Comparing touch senses of naïve and expert panels through treated hair swatches: which associated wordings correlate with hair physical properties?

OBJECTIVES: This study (i) compared the sense of touch between a naïve and expert panels, under visual or blind conditions, using differently treated hair swatches and (ii) explored possible common wordings used by both panels and their possible links with some physical properties of hairs. METHODS: Two sets of 15 hair swatches of Caucasian and Chinese origins were differently treated (bleached, permed, brushed, etc.) or organized (root-tip vs. tip-root). These were evaluated by tactile assessments by two panels (105 naïve consumers and 10 hair experts) under visual or blind conditions, in two geographical locations. A series of 17 defined antonym adjectives, as descriptors, allowed responses of each panel to being scored and their preference mappings to being defined on a like-dislike scale. Hair swatches were measured and assessed by various instrumental techniques (bending, diameter, cuticle cohesion, alignments of hair). RESULTS: Apart from a few overlaps, all 15 hair swatches were well differentiated by both panels which showed a global agreement, making experts reliable assessors. Only three descriptors among 17 correlated with some objective measurements. Tactile-visual assessments differ from those performed tactile blind in both panels. Agreements between both panels appear, however, closer under tactile-blind conditions. CONCLUSION: Trained hair experts were confirmed as reliable representatives of a larger and naïve cohort, viewed as consumers. Hair swatches were well differentiated by both panels, with comparable descriptor rankings.

Nasal Tip Reconstruction Using Integra Bilayer Wound Matrix: An Alternative to the Forehead Flap.

UNLABELLED: Large defects of the nasal tip with exposure of the underlying cartilage pose a significant reconstructive challenge to the plastic surgeon. OBJECTIVE: This article presents a case of a large nasal tip defect following basal cell excision that was successfully treated with Integra bilayer wound matrix and skin grafting. METHODS: Following tumor excision, meshed Integra bilayer wound matrix was placed over the exposed nasal tip cartilage. After 4 weeks, the silicone layer was removed and a full-thickness graft placed on the nasal tip. RESULTS: This reconstruction resulted in the restoration of patient's nasal tip with good contour and color match without the need for a forehead flap. CONCLUSION: This demonstrates the reconstructive potential of this modality in patients who are not candidates for reconstruction with a forehead flap.

Critical pathway methodology: effectiveness in congenital heart surgery.

Critical pathway methodology has been demonstrated to provide producible reduction in average length of stay (ALOS) in adults in certain diagnostic-related groups and operations such as coronary artery bypass grafting. The efficacy of this approach in congenital heart surgery was explored. Two hundred eighty-six consecutive patients from a health maintenance organization treated by a single surgeon since the institution of diagnostic-related group coding at that health maintenance organization constituted the study group. One hundred fourteen patients were treated at a university hospital without critical pathway methodology (group 1) and 172, subsequently at the health maintenance organization institution using the methodology (group 2). Operation/lesion, age, and diagnostic-related group matching was possible in 61 pairs. Examination of the ALOS Hospital (operative and postoperative days) for the entire cohort revealed a 43.8% reduction in ALOS Hospital (p < 0.0001) and a 39.0% reduction in ALOS Intensive Care Unit (p < 0.0001). There was also significant reduction in ALOS Hospital and ALOS Intensive Care Unit in the operation/lesion-matched subsets. Outcome measures including operative and late mortality, readmission, unscheduled emergency room and clinic visits, and health maintenance organization family assessment survey demonstrated no improvement in outcome with increased hospital stay. Thus, critical pathway methodology when used in patients undergoing a congenital heart operation produces a significant reduction in hospital stay and intensive care unit stay as well as quality patient care with uniformity of outcome.

Chronic recurrent esophageal strictures treated with balloon dilation in children with autosomal recessive epidermolysis bullosa dystrophica.

Two children (8- and 17-yr old) with autosomal recessive epidermolysis bullosa dystrophica and chronic esophageal strictures were treated with repeated balloon dilations. General anesthesia was by face mask adapted specifically for this procedure, with careful attention to avoid skin and mucus membrane damage. A balloon dilator positioned fluoroscopically over an angiographic guidewire was gently inflated until narrowings resolved. Dilations have been performed every 1-11 [4.3 +/- 3.2 (mean +/- SD)] months in the younger patient over the last 4.3 yr, and every 8-20 (14.5 +/- 5.9) months in the older patient over the last 4.8 yr, without serious complications. Both patients were able to swallow normal foods following dilations. Repeated balloon dilations of esophageal strictures in patients with epidermolysis bullosa dystrophica can be done safely. Further studies are indicated to determine its effectiveness and appropriateness as an alternative to colonic interposition.

Analyses of 95 first-trimester spontaneous abortions by chorionic villus sampling and karyotype.

PURPOSE: Our purpose was to determine the incidence of chromosomal aneuploidy in first-trimester pregnancy losses using chorionic villus sampling (CVS). STUDY DESIGN: All patients presenting for CVS with no fetal cardiac activity were offered CVS. RESULTS: Cytogenetic results were completed in 95 of 96 cases (99%). Eighty-three percent of the karyotypes were aneuploid. The 16 euploid fetuses had no excess of females. CONCLUSION: CVS is the most reliable method of determining the karyotype of spontaneously aborted fetuses. The incidence of aneuploidy is much greater than in previous reports that analyzed passed products of conception. CVS should be offered to women who present with first-trimester spontaneous abortions.

Decreasing risk of pregnancy loss following chorionic villus sampling. Elimination of transabdominal chorionic villus sampling during the ninth week of pregnancy.

Chorionic villus sampling (CVS) is a method of obtaining fetal cells in the first trimester of pregnancy for genetic analysis. The transcervical (TC) approach was the first technique to be widely used. In the National Institute of Child Health and Human Development collaborative study the absolute loss rate following CVS (the total number of spontaneous abortions and neonatal deaths following CVS) was 4%. More recently the transabdominal (TA) approach has been introduced. This study compares the loss rates for the two approaches at various gestational ages for three 6-month periods following the addition of the TA approach with each other and with the loss rates prior to the introduction of TA CVS. We found that the percentage of pregnancy losses following TA CVS during the ninth week of gestation (63-69 days) was consistently higher than for TC CVS performed at the same gestational age. The loss rate for TC CVS has steadily decreased since the introduction of TA CVS after remaining the same for the two years prior to the introduction of the TA approach. After minimizing the number of TA CVS performed during the ninth week of gestation, the overall loss rate during the most recent 6-month period has been reduced to 0.94%. We conclude that the lowest loss rate following CVS can be obtained if both the TA and TC methods are available, and that the number of TA procedures performed during the ninth week of gestation is minimized.

Term birth after midtrimester hysterotomy and selective delivery of an acardiac twin.

OBJECTIVE: Our aim was to determine whether hysterotomy and selective removal of an acardiac twin could improve the outcome of the "pump" twin. STUDY DESIGN: A literature and case review of the outcome of the acardiac twin malformation was performed. When an acardiac malformation was diagnosed at 19 weeks' gestation the patient was monitored with weekly ultrasonographic examinations. At 23 weeks' gestation, no blood flow could be demonstrated to the acardiac twin and it was thought that the continued presence of the acardiac twin posed a risk to the "pump" twin. A midtrimester hysterotomy was performed and the acardiac twin was delivered. RESULTS: After the midtrimester hysterotomy, the pregnancy progressed to term and a healthy female infant was delivered by elective cesarean section at 37 weeks' gestation. CONCLUSION: Midtrimester hysterotomy may be a useful intervention in cases of twinning when one fetus is a threat to the health of the other.