Photographic Views Research Articles

Use of platelet rich fibrin and platelet rich plasma in combination with fat graft; which is more effective during facial lipostructure?

Purpose: Fat grafts have always represented a challenge in inducing the necessary neoangiogenesis, which results in significant resorption. This study was designed to compare the efficiency of firstand second-generation platelet-rich plasmas (PRPs) combined with a fat graft during facial lipostructure surgery. Methods and Materials: To address the research purpose, the investigators designed and implemented a double-blinded prospective clinical trial. The patients underwent bilateral facial lipostructure, a natural long-lasting method of filling and supporting the face using intricate layers of infiltrated autologous fat. The method involved the use of PRP on 1 side and platelet-rich fibrin (PRF) on the other side. The study population was composed of all patients presenting to the authors’ department for the evaluation and management of facial contouring in the cheek and cheekbone areas from June 2008 through December 2010. The primary predictor variable was the type of combination (PRP/fat or PRF/fat). The outcome variables were the amount of resorption, which was estimated by comparing preand postsurgical photographic views, pain, edema, and bruising. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test and Levene test) were used to compare the treatment efficacy and complications between the groups. Results: Twenty-five patients (8 men and 17 women) underwent bilateral facial lipostructure surgery in the cheek and cheekbone areas using PRP and PRF. One year after the operation, a slight esthetic asymmetry was noticeable, with greater average resorption on the PRP/fat side. Conclusions: This first comparative clinical study highlights the value of using concentrated platelets for adipocyte grafts. The results suggest that the combination of fat and PRF is more effective than the combination of fat and PRP in the context of facial lipostructure surgery. © 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:610-621, 2013

Re

Sir: The article “Does Knowledge of the Initial Technique Affect Outcomes after Repeated Breast Reduction?” by Ahmad et al. 1 was reviewed at the University of California, San Francisco plastic surgery monthly journal club meeting. We have questions pertaining to (1) the procurement of operative records from the surgeon who performed the original reduction mammaplasty and (2) the standard for and application of determining “outcomes.” First, between 1998 and 2010, the authors operated on 12 patients whose primary surgery was performed by a surgeon other than themselves. On none of these were the authors able to recover the original records, despite the fact that there was “an attempt to obtain the operative report describing the primary breast reduction technique.” Were valid authorization forms obtained from patients requesting the primary surgeon to release records to the authors obtained and rejected? The accepted standard for good patient relations is that a physician should supply records. If a patient refuses to sign such a request, one might question the patient’s forthrightness, especially if advised that to render the best care most physicians feel that having all the pertinent information is important, particularly in secondary surgery. Second, we feel that the term “outcomes” embraces both safety and efficacy. The article lends credence to the safety of their procedure vis-à-vis nipple-areola survival. They state that “patients underwent repeated breast reduction for recurrent hypertrophy, inadequate volume reduction, and significant postoperative breast volume asymmetry.” We note an absence of concern that the nipple-areola complex was too low or that the inframammary scar was unacceptable. Figures 4 and 5 show a nipple-areola planned elevation of only 1 to 2 cm; therefore, it is not surprising that circulation was adequate. Furthermore, one would not expect those patients on whom the authors did not perform a circumareolar incision to experience nipple-areola necrosis regardless of the orientation of the original pedicle. Figures 3 and 6 appear to be the same patient. We noted that even though there was no circumareolar incision, the removal of the “wedge” of breast tissue apparently resulted in bilateral loss of nipple projection visible on all three photographic views. We speculate that the patient most likely had an inferior pedicle procedure initially and that the secondary procedure resulted in denervation of the nipple. The oblique views in Figure 6 also show persistence, or recurrence, of pseudoptosis after revision. We recognize that the vertical skin markings with a variety of pedicles is an effective and excellent reduction and mastopexy technique; however, in those patients who already have an inframammary scar, we have found it helpful to correct pseudoptosis by resecting skin in both the vertical and horizontal directions as illustrated below. An additional benefit can be an apparent lowering of the nipple-areola complex. Judicious glandular resection with a goal of original pedicle conservation is performed as required to reduce volume. Liposuction is reserved for correction of discrete areas of prominence (Fig. 1).Fig. 1: Correction of pseudoptosis using vertical and horizontal skin excision.Based on our own experience, we respectfully suggest that every effort should be made to obtain the orig inal operative note (in the vast majority of cases, we have been able to do so). Criteria in addition to nipple-areola survival should be considered in judging the “outcomes” of repeated breast reduction surgery. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Mauricio Kuri, M.D. Gilbert P. Gradinger, M.D. Department of Plastic Surgery University of California, San Francisco San Mateo, Calif.

