Vancomycin mixed with calcium sulphate beads provide a 2-3 week sustained local high antibiotic release elution profile which may impede the formation of a recurrent calpular contracture in conjunction with capsulotomy open and or capsulectomy as well as implant change.
- The document discusses various methods of fertility control or contraception, including both temporary and permanent methods.
- Temporary methods include barrier methods like condoms and diaphragms, as well as hormonal methods like oral contraceptive pills containing estrogen and progesterone.
- Permanent sterilization methods are also discussed briefly. The majority of the document focuses on describing the proper use and effectiveness of various contraceptive methods.
Castration is performed on male cattle to prevent reproduction and make them more docile. It reduces testosterone levels. Physical castration methods include using a Burdizzo clamp or rubber rings to cut off blood flow to the testes. This causes pain and inflammation. Surgical castration removes the testes and risks infection. All methods cause acute pain responses. Rubber rings may also cause chronic pain as tissue dies. Local anesthesia can reduce pain responses but effects are short-lived. Anti-inflammatory drugs provide longer-lasting analgesia and reduce stress. Castration increases disease risk due to immunosuppression so antibiotics are recommended. Overall castration is a painful procedure and pain management should be used.
Bringing basic dermatology to the pediatric medical home session 3 wartsppochildrens
This patient has atopic dermatitis, not molluscum. The best treatment is:
D. Hydrocortisone 2.5% ointment BID plus emollients for 2-3 weeks or until improved.
Topical corticosteroids are the mainstay of treatment for atopic dermatitis flares to reduce inflammation and itching. Emollients help maintain the skin barrier. Treatments for molluscum like tretinoin or cantharidin would not be appropriate here and could exacerbate the dermatitis.
Breast reconstruction has become an important part of breast cancer treatment to help restore a woman's body image and self-esteem after mastectomy. There are several options for reconstruction, including implants, flaps of tissue from the abdomen, back, or buttocks, or a combination of procedures. Immediate reconstruction at the time of mastectomy has advantages over delayed reconstruction in terms of cosmetic results and psychological impact. Proper patient selection considering health factors and goals is important to achieve a successful surgical outcome and recovery.
This document provides an overview of obstetric fistula, including its causes, management, treatment options, and prevention. It discusses the principles of fistula repair including pre-operative care, surgical techniques, post-operative care, and rehabilitation. Obstetric fistula is a condition that affects many girls and women in resource-poor countries due to complications during childbirth, leaving them isolated and in poverty. The document outlines the medical management and surgical procedures for treating fistula patients to repair damage and restore health. Prevention strategies emphasized include improving access to emergency obstetric care and maternal health services, as well as education programs to help communities understand safe motherhood practices.
This document discusses male contraception methods. It defines male contraception and outlines its benefits, including shared reproductive responsibility between partners and reducing burden on female partners. Common conventional methods are condoms and coitus interruptus. The male pill uses gossypol to inhibit spermatogenesis but has side effects. Vasectomy is a minor surgery that cuts or seals the vas deferens to prevent sperm in semen, while being highly effective and having minimal complications or side effects long-term. No-scalpel vasectomy is a common approach in India that is quick and has fewer complications than traditional vasectomy. Other methods discussed include open-ended vasectomy and vas-clips. Injection methods like RISUG
The document discusses medical termination of pregnancy (MTP) in India according to the MTP Act of 1971 and 1975. It defines MTP and outlines provisions, including that termination can occur up to 20 weeks and requires written consent. For first trimester termination, methods include medical (mifepristone/misoprostol) and surgical (vacuum aspiration). Second trimester termination methods include prostaglandins, dilation and evacuation, or instilling hypertonic solutions. Complications can be immediate like hemorrhage or remote like infertility. Termination aims to be safe and effective while following the law.
This presentation privdes facts and statistics for non-invasive procedure such as Macrolane.
Macrolane is a Nasha Gel for volume restoration and contouring of body surfaces.
- The document discusses various methods of fertility control or contraception, including both temporary and permanent methods.
- Temporary methods include barrier methods like condoms and diaphragms, as well as hormonal methods like oral contraceptive pills containing estrogen and progesterone.
- Permanent sterilization methods are also discussed briefly. The majority of the document focuses on describing the proper use and effectiveness of various contraceptive methods.
Castration is performed on male cattle to prevent reproduction and make them more docile. It reduces testosterone levels. Physical castration methods include using a Burdizzo clamp or rubber rings to cut off blood flow to the testes. This causes pain and inflammation. Surgical castration removes the testes and risks infection. All methods cause acute pain responses. Rubber rings may also cause chronic pain as tissue dies. Local anesthesia can reduce pain responses but effects are short-lived. Anti-inflammatory drugs provide longer-lasting analgesia and reduce stress. Castration increases disease risk due to immunosuppression so antibiotics are recommended. Overall castration is a painful procedure and pain management should be used.
Bringing basic dermatology to the pediatric medical home session 3 wartsppochildrens
This patient has atopic dermatitis, not molluscum. The best treatment is:
D. Hydrocortisone 2.5% ointment BID plus emollients for 2-3 weeks or until improved.
Topical corticosteroids are the mainstay of treatment for atopic dermatitis flares to reduce inflammation and itching. Emollients help maintain the skin barrier. Treatments for molluscum like tretinoin or cantharidin would not be appropriate here and could exacerbate the dermatitis.
