Publications (7)11.59 Total impact
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Article: Incidence of breast and chest wall asymmetries: 4D photography.
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ABSTRACT: Few authors have addressed preoperative soft tissue and chest wall analysis as it pertains to asymmetries that must be identified for preoperative breast augmentation planning. The authors evaluate the incidence of breast and chest wall asymmetries. In the present study, 125 consecutive patients underwent a voluntary dimensional analysis by a single practitioner, followed by a confirmatory 4D photographic analysis. During each patient's evaluation, the following measurements were recorded: distance from nipple to inframammary fold (IMF), base width, distance from sternal notch to nipple, horizontal areolar width, vertical areolar height, upper and lower pole pinch tests, and medial and lateral pinch tests. Following exclusion of patients who had undergone prior breast surgery, 117 patients were included in the final statistical analysis. Significant differences between right and left breasts were found in 81.7% of patients in one or more of the measured dimensions (p < .05). The manual measurements were confirmed with computerized 4D photography, and there was no significant difference found between the two measurement types in any objective parameter. However, there was a significant difference in the level of chest wall asymmetries identified by 4D photography. Nipple-to-IMF position asymmetry was present in 59.6% of the patients, and sternal notch-to-nipple asymmetry was present in 81.2%. Overall, 100% of the women had some degree of asymmetry (soft tissue and/or chest wall) confirmed by 4D photography. The 4D photography measurements in this study were consistent with objective manual measurements but provided the added benefit of identifying chest wall asymmetries more objectively. The data from this study underscore the importance of developing a systematic preoperative breast and chest wall analysis that can be individualized for each patient. The resulting asymmetries should then be discussed with the patient, along with the potential for continued or more pronounced asymmetry postoperatively.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 06/2011; 31(5):506-10. -
Article: Outcomes of vacuum-assisted closure for the treatment of wounds in a paediatric population: case series of 58 patients.
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ABSTRACT: This retrospective case series describes our experiences and outcomes using the vacuum-assisted closure (VAC) Therapy System for the management of difficult acute and chronic wounds in paediatric patients. Difficult wounds that cannot be closed primarily can create major challenges in paediatric patient care. Decreasing the time to wound closure is especially critical when managing paediatric patients. A retrospective review of medical records for 58 consecutive paediatric patients treated with VAC therapy was performed. Demographics, diagnosis, length of therapy, time to closure, time to discharge, type of VAC dressing used, dressing change schedule, therapy settings, and complications were recorded for each patient. The median age of all 58 patients was 10 years (range, 10 days to 16 years). Fifty-four of the 58 wounds reached full closure. Patients were divided into five different groups according to diagnosis. The median time to closure for each group follows: Group 1 (abdominal wounds) 10 days (range, 3-99 days); Group 2 (surgical soft tissue deficit) 12 days (range, 3-30 days); Group 3 (trauma wounds) 7 days (range, 3-10 days); Group 4 (stage III/IV pressure ulcers) 15 days (range, 14-15 days); Group 5 (fasciotomy wounds) 5 days (range, 5-10 days). No complications were recorded for any of the patients. The results demonstrate that VAC therapy may be a viable, safe and effective method of managing this difficult-to-treat population.Journal of Plastic Reconstructive & Aesthetic Surgery 11/2008; 62(11):1428-36. · 1.49 Impact Factor -
Article: The impact of intercurrent EBV infection on ATP levels in CD4+ T cells of pediatric kidney transplant recipients.