No Easy Target

Auditory brainstem implants have failed to produce consistent clinical results comparable to those with the cochlear implant, both with surface and penetrating electrodes. To determine neuromorphological constraints of the auditory brainstem implant interface. The size, shape, surface depth, and spatial orientation of 33 human cochlear nuclei in 20 brainstem specimens obtained at autopsy were systematically analyzed in 792 slices each with a thickness of 8 μm. Three-dimensional renderings of the cochlear nucleus complex were obtained from a true-to-scale model, and the resulting photographic views were arranged according to the axes of the brainstem. The dimensions of the ventral and dorsal cochlear nuclei in the axial, coronal, and sagittal planes correlated linearly with each other. There were no significant side differences. Maximum dimensions of the whole cochlear nuclear complex were 8.01 × 1.53 × 3.76 mm. The appearance of the ventral and dorsal nuclei combined resembles a distorted X shape from a lateral view and an angulated wedge shape when viewed from above. Slanted into the depth of the brainstem above the facial nerve entrance, the superior boundary of the ventral nucleus is located more than 7 mm off the surface of the brainstem on average. In the absence of appropriate surface landmarks and imaging guidance, to gain tonotopic access to the human cochlear nucleus with surface and depth electrode remains a major challenge. Due to its location close to the surface, the dorsal cochlear nucleus is vulnerable to surgical manipulation and to tumors.

Use of Platelet-Rich Fibrin and Platelet-Rich Plasma in Combination With Fat Graft: Which Is More Effective During Facial Lipostructure?

Fat grafts have always represented a challenge in inducing the necessary neoangiogenesis, which results in significant resorption. This study was designed to compare the efficiency of first- and second-generation platelet-rich plasmas (PRPs) combined with a fat graft during facial lipostructure surgery. To address the research purpose, the investigators designed and implemented a double-blinded prospective clinical trial. The patients underwent bilateral facial lipostructure, a natural long-lasting method of filling and supporting the face using intricate layers of infiltrated autologous fat. The method involved the use of PRP on 1 side and platelet-rich fibrin (PRF) on the other side. The study population was composed of all patients presenting to the authors' department for the evaluation and management of facial contouring in the cheek and cheekbone areas from June 2008 through December 2010. The primary predictor variable was the type of combination (PRP/fat or PRF/fat). The outcome variables were the amount of resorption, which was estimated by comparing pre- and postsurgical photographic views, pain, edema, and bruising. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test and Levene test) were used to compare the treatment efficacy and complications between the groups. Twenty-five patients (8 men and 17 women) underwent bilateral facial lipostructure surgery in the cheek and cheekbone areas using PRP and PRF. One year after the operation, a slight esthetic asymmetry was noticeable, with greater average resorption on the PRP/fat side. This first comparative clinical study highlights the value of using concentrated platelets for adipocyte grafts. The results suggest that the combination of fat and PRF is more effective than the combination of fat and PRP in the context of facial lipostructure surgery.

The Effects of Pore Fluids with Different Dielectric Constants on the Geotechnical Behaviour of Kaolinite

The properties of pore fluid in clayey soil are usually influential on the intergranular physicochemical forces, i.e., on the geotechnical properties of clay. In this paper, the Atterberg limits of kaolinite were determined for pure water and four different chemical fluids with various concentrations (20, 40, 60 and 80) whose dielectric constants represent a wide range of interval, and kaolinite’s shear strength and compression behaviors were investigated by using the specimens obtained by consolidating the mixtures under 100 kPa pressure with water content twice their liquid limits. During the tests, an optical microscope was used to take the photographic views of the structural changes taking place on kaolinite due to the changing pore fluids. According to the experimental results, the effect of the chemical fluids caused to have increase in shear strength values and decrease in compression and swelling index values obtained by the consolidation tests. Moreover, kaolinite’s liquid limit increased with the increasing chemical fluid concentration and decreasing dielectric constant of the pore fluid. The changes observed on the geotechnical properties of kaolinite subjected to chemical fluids can be explained with intergranular Van der Waals attraction forces whose increase causes the flocculation of particles and the tendency of the clayey soil to behave like the silt–fine sand. Additionally, the optical microscope views taken during the experiments also supported these conditions clearly.