Breast reconstruction has become an important part of breast cancer treatment to help restore a woman's body image and self-esteem after mastectomy. There are several options for reconstruction, including implants, flaps of tissue from the abdomen, back, or buttocks, or a combination of procedures. Immediate reconstruction at the time of mastectomy has advantages over delayed reconstruction in terms of cosmetic results and psychological impact. Proper patient selection considering health factors and goals is important to achieve a successful surgical outcome and recovery.
This document provides an overview of obstetric fistula, including its causes, management, treatment options, and prevention. It discusses the principles of fistula repair including pre-operative care, surgical techniques, post-operative care, and rehabilitation. Obstetric fistula is a condition that affects many girls and women in resource-poor countries due to complications during childbirth, leaving them isolated and in poverty. The document outlines the medical management and surgical procedures for treating fistula patients to repair damage and restore health. Prevention strategies emphasized include improving access to emergency obstetric care and maternal health services, as well as education programs to help communities understand safe motherhood practices.
This document discusses male contraception methods. It defines male contraception and outlines its benefits, including shared reproductive responsibility between partners and reducing burden on female partners. Common conventional methods are condoms and coitus interruptus. The male pill uses gossypol to inhibit spermatogenesis but has side effects. Vasectomy is a minor surgery that cuts or seals the vas deferens to prevent sperm in semen, while being highly effective and having minimal complications or side effects long-term. No-scalpel vasectomy is a common approach in India that is quick and has fewer complications than traditional vasectomy. Other methods discussed include open-ended vasectomy and vas-clips. Injection methods like RISUG
The document discusses medical termination of pregnancy (MTP) in India according to the MTP Act of 1971 and 1975. It defines MTP and outlines provisions, including that termination can occur up to 20 weeks and requires written consent. For first trimester termination, methods include medical (mifepristone/misoprostol) and surgical (vacuum aspiration). Second trimester termination methods include prostaglandins, dilation and evacuation, or instilling hypertonic solutions. Complications can be immediate like hemorrhage or remote like infertility. Termination aims to be safe and effective while following the law.
This presentation privdes facts and statistics for non-invasive procedure such as Macrolane.
Macrolane is a Nasha Gel for volume restoration and contouring of body surfaces.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, has a shorter recovery time, and allows the uterus to be preserved. The document provides details on the various techniques for endometrial ablation as well as preoperative preparation and counseling. It emphasizes the importance of completely ablating the entire endometrial thickness for treatment to be effective.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
This document discusses the management of neonates with abdominal wall defects. It covers prenatal and postnatal management as well as techniques for gastroschisis, omphalocele, and giant omphalocele. For gastroschisis, primary closure is preferred if the bowel is easily reducible, otherwise staged closure with a silo is used. Omphalocele management depends on size, with primary closure for small defects and escharotic therapy or staged closure for giant defects. Prognostic factors, complications, and new techniques are also reviewed.
This document discusses myomectomy, which is a common surgery to remove uterine fibroids while preserving the uterus. It describes the different surgical approaches including open, endoscopic, hysteroscopic, and laparoscopic. For each approach, it provides details on patient selection, preoperative mapping and imaging, surgical tools and techniques, tips to prevent complications, and post-operative concerns. It emphasizes the importance of adequate training to equip gynecologists with the skills to perform these minimally invasive procedures.
1. The document describes various methods for terminating a pregnancy in the first and second trimesters, including both medical and surgical options.
2. Common medical first trimester termination methods include mifepristone and misoprostol, methotrexate and misoprostol, while surgical options include menstrual regulation, vacuum aspiration, and dilation and evacuation.
3. Second trimester terminations may involve dilation and evacuation between 13-14 weeks or administration of hypertonic solutions after 14 weeks, along with oxytocin to induce labor. Procedures become more complex in the second trimester.
anaesthesia management for meningomyelocoele management. Anaesthesia management has been described with specific concerns in these patients. Key management stratergies have also been discussed in detail.
1. Caesarean myomectomy was historically discouraged due to risks of hemorrhage, difficulty securing hemostasis, and potential need for hysterectomy or blood transfusion.
2. However, recent evidence suggests that caesarean myomectomy can be safely performed by an experienced surgeon, even in cases of large myomas, without increasing intra- or post-operative complications when proper techniques are used.
3. Future fertility and subsequent pregnancy outcomes appear unaffected by caesarean myomectomy according to current evidence.
•Recognize patients at risk for diabetic foot infections
•Design a diagnostic work-up for diabetic foot osteomyelitis
•State the principles of management of diabetic foot infections
This document discusses permanent contraception options for men and women, including vasectomies and tubal ligations. It provides details on the procedures, such as vasectomies involving transecting and occluding the vas deferens through non-scalpel or scalpel methods. Tubal ligations can be performed through abdominal, laparoscopic, or vaginal approaches. Both procedures are generally safe and effective but require extensive counseling as they provide permanent sterilization.
This document discusses fertility preservation options for cancer patients. It begins by noting that advances in cancer treatment have led to improved survival rates but also increased risks of infertility. It then discusses the field of oncofertility, which aims to provide fertility preservation options for young cancer patients. The document reviews fertility preservation guidelines and options for both female and male patients, including embryo/oocyte cryopreservation, ovarian tissue cryopreservation, and sperm cryopreservation. It stresses the importance of discussing fertility preservation with patients before starting cancer treatment.
This document discusses first and second trimester abortion procedures. It provides information on the definition of abortion, incidence rates, factors linked to spontaneous abortion, techniques used in the first trimester including medical abortion using misoprostol and surgical abortion, and considerations for each method. It also discusses procedures for second trimester abortion such as dilation and evacuation and medical abortion regimens using mifepristone and misoprostol. Complications are outlined and Nepal's abortion laws are summarized.
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.
