Clinical Determinants Differentiating the Severity of SARS-CoV-2 Infection in Cancer Patients: Hospital Care or Home Recovery.

Background: Cancer patients may carry a worse prognosis with SARS-CoV-2 infection. Most of the previous studies described the outcomes of hospitalized cancer patients. We aimed to study the clinical factors differentiating patients requiring hospital care vs. home recovery, and the trajectory of their anti-cancer treatment. Methods: This study was conducted in a community cancer center in New York City. Eligible patients were those who had cancer history and were diagnosed of SARS-CoV-2 infection between March 1 and May 30, 2020, with confirmatory SARs-CoV-2 virus test or antibody test. Four groups were constructed: (A) hospitalized and survived, (B) hospitalized requiring intubation and/or deceased, (C) non-hospitalized, asymptomatic, with suspicious CT image findings, close exposure, or positive antibody test, and (D) non-hospitalized and symptomatic. Results: One hundred and six patients were included in the analysis. Thirty-five patients (33.0%) required hospitalization and 13 (12.3%) died. Thirty (28.3%) patients were asymptomatic and 41 (38.7%) were symptomatic and recovered at home. Comparing to patients who recovered at home, hospitalized patients were composed of older patients (median age 71 vs. 63 years old, p = 0.000299), more who received negative impact treatment (62.9 vs. 32.4%, p = 0.0036) that mostly represented myelosuppressive chemotherapy (45.7 vs. 23.9%, p = 0.0275), and more patients with poorer baseline performance status (PS ≥ 2 25.7 vs. 2.8%, p = 0.0007). Hypoxemia (35% in group A vs. 73.3% in group B, p = 0.0271) at presentation was significant to predict mortality in hospitalized patients. The median cumulative hospital stay for discharged patients was 16 days (range 5-60). The median duration of persistent positivity of SARS-CoV-2 RNA was 28 days (range 10-86). About 52.9% of patients who survived hospitalization and required anti-cancer treatment reinitiated therapy. Ninety-two percent of the asymptomatic patients and 51.7% of the symptomatic patients who recovered at home continued treatment on schedule and almost all reinitiated treatment after recovery. Conclusions: Cancer patients may have a more severe status of SARS-CoV-2 infection after receiving myelosuppressive chemotherapy. Avoidance should be considered in older patients with poor performance status. More than two thirds of patients exhibit minimal to moderate symptoms, and many of them can continue or restart their anti-cancer treatment upon recovery.

Injection Lipolysis: A Systematic Review of Literature and Our Experience with a Combination of Phosphatidylcholine and Deoxycholate over a Period of 14 Years in 1269 Patients of Indian and South East Asian Origin.

BACKGROUND: Phosphatidylcholine and deoxycholate (PC-DC) injections have been used as nonsurgical alternatives to liposuction. DC as a constituent for lipolysis has recently been approved by the US Food and Drug Administration. AIM: PC and DC have independently been used in lipolysis. We hereby present a systematic review of literature on injection lipolysis and share our experience of using DC in combination with PC for injection lipolysis. We have retrospectively evaluated the effects of PC-DC treatments in varied age groups, both sexes, and over different target areas. MATERIALS AND METHODS: This study spans over 14 years wherein 1269 patients of different age groups and sex were treated with injection lipolysis with PC-DC combination. The PC-DC cocktail injection was given to all patients for an average four sessions every 4 weeks, and the results were assessed after 8 weeks from the last session. RESULTS: The effects were best appreciated over the face (malar, jawline, and submental areas) and upper arm, whereas average effect was observed on the thighs and around the knees. We have also used lipolysis as a primary modality as well as a touch-up modality following liposuction. The results are better appreciated in primary lipolysis. The need for follow-up sessions (1-2 sessions) of lipolysis and the quantification of results in subsequent sessions reveal that maximal improvement is achieved in the first session. CONCLUSION: PC-DC cocktail used for lipolysis as a local administration is effective for reducing unwanted fat. It shows great efficacy in treating localized fat, especially over the face and bra roll in the women of younger age group (20-30 years).

Lip designing: the need for a beautiful smile: an Indian perspective.

