Triple-Plane Augmentation Mastopexy.

Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. The aim was to achieve harmonious, natural fullness, better projection, and appropriate size with limited scarring. We named this technique triple-plane augmentation mastopexy as three planes are used: the first plane is the subfascial plane, the second is the subglandular plane, and the third is the subpectoral plane. METHODS: A retrospective review was performed of 75 consecutive cases of grade 3 or glandular ptosis treated in a single clinic by three separate surgeons adopting the same technique from January 2010 to January 2017. Triple-plane augmentation mastopexy begins by undermining the breast tissue through a tunnel until the second rib is in the prepectoral plane. Then, the subpectoral pocket for the implant is dissected with release of the lower border of the pectoralis major and avoiding release of the sternal border. Subsequently, the breast tissue is suspended at the lower border of the second rib, followed by subpectoral insertion of the implant and skin envelope excision. RESULTS: Surgical follow-up varied from a minimum of 6 months to a maximum of 6 years, with an average of 3 years. Among a total of 75 patients, 64 patients (85.3%) complied with follow-up and 49 (76.5%) of these patients were satisfied. Complications varied from early complications (14.6%) to late complications (21.5%). CONCLUSIONS: Grade 3 and glandular ptosis represent a challenge to plastic surgeons. Traditional techniques may fail to achieve optimized results. Triple-plane augmentation mastopexy is a safe, reliable procedure that ensures long-term desired aesthetic outcomes with limited scarring.

Group B streptococcal ventriculitis: a report of three cases and literature review.

This report presents three cases of neonatal group B streptococcal ventriculitis and assesses seven others identified by a literature review. In contrast to the well described acute manifestations of group B streptococcal meningitis, disease onset tended to be insidious with four of seven cases presenting over a period of 1 to 6 weeks and six cases presenting with nonspecific signs and symptoms without fever. Persistent protein content elevation and low glucose level in the cerebrospinal fluid was observed, indicating chronic inflammation. All patients developed obstructive hydrocephalus requiring ventriculoperitoneal shunt placement. One child died, and six of nine survivors were left with significant neurologic deficits. Physicians should be aware of this indolent but serious manifestation of group B streptococcal infection.

Clinical and microbiological spectrum of meningococcal disease in adults during Hajj 2000: an implication of quadrivalent vaccination policy.

OBJECTIVE: To describe the epidemiological, clinical and laboratory features of meningococcal disease and explore the factors responsible for its morbidity and mortality among the pilgrims during Hajj 2000. SETTING: This study was conducted at King Faisal Hospital, Makkah, Saudi Arabia. METHOD: Any patient suspected of meningococcal disease during the period of pilgrimage presenting with fever, head ache, signs of meningeal irritation and turbid CSF, confirmed on gram stain smears. Latex agglutination test and culture was included in this study. Their clinical features, management and outcome was recorded and analysed. RESULTS: Of 105 confirmed cases of meningococcal disease, 64% had predominantly meningitis, 36% meningococcaemia and meningitis. Meningococcal rash was found in 2% and co-morbidity in 18% of cases. Antibiotics used empirically were benzylpenicillin or ceftriaxone along or in combination. Overall case fatility rate was 34%. Delay in diagnosis, delay of antibiotic administration, older patients and patients with serious concurrent medical problems, were the factors leading to higher than expected mortality rate. Maximum number of patients were Pakistanis (18%) followed by Indians (15%) and Indonesians (12%). Overall serogrouping was as follows: group A (44), W135 (19), B (1) and untypable (1). Serogroup W135 appeared more invasive and more fatal. CONCLUSION: Quadrivalent vaccine ACYW135 is recommended for pilgrims to enter Saudi Arabia and for mass vaccination in local population.

Clinical presentation of spontaneous primary hypothyroidism in adults.

In a retrospective study of 309 cases of hypothyroidism seen at King Fahd Hospital of the University (KFHU), Al-Khobar, 124 (90 Saudis and 34 non-Saudis) adult patients with spontaneous primary hypothyroidism satisfied the inclusion criteria for detailed analysis. Their male:female ratios for Saudis and non-Saudis were 1:4.6 and 1:3.9 respectively. The majority were diagnosed in their third and fourth decades. The prevalence of previously undiagnosed spontaneous and biochemically overt primary hypothyroidism in Saudis was 5.2/1000 females and 0.94/1000 males. FT4I was normal in 43 (35%) and low in 81 (65%). FT4I correlated with cold intolerance, constipation, dry skin, hoarseness, delayed reflex relaxation, and coarse and cold skin. In rank order, presenting symptoms in those with low FT4I were tiredness (56%), cold intolerance (38%), constipation, weight gain, menstrual disturbance - especially amenorrhea - (36% each), dry skin (35%), hoarseness (31%); signs were coarse skin (53%), delayed reflex relaxation (32%), cold skin and goiter (24% each). The above clinical findings may help physicians in the early detection of primary hypothyroidism. Population-based studies are necessary to provide more data on this disease in this country.