Impact of Parental Consanguinity on the Frequency of Orofacial Clefts in Jordan.

ABSTRACT: Orofacial clefts (OFCs) are the most common craniofacial congenital anomalies, and its prevalence is highest among Asian populations. The aim of this retrospective case-control study is to evaluate the effect of parental consanguinity on the frequency of OFCs at Jordan University Hospital over a 15-year-period. The study group consists of all patients with OFCs presented to the major tertiary referral center in Jordan during the last 15 years, along with age and gender-matched controls. The authors analyzed the risk of different predictors, including consanguinity, on the development of OFCs, both cleft lip with or without cleft palate (CL/P) and cleft palate only. A total of 332 participants were included in this study, with a mean age of 74.36 (±48.75) months. The authors included 129 (38.9%) OFCs, and 203 (61.1%) controls. The percentage of parental consanguinity among OFCs group was 41.1%, compared to only 24.1% for controls, a difference that was statistically significant (P = 0.001). On logistic regression analysis, the authors found that parental consanguinity is a significant predictor for the occurrence of OFCs (P = 0.007), where people with consanguineous marriage have 2 times higher risk (odds ratio of 0.504, with 95% confidence interval 0.306-0.830) to have offspring with OFCs. Moreover, lower birth weight babies are also significantly more associated with OFCs (P = 0.014), with an odds ratio of 1.819 (95% confidence interval 1.131 2.926). Among the Jordanian population, the authors found that consanguinity and lower birth weight were the only variables significantly associated with the development of OFCs.

A Rare Sequela of Constriction Band Syndrome: Case Report.

The patient in this case report is a 19-year-old man who presented with left foot cauliflower lesion. He complained of an inability to wear proper shoes, in addition to an unpleasant appearance of his foot. The lesion was present since his birth. Based on history and physical examination, the top 2 differential diagnoses at this stage were pediatric neurofibroma and constriction band syndrome (CBS). Laboratory investigations and x-ray were ordered for the patient. X-ray showed absence of most of the phalanges of the first, second, and third toes, with swelling of the overlying soft tissues of the foot. CBS was confirmed. Excision of the lesion was done along with skin graft applied on the area. Biopsy showed skin with dermal fibrosis and extensive adipose tissue infiltration without any sign of atypia or malignancy. The patient was discharged with regular follow-up appointments.

High-pressure injection injuries to the hand: A 14-year descriptive study.

BACKGROUND: High-pressure injection (HPI) injury is an unusual type of injury in hand trauma, which could lead to a serious morbidity. We aimed to assess the clinical presentation, management, and outcome with HPI injury of the hand. METHODS: A retrospective study was conducted between 2001 and 2015 for patients with HPI injuries who were admitted to a Level 1 trauma center. We reviewed the medical records, imaging files, and demographic data including gender, age, mechanism of injury, and site of hand injury. The kind of injected materials, time to first treatment procedure, clinical management, and complications were also described. RESULTS: A total of 32 cases of HPI injuries were included in the study. The average age of the patients was 32.7 ± standard deviation 8.3 years, and all the patients were right handed. The most common material involved was grease (53%), followed by paints (25.0%), chemicals (9.4%), and air (6.3%). The most commonly affected part of the hand was the palm (31.3%), followed by index finger (25.0%). The average delay in the presentation was 12 h (range 3-96 h), and the mean hospital stay was 5.8 days. Management included debridement (90.6%) or conservative treatment (9.4%). Complications included chronic pain (9.4%), followed by amputation (3.1%). CONCLUSIONS: HPI injury is not uncommon, usually underestimated, and needs more community awareness, particularly laborers. Delay of treatment could increase the risk of amputation. Therefore, it is important to inform the risk groups about the seriousness of such injuries and to take preventive measures.

Intravascular extra-digital glomus tumor of the forearm.

Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case.

Issues related to advances and controversies in breast cancer management: a multicultural experience.

The overview of current diagnostic and therapeutic advances and controversies in the management of breast cancer is presented. Specific topics and their impact on breast reconstruction surgeons practicing in culturally different areas and with variable access to breast education and health care are discussed. The following approaches to the most common types of problems are presented: prophylactic mastectomy for women at high risk of breast cancer, size and location of the primary tumor and feasibility of breast conserving surgery and oncoplastic approach, management of the axilla, post-mastectomy radiation and chemotherapy, emerging breast reconstructive techniques (fat transfer, stem cells) and cancer risk, oncological follow up and imaging of the reconstructed breast, including illustrative cases. This material should help oncological and plastic surgeon specialists to understand each other's considerations for the best possible outcome of the breast cancer treatment.

A perforator-based bilobed fasciocutaneous flap: an additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease.

