The ear is a common site for keloid formation, usually after trauma or ear piercing. This study is a meta-analysis to identify effective treatments for ear keloids after surgical excision.
A ...systematic literature review and meta-analysis were performed using core databases. Postoperative adjuvant treatment modalities for ear keloids and recurrence rates were extracted and analyzed. Fixed and random effect models were applied.
Twenty-five studies published before August of 2015 were identified. The recurrence rate after surgical excision of an ear keloid in the triamcinolone group was estimated as 15.4 percent (95 percent CI, 9.4 to 24.1 percent; p < 0.001). The recurrence rate in the radiation therapy group was estimated as 14.0 percent (95 percent CI, 9.6 to 19.9 percent; p < 0.001).
Although a large-scale, randomized study is required for confirmation, both triamcinolone and radiation therapy provided outstanding treatment for ear keloids after surgical excision without a significant difference between the two treatments.
Despite the significant reduction decades ago in sudden unexpected death in infancy (SUDI), decline of rates has slowed and stalled in some countries, including the USA. This led to an appreciation ...of ethnic variations in SUDI rates and the need to increase cultural sensitivity regarding sleep practices and circumstantial factors of SUDI. The study explored SUDI-related factors, in journal articles from two geo-cultural regions (Asian and Western countries), particularly for factors related to infant sleep practices.
A systematic review was conducted to identify SUDI-related factors in articles from PubMed, Scopus, and the Korean Citation Index from January 1992 to April 2019. From each article, SUDI-related factors were retrieved and categorized through the identification, aggregation, and categorization of factors into the areas of the triple risk model (TRM) of SUDI by their meanings and commonality. Significant trends in the frequency of factors were analyzed across time and between the two geo-cultural regions (Asian and Western countries) of article.
From a review of 218 articles (38 Asian and 180 Western articles), 84 SUDI-related factors were identified: 39 factors for TRM 1, 44 factors for TRM 2, and one factor for TRM 3. Four of the top-ranked 10 factors were found in both cultural zones: sleep position, male sex, bed-sharing, and genetics. Both cultural zones identified sleep position (44.0%), bed-sharing (22.0%), and rooming-in (16.5%) as the three most important sleep-related factors for SUDI. Variations between the cultural zones were observed in the place of SUDI occurrence, overheating, swaddling or bedding standards, and smoking.
Regardless of the urgent need to identify SUDI-related factors in low-SUDI societies, Asian cultures showed a significant lack of articles on SUDI. Several sociocultural issues were recognized such as the meaning of bed-sharing and rooming-in, along with residential styles and traditional health beliefs on sleep-related SUDI factors. Particularly little attention towards smoking was found in Asian articles in terms of frequency, suggesting the need to enhance SUDI reduction strategies by incorporating gender-sensitive smoking cessation interventions. This review of SUDI factors requests child health professionals to be alert to sociocultural variations in sleep practices and SUDI factors.
With the introduction of modern imaging technology into the forensic field, postmortem imaging, particularly postmortem computed tomography (PMCT), has gained increasing importance in forensic ...investigations of deaths. In recent years, PMCT, which aims to provide observer-independent, reproducible forensic assessment in a minimally invasive manner, has been incorporated into routine forensic practice in many medicolegal institutions worldwide as a complement to autopsy. To address questions with regard to vascular pathologies, postmortem computed tomography angiography (PMCTA) has been developed and has become a useful tool for exploring the vascular system. Currently, these techniques play roles in screening for potential pathologies for later autopsy confirmation, facilitating focused dissection of the target area, and visualizing lesions that would be difficult or impossible to detect during autopsy. Adequate image interpretation requires knowledge and understanding of postmortem changes in the body and artefacts related to PMCT and PMCTA. This article reviews the PMCT and PMCTA techniques in terms of their indications, applications, advantages, and limitations for cardiothoracic applications. Our findings will enhance readers' understanding of emerging CT techniques in forensic radiology.
There are many treatment modalities associated with osmidrosis. The purpose of this study was to identify and compare effective osmidrosis treatments.
A systematic literature review and meta-analysis ...were performed using MEDLINE, EMBASE, and Cochrane databases. The osmidrosis treatment modalities were extracted as predictor variables, and recurrence and complications were extracted as outcome variables. Subgroup analysis was performed with regard to combined curettage, and fixed and random effect models were applied.
Forty studies published prior to February 2016 were identified. The group that received surgery had the lowest incidence of recurrence as 3.0%, followed by the liposuction and laser groups (5.5%, 8.2%, respectively). The liposuction group had the lowest incidence of complications (hematoma, 1.6%; necrosis, 1.5%), followed by the surgery (hematoma, 1.9%; necrosis, 2.1%) and laser groups (hematoma, 3.1%; necrosis, 4.5%). When combining curettage, the recurrence rate was lower in the surgery (P = 0.06) and liposuction groups (P < 0.01).
