Necrotizing Soft Tissue Infection Following a Closed Distal Radius Fracture: A Case Report and Literature Review.

Necrotizing soft tissue infections (NSTIs), characterized by extensive soft tissue destruction, are rare but life-threatening. We present a case of a NSTI in a healthy 65-year-old woman following a closed distal radius fracture. The patient presented with severe pain, fever, and lethargy 4 days after her index injury, with physical examination of the right upper limb revealing erythema and swelling to the mid-humeral level and blisters of the fingers and hand. Multiple surgical debridements were required to control the infection, which was caused by Streptococcus pyogenes. This case highlights the rapid progression and devastating consequences of NSTI, which can occur even in the setting of closed injuries in patients without comorbidities. Prompt diagnosis, early surgical intervention, and appropriate antimicrobial therapy are crucial in managing this pathology.Level of Evidence: Level 5.

Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes.

BACKGROUND: Breast augmentation mammaplasty (BAM) remains the most popular cosmetic procedure done worldwide. Bleeding in this procedure increases the chance of capsular contracture. Tranexamic acid (TXA), an antifibrinolytic, has been widely used by other surgical specialties to reduce bleeding. OBJECTIVES: We aimed to evaluate the use of TXA in BAM surgery. METHODS: This was a single-surgeon case series of all patients who underwent primary BAM from March 2017 to March 2018 and received topical TXA spray to the implant pocket before implant insertion. Early postoperative complications and long-term outcomes, such as capsular contracture and revisional surgery, were recorded and described. RESULTS: Two hundred and eighty-eight patients were included in the study with an overall complication rate of 2.8% over 5 years. No patients had postoperative bleeding or hematoma formation. One patient had a seroma, managed with ultrasound drainage. Complications requiring reoperation included rippling (3, 1.0%), pocket revision (2, 0.7%), capsule contracture (1, 0.3%) and rupture (1, 0.3%). CONCLUSIONS: This study highlights the safety and potential benefits of the use of topical TXA in breast augmentation, with low bleeding and capsular contracture rates.

External validation in an Australian population of the EORTC-DeCOG nomogram predicting recurrence, distant metastasis and overall mortality in melanoma patients with positive sentinel lymph nodes.

BACKGROUND: Calculating an accurate prognosis for melanoma patients who have a positive sentinel node (SN) biopsy is important both for them and for their treating doctors to guide decision-making, particularly when adjuvant systemic therapy is being considered. The recently published EORTC-DeCOG nomograms aim to provide this via an online portal that predicts 5-year rates for recurrence, distant metastasis and overall mortality. The present study provides external validation of these nomograms. METHODS/MATERIALS: De-identified data from patients with a positive SN biopsy between 2003 and 2015 were extracted from the prospectively maintained Melanoma Institute Australia (MIA) research database. ROC-curves with C-statistics, regression co-efficients and Decision Curve Net Benefit analyses were performed using the integrated private validation portal on the nomograms' hosting platform (Evidencio). RESULTS: Complete data were available for 352 patients. The respective C-statistics for recurrence, distant metastasis and overall mortality nomogram validations were 0.68, 0.69 and 0.66. CONCLUSION: The performance of the nomograms in predicting recurrence and distant metastasis was similar in the MIA and the development populations, suggesting that they are robust. However, the overall mortality nomogram performance was significantly poorer in the MIA population (C-statistic 0.66) than in the original EORTC-DeCOG derivation cohort (C-statistic 0.70) and may therefore be less reliable for clinical use.

Unilateral Pterional Polycraniosynostosis Treated with Craniectomy and Helmet Therapy.

Craniosynostosis is a condition in which one or more of the cranial sutures have fused prematurely, affecting the growth pattern and contours of the infant skull. The pterion is the junction of temporal, frontal, parietal, and sphenoid bones of the skull. We present a case of unilateral pterional craniosynostosis, which was treated with strip craniectomy and helmet therapy.

The contribution of personality to longevity: findings from the Australian Centenarian Study.

OBJECTIVES: To examine whether centenarians have a unique set of personality traits, which may in part explain their longevity. METHODS: 79 Australian centenarians completed the NEO Five Factory Inventory (NEO-FFI), Connor-Davidson Resilience Scale (CD-RISC) and Life Orientation Test Revised (LOT-R) to assess different dimensions of their personalities. Centenarians were asked to answer items of the NEO-FFI, CD-RISC and LOT-R based on current views, and were then asked to recall in the presence of an informant (e.g. carers, offspring) on past personality (i.e. at mid-adult-life). Both sets of answers were recorded and analysed. RESULTS: Centenarians were currently low in Openness and Extraversion and high in Neuroticism, but were low in Openness and high in Neuroticism, Conscientiousness and Extraversion when reflecting on past traits. Currently, centenarians in high care facilities reported higher levels of Neuroticism, as did centenarians who did not socialize. Cognitively intact centenarians reported higher levels of Agreeableness; and males reported lower Neuroticism compared to females when reflecting on past experiences. DISCUSSION: Centenarians were characterized by several personality traits, which facilitated positive health behaviors and thus contributed to their longevity. It is possible that personality may not be static across the lifespan, but instead, reflect advancing age, psychosocial factors and changes in life circumstances.

Morbidity profiles and lifetime health of Australian centenarians.

