Wall Skin Research Articles

A skin stretch system for the immediately closing of the large skin defects of the anterior chest wall following large keloid excision

Large anterior chest wall skin defects following keloid resection, which are not suitable for primary closure, represent a substantial reconstructive challenge, partly due to the expected high tension closure and the considerable rate of recurrence. The TopClosure® Tension Relief System (TRS) is a novel skin stretching and wound closure-secure system which has been shown as a substitute for skin grafts, tissue expanders, and flaps. A 36-year-old man presented with a large keloid with ulcerations on the anterior chest wall. The patient underwent surgical resection of the keloid with immediate primary closure of the chest wall skin defect using the TRS. The surgical procedure and the postoperative period were uncomplicated. The wound was completely closed with a slightly raised scar after the 15th month follow-up. This is a rare case of immediate primary closure of a skin defect following resection of a large keloid of the anterior chest wall by the application of a skin stretching technique named as TRS. The TopClosure® TRS can help simplify the surgical procedures and shorten the operative time. Furthermore, the appliance can also be used for cosmetic improvements of the scar and minimize the need for future reconstructive procedures as well. Level of Evidence: Level V, therapeutic study

Original endoscopic orbital decompression of lateral wall through hairline approach for Graves' ophthalmopathy: an innovation of balanced orbital decompression.

BackgroundOrbital decompression is an important surgical procedure for treatment of Graves’ ophthalmopathy (GO), especially in women. It is reasonable for balanced orbital decompression of the lateral and medial wall. Various surgical approaches, including endoscopic transnasal surgery for medial wall and eye-side skin incision surgery for lateral wall, are being used nowadays, but many of them lack the validity, safety, or cosmetic effect.Patients and methodsEndoscopic orbital decompression of lateral wall through hairline approach and decompression of medial wall via endoscopic transnasal surgery was done to achieve a balanced orbital decompression, aiming to improve the appearance of proptosis and create conditions for possible strabismus and eyelid surgery afterward. From January 29, 2016 to February 14, 2017, this surgery was performed on 41 orbits in 38 patients with GO, all of which were at inactive stage of disease. Just before surgery and at least 3 months after surgery, Hertel’s ophthalmostatometer and computed tomography (CT) were used to check proptosis and questionnaires of GO quality of life (QOL) were completed.FindingsThe postoperative retroversion of eyeball was 4.18±1.11 mm (Hertel’s ophthalmostatometer) and 4.17±1.14 mm (CT method). The patients’ QOL was significantly improved, especially the change in appearance without facial scar. The only postoperative complication was local soft tissue depression at temporal region. Obvious depression occurred in four cases (9.76%), which can be repaired by autologous fat filling.InterpretationThis surgery is effective, safe, and cosmetic. Effective balanced orbital decompression can be achieved by using this original and innovative surgery method. The whole manipulation is safe and controllable under endoscope. The postoperative scar of endoscopic surgery through hairline approach is covered by hair and the anatomic structure of anterior orbit is not impacted.

An uncommon complication in the drainage of a chest wall skin abscess: pneumothorax and subcutaneous emphysema

Skin and soft tissue infections are frequent cases of emergency services. Treatment of these patients is usually performed ambulatory in the form of abscess drainage and oral antibiotic therapy. In this article, it was aimed to draw attention to the fact that a rib fracture may be seen after abscess drainage made by inexperienced persons and that might lead to presentation with more complicated situation

Analysis on the Effect of Application of the DIEP Flap in Breast Reconstruction Surgery

Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy, which are possibly due to burns, trauma, infections, congenital dysplasia and sex reassignment surgery etc., with the prevalence of unilateral breast reconstruction. After attempting to carry out breast reconstruction with latissimus dorsi, many surgeons constantly improved, designed, and modified multiple forms of operation programs and thus promote increasing improvement in repair and reconstruction of the breast after breast reduction surgery and mastectomy for breast cancer [1] Currently, breast reconstruction after breast cancer surgery is just in the early stage while it has occupied an important position in developed countries,therefore, the knowledge of breast reconstruction needs to be enhanced and publicized in our country. Some data show the quality of life in patients following breast reconstruction surgery is significantly higher than that in patients undergoing lumpectomy plus radiotherapy or simple mastectomy. More and more patients pursue breast reconstruction after mastectomy for breast cancer. Breast reconstruction is roughly divided into lost chest wall skin repair, hemispherical breast reconstruction, anterior axillary fold repair, plastic surgery for subclavian depression, nipple and areola reconstruction and asymmetrical breast repair. In the reconstruction of breasts, it is necessary to endeavor to make the rebuilt breast symmetrical to the healthy side so that future adjustment will be simple and easily feasible.

Numerical Modeling of Transpiration-Cooled Turbulent Channel Flow with Comparisons to Experimental Data

Transpiration cooling is a promising active cooling technique that provides coolant through a porous wall at a rate sufficient to maintain temperatures below a desired limit. The present study uses ANSYS® CFX to numerically investigate the influence of cooling gas injection on the temperature, velocity, and wall skin friction in the boundary layer of a subsonic turbulent hot-gas channel flow for various blowing ratios (), hot-gas temperatures (), and Mach numbers (, ). Here, a cooled permeable porous ceramic matrix composite sample with a hot-gas channel flow is simulated using a monolithic and two-domain approach. For the two-domain approach, separate solvers are used for the hot-gas and porous domains, respectively. These are applied alternatively and coupled to each other by boundary conditions imposed at the respective interface. The simulations are validated against experimental data and provide complementary insight into the effects of the cooling, which cannot be assessed from experimental measurements alone. The results show that, although a monolithic approach would be more convenient from a numerical point of view, a two-domain approach has proven to be superior in matching experimental data for this study. Furthermore, improved thermal boundary-layer profiles downstream of the porous sample are obtained by including the aft wall in the coupling process. This study adds to the limited theoretical and numerical investigations found in the literature on transpiration cooling.

The Relative Effects of Manual Versus Automatic Exposure Control on Radiation Dose to Vital Organs in Total Hip Arthroplasty.

Technologic advances have reduced medical radiation exposure while maintaining image quality. The purpose of this study was to determine the effects of the presence of total hip arthroplasty implants, compared with native hips, on radiation exposure of the most radiosensitive organs when manual and automatic exposure control settings are used. Detection probes were placed at six locations (stomach, sigmoid colon, right pelvic wall, left pelvic wall, pubic symphysis, and anterior pubic skin) in a cadaver. Radiographs were obtained with the use of manual and automatic exposure control protocols, with exposures recorded. A total hip arthroplasty implant was placed in the cadaver, probe positioning was confirmed, and the radiographs were repeated, with exposure values recorded. The control probe placed at the stomach had values ranging from 0.00 mSv to 0.01 mSv in protocols with and without implants. With the manual protocol, exposures in the pelvis ranged from 0.36 mSv to 2.74 mSv in the native hip and from 0.33 mSv to 2.24 mSv after implant placement. The increases in exposure after implant placement, represented as relative risk, were as follows: stomach, 1.000; pubic symphysis, 0.818; left pelvic wall, 1.381; sigmoid colon, 1.550; right pelvic wall, 0.917; and anterior pubic skin, 1.015. With automatic exposure control, exposures in the pelvis ranged from 0.07 mSv to 0.89 mSv in the native hip and from 0.21 mSv to 1.15 mSv after implant placement. With automatic exposure control, the increases in exposure after implant placement, represented as relative risk, were as follows: stomach, 1.000; pubic symphysis, 1.292; left pelvic wall, 1.476; sigmoid colon, 2.182; right pelvic wall, 3.000; and anterior pubic skin, 1.378. The amount of radiation to which patients are exposed as a result of medical procedures or imaging, and whether exposure is associated with an increased risk of malignant transformation, are the subject of ongoing debate. We found that after insertion of a total hip arthroplasty implant, exposure values increased threefold at some anatomic locations and surpassed 1 mSv, the generally accepted threshold for concern. Radiation exposure to radiosensitive organs increased up to threefold after total hip implantation with automatic exposure control and up to approximately 1.5 times with the manual protocol. Doses were greater with manual exposures than with automatic exposure control (except at the control probe on the stomach, where exposure was negligible, as expected). However, after implant placement, doses increased more with automatic exposure control than with manual exposure. This difference can be attributed to increased scatter and the difficulty of dose modification because of the density of the implant. Current radiographic protocols should be reassessed to determine if the benefits of frequent radiographs outweigh the newly demonstrated risks.

