CME Article Research Articles

A recurring blistering eruption on the palms

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Fine Details That Improve Nasal Reconstruction.

After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap. Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.

Modern Fat Grafting Techniques to the Face and Neck.

After studying this article, the participant should be able to: 1. Understand age-related changes to the face and neck and pertinent anatomy and discuss important aspects of fat graft harvesting, processing, and infiltration. 2. Recognize key differences between common techniques for fat processing and infiltration and develop a plan for patients based on site-specific facial anatomical zones. 3. Appreciate the utility of fat grafting as an adjunct to other facial rejuvenating procedures such as face lift and blepharoplasty procedures and list the potential complications from fat grafting to the face and neck. Fat grafting to the face and neck aids in volume restoration, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. Often, fat grafting may sufficiently restore facial volume alone or in conjunction with other facial rejuvenation procedures. Facial/neck fat grafting requires a systematic and thoughtful approach, with special care to atraumatic technique. This CME article covers the principles and techniques for modern facial fat grafting to the face and neck. Increasing data support the ability of autologous fat to produce significant and sustainable appearance-related changes. The authors follow the general principles of the Coleman technique for facial fat grafting and have observed tremendous success over the years. Other techniques for facial fat grafting are also discussed including microfat and nanofat processing. As the understanding of facial fat compartments continues to evolve, the authors may better predict fat grafting outcomes following augmentation. Finally, the technique described as "lipotumescence" has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.

Pain Management During Labor: Part 1—Pathophysiology of Labor Pain and Maternal Evaluation for Labor Analgesia

Dr. Gonzalez is Medical Director of Perioperative Services, Einstein Medical Center, Elkins Park, Pennsylvania; Dr. Trehan is Associate Professor and Chief, Division of Acute and Chronic Pain Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; and Dr. Kamel is Professor and Vice Chair for Education, Department of Anesthesiology and Critical Care Medicine, Lewis Katz School of Medicine at Temple University, 3401 N. Broad St, Philadelphia, PA 19140; E-mail: [email protected]. The authors, faculty and all staff in a position to control the content of this CME/NCPD activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. This article was published originally in Topics in Obstetrics & Gynecology. 2016;36(11):1-8. CME Accreditation Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This CME activity expires on July 31, 2023. NCPD Accreditation Lippincott Professional Development is accredited as a provider of nursing continuing professional development (NCPD) by the American Nurses Credentialing Center's Commission on Accreditation. Lippincott Professional Development will award 2.5 contact hours for this NCPD activity. This activity has been assigned 1.0 pharmacology credit. Instructions for earning ANCC contact hours are included on page 11 of the newsletter. This NCPD activity expires on June 7, 2024.

The risk of chemical leucoderma with skin-lightening therapies.

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Prenatal care

Durch eine sinnvolle Schwangerenvorsorge können mögliche Risiken für Mutter und Kind während der Schwangerschaft frühzeitig erkannt werden. Diese Risiken, die sich aus Anamnese und Befunden ergeben, dienen als Grundlage für die weitere, an Risiken angepasste medizinische Betreuung in der Schwangerschaft und während der Geburt. Durch ein strukturiertes und flächendeckendes nationales Schwangerenvorsorgekonzept lassen sich mütterliche und fetale Mortalität und Morbidität senken. Die Weltgesundheitsorganisation (WHO) empfiehlt mindestens 8 Vorsorgetermine. Für die gute Nachvollziehbarkeit der Untersuchungen und erhobenen Befunde soll gemäß den Vorgaben der WHO ein der Frau mitgegebenes Dokument genutzt werden. In Deutschland wird Schwangerenvorsorge seit mehr als 50 Jahren standardisiert, klar strukturiert und flächendeckend angeboten auf der Basis des etablierten Mutterpasses und regelmäßiger Adaptation der gesetzlichen Vorgaben der Mutterschafts-Richtlinien. Der Beitrag stellt internationale Empfehlungen und Veröffentlichungen, aktuelle Entwicklungen in Deutschland und Kontroversen zur Versorgung von Schwangeren vor.

Triangular flap technique for unilateral cleft lip deformity

The triangular flap lip repair is one of the two main techniques used for the correction of a cleft lip deformity worldwide. Many surgeons in Indian subcontinent and Europe use the triangle flap technique as their first choice. This CME article describes the details of the triangular flap technique as modified by Dr. C P Sawhney. The rationale of the technique, lip markings, planning of incisions, and the detailed operative steps are described. The merits and demerits of this versatile technique are also discussed.

The role of the behavioural immune system in stigma related to skin diseases needs to be explored.

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Facial Transplantation: Principles and Evolving Concepts.

After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date. This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date.

The Extended Retrosigmoid Approach

Dr. Basma is a Cerebrovascular and Skull Base Fellow, Dr. Cai is Research Fellow, and Dr. Krisht is Director, Arkansas Neuroscience Institute, CHI Saint-Vincent North, 6020 Warden Rd Ste 100, Sherwood, AR 72120; E-mail: [email protected]. The authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity. Category: Skull Base Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on May 14, 2023.