AIM: To examine the lifetime prevalence and initial onset of diseases among centenarians. METHODS: In this descriptive study, we administered structured questionnaires by interview to 188 centenarians and asked about the presence and timing of 14 common age-related diseases. RESULTS: The most common conditions were ocular disease (70%), arthritis (58%) and hypertension (40%). Average age at disease onset was 80 years, and average number of comorbidities was 3. Participants were characterised into three morbidity profiles - survivors (46%), delayers (34%) and escapers (19%). No participants had a diagnosis of dementia or osteoporosis before age 80 years. CONCLUSION: Relative to the general population, a select sample of Australian centenarians reported lower rates of chronic conditions, with many escaping osteoporosis, dementia, cardiovascular disease, respiratory illnesses, cancers, anxiety and depression. Increasing age is correlated with increasing morbidity but a few centenarians reached 100 years of age without disease.

Lymphatic malformations: clinical course and management in 64 cases.

BACKGROUND: Lymphatic malformations (LM) are rare vascular malformations. OBJECTIVES: To define the clinical characteristics of children with LM and their management. METHODS: We performed a retrospective chart review of children with LM and telephone interviews with parents. Demographic and clinical features, diagnostic imaging, treatments and complications were recorded. RESULTS: Thirty male and 34 female patients with LM were identified. The anatomic location of the LM was most frequently the head and neck (48%). LM involved the left side of the body more frequently (62%). Children presented most commonly with swelling as skin coloured tumours or cysts, and less frequently with hemihypertrophy, bruising, and superficial pseudo-vesicles. Most LM were macrocystic (60%), followed by microcystic (24%) and mixed (16%). The mean age at diagnosis was 37 months, with 51% of LM obvious at birth. LM caused morbidity in 70% of cases and death in one child. Treatments were sclerotherapy with sodium tetradecyl sulfate 3% (30.5%), OK-432 (17%) and doxycycline (10%); 27% received surgery; 34 % had no treatment. CONCLUSIONS: LM are heterogeneous vascular malformations that may result in significant morbidity. Diagnosis is often delayed. A multidisciplinary approach to management including dermatology, diagnostic and interventional radiology and paediatric surgery is important.

Physical, mental, and cognitive function in a convenience sample of centenarians in Australia.

OBJECTIVES: To examine the physical, mental, and cognitive function of centenarians. DESIGN: Descriptive study using a structured questionnaire and convenience sampling. SETTING: Residential care facilities and private dwellings in Australia. PARTICIPANTS: A convenience sample of 188 centenarians. MEASUREMENTS: The Hospital Anxiety and Depression Scale (HADS) screened for anxiety and depression. The Katz Index of Independence in Activities of Daily Living (Katz ADL) was used to assess functional status. The Quality of Life Scale was used to assess quality of life. The Mini-Mental State Examination (MMSE) was used to screen for dementia. Structured responses were obtained for living arrangement, marital status, social relationships, and supports. RESULTS: Centenarians had regular contact with friends (59%), neighbors (62%), and families (72%); 54% were religious and 43.5% had received social supports. Average MMSE and Katz ADL scores were 21.5 and 3.7, respectively; 45% had scores on the MMSE indicative of dementia, 10% indicated anxiety and 14% depression on the HADS. Participants with poor ratings of health experienced higher rates of anxiety and depression than their healthier counterparts. CONCLUSION: In this convenience sample of Australian centenarians, anxiety and depression was relatively nonexistent, and most reported a high quality of life. This was despite objective deterioration in functional status, paralleling the aging process, and high dependence on others for everyday tasks. Potentially, this is suggestive of a unique ability within the sample to adapt to aging and its limitations.

Higher blood pressure associated with higher cognition and functionality among centenarians in Australia.

BACKGROUND: The objective of this study was to examine blood pressure (BP) and cholesterol levels among centenarians in Australia, and to compare the relationship between these biological parameters with cognitive and functional status. METHODS: We performed BP (n = 142) and cholesterol (n = 67) measurements using the Omron automated sphygmomanometer (Omron Healthcare, Melbourne, Australia) and the LDX Cholestech Analyzer (Inverness Medical, San Diego, CA), respectively. A medical history was also obtained. Cognitive and functional statuses were assessed using the Mini-Mental State Examination (MMSE) and Katz Index of Independence in Activities of Daily Living (Katz ADL), respectively. RESULTS: Average age of participants was 101.1 years. Hypertension was demonstrated in 1% according to the WHO criterion (≥140/90 mm Hg). However, 38% of centenarians were hypertensive, defined as having a medical diagnosis of hypertension, and/or being on antihypertensive medications, and/or having a BP measurement ≥ 140/90 mm Hg. Mean values were: systolic = 130 mm Hg (90-182 mm Hg), diastolic = 70 mm Hg (44-98 mm Hg), and pulse pressure (PP) = 60 mm Hg (20-130 mm Hg). Hypercholesterolaemia was only detected in 8% of participants. Hypertension was not associated with increased risk of hypercholesterolaemia. Low systolic BP (SBP) and narrower PP was associated with lower MMSE scores. High SBP and wider PP was associated with better functional status. CONCLUSIONS: Centenarians have a very low prevalence of high BP and high cholesterol compared with the general population. There seems to be an inverse relationship between the risk factors for cardiovascular disease vs. the risk factors for dementia in our sample. There appears to be a complex interaction between BP and health in old age.