In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
Induction of labor involves initiating uterine contractions to achieve vaginal delivery. It can be done through medical methods like prostaglandins or oxytocin, or surgical methods like stripping membranes or amniotomy. Key indications for induction include post-term pregnancy, preeclampsia, diabetes, and suspected fetal compromise. Factors like cervical readiness and fetal position are assessed first to determine suitability. Methods involve prostaglandins administered vaginally or oxytocin infusion, which carry risks of hyperstimulation and fetal distress if not carefully monitored.
This document summarizes various contraceptive methods including barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills and injectables, intrauterine devices, and permanent sterilization methods. It describes how each method works to prevent pregnancy and lists the advantages and disadvantages of each. Reversible long-acting methods like IUDs and implants are highly effective but have potential side effects while barrier methods are less effective but have fewer health risks. Permanent sterilization via tubal ligation or vasectomy is intended to be very effective but cannot be reversed.
The document discusses management of postpartum haemorrhage (PPH). It outlines prevention through antenatal care, active management of the third stage of labor, and treatment through medical and surgical methods. Prevention focuses on risk identification and prophylactic oxytocics. Treatment begins with medical methods like uterotonic drugs and compression but may require procedures like uterine artery ligation, hysterectomy, or other surgeries to control bleeding if medical methods fail. Proper diagnosis, resuscitation, blood transfusion, and a multidisciplinary approach are essential to manage PPH.
This document describes the case of a 20-year-old woman who had a mechanical valve replacement in 2010 and became pregnant in 2012. During her pregnancy, she was treated with vitamin K antagonists until week 36 when she switched to heparin. After delivery, anticoagulation was stopped for several days due to hemorrhaging, which led to a large prosthetic valve thrombosis. She was referred to the authors' center and found to have an obstructive prosthetic valve thrombosis based on echocardiography imaging. She underwent urgent valve replacement surgery. The document concludes with recommendations on managing mechanical valve thrombosis and anticoagulation regimens during pregnancy.
The document discusses non-surgical management of postpartum hemorrhage (PPH). It outlines that PPH is a leading cause of maternal mortality, with causes including uterine atony, retained placenta, and coagulation disorders. Prevention focuses on risk identification and active management of the third stage of labor. Medical management includes uterotonics like oxytocin, carboprost, and misoprostol. Temporary measures like uterine packing, balloon tamponade, and embolization can control bleeding while arranging transfer for hysterectomy if needed.
Case presentation of severe papillomatosis of the larynx in non sexually active male teenager and discussion of biopsy finding of severe dysplasia and possible formation of laryngeal cancer
Long Term Weight Loss Following Abdominoplasty: Neurocrine FactorsRex Moulton-Barrett
This pilot study examines whether abdominoplasty leads to permanent weight loss and the potential neurocrine factors involved. 21 patients who underwent abdominoplasty were reviewed. 90.5% reported weight loss, with 47.6% maintaining loss over 1 year. The greatest predictor of long-term loss was pre-op weight between 140-210 lbs. Patients cited increased satiety as the main reason for loss. Satiety levels correlated with short vs long-term loss. A future study is proposed to test gut hormone levels before and after surgery to examine their association with reported satiety and weight loss.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, has a shorter recovery time, and allows the uterus to be preserved. The document provides details on the various techniques for endometrial ablation as well as preoperative preparation and counseling. It emphasizes the importance of completely ablating the entire endometrial thickness for treatment to be effective.
This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.
This document discusses the management of neonates with abdominal wall defects. It covers prenatal and postnatal management as well as techniques for gastroschisis, omphalocele, and giant omphalocele. For gastroschisis, primary closure is preferred if the bowel is easily reducible, otherwise staged closure with a silo is used. Omphalocele management depends on size, with primary closure for small defects and escharotic therapy or staged closure for giant defects. Prognostic factors, complications, and new techniques are also reviewed.
This document discusses myomectomy, which is a common surgery to remove uterine fibroids while preserving the uterus. It describes the different surgical approaches including open, endoscopic, hysteroscopic, and laparoscopic. For each approach, it provides details on patient selection, preoperative mapping and imaging, surgical tools and techniques, tips to prevent complications, and post-operative concerns. It emphasizes the importance of adequate training to equip gynecologists with the skills to perform these minimally invasive procedures.
1. The document describes various methods for terminating a pregnancy in the first and second trimesters, including both medical and surgical options.
2. Common medical first trimester termination methods include mifepristone and misoprostol, methotrexate and misoprostol, while surgical options include menstrual regulation, vacuum aspiration, and dilation and evacuation.
3. Second trimester terminations may involve dilation and evacuation between 13-14 weeks or administration of hypertonic solutions after 14 weeks, along with oxytocin to induce labor. Procedures become more complex in the second trimester.
anaesthesia management for meningomyelocoele management. Anaesthesia management has been described with specific concerns in these patients. Key management stratergies have also been discussed in detail.
1. Caesarean myomectomy was historically discouraged due to risks of hemorrhage, difficulty securing hemostasis, and potential need for hysterectomy or blood transfusion.
2. However, recent evidence suggests that caesarean myomectomy can be safely performed by an experienced surgeon, even in cases of large myomas, without increasing intra- or post-operative complications when proper techniques are used.
3. Future fertility and subsequent pregnancy outcomes appear unaffected by caesarean myomectomy according to current evidence.
