The attractiveness penalty imposed by facial paralysis is significant, with paralyzed faces considered markedly less attractive than normals. However, the ratings did not change significantly when patients smiled, despite the increased asymmetry that occurs through smiling. Observers were moderately good at identifying the presence of facial paralysis, but less good at distinguishing side of involvement. These results have important implications for patient counseling and management of facial paralysis patients in an evidence-based manner.
Patients with facial paralysis were classified as having a negative affect display the vast majority of the time. Antithetically, normal faces in repose were classified as neutral the majority of the time; they were classified as positive the majority of the time when smiling. These novel results demonstrate the impact of the facial paralysis defect on perception by observers. Laryngoscope, 2011.
There were highly statistically significant differences in attention paid to the nasal area of crooked noses preoperatively and postoperatively, and there were no differences in attention to the nasal area between the postoperative noses and the normal noses. This represents a novel method for objectively evaluating attention and success of surgical procedures to minimize the appearance of deformities.
The attractiveness penalty caused by a lesion was correlated with size but not location. Importance to repair was correlated with how disturbing and bothersome it was but not with how the lesion diminished attractiveness. All large lesions and small central lesions were considered important to repair by observers. These results will help us predict the true impact of lesions and support evidence-based treatment plans.
L actobacilli are gram-positive, rod-shaped bacteria that are rarely infectious, and their presence as commensal organisms in the gastrointestinal tract is associated with protection against pathogens, stimulation of the immune system, and positive effects on colonic health and the host's nutrition. Nevertheless, lactobacilli have also been identified in some clinical reports as causal agents of dental caries, infectious endocarditis, urinary tract infections, and intra-abdominal, liver, and spleen abscesses. Endocarditis due to Lactobacillus is associated with impaired immunity, structural heart disease, recent surgery, prolonged antibiotic therapy, and severe comorbid conditions.2 Some clinical reports show a 30% mortality rate associated with endocarditis caused by lactobacilli.3 Probiotic agents that serve as entry vehicles for Lactobacillus have been identified as a relatively new risk factor in the genesis of these infections. 4 Case ReportA 48-year-old man with a history of paroxysmal supraventricular tachycardia (ablated in the past), mild aortic regurgitation, and the implantation (4 years earlier) of upper and lower dental bridges, presented at our emergency department. He reported exertional shortness of breath, increased lower-extremity edema, 3 months of intermittent fever ranging from 100.4 to 102.9 °F, and recent left-upper-quadrant abdominal pain.The patient was lethargic. His vital signs included a blood pressure of 112/43 mmHg, a heart rate of 113 beats/min, a respiratory rate of 20 breaths/min, and an oral temperature of 99 °F. His examination was notable for jugular venous distention (12 cm), a grade III/IV holosytolic murmur heard over the left lower sternal border, crackles in the lung bases bilaterally, splenomegaly, 3+ pitting edema bilaterally up to the knees, and scattered red macules anterior to the shins. His laboratory results indicated pancytopenia, acute renal failure, and hypoalbuminemia. His white blood cell count was 3.9 × 10 3 /µL, hemoglobin 7.1 g/dL, platelet count 114 × 10 3 /µL, serum creatinine 4.51 mg/dL, and albumin 2.3 g/dL. The urinalysis showed many bacteria, hyaline and granular casts, microscopic hematuria, and 50 white blood cells per highpower field. Blood cultures from 2 different venipuncture sites grew Lactobacillus acidophilus.A transthoracic echocardiogram revealed a left ventricular ejection fraction of 0.60 and a membranous ventricular septal defect with a mobile, echodense, vegetative mass 1.1 cm in diameter, moving between the left ventricular outflow tract and the right ventricle. Mild dilation of the aortic root was found, together with mild aortic regurgitation.Initial antibiotic treatment with empiric vancomycin and piperacillin/tazobactam was switched to penicillin on treatment day 4 for a 6-week course after species Case Reports
