Photographic Misrepresentation on Instagram After Facial Cosmetic Surgery: Is Increased Photography Bias Associated With Greater User Engagement?

Background Before and after images are commonly used on Instagram to advertise aesthetic surgical treatments and are a powerful means of prospective patient engagement. Consistency between before and after images accurately demonstrating the postoperative result on Instagram, however, has not been systematically assessed. Objectives Our aim was to systematically assess facial cosmetic surgery before and after photography bias on Instagram. Methods The authors queried 19 Instagram facial aesthetic surgery-related hashtags on 3 dates in May 2020. The “top” 9 posts associated with each hashtag (291 posts) were analyzed by 3 plastic surgeons using 5-item rubric quantifying photographic discrepancies between preoperative and postoperative images. Duplicate posts and those that did not include before and after images after facial aesthetic surgery procedures were excluded. Results A total of 3,477,178 posts were queried. Photography conditions were observed to favor visual enhancement of the post-operative result in 282/291 analyzed top posts, with an average bias score of 1.71/5 (± 1.01). Plastic surgeons accounted for only 27.5% of top posts. Physicians practicing outside their scope of practice accounted for 2.8% of top posts including a general surgeon, dermatologist, dentist, ophthalmologist, and maxillofacial surgeon. Accounts with a greater number of followers (p = 0.017) and posts originating from Asia (p = 0.013) were significantly associated with a higher post-operative photography bias score. Conclusions Photographic misrepresentation, with photography conditions biased towards enhancing the appearance of the postoperative result, is pervasive on Instagram. This pattern was observed across all physician specialties and raises significant concerns. Accounts with a greater number of followers demonstrated significantly greater postoperative photography bias, suggesting photographic misrepresentation is awarded by greater user engagement.

Good Recovery of Prostate Carcinoma with Spine Metastases to T9 Following Laminectomy

Prostate carcinoma is a common health issue that can metastasise in the spine. A 65-year-old male was diagnosed with prostate carcinoma and two years later he developed a progressive neurological deficit over the bilateral lower limb. He experienced severe back pain, became paraplegic and the quality of life was severely impaired. Radiographic investigations were done and revealed osteoblastic bone metastasis at thoracic vertebrae with spinal cord compression. The patient underwent surgical decompression surgery at the T9 level mainly for pain control. Six months post-surgery not only the pain was well controlled but patient able to ambulate with walking aid. It is a rare post-operative result as the neurological recovery in a patient with complete paralysis is less than 3%. This type of recovery is possible when the cause of the neurological deficit is mainly mechanical compression from tumour rather than cord ischaemia from traumatic injury.

Periacetabular osteotomy using three-dimensional cutting and reposition guides: a cadaveric study

The goal of periacetabular osteotomy (PAO) is to reorient the acetabulum in a more physiological position. Its realization remains challenging regarding the final position of the acetabulum. Assistance with custom cutting- and reorientation-guides would thus be very helpful. Our purpose is to present a pilot study on such guides. Eight cadaveric hemipelvis were scanned using CT. After segmentation, 3D models of each specimen were created, a PAO was virtually performed and reorientation of the acetabula were defined. A specific guide was designed aiming to assist in iliac, posterior column and superior pubic ramus cuts as well as in acetabulum reorientation. Furthermore, the acetabular position was planned. Three-dimensional printed guides were used to perform PAO using the modified Smith-Peterson approach. The post-operative CT images and virtually planned acetabulum reorientation were compared in terms of acetabular index (AC), lateral centre edge angle (LCE), acetabular anteversion angle (AcetAV). There was no intra-articular or posterior column fracture seen. Two cadavers showed very low bone quality with insufficient stability of fixation and were excluded from further analysis. Correlation between the post-operative result and planning of the six included cadavers revealed the following mean deviations: 5° (SD ±3°) for AC angle, 6° (SD ±4°) for LCE angle and 15° (SD ±11°) for AcetAV angle. The use of 3D cutting and reorientation blocks for PAO was possible through a modified Smith-Peterson approach and revealed accurate fit to bone, accurate positioning of the osteotomies and acceptable planned corrections in cadavers with good bone quality.

Heterotaxy syndrome with intestinal malrotation, polysplenia and azygos continuity

Heterotaxy syndrome is a situs anomaly that comprises a large spectrum of cardiac and extracardiac malformations. Its association with intestinal malrotation is frequent. This later might be asymptomatic or manifest by signs of abdominal discomfort or of intestinal obstruction. We report on the case of a full term, small for gestational age neonate in whom heterotaxy syndrome with partial situs inversus abdominalis, intestinal malrotation, polysplenia and vena azygos continuity was diagnosed at prenatal echography. Due to the high risk of volvulus carried by the malrotation, Ladd’s procedure was performed at the age of two months. Follow-up examination at the age of four years shows excellent post-operative result and normal development of the child.

Bristow-Latarjet Technique: Still a Very Successful Surgery for Anterior Glenohumeral Instability - A Forty Year One Clinic Experience

AIM: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.PATIENTS AND METHODS: Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated.RESULTS: Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0–18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78–100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor.CONCLUSION: The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations.

Lymphangiectasis of lower limb: A rare challenging case

ABSTRACTLymphangiectasis usually occurs in the viscera. Involvement of the lower limb is very rare. It is difficult to establish the diagnosis without detailed investigations. Clinical features are peculiar and may mimic lymphoedema of different origins which needs to be ruled out. Contrary to the expectation, the post-operative result is excellent in the long-term follow-up.