•Recognize patients at risk for diabetic foot infections
•Design a diagnostic work-up for diabetic foot osteomyelitis
•State the principles of management of diabetic foot infections
This document discusses permanent contraception options for men and women, including vasectomies and tubal ligations. It provides details on the procedures, such as vasectomies involving transecting and occluding the vas deferens through non-scalpel or scalpel methods. Tubal ligations can be performed through abdominal, laparoscopic, or vaginal approaches. Both procedures are generally safe and effective but require extensive counseling as they provide permanent sterilization.
This document discusses fertility preservation options for cancer patients. It begins by noting that advances in cancer treatment have led to improved survival rates but also increased risks of infertility. It then discusses the field of oncofertility, which aims to provide fertility preservation options for young cancer patients. The document reviews fertility preservation guidelines and options for both female and male patients, including embryo/oocyte cryopreservation, ovarian tissue cryopreservation, and sperm cryopreservation. It stresses the importance of discussing fertility preservation with patients before starting cancer treatment.
This document discusses first and second trimester abortion procedures. It provides information on the definition of abortion, incidence rates, factors linked to spontaneous abortion, techniques used in the first trimester including medical abortion using misoprostol and surgical abortion, and considerations for each method. It also discusses procedures for second trimester abortion such as dilation and evacuation and medical abortion regimens using mifepristone and misoprostol. Complications are outlined and Nepal's abortion laws are summarized.
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.
In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
Induction of labor involves initiating uterine contractions to achieve vaginal delivery. It can be done through medical methods like prostaglandins or oxytocin, or surgical methods like stripping membranes or amniotomy. Key indications for induction include post-term pregnancy, preeclampsia, diabetes, and suspected fetal compromise. Factors like cervical readiness and fetal position are assessed first to determine suitability. Methods involve prostaglandins administered vaginally or oxytocin infusion, which carry risks of hyperstimulation and fetal distress if not carefully monitored.
This document summarizes various contraceptive methods including barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills and injectables, intrauterine devices, and permanent sterilization methods. It describes how each method works to prevent pregnancy and lists the advantages and disadvantages of each. Reversible long-acting methods like IUDs and implants are highly effective but have potential side effects while barrier methods are less effective but have fewer health risks. Permanent sterilization via tubal ligation or vasectomy is intended to be very effective but cannot be reversed.
The document discusses management of postpartum haemorrhage (PPH). It outlines prevention through antenatal care, active management of the third stage of labor, and treatment through medical and surgical methods. Prevention focuses on risk identification and prophylactic oxytocics. Treatment begins with medical methods like uterotonic drugs and compression but may require procedures like uterine artery ligation, hysterectomy, or other surgeries to control bleeding if medical methods fail. Proper diagnosis, resuscitation, blood transfusion, and a multidisciplinary approach are essential to manage PPH.
This document describes the case of a 20-year-old woman who had a mechanical valve replacement in 2010 and became pregnant in 2012. During her pregnancy, she was treated with vitamin K antagonists until week 36 when she switched to heparin. After delivery, anticoagulation was stopped for several days due to hemorrhaging, which led to a large prosthetic valve thrombosis. She was referred to the authors' center and found to have an obstructive prosthetic valve thrombosis based on echocardiography imaging. She underwent urgent valve replacement surgery. The document concludes with recommendations on managing mechanical valve thrombosis and anticoagulation regimens during pregnancy.
The document discusses non-surgical management of postpartum hemorrhage (PPH). It outlines that PPH is a leading cause of maternal mortality, with causes including uterine atony, retained placenta, and coagulation disorders. Prevention focuses on risk identification and active management of the third stage of labor. Medical management includes uterotonics like oxytocin, carboprost, and misoprostol. Temporary measures like uterine packing, balloon tamponade, and embolization can control bleeding while arranging transfer for hysterectomy if needed.
Case presentation of severe papillomatosis of the larynx in non sexually active male teenager and discussion of biopsy finding of severe dysplasia and possible formation of laryngeal cancer
Long Term Weight Loss Following Abdominoplasty: Neurocrine FactorsRex Moulton-Barrett
This pilot study examines whether abdominoplasty leads to permanent weight loss and the potential neurocrine factors involved. 21 patients who underwent abdominoplasty were reviewed. 90.5% reported weight loss, with 47.6% maintaining loss over 1 year. The greatest predictor of long-term loss was pre-op weight between 140-210 lbs. Patients cited increased satiety as the main reason for loss. Satiety levels correlated with short vs long-term loss. A future study is proposed to test gut hormone levels before and after surgery to examine their association with reported satiety and weight loss.
Sub-Mental Intense Pulse Light Assisted laser Liposuction Rex Moulton-Barrett
The document discusses various techniques for laser lipolysis and fat reduction, including both surgical and non-surgical methods. It provides details on 8 different laser-assisted liposuction systems approved by the FDA between 2006-2009, outlining their key specifications and clinical studies. It also reviews other subcutaneous lipolysis techniques such as injection lipolysis, topical creams, oral medications and trans-cutaneous non-laser methods.
This document discusses a 9 year clinical experience using Kelo-cote silicone gel for wound healing. It provides an overview of different types of wounds and factors that influence healing. Choices for topical therapy are outlined for both dry and wet wounds. The principles and methods of wound bed preparation including debridement are described. Considerations for autolytic, enzymatic, and bacterial balance in wound healing are also covered.
Role for Turbinectomy In the Crowded Nasal Airway, Is Empty Nose Syndrome A R...Rex Moulton-Barrett
Does Empty Nose Syndrome Occur following turninectomy in patients with a crowded nasal airway? Hoe successful is turbinectomy in relieving nasal obstruction and chronis sinus headaches
This document summarizes various treatments for chronic rhinitis. It defines chronic rhinitis and discusses its causes such as allergies, vasomotor rhinitis, and infections. It then examines the physiology behind nasal congestion and various assessment techniques. It provides details on medical therapies like steroids, antihistamines, and immunotherapy. Surgical treatments covered include inferior turbinate procedures like outfracture, resection, and laser/cautery techniques. Overall, the document provides an in-depth overview of chronic rhinitis diagnoses and both medical and surgical management options.