BackgroundThere have been numerous studies regarding atrial fibrillation (AF) associated with cardiac and pulmonary surgery; however, studies looking at esophagectomy and atrial fibrillation are sparse. The goal of this study was to review our institution’s atrial fibrillation rate following esophagectomy in order to better define the incidence and predisposing factors in this patient population.MethodsA retrospective chart review of all patients undergoing esophagectomy with transcervical endoscopic mobilization of the esophagus (TEEM) at the Medical College of Wisconsin and Affiliated Hospitals from July 2009 through December 2012.ResultsSeventy-one patients underwent TEEM esophagectomy during the study period. Of those, 23 (32.4%) patients developed new atrial fibrillation postoperatively. ICU (Intensive Care Unit) length of stay was 7.1 days for those that did not receive amiodarone, compared to 5.3 days for those that did receive amiodarone (p < 0.025). Those that went into AF spent on average 9.3 days in the ICU compared to 4.7 days for their counterparts that did not go into AF (p < 0.006). Total length of stay was not statistically different between populations [15.1 +/− 11.3 days compared to 13.5 +/− 9.4 days for those who did not go into AF (p < 0.281)]. Receiving preoperative amiodarone was found to reduce the overall incidence of AF. There was a trend towards decreased risk of going into AF in those who received preoperative amiodarone with an adjusted hazard ratio of 0.555 (p = 0.057).ConclusionSimilar to data reported in previous literature, postoperative atrial fibrillation was found to increase ICU length of stay as well as overall length of hospital stay. Preoperative amiodarone administration displayed a trend toward decreasing the rates of atrial fibrillation in patients undergoing TEEM.
See related commentary on pages 290-1.While attending the 11th annual FACTS-Care meeting, I had the pleasure of participating on a panel of residents discussing various issues in providing optimal cardiovascular and thoracic critical care and how those issues affect patient care and the learning process. As a second-year integrated cardiothoracic surgery resident at the Medical College of Wisconsin, providing optimal care in the intensive care unit (ICU) is currently a process in active learning for me. My contribution was discussing the different ICU models: closed, open, and comanaged. The closed ICU model is used at one of the smaller hospitals within our system where we rotate. In this model, the critical care team assumes complete care of the patient on admission to the ICU, excluding the surgical team from management decisions. Although this model assures a consistent approach because it is always the same managing team, the potential contributions by the surgical team are overlooked. As a result of this one-sided approach, disagreements on optimal patient management between the ICU team and surgical team often arise. As a cardiothoracic surgery resident, I do not find this model optimal for academic enrichment.In comparison, an open model allows for any physician to admit to the ICU, with or without an ICU consult. Often an ICU consult is obtained, allowing both teams to have input but not necessarily in an organized fashion. Multiple teams writing multiple orders for conflicting treatment plans leads to significant frustration among ICU and surgical teams, a view shared by most panel participants. Because of the minute-to-minute care often required of these patients and the operating room duties required by the surgical team, patient care can suffer. In either of these scenarios, learning is poor and patient care is suboptimal.In a comanaged ICU model, both primary and ICU teams contribute to patient management decisions in an organized manner. Rounds are done in the morning, with all managing teams represented; everyone contributes their thoughts, and a treatment plan is arrived at. A comanaged ICU allows minute-to-minute management by the on-site ICU team while also taking advantage of the insight of the surgical team. For this system to work, however, communication is critical. The designation of a team leader is crucial, and it is most often the ICU attending who assumes this role. This model fosters a smooth work flow, allowing optimal learning and improved patient care. Most panel participants stated that the comanaged model was preferred because of the shared patient care responsibility and the academic benefits. This model, however, was not in place at all the panel participants' institutions. The overall consensus of the critical care specialists and surgeons present was that a comanaged model is preferred in an academic environment.In a profession where the unexpected can occur at a moment's notice, it is important to have a team that is vigilant regarding the patient at all times. Unfortunately...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.