Indian American Rhinoplasty

The goal of this article is to help U.S. plastic surgeons better understand why Indian American rhinoplasty is different from other ethnic rhinoplasties in their practice. The study is composed of three parts: a review of the cultural perspectives of Indian Americans toward aesthetic surgery, an investigation into the aesthetic ideals of the Indian American nose, and an overview of operative strategies to achieve these ideals. A total of 35 Indian Americans who were dissatisfied with their nasal appearance were analyzed, 15 prospectively and 20 retrospectively. Group 1 consists of 15 Indian American women who were unhappy with the appearance of their nose. Standard photographs and anthropometric measurements were taken. Anterior and lateral photographic views were morphed to the patient's subjective ideal. Actual and ideal images were compared and analyzed. Group 2 consists of a retrospective review of 20 consecutive Indian American rhinoplasty cases with a follow-up of 1 to 6 years. The majority of the group 1 participants complained of a dorsal "hump," a downwardly rotated tip, and/or a large nose. The average subjective ideal nasolabial angle was determined to be 101.6 degrees. Based on the authors' analysis, three categories of nasal deformities were identified and operative strategies are discussed. Evaluation of the 20 clinical cases indicated that a more conservative surgical approach is warranted in these patients. Indian American rhinoplasty patients present a challenging range of nasal deformities requiring careful surgical planning. A clear understanding of the patient's desires is essential to achieving patient satisfaction. Therapeutic, IV.

La ilustración del dolor: cobertura fotográfica de los sucesos en los diarios de información general en España (1977-2000).

The evolution in design of newspapers during the last 25 years of twentieth century has turned photography into one of the most important elements of the press coverage. The technical advances in printing and publishing, together with the powerful influence of television, have cemented its rising importance. Within this change, accident and crime reports, far from being an exception, have become one of the cutting-edge areas. This is confirmed in this article, which analyses the evolution of photographic view in the Spanish quality newspapers (El Pais, Abc, El Mundo, Diario 16, La Vanguardia de Barcelona, El Periodico de Catalunya and El Correo Espanol-El Pueblo Vasco) in their coverage of eleven of the main big accidents, natural disasters and crimes that occurred in Spain between 1977 and 2000.

A study on photographic views in movie contents. - focused on ‘Baraka' -

A study on photographic views in movie contents. - focused on ‘Baraka' -

Principles and practice of external digital photography in ophthalmology

It is mandatory to incorporate clinical photography in an ophthalmic practice. Patient photographs are routinely used in teaching, presentations, documenting surgical outcomes and marketing. Standardized clinical photographs are part of an armamentarium for any ophthalmologist interested in enhancing his or her practice. Unfortunately, many clinicians still avoid taking patient photographs for want of basic knowledge or inclination. The ubiquitous presence of the digital camera and digital technology has made it extremely easy and affordable to take high-quality images. It is not compulsory to employ a professional photographer or invest in expensive equipment any longer for this purpose. Any ophthalmologist should be able to take clinical photographs in his/her office settings with minimal technical skill. The purpose of this article is to provide an ophthalmic surgeon with guidelines to achieve standardized photographic views for specific procedures, to achieve consistency, to help in pre-operative planning and to produce accurate pre-operative and post-operative comparisons, which will aid in self-improvement, patient education, medicolegal documentation and publications. This review also discusses editing, storage, patient consent, medicolegal issues and importance of maintenance of patient confidentiality.

P2-16-16: Nipple Sparing Mastectomy and Immediate Breast Reconstruction: Critical Appraisal of Five Year, Single Centre Outcomes.