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ABSTRACT: ImmuKnow measures ATP (ng/mL) in PHA-activated CD4+ T cells from patient's whole blood. According to published reports, median ImmuKnow is 258 ng/mL in stable pediatric kidney transplant (PKT) recipients > or =12 yr, and 165 ng/mL in those <12 yr. However, data on the effect of infection or AR on ImmuKnow are scarce. We studied the effect of Epstein-Barr virus (EBV) viremia on ImmuKnow in PKT with GD. Twenty-eight PKT with GD were reviewed. Group 1 has 19 PKT > or =12 yr, and group 2 has nine PKT <12 yr. Mean follow-up was 19.4 +/- 12 months. All ImmuKnow values discussed in this study were measured during GD +/- fever. None had ImmuKnow pretransplant. EBV DNA was isolated from patient blood by real-time PCR. Group 1 has eight boys and 11 girls (mean age = 16.6 +/- 2.4 yr). Group 2 has two boys and seven girls (mean age = 6 +/- 3.1 yr). Median ImmuKnow was 292 ng/mL in group 1, and 370 ng/mL in group 2. Nine children developed EBV viremia: two in group 1 (median ImmuKnow = 273 ng/mL), and seven in group 2 (median ImmuKnow = 475 ng/mL). Overall mean ImmuKnow in the nine EBV viremic patients was higher than that in the 19 non-viremic ones (422 +/- 176 ng/mL, and 302 +/- 113 ng/mL, respectively, unequal variance t-test, p = 0.08). Eight children developed AR (all in G1, median ImmuKnow = 272 ng/mL). In group 1, one patient developed concurrent EBV viremia and rejection, while another patient developed EBV viremia six months following a rejection episode. In group 2, none developed simultaneous AR, CMV, or BK virus infection with EBV viremia. None developed post-transplant lymphoproliferative disease. In summary, EBV viremia was paradoxically associated with high ImmuKnow in PKT <12 yr. This suggests strong co-stimulation of PHA-activated CD4+ T cells by EBV-transformed B cells.Pediatric Transplantation 10/2008; 13(7):851-5. · 1.48 Impact Factor -
Article: Longitudinal metabolic and cognitive changes in mild cognitive impairment patients.
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ABSTRACT: Advancements in clinical therapies have identified the need for biomarkers of early Alzheimer disease that distinguish the earliest stages of pathology and target those patients who are likely to gain the most benefit. The aim of this study was to characterize the longitudinal metabolic changes measured by 1H magnetic resonance spectroscopy in correlation to neuropsychologic indices of episodic memory, attention and mental processing speed, language facility, and executive function in subjects with mild cognitive impairment (MCI). Quantitative 1H magnetic resonance spectroscopy of the posterior cingulate gyrus was performed and repeated at 11.56+/-4.3 months. N-acetyl aspartate (NAA), total choline (Cho), total creatine (Cr), myo-inositol (mI), and glutamate/glutamine (Glx) metabolite levels were measured, corrected for cerebrospinal fluid dilution, and ratios calculated in MCI and cognitively normal subjects. In the first study, MCI subjects showed lower NAA levels, NAA/Cho, and NAA/mI ratios and increased Cho/Cr and mI/Cr compared with controls. In the follow-up study, 36% of the MCI subjects [atypical MCI (atMCI)] showed interval increases in NAA, Cr, and Glx levels compared with 64% of MCI subjects (typical MCI) who showed an interval decrease in NAA, Cr, and Glx. Both MCI subgroups had higher Clinical Dementia Rating scores and lower scores on episodic memory, phonemic, and semantic word fluency tasks, compared with controls. The annualized rate of change in metabolic and cognitive status did not differ between normal aging and MCI subjects. atMCI subjects showed significant negative correlations between metabolite levels and executive function task scores, with NAA/mI showing a significant positive correlation with phonemic and semantic word fluency. There were no significant correlations between metabolite levels and cognitive performance in tMCI subjects; however, NAA/mI and mI/Cr were negatively correlated with executive function tasks. These results indicate 2 distinct evolving metabolite profiles that correlate with changes in executive function and can be used to differentiate MCI from normal aging.Alzheimer disease and associated disorders 07/2008; 22(3):269-77. · 2.88 Impact Factor -
Article: Negative pressure wound therapy with instillation: a pilot study describing a new method for treating infected wounds.