Familial neurofibromatosis type 1 has diverse manifestations in skin and is associated with steatocystoma multiplex

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How safe is it to use ultrasound in prenatal medicine? Facts and contradictions - Part 2 - Laboratory experiments regarding non-thermal effects and epidemiological studies.

The first part of this CME article (issue 5/20) provided a detailed examination of the biophysical effects of ultrasound waves, the exposure values, and in particular the thermal effect. In vivo and in vitro measurements have shown that the temperature increase in tissue associated with B-mode ultrasound is far too low to pose a potential risk. Even experiments with exposure values in the range of pulsed Doppler have shown that temperature increases of over 1.5 °C can only occur in areas in direct contact with the probe, thus making a limited exposure time particularly in the case of transvaginal application advisable. The second part of this CME article describes various laboratory and animal experiments for evaluating non-thermal effects and also presents the most important epidemiological studies in the last 30 years in the form of an overview and review. In addition to direct insonation of isolated cells to examine possible mutagenic effects, the blood of patients exposed in vivo to ultrasound was also analyzed in multiple experiments. Reproducible chromosome aberrations could not be found in any of the studies. In contrast, many experiments on pregnant rodents showed some significant complications, such as abortion, deformities, and behavioral disorders. As in the case of thermal effects, the results of these experiments indicate the presence of an intensity- or pressure-dependent effect threshold. Numerous epidemiological studies examining possible short-term and long-term consequences after intrauterine ultrasound exposure are available with the most important studies being discussed in the following. In contrast to information presented incorrectly in the secondary literature and in the lay press, health problems could not be seen in the children observed in the postpartum period in any of these studies.

Introduction to Endoscopic Spine Surgery

Dr. Derman is a Spine Surgeon, Texas Back Institute, 6020 West Parker Rd, Ste 200, Plano, TX 75201; E-mail: [email protected]. The author, faculty, and all staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations related to this CME activity. Dr. Derman has disclosed that he serves as paid teaching faculty for Joimax. Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on April 30, 2023.

The Transsphenoidal Approach and Its Variants: Part II

Dr. Krisht is Director, Arkansas Neuroscience Institute, CHI Saint-Vincent North, 6020 Warden Rd Suite 100, Sherwood, AR 72120; E-mail: [email protected]. The author, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity. Category: Tumor This article was published originally in Contemporary Neurosurgery. 2002;24(26):1–6. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on March 29, 2023.

Genotype-guided medical treatment of arteriovenous malformation.

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Drivers of Costs and Predictors of Health Care Utilization After Elective Spinal Surgery

Dr. Gerlach is a Resident, Mr. Plantz is a Medical Student, and Dr. Patel is Professor, Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, #1350, Chicago IL 60611; E-mail: [email protected]. Dr. Gerlach, Mr. Plantz, and all faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity. Dr. Patel has disclosed that he is a consultant for Zimmer Biomet, DePuy Synthes, nView, Amedica, and Kuros Biosciences; is involved with product design for, and receives royalties from, Nuvasive, Zimmer Biomet, Amedica, and Alphatec Spine; is a stock shareholder in Amedica, Vital5, Nocimed, Cytonics, nView, Tissue Differentiation Intelligence, and Endoluxe; and receives fellowship program support from NuVasive and AO Spine North America. Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on March 31, 2023.

Effectiveness of Bioskills Training in Spinal Surgery

Dr. Foley is a Research Fellow, and Dr. Hsu is Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 675 North Saint Clair St, Chicago, IL 60611; E-mail: [email protected]. Dr. Foley and all faculty and staff in a position to control the content of this CME activity, and their spouses/life partners (if any), have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity. Dr. Hsu has disclosed that he is a consultant for Stryker, Asahi, Wright Medical, Medtronic, and Bioventus. Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on February 28, 2023.

The blister that got out of hand

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Ultrasound-guided minimally invasive diagnostics and treatment in the head and neck area

Tumoral lesions in the head and neck region represent a diagnostic and therapeutic challenge in otorhinolaryngologic routine. High-resolution ultrasound is usually able to guide diagnosis. Nevertheless, adefinite differentiation between benign and malignant lesions can only be achieved by tissue biopsy. The various options for obtaining samples for histopathological or cytological examination-from minimally invasive ultrasound-guided fine-needle biopsy to punch biopsy and open surgical biopsy-will be discussed in the first part along with the associated advantages and disadvantages. In the second part of this CME article, minimally invasive ultrasound-guided therapeutic options in the head and neck region which can be performed on an outpatient basis are depicted.

Diagnostic principles of thyroid tumors in pathology : Relevant changes due to the current WHO classification

The current edition of the WHO classification of thyroid tumors (2017) contains anumber of very relevant changes with considerable consequences for the diagnostic assessment of thyroid specimens. This applies to both the histomorphological examination of surgical specimens and the preoperative fine needle biopsy (FNB). In addition, molecular pathological examinations are becoming increasingly important in the diagnosis of thyroid tumors. Changes affect practically all areas of thyroid tumor diagnostics. Some of these changes have far-reaching consequences that justify acomprehensive commentary and query of the knowledge acquired in the form of this CME article.