Cutaneous metastasis of gastric carcinoma: A rare case with unusual presentation site

Skin metastases are relatively rare but are of important clinical significance because they usually indicate a worse prognosis. The most common sources are lung and colorectal cancers in males and breast and colorectal in females. In this report, we presented a chest wall skin metastasis of gastric origin in a 50-year-old male. Tumor metastasis to unusual locations such as chest wall skin and from unusual origins such as stomach is of great clinical importance.

Gemella Morbillorum: A Rare Cause of Empyema Necessitans

SESSION TITLE: Lung Infections 2 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Empyema necessitans is a rare condition that arises when pus from the pleural cavity penetrates through the adjacent tissues to form a chest wall abscess. It can occur in the setting of delayed treatment of pleural infections. We present a case of empyema necessitans as a result of suspected chest wall trauma. CASE PRESENTATION: A 59 year old female was referred to the hospital by her pulmonologist after an incidental finding of a right lower lobe pulmonary embolism, right chest wall hematoma, and a right upper lung effusion on computed tomography (CT) scan of the chest. One month prior she had suffered a fall and developed progressively worsening dyspnea. She denied any fevers, chills, chest wall swelling, pain, or skin abrasions. Prior to the initiation of anticoagulation, a thoracentesis was performed to rule out a hemothorax. Imaging also noted a communication between the pleural effusion and a collection in the anterior chest wall. Thick purulent material was noted on CT guided thoracentesis and drainage of the chest wall abscess. A chest tube was placed in the pleura and a pig tail drain in the chest wall. The patient was empirically started on piperacillin-tazobactam. Microbiological studies from the pleural fluid and thoracic abscess were positive for Gemella morbillorum. The chest tube and pig tail drain were removed after 4 days when resolution of the empyema and chest wall abscess were noted. The patients dyspnea resolved and the patient was discharged on a 14 day course of Doxycycline. DISCUSSION: On review of the literature, most reported cases of empyema necessitans were caused by Mycobacterium tuberculosis, Actinomyces israelii, Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas cepacia. Gemella morbillorum is a Gram-positive coccus which naturally inhabits the human oropharyngeal, gastrointestinal, and urogenital flora. However, it is infrequently isolated and rarely results in pleural infections. Additionally, chest wall trauma is a rarely reported inciting factor for an empyema necessitans. CONCLUSIONS: Our case highlights a rare occurrence where Gemella morbillorum was the causative agent of an empyma necessitans secondary to chest wall trauma. This brings to light that rare causes must be considered in the investigation of an empyema necissitans. Reference #1: Kono S, Nauser T. Contemporany empyema necessitatis. Am J Med. 2007;120:303-5. Reference #2: Benedetti P, Rassu M, Branscombe M, Sefton A, Pellizzer G. J. Med. Microbiol. 58(12):1652-1656 doi:10.1099/jmm.0.013367-0 DISCLOSURE: The following authors have nothing to disclose: Sohi Ashraf, Animesh Gour, Santhosh John, Shalinee Chawla No Product/Research Disclosure Information