Abstract Background Approximately 5,000 patients undergo breast reconstruction annually in the United Kingdom ( 2:1 ratio of immediate versus delayed respectively). Whilst skin sparing mastectomy is an accepted modality for local control in appropriately selected patients, nipple preservation remains controversial. In over 1,800 peer reviewed nipple sparing mastectomy (NSM) cases, the local event rate attributable to NAC preservation following NSM (therapeutic and prophylactic) is 0.16% with no evidence of deleterious impact on disease free survival. This study aims to evaluate in a selected cohort of patients, the oncological safety and aesthetic outcome of nipple- sparing mastectomy and immediate breast reconstruction (IBR). We highlight the surgical technique used and propose in/exclusion criteria. Material and Methods: Patients were identified retrospectively from our Institution's electronic patient records and WinPath™ database by searching clinical codes corresponding to NSM & IBR, performed by the senior authors (IJL and RD) between January 2004 and December 2008. Pre-operative selection criteria included: 100% pre-operative lesion characterisation; 5mm margin acceptance; submission of separate nipple core specimens for paraffin block histological assessment and re-excision of all involved/close margins. Follow-up data was verified from patients’ case notes, histo- pathological review and standardised photographic views. Endpoints include: local recurrence rate, disease free survival, peri-operative NAC subcutaneous tissue loss and validated aesthetic outcome measures. Results*: 84 patients underwent NSM & IBR for invasive disease. The mean age was 52.1 years and a median follow-up of 38 months. IBR utilised autologous tissue (latissimus dorsi or transverse rectus abdominus musculocutaneous flaps) with/without implant prosthesis. There was one case of local recurrence (1.2%) in a patient who declined re-excision of close/involved margins and no recorded breast cancer related deaths. Peri-operative complication rates were within the national mastectomy breast reconstruction audit outcome guidelines. Conclusion: In this cohort of patients, nipple sparing mastectomy and immediate breast reconstruction achieves comparable oncological outcomes with excellent aesthesis relative to traditional ablative procedures for local control. Nipple preservation although not evaluated independently does enhance cosmetic outcomes. *(Preliminary analysis) Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-16.

Generating a new sense of place in the age of the metaview

Photography has always played an important role in forming our sense of place. Individual photographs have been crucial in establishing the significance of special places in Australian culture. Now, however, the digital revolution and the online revolution have opened up new possibilities for creating expanded photographic views of Australian places from archival photographs and uploaded personal photographs. These go beyond the conventional single frame into what we call a “metaview”, a coherent view made up of multiple online images. How is this emerging form, hosted by libraries, museums and major websites, affecting the formation of a sense of place in Australia?

Photography and the USA

From Ansel Adams to Carleton Watkins, Diane Arbus to Weegee, Richard Avedon to James VanDerZee, American photographers have recorded their vast, multicultural nation in images that, for more than a hundred years, have come to define the USA. In Photography and the USA, Mick Gidley explores not only the medium of photography and the efforts to capture key events and moments through photographs, but also the many ways in which the medium has played a formative role in American culture. Photography and the USA encompasses the major movements, figures and works that are crucial to understanding American photography, but also pays attention to more obscure aspects of photography's history. Focusing on works that reveal many different facets of America, its landscapes and its people, Gidley explores the ambiguities of American history and culture. We encounter images that range from an anti-lynching demo in 1934 to Dorothea Lange's poster All races serve the crops in California; an early photographic view of Niagara Falls against the painstaking detail of Edward Weston's Pepper, No. 30; a fireman's fight in the San Francisco earthquake of 1906 to the Ground Zero images of 2001 by Joel Meyerowitz; an 1890s 'Wanted' image to Elliot Erwitt's shot of the Nixon-Kruschchev 'Kitchen Debate'. Organizing his narrative around the themes of history, technology, the document and the emblem, Mick Gidley not only presents a history of photography, but also reveals the complexities inherent in reading photographs themselves. A concise yet comprehensive overview of photography in the United States, this book is an excellent introduction to the subject for American Studies or visual arts students, or for anyone interested in US history or culture.

Fusion and visualization of intraoperative cortical images with preoperative models for epilepsy surgical planning and guidance