This document summarizes new developments in plastic surgery presented by Dr. Rex Moulton-Barrett in 2010. It discusses new fillers such as Sculptra, Radiesse, and ArteFill that provide both temporary and permanent volume restoration. Botulinum toxin treatments are summarized, noting their use for frown lines, sweating, and off-label uses. The Sciton Profile broad band light and SkinTyte devices are presented as new technologies for skin rejuvenation through collagen remodeling using controlled cooling. The philosophy of plastic surgery is described as employing multiple modalities to renew skin elasticity and tighten the dermis through skin care, lasers, and other technologies.
Hormone therapy options offered at a medi-spa include bioidentical hormones for women and men, hormone therapy for gynecomastia using tamoxifen, a "Skinny Shot" program using HCG injections and a very low calorie diet for weight loss, and oral supplements or injections claimed to stimulate or supplement growth hormone. However, the FDA has found no evidence that HCG causes weight loss, and studies on HCG for weight loss show no benefit compared to placebo. Risks of the various hormone therapies include side effects and lack of evidence for some purported benefits.
This document provides an overview of common conditions of the hand, including relevant anatomy, physiology, clinical assessment, and management. It describes the bones, muscles, tendons, nerves, and other structures of the hand. Common conditions are discussed such as carpal tunnel syndrome, trigger finger, osteoarthritis, and burns. Evaluation involves examining range of motion, strength, sensation, and specialized tests. Management may include splinting, injections, or surgery depending on the condition.
This document discusses the use of botulinum toxin type A (BoTox) injections for the treatment of migraines. It provides background on how BoTox was first found to reduce migraine symptoms accidentally in 1992 when injected into the forehead to treat wrinkles. Several clinical studies are summarized that showed BoTox injections into specific head and neck muscles significantly reduced migraine frequency and severity. The document reviews the mechanisms of action by which BoTox is believed to treat migraines and provides details on injection techniques targeting specific muscles and nerves. Safety considerations for BoTox injections are also mentioned.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Calcium sulphate vaco cap talk
1. Vancomycin Calcium Sulphate Beads in the Prevention of
Recurrent Capsular Contracture of The Breast - A Pilot Study
Olivia Jackson B. Sc., U C Davis & Rex Moulton-Barrett, MD, FACS
Plastic & Reconstructive Surgery, Alameda, California
2. Are the previous concepts on
prevention, causation & treatment
of capsular contractures:
evidence based or ‘ medical fashion ’ ?
3. U.S. Breast Implantation Statistics 2016U.S. Breast Implantation Statistics 2016
ASPS 2016 Plastic Surgery StatisticsASPS 2016 Plastic Surgery Statistics
• 290,567 Augmentations: no. 1 cosmetic surgery290,567 Augmentations: no. 1 cosmetic surgery
• 89,000/109,256 (89,000/109,256 ( 81%81% ) Breast Reconstructions) Breast Reconstructions
• 2011-20162011-2016 rate increaserate increase by +/-by +/- 3% / yr3% / yr
• 28,467 (28,467 ( 10%10% ) Augmentation) Augmentation implantsimplants removedremoved
4. Relevance of Capsular ContractureRelevance of Capsular Contracture
After Breast AugmentationAfter Breast Augmentation
• The most common complication & reason for removal / reoperation
• >10 x more common than explantation for acute infection / extrusion
• Incidence after Breast Augmentation 3-29%: >= to Grade III +/-r II
• Headon, Kasem & Mokbel, 2015: ‘Overall incidence’ 10.6%
5. Definition of Capsular ContractureDefinition of Capsular Contracture
Baker Classification, 1976: Breast Augmentation
I- Natural
II- Minimal: palpable firmness noticed by surgeon only
III- Moderate: Firmness noticed by patient
IV- Severe: Obvious distortion of breast shape
Spear and Baker, 1995: Prosthetic Breast Reconstruction
Ia- Natural
Ib- soft detectable by physical examination only
II- mildly firm by examination, may be visibly detectable
III- moderately firm, readily detectable visually, may be acceptable
IV- severe, symptomatic, unacceptable esthetically, needs surgery
6. 1. Older patient vrs young
2. Smooth vrs textured
3. Silicone elastomer vrs polyurethane shell
4. Subglandular vrs submuscular
5. Silicone vrs saline
6. Previous XRT vrs no XRT
7. Implantation < 6 -12 months after pregnancy / breast feeding
8. Incision: transglandular: mastopexy>periareola>= transaxillary
vrs inframammary incision
9. Touch technique vrs no touch technique +/- nipple shields
10. Talc / Lap packing vrs talc-free gloves & no packing
11. No irrigation triple antibiotic +/- betadine 5-10%
12. Delayed replacement: deflated saline / ruptured silicone implant
13. Blood / hematoma in pocket vrs dry pocket dissection +/ -drain
14. No IV antibiotics vrs IV Vancomycin & Ancef +/-orals
Clinical Factors Associated With Capsular
Contractures after Primary Augmentation
( no randomized, controlled, blinded studies to date )
7. 1. The Same Factors as for Primary Augmentation
2. Replacement of implant in the same pocket vrs neo-pocket
3. Neo-pocket adjacent vrs change to trans-pectoral :
sub-muscular sub-glandular
4. Capsulotomy vrs sub total / total capsulectomy
5. No prolonged vrs prolonged oral antibiotics
6. No ADM vrs ADM grafting
7. Replace with same implant vrs new implant
8. No steroid injection vrs injection into the capsular bed
9. No BoTox injection vrs injection into the capsular bed
10. No fat grafting vrs peri-capsular fat grafting & capsulotomy
11. Prior reconstructive implantation vrs esthetic augmentation
Clinical Factors Associated With
Recurrent Capsular Contractures
( no randomized, controlled, blinded studies to date )
8. Incidence of Recurrent Capsular Contracture (CC)Incidence of Recurrent Capsular Contracture (CC)
Wan & Rohrich, 2016 PRS: 137:826-841Wan & Rohrich, 2016 PRS: 137:826-841..