BACKGROUND: Smile is the defining element of the face, its impact holding utmost importance in the perception of feelings. Lip is an integral part for a perfectly perceived smile. The aim of the present manuscript is to present an innovative approach to smile improvement by lip design in Indian context. MATERIALS AND METHODS: Thirty-five patients who had undergone smile design (lip) in the institute were taken up for retrospective analysis. The technique of using fillers for lip augmentation was assessed, and the final result evaluated. RESULTS: Demographic details are presented . We observed that the upliftment of the lips was more visible, and the fillers enhanced the volume resulting in an attractive smile. CONCLUSION: Smile reconstruction has been revolutionized by the new filler materials for volume augmentation of lips. We advocate this novel approach of lip design using fillers to generate a gorgeous smile.

Periprosthetic atypical mycobacterial infection in breast implants: a new kid on the block!

INTRODUCTION: Breast augmentation is one of the most commonly performed cosmetic surgical procedures. Infection in the breast implant surgery can range from simple wound infection to periprosthetic infection usually with skin commensals such as staphylococci. However, with routine use of broad-spectrum antibiotics atypical mycobacterial infections are being increasingly reported. MATERIAL AND METHODS: We studied 12 cases of atypical mycobacterial breast implant infections over a period of 8 years from 2002 to 2010. Six of them were primarily operated at our centre and six referred from elsewhere after implant infection. Age range was 30-40 years and follow-up after secondary surgery ranged from 1 to 5 years. All patients were explanted and started on combination antibiotics namely, clarithromycin, gatifloxacillin and linezolid for 3 months. After a period of 3 months, all patients underwent implant surgery again with the same antibiotic cover for 6 weeks. RESULT: All the secondary implant augmentations were successful. Organisms grown in primary culture were Mycobacterium fortuitum and M. chelonei. All patients were satisfied with the final breast form and size achieved. CONCLUSION: The possibility of an atypical mycobacterial infection should always be at the back of the mind of an alert surgeon to prevent a periprosthetic infection from compromising the final aesthetic result of a breast implant procedure. Diagnosed early and eradicated in time, the final result is not compromised.

Volume enhancement of upper lip in secondary cleft deformity using composite mastoid tissue.

BACKGROUND: Secondary cleft lip deformity correction needs thorough assessment and planning to optimize treatment and achieve good results. Deficient volume of the upper lip, which is one of the most common secondary cleft lip deformities, has been addressed in many ways using tissues from local or distant areas. Consideration must be given to safety, easy availability of the tissues, minimum morbidity, and longevity of the results when selecting a procedure. METHODS: This retrospective study included ten patients with a minimum follow-up of 1 year. Composite mastoid fascia was harvested through a postauricular incision and used to augment deficient lip volume in secondary cleft lip deformities. Clinical assessment and measurement was performed by measuring the vertical height and projection of the deficient upper lip before and after surgery. RESULTS: At the end of 1 year the average increase in the vertical height of the vermilion was 27.11% compared to the preoperative readings, with an average loss of 12.81% of increase at 1 year. The lateral projection showed an increase of 23.88% compared to the reading taken before surgery, with a loss of 9.75% at the end of 1 year. The donor site incision was concealed behind the ear and lip incisions were invisible in the long term. There were no major complications. CONCLUSION: This is a good way of augmenting the lip with due consideration given to longevity of the result and minimal morbidity. This method might also by used for permanent cosmetic lip enhancement for those with very thin lips.

Ethnic rhinoplasty.

This article examines the surgical techniques of rhinoplasty in relation to aesthetic considerations of various ethnic groups. Rhinoplasty in general is challenging, particularly in the ethnic population. When considering rhinoplasty in ethnic patients one must determine their aesthetic goals, which in many cases might deviate from the so-called norm of the "North European nose." An experienced rhinoplastic surgeon should be able to navigate his or her way through the nuances of the various ethnic subsets. Keeping this in mind and following the established tenets in rhinoplasty, one can expect a pleasing and congruous nose without radically violating ethnicity.

Improved surgical access for facial dimple creation.

As an alternative to blind coring of the soft tissue from the buccal mucosa to the dermis or the placement of transcutaneous sutures, both of which can be associated with untoward side effects, the authors describe a safe and effective method for creating dimples through an open technique that replicates the anatomical basis of a natural dimple.