Objective: During epilepsy surgery it is important for the surgeon to correlate the preoperative cortical morphology (from preoperative images) with the intraoperative environment. Augmented Reality (AR) provides a solution for combining the real environment with virtual models. However, AR usually requires the use of specialized displays, and its effectiveness in the surgery still needs to be evaluated. The objective of this research was to develop an alternative approach to provide enhanced visualization by fusing a direct (photographic) view of the surgical field with the 3D patient model during image guided epilepsy surgery.Materials and Methods: We correlated the preoperative plan with the intraoperative surgical scene, first by a manual landmark-based registration and then by an intensity-based perspective 3D-2D registration for camera pose estimation. The 2D photographic image was then texture-mapped onto the 3D preoperative model using the solved camera pose. In the proposed method, we employ direct volume rendering to obtain a perspective view of the brain image using GPU-accelerated ray-casting. The algorithm was validated by a phantom study and also in the clinical environment with a neuronavigation system.Results: In the phantom experiment, the 3D Mean Registration Error (MRE) was 2.43 ± 0.32 mm with a success rate of 100%. In the clinical experiment, the 3D MRE was 5.15 ± 0.49 mm with 2D in-plane error of 3.30 ± 1.41 mm. A clinical application of our fusion method for enhanced and augmented visualization for integrated image and functional guidance during neurosurgery is also presented.Conclusions: This paper presents an alternative approach to a sophisticated AR environment for assisting in epilepsy surgery, whereby a real intraoperative scene is mapped onto the surface model of the brain. In contrast to the AR approach, this method needs no specialized display equipment. Moreover, it requires minimal changes to existing systems and workflow, and is therefore well suited to the OR environment. In the phantom and in vivo clinical experiments, we demonstrate that the fusion method can achieve a level of accuracy sufficient for the requirements of epilepsy surgery.

Abstract P5-14-17: Value of Photographic Side-Views in the Objective Evaluation of the Aesthetic Result of Breast Cancer Conservative Treatment

Abstract Aims: The BCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software tool created for the objective evaluation of the aesthetic result of Breast Cancer Conservative Treatment (BCCT). It makes use of a face-only photographic view of each patient and might thus have been considered insufficient for an accurate evaluation of the aesthetic result. So far, there are not many studies reporting the value of side-views in the objective evaluation of the aesthetic result after BCCT. Therefore the purpose of this work was to compare the input value of a set of asymmetry measures captured on patients photographic side-views with the aesthetic evaluation obtained by the software (face-view only) and a consensus expert panel classification. Methods: Photographic face-views and bilateral side-views of 63 patients, taken after BCCT, were subjectively evaluated by a panel of experts (consensus), objectively evaluated by BCCT.core software (face-views only) and by an extension of the BCCT.core developed to make use of face and bilateral side-views. We captured a set of previously determined features on face-views with the BCCT.core classic software and a new set of asymmetry measurements were taken over the bilateral side-views: breast size difference, nipple distance to breast contour, nipple distance to thoracic wall, nipple distance evaluation, breast compliance evaluation and breast ptosis difference. An initial classification was given to each patient using features captured from face-views and subsequently bilateral side-views measurements were added and a final result was obtained using specific classification methods for this kind of data, namely, Support Vector Machines (SVM). The aesthetic result was classified in four classes: excellent, good, fair and poor. To test the obtained results, agreement between the consensus expert panel, face-view only evaluation and face and side-views evaluation was computed using a Misclassication Error Rate (MER) and a weighted MER. This method is based on the comparison of the classifications of the consensus (ground truth) and classifier patient result, in that zero means all classifications are correct and 1 means none of the classifications is correct; the weighted MER takes into account the fact that humans tend to use more the middle classes in detriment of extreme classes, which led us to adopt higher costs to the misclassifications of the cases classified as excellent or poor. Results: The test results concerning the misclassification error using face-views only was 0.37 and 0.60 for MER and weighted MER respectively. With the addition of bilateral side-views the misclassification error was 0.32 and 0.53. Conclusions: We have developed a new model for the assessment of the aesthetic outcome of BCCT, with the addition of features obtained from patients’ photographic side-views. Although these preliminary results are better, the difference between the face-view only evaluation and the face-view and side-view evaluation is not statistically significant. However they suggest that asymmetry measures captured on side-views may add some value to the objective evaluation of the aesthetic result after BCCT. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-17.