Incidence of recurrent CC %
•24/461 articles up to 4/2015: 0-54%
•Capsulotomy vrs Capsulectomy conflicting data
•Partial vrs total Capsulectomy conflicting data
•
•Site change Neo +/- Trans Muscle 0-12 % vrs no site change: 0-54%
•
•Implant Exchange 0-26% vrs same implant 33-54%
vrs No ADM
•6 articles using ADM 0-2.6% +site change 3/6: 50%
0% + no site change 1/6: 16%
9. 1. Early massage and superior compression
2. Closed capsulotomy- Dan Baker 1975: 75% resolution at 2 yrs
3. Ultrasound / Aspen – randomized clinical study 2017-2018
4. Low Dose Laser – randomized study: conclusions not helpful
5. Medication:
• Accolate – Zafirlukast: leukotrine receptor antagonist: check LFT’s
• Singulair – Montelukast: minimal results at most
• Tamoxifen – Myofibroblast: Block Er - receptors⍺
⚠︎
Post Operative Factors: Prevention & / 0r
Treatment of Capsular Contractures
10. Peri-Prosthetic Inflammation
•Fibroblast ‘transient immortalization’– loss p53 senescence
•Macrophages
•TGF- β
•Myofibroblasts: estrogen receptors ( Er - , 1/⍺ )β
stimulated by mechanical stress / tension
•Fibroblast collagen parallel layering – texturing reduces
Bacterial Colonization
•Bacterial Colonization – also without capsular contracture
•Bacterial Biofilms - also without capsular contracture
Multifactorial Pathophysiological
Causes of Capsular Contractures
11. • Implant Colonization with bacteria:
Staphylococcus epidermidis 56%with CC vrs 18% with no CC
Virden, et al, 1992. Aesthetic Plast Surg 16:173-179
• Endogenous Bacterial Flora Cultured from Breast Tissue:
■ Benign: not the same as skin flora & also different from malignancy
(Bacillus>Acinetobacter,>Enterbacteriaeae>Pseudomonas,>Staphlococcus>Proprionibact)
■ Malignant: Fusobacterium, Atopbium,Gluconacterobacter, Hydrogenophaga
Lactobacillus
■ Early Acute Infection: Staphloccus aureus, streptococcus, gram-negatives
■ Late infection: Coagulase negative staph., Propionibacterium spp.
• Biofilm Producing bacteria from the capsule
Propionbacterium acnes
Staphylococcus epidermidis: 80% oxacillin resistant
• Bacteria cultured from textured implants associated with ALCL
Ralstonia spp: in the water reservoirs
Capsular Contracture and Bacterial Colonization
12. • 65 - 80% of human infections associated with biofilms
• 5 stages of a Biofilm
• Composition of Biofilms < = 97% water
2% microbial cells
2% Extracel Polymeric Substances ie protein enzymes
1-2% Polysaccharides –adhesion + immune barrier
1-2% DNA / RNA
Calcium Sulphate Beads with
Vancomycin
planktonic eradicate
• MRSA and Staph epidermidis biofilm formation prevention
mature biofilm may reduce
• Biofilm of IV Staph Aureus requires a 4 X increase in antibiotic MIC (50)
• Rough surfaces and or foreign bodies are more susceptible to biofilms
• Nutrient / O2 / waste dormancy =↓ ↓ ↑ → reduced antibiotic susceptibility
Relevance of Biofilms in Medicine
13. PMMA filler / beads: do not dissolve & beads need to be removed
• high levels of antibiotics 2-3 days surface area diffusion∝
• prolonged release below MIC may support biofilms
Bioceramic Beads: dissolve and beads do not need to be removed
• Calcium Phosphate: Monocalcium: mono or anhydrous
Dibasic calcium: anhydrous, hemihydrous
Tricalcium: simple, and⍺ β
Hydroxyapatite: & calcium deficient
Biphasic Tricalcium
Tetracalcium
Octacalcium
• Calcium Sulphate Anhydrous = anhydrate
Dehydrate = gypsum = Plaster of Paris
Hemihydrate: and⍺ β
Antibiotic Beads in Medicine
14. Calcium Sulphate: • used since 1892, initially used as a bone graft
• gypsum: impure, acidic, inflammatory
( self limiting synovitis and post-op drainage )
• hemihydrate with water exothermic reaction
• hemihydrate dissolves in 3-6 weeks soft tissue
• Medical Grade alpha hemi-hydrate 1997:
■ Prevention & treatment osteomyelitis
■ Preventive & treatment of infection in joint replacement
■ Treatment of prosthetic vascular graft infections
■ Deep diabetic foot infections
■ Deep neck infections adjacent to the carotid artery
Calcium Phosphate: • longer resorption time 1 / water solubility⍺
• resorption may be 6 months to 10 years
• can be made into a strong cement