Pentalogy of Cantrell

Pentalogy of Cantrell is a rare syndrome that consists of defects involving the diaphragm, abdominal wall, pericardium, heart and lower sternum. A 2 –day- old male neonate presented to the pediatric surgical unit in the Maternity and Child Teaching hospital\AL-diwaniya with abdominal wall defect,precious baby deliverd by C\S to the mother with history of primary infertility for more than 13 year, The first clinical evaluation revealed epigastric omphalocele ( liver ,spleen and transverse colon were exposed with rupture sac , sternal defect , and ectopia cordis. U\S ,echocardogram and radiological studies were done to exclude others associated anomalies , Staged closure decided because the primary closure will significantly compromise ventilation or abdominal viscera .The first surgery was closure of both abdominal and thoracic defect ,bilateral flank and lateral chest wall release incisions and skin flap done for this closure. The patient had an uncomplicated postoperative course. A chest CT was performed at 2 weeks of life and demonstrated a very hypoplastic appearing anterior chest wall and a stenosis of the left mainstem bronchus as the cause of the patient's left lung hyperinflation. Monthly evaluation were done till he became at age of two years and every thinks were normal a part from abdominal distention (herniated viscera) which affected and limited the physical activity so the second stage was done, reinforced Dacron mesh placed to the anterior abdominal wall to protects the herniated bowel and redirects the pressure in the abdomen and to promotes enlargement of abdominal cavity.

A Prototype Therapy System for Transcutaneous Application of Boiling Histotripsy.

Boiling histotripsy (BH) is a method of focused ultrasound surgery that noninvasively applies millisecond-length pulses with high-amplitude shock fronts to generate liquefied lesions in tissue. Such a technique requires unique outputs compared to a focused ultrasound thermal therapy apparatus, particularly to achieve high in situ pressure levels through intervening tissue. This paper describes the design and characterization of a system capable of producing the necessary pressure to transcutaneously administer BH therapy through clinically relevant overlying tissue paths using pulses with duration up to 10 ms. A high-voltage electronic pulser was constructed to drive a 1-MHz focused ultrasound transducer to produce shock waves with amplitude capable of generating boiling within the pulse duration in tissue. The system output was characterized by numerical modeling with the 3-D Westervelt equation using boundary conditions established by acoustic holography measurements of the source field. Such simulations were found to be in agreement with directly measured focal waveforms. An existing derating method for nonlinear therapeutic fields was used to estimate in situ pressure levels at different tissue depths. The system was tested in ex vivo bovine liver samples to create BH lesions at depths up to 7 cm. Lesions were also created through excised porcine body wall (skin, adipose, and muscle) with 3-5 cm thickness. These results indicate that the system is capable of producing the necessary output for transcutaneous ablation with BH.

Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest wall thicknesses is with 50 cm FSD and zero (vertical) tube angle, while in large contour patients, it is with 100 cm FSD and zero tube angle. Finally, chest wall kilovoltage and electron therapies were compared, which revealed that electron therapy produces a better dose distribution than kilovoltage therapy.

Numerical solutions for gyrotactic bioconvection of dusty nanofluid along a vertical isothermal surface

The aim of the present paper is to establish the detailed numerical results for bioconvection boundary-layer flow of a two-phase dusty nanofluid. The dusty fluid contains gyrotactic microorganisms along an isothermally heated vertical wall. The physical mechanisms responsible for the slip velocity between the dusty fluid and nanoparticles, such as thermophoresis and Brownian motion, are included in this study. The influence of the dusty nanofluid on heat transfer and flow characteristics are investigated in this paper. The governing equations for two-phase model are non-dimensionalized and then solved numerically via two-point finite difference method together with the tri-diagonal solver. Results are presented graphically for wall skin friction coefficient, rate of heat transfer, velocity and temperature profiles and streamlines and isotherms. To ensure the accuracy, the computational results are compared with available data and are found in good agreement. The key observation from the present analysis is that the mass concentration parameter, Dρ, extensively promotes the rate of heat transfer, Qw, whereas, the wall skin friction coefficient, τw, is reduced by loading the dust parameters in water based dusty nanofluid.