Stillness and the Anticinematic in the Work of Fiona Tan

Fiona Tan's video installation Island (2008) is a twelve-minute black- and-white film composed of footage taken by Tan while she was staying on the Swedish island of Gotland, the largest island in the Baltic Sea. The visual subject of Island is the natural landscape of Gotland's peninsula of Narsholmen, and the majority of the film is made up of a series of shifting long takes, which, in their sameness and repetition, get at the barrenness of the stark landscape. 1 Like her other recent installations—including A Lapse of Memory (2007), Rise and Fall (2009), and Disorient (2009)— Island abstracts the more overt postcolonial themes of Tan's earlier work focus on broadly conceived questions of provenance, place, and medium. 2 In the opening fixed shot of Island , a few scrubby pine trees and a lighthouse, which is the only sign of human life, punctuate the shore of the peninsula. An expanse of calm water keeps the land at a distance. The atmospheric sound of the film emerges: the lilting noise of lapping water and a slight wind envelops the viewer in the natural poetics of a soundscape that attends the sub - sequent still views of the island. The establishing shot is followed by a closer view of the shore, isolating and pausing on the image and shape of a solitary tree. Then, unhurried, the film cuts another long, still shot of a group of similar trees gathered at the edge of the water, the silhouettes of their spare trunks intersecting the horizontal striations of the screen where water meets land and land meets sky. Absent of narration, the initial shots of landscape and trees in Island are not only still but untethered by the subsequent narrative voice-over (spoken by Heathcote Williams), which presents the story of an unidentified and unseen woman who has come the island to think, an act of contemplation that is opened up by the stilled space within the images of landscape. The tree is figured as the dominant subject of the multiple still shots, shaped through fragmented and photographic perspectives on the landscape. The filmed images of trees in Island bring cinema bear upon photography, recalling the history of the photographic view and a distinct lineage of tree photographs that dates the invention of the medium. That the trees are themselves not photographs but

Morphometry and abnormalities of the feet of Kaimanawa feral horses in New Zealand

The present study investigated the foot health of the Kaimanawa feral horse population and tested the hypotheses that horses would have a large range of foot morphology and that the incidence of foot abnormality would be significantly high. Abnormality was defined as a variation from what the two veterinarian assessors considered as optimal morphology and which was considered to impact negatively on the structure and/or function of the foot. Fifteen morphometric variables were measured on four calibrated photographic views of all four feet of 20 adult Kaimanawa feral horses. Four morphometric variables were measured from the lateromedial radiographs of the left forefoot of each horse. In addition, the study identified the incidence of gross abnormality observed on the photographs and radiographs of all 80 feet. There was a large variation between horses in the morphometric dimensions, indicating an inconsistent foot type. Mean hoof variables were outside the normal range recommended by veterinarians and hoof care providers; 35% of all feet had a long toe conformation and 15% had a mediolateral imbalance. Abnormalities included lateral (85% of horses) and dorsal (90% of horses) wall flares, presence of laminar rings (80% of horses) and bull-nose tip of the distal phalanx (75% of horses). Both hypotheses were therefore accepted. The Kaimanawa feral horse population demonstrated a broad range of foot abnormalities and we propose that one reason for the questionable foot health and conformation is lack of abrasive wearing by the environment. In comparison with other feral horse populations in Australia and America there may be less pressure on the natural selection of the foot of the Kaimanawa horses by the forgiving environment of the Kaimanawa Ranges. Contrary to popular belief, the feral horse foot type should not be used as an ideal model for the domestic horse foot.

Misreading Feuerbach: Susan Sontag, Photography and the Image-World

Misreading Feuerbach: Susan Sontag, Photography and the Image-World

Slope and rainfall effects on the volume of sediment yield by gully erosion in the Souar lithologic formation (Tunisia)

The Souar lithologic formation in semi-arid Tunisia is undergoing severe gully erosion which is threatening soil and water resources. Soil conservation strategies have focused more on terracing than on gully control techniques, since the contribution of gully sediment yield in the overall soil loss from watersheds is unknown. The paper reports investigations into the sediment yield provided by head-cut as well as sidewall–floor erosion of first order gullies on gentle and steep slope catchments underlined by the Souar lithologic formation. We measured mean field sediment volumes evacuated by different headward reaches of 10 and 9 gullies located on gentle and steep slope catchments, respectively. Two equations between the length of the gully head cutting and the corresponding volume of evacuated sediment were established. The treatment with a Geographic Information System (Arc View) of air photographs of six flights from 1952 to 2000 allowed the calculation of the volume of sediment provided both by head cutting and gully sidewalls–floor erosion through the following up of gully extension in eight catchments during the five periods separating the dates of these flights. Total gully erosion was on average 1.66 m3 ha− 1 year− 1 for the gentle slopes and 5.603 m3 ha− 1 year− 1 for the steep slopes. Sidewalls–floor contribution in total erosion was on average 81.5% for the gentle slopes and 77.8% for the steep slopes. We found out that the mean annual rainfall resulting from 40 mm daily rainfall threshold explained better the variation of annual head cutting sediment yield for these five periods than any other annual rainfall resulting from lower daily rainfall thresholds. Two equations between these two variables were established both for gentle and steep slope catchments.

Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment

Two programs were recently developed for the aesthetic evaluation of results in breast cancer conservative treatment: the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and the Breast Analyzing Tool (BAT). Both make use of a face-only photographic view of the patient and were developed to overcome the lack of reproducibility observed with subjective visual evaluation. The BCCT.core analyses several parameters related to asymmetry, color differences and scar appearance, while the BAT considers only asymmetry measurements. The purpose of this study was to compare the performance of these two methods. Digital pictures of 59 patients from Porto and 60 from Vienna were evaluated subjectively by two panels using the four-class Harris scale. The Porto photographs had a similar backlight and better quality, and were evaluated by an international panel of 23 experts. The Vienna photographs had different backlight and lower quality, and were evaluated by four students and two breast cancer specialists. All 119 cases were submitted to analysis using the BCCT.core and BAT. Agreement between the software programs and the subjective evaluation was calculated using kappa (k), weighted kappa statistics (wk) and error rate (er). In overall analysis, BCCT.core program obtained a better agreement with the subjective evaluation (k = 0.56; wk = 0,64; er = 0.20) than the BAT software (k = 0.39; wk = 0.46; er = 0.42) (P < 0.0007). Results were again better for the BCCT.core program, when analysing the photographs obtained in Porto (k = 0.71; wk = 0.78; er = 0.14) than for the BAT (k = 0.35; wk = 0.41; er = 0.51) (P < 0.0003) while no significant differences in agreement were obtained regarding the Vienna images (P > 0.1). The results suggest that the inclusion of multiple parameters in image analyses of aesthetic results has the potential to improve results. However, picture quality is probably important for analysis of other features besides asymmetry.

Efficacy of Fibrin Sealant (Human) (Evicel) in Rhinoplasty

To determine whether patients receiving fibrin sealant placed in a single lateral osteotomy site during rhinoplasty will note substantial improvement in pain, bruising, swelling, and overall healing compared with the untreated side and to determine whether blinded observers detect a substantial difference in bruising and swelling on the basis of review of standard postoperative photographs. We conducted a prospective, randomized, single-blind, controlled trial of the use of fibrin sealant (human) (Evicel; Johnson & Johnson-Wound Management, Somerville, New Jersey) in 10 consecutive patients undergoing lateral osteotomy in rhinoplasty. Written consent was obtained from all participants. Each patient was randomized for the use of fibrin sealant on either the right or the left side with the contralateral side acting as the control. Patients were evaluated on postoperative days 1, 7, and 21 with standard photographic views and a patient questionnaire. The blinded observers consisted of 5 raters familiar with the outcomes and results of rhinoplastic surgery. The observers evaluated all photographs and completed a grading scale to define bruising and swelling on each side. The mean patient age was 41 years (age range, 21-66 years). Half of the patients were women. The blinded observer Wilcoxon rank sum test revealed a statistically significant difference on postoperative day 1 for bruising (P< .03; Wilcoxon critical z value, 1.99) and swelling (P< .01; 2.41). Similar findings were discovered on postoperative day 7 for both bruising and swelling (P< .03). On postoperative day 21, bruising retained statistical significance (P< .05); however, swelling did not achieve statistical significance. Patient questionnaires were evaluated and significance was determined for the treated compared with the untreated side of the nose on postoperative days 1, 7, and 21. Categories included pain, bruising and swelling, and overall rate of healing. The Wilcoxon rank sum test revealed no significance for pain or overall rate of recovery (P> .06) on postoperative days 1, 7, or 21. However, bruising and swelling both achieved statistical significance. On postoperative day 1, both pain and swelling scales achieved a significance of P< .01 (Wilcoxon critical z value, 2.34). On postoperative day 7, bruising achieved significance at P< .005 (Wilcoxon critical z value, 2.63) and swelling achieved significance at P< .01 (2.45). Both bruising and swelling achieved equal significance on postoperative day 21 (P< .01; Wilcoxon critical z value, 2.57 and 2.45, respectively). Fibrin sealant applied to a lateral osteotomy site significantly reduced bruising and swelling per patient report on postoperative days 1, 7, and 21. Physician observation reported significant reduction in bruising on postoperative days 1, 7, and 21 and reduction in swelling on postoperative days 1 and 7. The ease of application and versatility of fibrin sealant enable rapid healing after rhinoplasty and produce increased patient satisfaction.