Polyphasic Ceramics: • + Potassium Sulphate short & longer release
Use of Antibiotic Bioceramics in Medicine
15. Commercially Available Antibiotic Beads Kits
of Calcium Sulphate Hemi- Hydrate∝
3mm 4.8mm
OsteoSet ( Wright Medical ) Gypsum derived: less hydrophilic
510(k) 2001: bone void filler 2 size beads 3, 4.8mm
No 510(k) for + antibiotics 5ml rapid 5 min and 20 minute cure
$1,100
Stimulan ( Biocomposites ) synthetic: hydrophilic mix
510(k) 2015: bone void filler 3 size beads 3, 4.8, 6mm
No 510(k) for + antibiotics 5ml rapid 4 min and 12ml 8 min cures
$1,000
16. 1. 12mls of OsteoSet powder to bowl from kit
1.Add 500mg Vancomycin powder to the bowl
2. Add diluent from small bottle in kit, makes 5mls in total
3.Alow to sit for 1 minute without touching
4.Mix thoroughly with plastic spatula in kit for 45 seconds into paste
5.Press paste into the mold 3mm smaller side: makes 200 x 3mm beads
6.Fast Cure allow to sit 3-5 minutes ( regular kit = 15-20 minutes )
7.Flex mold to remove beads
How to Make Vancomycin OsteoSet Fast Cure 3mm Beads
17. • Severe vascular or neurological disease
• Uncontrolled diabetes
• Severe degenerative bone disease
• Pregnancy
• Hypercalcemia
• Renal compromised patients
• Patients with a history of or active Pott’s disease
• Where intra-operative soft tissue coverage is not planned or possible
Contraindications for the use of OsteoSet Beads
18. • Hypercalcaemia: 2 case reports
Kaliiala & Hadda, 2015: 15 pts s/p revision hip / knee surgery
all 15 peri-prosthetic infections
Stimulan 10mls + 1g vancomycin
+ 240mg gentamicin
‘radiological absorption’: 21-45 days
3/15 developed transient hypercalcemia
maximum POD#5: 1/3 was symptomatic
Carlson, et al, 2015: single case report
hip replacement infection
Osteoset beads – unspecified amount
+ 2g Vancomycin, 3.6 g Tobramycin
POD#6: 14.7 mg/dl max
Returned to normal POD# 8
Potential Complications Related To Calcium Sulphate Beads
19. • Increased Volume and Duration of Drainage: acidic elution
Stimulan purported 0-3.2% drainage rates ( > 30mls beads )
Osteoset purported* 23-50% drainage rates
* unsubstantiated competitor data
• Heterotopic Ossification: no reported cases for soft tissue
1-2%: avascular bed ( > 33mls beads )
Potential Complications Related To Calcium Sulphate Beads
20. Elution Profile of Calcium Sulphate / Vancomycin Beads
Aiken et al, 2015: 900 mg Vancomycin bead immersed in 4ml saline
3mm Stimulan Beads
Peak conc. 13.5 mg/L at 48 hrs
42 days later : 0.67 mg/L
6mm Stimulan Beads
Peak conc. 10.4 mg/L at 48 hrs
42 days later : 0.59 mg/L
MIC 90: planktonic MRSA is 1mg/L Vancomycin∝
MIC90+: biofilm MRSA:15mg/L but only if + rifampicin or tigecycline
21. Albright, et al, 2016: • Pilot Study, Retrospective
n=14 • Debridement of infected pocket +IV antibiotics
• PMMAplates/beads:2g Vancomycin+1.2gTobramycin
• Immediate Expander placed + drain
• Exchange for implant & removal plates / beads
• No reoperations for capsular contractures
• Mean follow-up 8.2 months
Sherif, et al, 2017: • Infected implant removed, partial capsulectomy
n=12 • 6/12 culture +: Staph epidermidis, Staph aureus
Enterobacter, yeast & Rhodococcus
• Stimulan + 1g Vancomycin, 1.2g Tobramycin
• Immediate new implant or expander replaced
• 75%,n=9 patients successful ‘salvage’ of implant
Off label Use of Antibiotic Beads in Breast Surgery
2016-2018
22. Kenna, et al, 2018: • Preventive Study to Reduce Expander Infection
• 3 years: 127 submuscular breast reconstructions
n=68 • Retrospective, non randomized, 68 / 127 + beads
• 5ml Stimulan beads + 500mg vancomycin
+ 240mg gentamicin
• all patients with Alloderm : IMF to Pect Major
• drains kept up to 4 weeks
• infections: + Beads: Pseudomonas (1)
No Beads: Pseudomonas (3), Staph epi (3), Escherichia coli (1)
• infections 1.5% +beads group vrs 11.9 %
• now using beads for all implant exchanges
• no mention of capsular contractures at all
Off label Use of Antibiotic Beads in Breast Surgery
2016-2018
23. Can peri & intra - capsular placement of 5mls of OsteoSet
3mm Beads + 500mg Vancomycin prevent recurrent
capsular contracture ?