Identifying a safe site for intercostal catheter insertion using the mid-arm point (MAP)

Background: Over 85% of chest injuries requiring surgical intervention can be managed with tube thoracostomy/intercostal catheter (ICC) insertion alone. However, complication rates of ICC insertion have been reported in the literature to be as high as 37%. Insertional complications, including the incorrect identification of the safe zone chest wall location for ICC placement, are common issues, with up to 41% of insertions occurring outside of this safe area. A new biometric approach using the patient's proportional skeletal upper limb anatomy to allow correct identification of the chest wall skin site for ICC insertion may reduce complications. Aim: The aim of this study was to examine the performance of the mid-arm point (MAP) method in identifying the safe zone for ICC insertion. Methods: Thirty healthy volunteers were recruited from The Alfred Hospital, a Level I Adult Trauma Centre in Melbourne, Australia. Blinded investigators used the MAP to measure the mid-point of the adducted arm of each volunteer bilaterally. A skin marking was placed on the anterior axillary line of the adjacent chest wall, and with the arm then abducted to 90 degrees, the underlying intercostal space was identified. Results: Using the MAP method, all of the 120 measurements fell within the ‘safe zone’ of the fourth to sixth intercostal spaces bilaterally. The median intercostal space identified was the fifth space, with investigators finding this in 86% of measurements independent of age, sex, height, weight or side. Conclusion: A simple technique using the MAP is a reliable marker for the identification of the safe zone for ICC insertion in healthy volunteers. The clinical utility for patients undergoing pleural decompression and drainage needs prospective evaluation.

Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants.

Background:Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants.Methods:Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed.Results:Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed).Conclusions:The CATS technique can be performed safely, with a desirable aesthetic outcome, and also symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.

Electrothermal transport of nanofluids via peristaltic pumping in a finite micro-channel: Effects of Joule heating and Helmholtz-Smoluchowski velocity

The present article studies theoretically the electrokinetic pumping of nanofluids with heat and mass transfer in a micro-channel under peristaltic waves, a topic of some interest in medical nano-scale electro-osmotic devices. The microchannel walls are deformable and transmit periodic waves. The Chakraborty-Roy nanofluid electrokinetic formulation is adopted in which Joule heating effects are incorporated. Soret and Dufour cross-diffusion effects are also considered. Under low Reynolds number (negligible inertial effects), long wavelength and Debye linearization approximations, the governing partial differential equations for mass, momentum, energy and solute concentration conservation are derived with appropriate boundary conditions at the micro-channel walls. The merging model features a number of important thermo-physical, electrical and nanoscale parameter, namely thermal and solutal Grashof numbers, the Helmholtz-Smoluchowski velocity (maximum electro-osmotic velocity) and Joule heating to surface heat flux ratio. Closed-form solutions are derived for the solute concentration, temperature, axial velocity, averaged volumetric flow rate, pressure difference across one wavelength, and stream function distribution in the wave frame. Additionally expressions are presented for the surface shear stress function at the wall (skin friction coefficient), wall heat transfer rate (Nusselt number) and wall solute mass transfer rate (Sherwood number). The influence of selected parameters on these flow variables is studied with the aid of graphs. Bolus formation is also visualized and analyzed in detail.

Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report

BackgroundPlasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects.Case presentationWe describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allowed diagnosis of plasmoblastic lymphoma and establishment of an immediate chemotherapeutic regimen, with rapid remission of compression symptoms.ConclusionsPlasmoblastic lymphoma is a very uncommon, difficult to diagnose, and aggressive disease. The presented case represents the first rare mediastinal plasmoblastic lymphoma in a human immunodeficiency virus-/human herpesvirus-8-negative patient. Pathologists should be aware that this tumor does appear in sites other than the oral cavity. Fine-needle aspiration biopsy is a low-cost, repeatable, easy-to-perform technique, with a high diagnostic accuracy and with very low complication and mortality rates. Fine-needle aspiration biopsy could represent the right alternative to surgery in those patients affected by plasmoblastic lymphoma, being rapid and minimally invasive. It allowed establishment of prompt medical treatment with subsequent considerable reduction of the neoplastic tissue and resolution of the mediastinal syndrome.