Surgical complications of lipoplasty--management and preventive strategies.

BACKGROUND: Lipoplasty and its associated complications are well researched and documented. In most articles, the focus has been on the major life-threatening complications of liposuction. Most of these major complications are related to conditions other than surgical trauma per se, namely anaesthesia, hypothermia, long duration of surgery and fluid overload. With the exception of pneumothorax and abdominal perforation, surgical trauma does not cause major complications. Although most surgical complications are classified as minor, they present as major events for patients and the treating physician. All efforts to prevent even minor complications to enhance patient satisfaction are needed. This article presents a review of only the surgical-trauma-related complications of lipoplasty and discusses their management and preventive strategy. METHODS: A review of 200 consecutive cases of lipoplasty, performed between July 2006 and December 2007, including large-volume liposuctions (LVLs) and combined liposuction abdominoplasties, was undertaken. Complications relating only to the surgical trauma of liposuction were analysed. RESULTS: Complications such as hyperpigmentation of access points, postoperative fluid collection, asymmetry, irregularity, external genital swelling and haematoma were noted. Postoperative fluid collection and haematoma required active intervention. Drainage of fluid collection using a liposuction cannula was effective and prevented recurrence and the need for repeated aspirations. Major surgical complications such as pneumothorax and abdominal wall perforations could be avoided by following simple rules. CONCLUSIONS: Major complications related to surgery can be avoided by following well-known safety guidelines. To enhance patient satisfaction, minor complications related to surgical trauma need to be addressed aggressively. This article discusses methods to lower the incidence of most surgical complications.

Anesthesia considerations in large-volume lipoplasty.

BACKGROUND: Large-volume lipoplasty is becoming more common and has been proven to be safe and effective. Large-volume lipoplasty is normally performed with the patient under general anesthesia. Techniques of general anesthesia and fluid management are important factors in improving the safety of large-volume lipoplasty. OBJECTIVE: Certain important considerations in anesthesia and perioperative management can improve outcomes in large-volume lipoplasty. Our objective is to present our protocol and technique for general anesthesia in large-volume lipoplasty METHODS: Large-volume lipoplasty (5 to 18.5 L) was performed on 32 patients under general endotracheal anesthesia. Important considerations included proper selection of patients, low flow of anesthesia gases, prevention of hypothermia, deep vein thrombosis prophylaxis, intraoperative fluid ratio of 1, Foley catheter to monitor urine output, and postoperative overnight or longer monitoring in a well-equipped hospital. Maintaining the endotracheal cuff pressure between 20 to 30 mm of water helped to reduce incidence of sore throat. Addition of lidocaine in wetting solution helped to reduce requirement of general anesthetic agents and as a result, postoperative recovery was faster and more pleasant. RESULTS: Major complications did not occur in any patients. Minor complications encountered were nausea, vomiting, and shivering and occurred in about 25% of patients. All patients were able to walk without support 4 hours after surgery. In spite of minor complications, all patients reported the postoperative recovery to be better than expected. CONCLUSIONS: General anesthesia for large-volume lipoplasty is safe. Postoperative recovery can be made faster and more pleasant by following these recommendations.

Technical considerations in replantation of total scalp avulsions.

Total scalp avulsions are devastating injuries and replantation is the best form of reconstruction. We present our experience of replantation of six totally avulsed scalps done between 1996 and 2004. All were technically successful, but one was lost in the post-operative period due to accidental shearing of the scalp during nursing care. A single team performed the surgery in all cases and the average operating time was 6 h. No vein grafts were used. Hair growth was satisfactory in all cases. None underwent formal nerve repair but there was adequate sensory recovery in all of them by 6-9 months. A small area of skin necrosis in the occipital area (three cases), telecanthus and epiphora (two cases) were the minor complications. The available Literature highlights the need for multiple teams to reduce the long operating time, the use of multiple vein grafts and the complexities involved. Since, they are rare injuries, gaining wide experience is difficult. In this article we offer recommendations in pre-op preparation, vessel identification, technique of anchoring the avulsed scalp prior to vessel anastomosis and post-op care to make this rare procedure quicker, easier and successful.