Surgery treatment has been demonstrated as the most effective result for treating osmidrosis. Liposuction has been identified as the most effective treatment, with the lowest number of associated complications. Combining the curettage method was an effective option for lowering recurrence rate in surgery and liposuction treatments. Finally, laser treatment was not significantly associated with benefits.
Abstract Buckle rib fractures are incomplete fractures involving the inner cortex alone, and are rarely detected on routine chest X-ray or at autopsy. The characteristics of these fractures have not ...been well evaluated in situ although they are commonly observed on postmortem CT images especially following CPR. The postmortem CT findings in 42 cases showing buckle rib fractures caused by CPR were reviewed. The cause of death in all cases was non-traumatic. The shape, number, location, and distribution of these buckle rib fractures and their relationship to other types of rib fractures were evaluated using a novel oblique axial multiplanar reconstruction technique. Almost all incomplete rib fractures associated with CPR are buckle rib fractures (90.5%). All rib fractures were distributed from the second to ninth ribs with over 95% being within the second to seventh ribs. Buckle rib fractures are dominant in the seventh to ninth ribs and the proportion of buckle rib fractures located in the vicinity of the costochondral junctions increases with the lower ribs. Over 97% of all CPR associated rib fractures are located in the anterior one third of the ribs based on a new measurement method utilizing oblique axial multiplanar reconstruction of the CT data. When recognition of incomplete or buckle rib fractures on postmortem CT is taken into account, detection of symmetry and continuity of rib fractures typically associated with CPR is improved compared with the detection of complete fractures alone. Recognition of buckle rib fractures and their characteristics on postmortem CT is of benefit to the forensic pathologist in evaluating the possibility of CPR and the differentiation of resuscitative artifact from forensically significant visceral injury observed at autopsy.
The barbed suture technique uses newly developed materials for flexor tendon repair. In this study, the authors examine the effectiveness of using barbed sutures in flexor tendon repair compared with ...conventional methods.
A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Barbed suture and conventional suture methods were extracted as predictor variables, and maximum force, gap formation force, and cross-sectional area were extracted as outcome variables. Subgroup analyses were performed according to the source of suture materials and the number of strands. The Newcastle-Ottawa Scale was used to assess the quality of studies. Publication bias was evaluated using funnel plots.
The search strategy identified 86 publications. After screening, 12 articles were selected for review. Barbed sutures are comparable in effectiveness to conventional methods in terms of maximum force, gap formation force, and cross-sectional area. In the subgroup analysis, barbed sutures also have comparable effects to conventional methods in terms of maximum force and gap formation force.
The authors' meta-analysis found that the use of barbed sutures in flexor tendon repair was competitive compared to conventional methods in terms of maximum force and gap formation force. Long-term in vivo studies are needed to confirm these findings.
Therapeutic, V.
Keloids are difficult to remove successfully and there is no universally accepted treatment. After surgical excision of the keloid, there are various management methods for prevention of keloid ...recurrence, such as intralesional injection, radiation, and topical agents. A few studies have compared topical agents with other treatments. The aim of this study was to investigate effective topical agents for the prevention of recurrent keloid after surgical excision.
Eligible articles were sought using core databases, including Medline, Embase, and Cochrane databases, up to April 2016. The predictor variables were mitomycin C (MC) and imiquimod cream treatment after keloid excision. The outcome variable was keloid recurrence rate.
The search strategy identified 120 publications. After screening, 9 articles were selected for review. Articles were divided into 2 groups: MC and imiquimod cream. The recurrence rate after surgical excision in the MC group was estimated to be 16.5%, and that in the imiquimod cream group was estimated to be 24.7%.
If intralesional injection or radiation is not available, then MC or imiquimod 5% cream could be an effective alternative in preventing keloid recurrence.
In South Korea, most postmortem examination certificates (death certificates) are issued by attending physicians working in the emergency department (ED). However, ED overcrowding has made continuous ...education and quality control of the postmortem examination certificate difficult. In this context, the National Forensic Service (NFS) is conducting an on-site postmortem inspection (OPI) project.
In this study, we analyzed the discrepancy between postmortem inspection conducted by emergency physicians and forensic pathologists and identified the effects of the OPI project.
The study examined cases where OPIs were conducted by NFS medical examiners (forensic pathologists) on patients who died on arrival or died in the ED where the OPI project is being conducted. The case reports written by emergency physicians were compared with the postmortem examination certificates written by medical examiners to analyze the discrepancy in cause and manner of death between the two groups.
A total of 75 field examinations were conducted during the study period, with a 56% agreement rate between the two groups regarding cause of death. Manner of death was consistent at 73.3% and the most common reason for requesting an OPI was that the cause of death was presumed to be natural, but what that cause may be was unclear.
The discrepancy in postmortem examinations between emergency physicians and medical examiners is attributed to various factors. To ensure more reliable postmortem examinations, emphasis should be placed on improving the death investigation system and quality control activities for physicians.
•Postmortem inspection by emergency physicians and forensic pathologists was compared.•Cause of death was consistent at 56% in both groups.•Manner of death was consistent at 73.3% in both groups.•Improving the death investigation system and quality control is important.
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