Nanofluid bioconvection with variable thermophysical properties

Abstract The prime purpose of this analysis is to investigate the effect of variable thermophysical properties of nanofluid on bioconvection boundary layer flow along a uniformly heated vertical cone. The governing equations with associated boundary conditions for this phenomenon are converted into a non-dimensional form via continuous transformations, which are then solved by using the implicit finite difference method. How does the phenomena of heat transfer is effected due to the temperature-dependent thermophysical properties of the fluid is the question investigated in this manuscript. Comprehensive numerical computations are carried out for a wide range of the parameters that are describing the flow characteristics. The influence of the physical parameters on the distribution of velocity and temperature profiles, wall skin friction and local rate of heat transfer is explored. Comparison with some special cases is also done and good agreement is found. It is recorded that the variable thermophysical properties of the fluid are more likely to promote the rate of heat transfer, Qw as compared to fluid having constant properties.

Monostatic ultra-wideband GPR antenna for through wall detection

The aim of this paper is to present a monostatic arc-shaped ultra-wideband (UWB) printed monopole antenna system with 3-16 GHz frequency bandwidth suitable for through-wall detection. Ground penetrating radar (GPR) technique is used for detection with the gain of 6.2 dB achieved for the proposed antenna using defected ground structure (DGS) method. To serve the purpose, a simulation experiment of through-wall detection model is constructed which consists of a monostatic antenna act as transmitter and receiver, concrete wall and human skin model. The time domain reflection of obtained result is then analysed for target detection.

Prediction of Gestational Diabetes Mellitus in Early Pregnancy: Is Abdominal Skin Fold Thickness 20 mm or More an Independent Risk Predictor?

Background: Gestational Diabetes Mellitus (GDM) is associated with several maternal and perinatal complications. Early detection and treatment can improve pregnancy outcomes. Objectives: To determine the prevalence, risk factors and predictors of GDM in early pregnancy at the University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt Nigeria. Methods: A cohort of 235 mothers who registered for antenatal care between 15 - 18 weeks of gestation at UPTH was prospectively studied. Their socio-demographic data, examination findings, anthropometric measurements, fasting blood sugar at booking and OGTT results at 28 weeks gestation were collated and entered into PC with SPSS for windows version 21.0 which was also used for the analysis. Variables were expressed as absolute numbers, percentages or means with standard deviations and significant differences determined using chi square test or the student “t” test as appropriate. The level of significance was set at P Women who had GDM were significantly older (P = 0.001), had higher weight (t = 2.95, P = 0.01), BMI (t = 2.29, P = 0.02), abdominal skin fold thickness (t = 4.15, P = 0.001), blood pressure (t = 3.38, P = 0.001) compared to women who did not. Previous history of GDM was significantly different between two groups as χ2 = 93.56 and P = 0.001. Abdominal skin fold thickness and prior GDM history were found to be independent predictors of GDM on application of multiple logistic regression analysis. Conclusion: The prevalence of GDM in Port Harcourt is 14.9% and major risk factors are obesity, previous GDM history, advanced age and hypertension. Abdominal skin fold thickness ≥ 20 mm is an independent predictor. The risk of developing GDM can be predicted in early second trimester using algorithm incorporating risk factor screening and anterior abdominal wall skin fold thickness estimation.

Combined abdominoplasty with scar-less open cholecystectomy

When abdominoplasty is desired, special considerations must be taken in Patients with previous abdominal scars. Open cholecystectomy scar is a relative contraindication for abdominoplasty, due to extensive abdominal flap undermining, which reaches higher up to the costal margins. In our patient the procedure of combined abdominoplasty and open cholecystectomy was completed without leaving any scar of open cholecystectomy, and this led to a better cosmetic results and viability of the whole abdominal wall skin with no complications from both procedures.