A great variety of procedures have been proposed for the cure of sacrococcygeal pilonidal disease. A bilobed fasciocutaneous flap, based on the parasacral perforators, is described. This retrospective study was conducted to evaluate our experience with bilobed fasciocutanous flaps and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. Eight bilobed fasciocutanous flaps have been performed between February 2004 and September 2006. Eight males, aged 19 to 35 years (mean age: 26.2 years), presented with chronic and recurrent pilonidal disease. The duration of the disease was ranged from 2 to 6 years (mean age: 3.8 years). The sinuses were excised in a vertical, elliptical fashion and the defect closed using a bilobed fasciocutanous flap. This flap was designed using the parasacral perforators and tailored to obliterate the midline defect. Primary wound healing was achieved in all patients. Large defects after excision can easily be closed using the bilobed fasciocutaneous flap. The flap provides a tensionless wound closure. Hospitalisation is brief, and the postoperative course is comfortable. No recurrence was seen in any of the eight cases. This procedure is indicated in patients in whom wide skin resection is required, because of the tension-free skin closure in such cases. This technique enabled regional reconstruction, conserved tissues, and provided satisfactory aesthetic results. Therefore, this procedure can be considered an additional, useful tool in the treatment of pilonidal sinus.

Subtotal reconstruction of the burned auricle.

The goal for external ear reconstruction is to restore the function of the helical rim in order to provide support for eyeglasses and to provide a cosmetically acceptable auricle. Reconstruction necessitates both flap coverage and flexible framework formation. This article reviews 22 patients who underwent subtotal reconstruction of the auricles after burns. The study was conducted from 1996 to 2003. The study group consisted of 14 male and 8 female patients aged 6-43 years (mean 21.9 years). Different modalities have been used: the temporoparietal fascial flap (eight patients), the subcutaneous pocket technique (11 patients), the pre-auricular skin flap (four patients), and the post-auricular skin flap (three patients). The flaps were used for coverage of fabricated autogenous cartilage in all patients. Both aesthetic and functional outcome was satisfactory.

Intraabdominal pressure after full abdominoplasty in obese multiparous patients.

This study measured intraabdominal pressure in morbidly obese and multiparous patients who underwent abdominoplasty with musculoaponeurotic plication. The purpose of this study was to evaluate any potential adverse effect on pulmonary function by virtue of pulmonary function tests and measurement of peak airway pressure. The study included 43 multiparous, morbidly obese women (mean body mass index, 35.8 kg/m2) with a mean age (+/- SD) of 38.6 +/- 7 years. All had full abdominoplasty and repair of the musculoaponeurotic system during the period from June of 1999 to May of 2002. Forty-three morbidly obese multiparous patients were seen over a period of 24 months. Their intraabdominal pressure was estimated by measuring the intravesical pressure before and after repair of severe diastases (divarication) of the rectus abdominis muscles with severely flaccid myofascial component before using a hydrometer connected to a Foley catheter both before and after repair. All patients had pulmonary function checked before and 2 months after the repair. The study confirmed that there are minimal changes on the intraabdominal pressure parameters compared with measurement before and after full abdominoplasty with plication of the rectus muscles, with minimal to negligible changes in the intrathoracic pressure. These changes are clinically and statistically significant (p < 0.0001). The study also recommended the safety of full abdominoplasty and repair of the musculoaponeurotic system in multiparous and morbidly obese patients. Furthermore, no statistically significant difference was found in pulmonary function parameters before and after surgery in patients with a history of bronchial asthma.

The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up.

Solitary lipomas and familial multiple lipomatosis are the most common benign tumors and are very well encapsulated. They are very slow growing and have the potential for recurrence if incompletely excised and a very remote chance for malignant changes. These can be freed from surrounding tissue without difficulty, but because of the fibrous nature of the capsule, its violation is more likely with suction technique and may result in an inadequate resection, possibly leading to recurrence. Furthermore, liposuction alone will not allow histopathological study of the swellings. Therefore, we report here the treatment of moderate (>4-10 cm) and large (>10 cm) lipomas with liposuction-assisted surgical extraction of the capsule via the same wound (1 cm in length). This capsule extraction is aimed at avoiding recurrence and evaluating the histopathological nature of these swellings. 16 patients (nine men and seven women) presented with solitary lipomas (in 11 patients) and multiple lipomas (in five patients) have been successfully treated. Methods involved 1-cm incision for both liposuction and surgical removal of the capsule. Another 1-cm counter-incision may be needed in case of large size lipomas. High patient satisfaction was achieved because of the good cosmetic results due to the small postoperative residual scar and the smooth postoperative course. There has been no recorded recurrence in six years postoperative followup.