In conjunction with:
• IV antibiotics and 10 days of post-operative oral antibiotics
• Capsulectomy, partial capulectomy & or open capsulotomy
• Early superior compression and breast massage
• In office closed capsulotomy if indicated: Baker Grade II-III
Purpose of Current Pilot Study
24. • Pearl IRB re Study No. 17-RMB-101: ‘IRB Exempt’ 10/18/17
• Retrospective case review: chart and structured interview
• n = 14 implants & 10 patients
• Original Implantation: esthetic augmentation or reconstruction
• Indications for surgery: capsular contracture Baker III-IV
• Same surgeon and one post graduate student
• Follow-up to > 6 years: 2011-2018
Methods: Pilot Study CC with Antibiotic Beads
25. Methods: Pilot Study CC with Antibiotic BeadsMethods: Pilot Study CC with Antibiotic Beads
Data collected included:Data collected included:
Prior Procedure(s)Prior Procedure(s) Current SurgeryCurrent Surgery
• age, gravida, para
• date of last breast feeding
• esthetic or reconstructive
• surgical details: incisions, pocket
• numbers of surgery since then
• complications associated
• pre and final post op grade capsule
• date of surgery, follow up dates
• implants, incisions, drains / duration
• surgical details: capsulectomy/otomy
• use of simultaneous ADM
• complications of surgery
26. • + Retrospective review 50 primary augmentations ( 25 patients )
• document post-operative Baker grade
duration of follow-up
implant texture and silicone vrs saline
incision(s) used
• + Retrospective review 17 CC surgeries without antibiotic beads
• document Baker grade before vrs after surgery
Methods: Additional Information
27. • Surgery: outpatient
• IV Ancef was given within 30 minutes prior to surgery + 10 days po Keflex
• Incisions preexisting or new: inframammary, mastectomy, periareola,
mastopexy
• Explantation followed by capsulotomy, partial / complete capsulectomy
• Pocket irrigations 5% betadine then triple: Vanco/Bacitracin/Gentamicin
• Osteoset 5ml rapid 3mm beads 500mg vancomycin in peri-capsule / pocket
• All pts received new implants and no lap packing in the pocket
• All cases s/p capsulectomy were drained with a 7-10mm Jackson Pratt
• No: transposition of the pocket to opposite side of pectoralis
implant funnels , no-touch technique, nipple guards were utilized
Methods: Operative Details
28. Frequency Capsular Contracture after Primary Augmentation
n = 50 implants (25 patients)
14 Silicone: 4 Smooth & 10 Textured
36 Saline: 36 Smooth & 0 Textured
Incision:
50 Superior peri-areola
Final Grade: (48) I-II, (2) III, (0) IV
Mean follow-up: 10.2 months
CC rate (III-IV): 4%
Results: Primary Augmentations
29. n = 14 implants (10 patients)
Ages: (36-69) mean = 53
Para: (0-4) mean = 2.3
Prior Surgery
Indication for first surgery: 9 esthetic, 5 reconstruction
Prior XRT: 1/14
14 Implant used: 8 saline of which 5 textured, 6 silicone of which 4 textured
Incision: 1 mastectomy, 0 anchor, 4 transaxillary, 4 periareola, 5 inframammary
Number of previous surgeries for CC: 0-24, most common 0 (7/14)
Baker Grade: 7 III, 7 IV
Months from last surgery to current surgery: 4-396
Current Surgery
Capsular work done: 5 open capsulotomy, 5 partial, 4 total capsulectomy
Implants: 4 saline of which all 4 textured, 10 silicone of which 8 textured
Drain & Duration in days: 14/14, (5-34) mean = 16
Incision: 1 mastectomy, 3 anchor, 0 transaxillary, 5 periareola, 5 inframammary
Use of ADM- Alloderm: 1/14
Follow-up duration in months : (4-75) mean = 20.5 months
Final Grade: (10) I-II, (1) III, (3) IV
Complications: none
Results: Antibiotic Beads Pilot Study Prior + Current Surgical Details
30. Case example: 62 yr lady 33 yr after silicone augmentation Mexico
10/16 1/17 2/18
• Infra-mammary incision
• Bilateral total capsulectomy + 7mm JP
• 500mg Vancomycin in 200 3mm beads of 5mls OsteoSet
• implant replacement using Natrelle Inspira TRF 450
31. Implants Grade
+ Bead therapy _______ (I) ________ (II)______ _(III-IV)____
Prior to Surgery (n=14) 0 0 14
Bead Therapy (n=14 ) 10 0 4
71% improvement with surgery + beads
Implants
No Bead therapy _______ (I) ________ (II)_________(III-IV)____
Prior to Surgery (n=17) 0 0 17
After Surgery (n=17) 3 8 6
64% improvement with surgery + no beads
Surgery & Beads versus no Bead Therapy Fisher’s Exact one tailed Test (p= 0.497)
Results: Statistical Evaluation of Success of Antibiotic Bead Therapy
32. Summary Of ResultsSummary Of Results
• A Pilot Study was performed to determine the efficacy
of OsteoSet & Vancomycin Beads with replacement
of implant + capsulotomy / capsulectomy to prevent
recurrent capsular contracture
• While 71% showed an improvement with the use of the
beads so did 64% without using beads
• There was a 4% Grade III-IV capsular contracture rate
for primary breast augmentation
33. 1. The current results did not reach statistical significance, n= low sample size
• unable to show a difference between surgery with antibiotic beads vrs no beads
2. The surgical techniques used are in keeping with other current standards based on
a 4% rate of capsular contracture after primary augmentation
3. Symptomatic hypercalcemia has been reported with 10mls of Ca Sulphate beads
4. The inflammatory reaction to a biofilm may be individual including
the susceptibility of the biofilm to local immunity and antibiotic therapy
5. The 29% failure rate of surgery with Vancomycin beads may be a reflection of the
inadequate dosage of Vancomycin +/- need for an additional anti-staphlococcal agent
for biofilm producing bacteria, such as rifampicin ?
6. The results support further work, (n) & a prospective, randomized study↑
Conclusions