternative to lateral and anterior transposition of the anterior portion of the superior oblique tendon. It becomes the procedure of choice when surgery on the superior oblique tendon is precluded, either by the tendon's congenital absence or by previous surgery on the tendon. Nasal transposition of the superior rectus muscle or temporal transposition of the inferior rectus muscle is ideally suited for incyclotropia. No comparably effective operation exists.
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Affiliation(s)
- G K von Noorden
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
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Chu MW, Font RL, Koch DD. Visual results and complications following posterior iris-fixated posterior chamber lenses at penetrating keratoplasty. Ophthalmic Surg 1992; 23:608-13. [PMID: 1480369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We retrospectively reviewed the records of 13 patients with pseudophakic bullous keratopathy who had undergone penetrating keratoplasty combined with suturing of a posterior chamber intraocular lens (PC-IOL) with angulated haptics to the posterior iris using the four optic positioning holes. Corneal endothelial decompensation was associated with anterior chamber IOLs in nine cases, with iris-fixated lenses in three cases, and a subluxated PC-IOL in one case. Visual acuity was 20/40 or better in 46%, 20/50 to 20/100 in 31%, and 20/200 or worse in 23%. These visual results are comparable with those reported for other similar surgical series. In four of seven eyes that had preoperative peripheral anterior synechiae (PAS), postoperative extension of at least 2 clock hours occurred; progressive angle-closure glaucoma developed in two of the four. In all four eyes, the extension occurred in the region directly overlying the lens haptics. The angulated haptics of iris-sutured PC-IOLs may predispose to extension of PAS and development of progressive angle-closure glaucoma.
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Affiliation(s)
- M W Chu
- Cullen Eye Institute, Baylor College of Medicine, Houston, Tex
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