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ABSTRACT: This data review reports the results of 15 patients who were treated with Vacuum-Assisted Closure (VAC) negative pressure therapy system in addition to the timed, intermittent delivery of an instilled topical solution for management of their complex, infected wounds. Prospective data for 15 patients treated with negative pressure wound therapy (NPWT)-instillation was recorded and analysed. Primary endpoints were compared to a retrospective control group of 15 patients treated with our institution's standard moist wound-care therapy. Culture-specific systemic antibiotics were prescribed as per specific patient need in both groups. All data were checked for normality of distribution and equality of variance and appropriate parametric and non parametric analyses were conducted. Compared with the standard moist wound-care therapy control group, patients in the NPWT-instillation group required fewer days of treatment (36.5 +/- 13.1 versus 9.9 +/- 4.3 days, P < 0.001), cleared of clinical infection earlier (25.9 +/- 6.6 versus 6.0 +/- 1.5 days, P < 0.001), had wounds close earlier (29.6 +/- 6.5 versus 13.2 +/- 6.8 days, P < 0.001) and had fewer in-hospital stay days (39.2 +/- 12.1 versus 14.7 +/- 9.2 days, P < 0.001). In this pilot study, NPWT instillation showed a significant decrease in the mean time to bioburden reduction, wound closure and hospital discharge compared with traditional wet-to-moist wound care. Outcomes from this study analysis suggest that the use of NPWT instillation may reduce cost and decrease inpatient care requirements for these complex, infected wounds.International Wound Journal 07/2008; 5(3):399-413. · 1.46 Impact Factor -
Article: Longitudinal Metabolic and Cognitive Changes in Mild Cognitive Impairment Patients
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ABSTRACT: Advancements in clinical therapies have identified the need for biomarkers of early Alzheimer disease that distinguish the earliest stages of pathology and target those patients who are likely to gain the most benefit. The aim of this study was to characterize the longitudinal metabolic changes measured by 1H magnetic resonance spectroscopy in correlation to neuropsychologic indices of episodic memory, attention and mental processing speed, language facility, and executive function in subjects with mild cognitive impairment (MCI). Quantitative 1H magnetic resonance spectroscopy of the posterior cingulate gyrus was performed and repeated at 11.56±4.3 months. N-acetyl aspartate (NAA), total choline (Cho), total creatine (Cr), myo-inositol (mI), and glutamate/glutamine (Glx) metabolite levels were measured, corrected for cerebrospinal fluid dilution, and ratios calculated in MCI and cognitively normal subjects. In the first study, MCI subjects showed lower NAA levels, NAA/Cho, and NAA/mI ratios and increased Cho/Cr and mI/Cr compared with controls. In the follow-up study, 36% of the MCI subjects [atypical MCI (atMCI)] showed interval increases in NAA, Cr, and Glx levels compared with 64% of MCI subjects (typical MCI) who showed an interval decrease in NAA, Cr, and Glx. Both MCI subgroups had higher Clinical Dementia Rating scores and lower scores on episodic memory, phonemic, and semantic word fluency tasks, compared with controls. The annualized rate of change in metabolic and cognitive status did not differ between normal aging and MCI subjects. atMCI subjects showed significant negative correlations between metabolite levels and executive function task scores, with NAA/mI showing a significant positive correlation with phonemic and semantic word fluency. There were no significant correlations between metabolite levels and cognitive performance in tMCI subjects; however, NAA/mI and mI/Cr were negatively correlated with executive function tasks. These results indicate 2 distinct evolving metabolite profiles that correlate with changes in executive function and can be used to differentiate MCI from normal aging.Alzheimer Disease and Associated Disorders 06/2008; 22(3):269-277. · 2.81 Impact Factor -
Article: Comparison of outcomes with low-dose anti-thymocyte globulin, basiliximab or no induction therapy in pediatric kidney transplant recipients: a retrospective study.
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ABSTRACT: It is unclear which induction therapy yields the best outcomes in pediatric kidney transplantation. Retrospective data of 88 children receiving a renal allograft between November 1996 and October 2003 were analyzed. Patients received ATGI (n = 12), BI (n = 29), or NAI (n = 47). The mean ATG dose was 5.1 +/- 2.1 mg/kg. At 12 months, graft survival rates were 91.7%, 100%, and 97.9% for ATGI, BI, and NAI groups, respectively. Acute rejection rates at 12 months were 0 (ATGI), 20.6% (BI), and 10.7% (NAI). The mean GFR for ATGI (42.4 +/- 25.9 mL/min) was lower than for BI (78.3 +/- 27.2 mL/min), and NAI (66 +/- 28.3 mL/min) at 12 months (p < 0.05). One ATGI patient developed CMV pneumonia but none developed post-transplant lymphoproliferative disorder. Although there was no renal allograft survival benefit with either ATGI or BI, relative to NAI, the absence of acute rejection and equivalent rates of viral infections in the higher-risk ATGI recipient group suggests that the treatment strategy is promising. A large prospective study is needed to better define the role of ATGI in pediatric kidney transplantation.Pediatric Transplantation 02/2008; 12(1):32-9. · 1.48 Impact Factor
