J E N N I F E R L. W a L D E N, M. D. C U R R I C U L U M V I T
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Congenital Problems in the Pediatric Breast Disclosure
3/20/2019 Congenital Problems in the Pediatric Breast Alison Kaye, MD, FACS, FAAP Associate Professor Pediatric Plastic Surgery Children’s Mercy Kansas City © The Children's Mercy Hospital 2017 1 Disclosure • I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation 1 3/20/2019 Pediatric Breast • Embryology • Post-natal development • Hyperplasia • Hypoplasia • Deformation Embryology 4th week of gestation: 2 ridges of thickened ectoderm appear on the ventral surface of the embryo between the limb buds 2 3/20/2019 Embryology By the 6th week ridges disappear except at the level of the 4th intercostal space Breast Embryology In other species multiple paired mammary glands develop along the ridges – Varies greatly among mammalian species – Related to the number of offspring in each litter 3 3/20/2019 Neonatal Breast • Unilateral or bilateral breast enlargement seen in up to 70% of neonates – Temporary hypertrophy of ductal system • Circulating maternal hormones • Spontaneous regression within several weeks Neonatal Breast • Secretion of “witches’ milk” – Cloudy fluid similar to colostrum – Water, fat, and cellular debris • Massaging breast can exacerbate problem – Persistent breast enlargement – Mastitis – Abscess 4 3/20/2019 Thelarche • First stage of normal secondary breast development – Average age of 11 years (range 8-15 years) • Estradiol causes ductal and stromal tissue growth • Progesterone causes alveolar budding and lobular growth Pediatric Breast Anomalies Hyperplastic Deformational Hypoplastic 5 3/20/2019 Pediatric Breast Anomalies Hyperplastic Deformational Hypoplastic Polythelia Thoracostomy Athelia Polymastia Thoracotomy Amazia Hyperplasia Tumor Amastia Excision Thermal Tumors Poland Injury Syndrome Tuberous Gynecomastia Penetrating Injury Deformity Adapted from Sadove and van Aalst. -
Delguercio Day Proceedings 2018
Fifteenth Annual Louis R.M. Del Guercio Distinguished Visiting Professorship and Research Day Presented at New York Medical College 7 Dana Road Facility Valhalla, New York December 19, 2018 PROCEEDINGS Program Committee: JORGE CON, MD THOMAS DIFLO, MD RIFAT LATIFI, MD KRIST NIKOLLA, MPH JOHN A. SAVINO, MD KATHRYN SPANKNEBEL, MD THOMAS SULLIVAN KEVIN WOLFE, PHD 1 Table of Contents: Podium Presentations…...............................p.03 Moderated Oral Poster Presentations…......p.29 Poster Exhibits…….…................................p.59 2 Podium Presentations (In alphabetical order) 3 TITLE: PREOPERATIVE MENINGIOMA EMBOLIZATION IS SAFE BUT COSTS MORE THAN NON- EMBOLIZATION RESECTIONS: A MULTI-CENTER RETROSPECTIVE MATCHED CASE-CONTROL STUDY Authors: ANUBHAV G. AMIN MD1(PGY6), John V. Wainwright MD1 , Ilya Rybkin MS2, Hussam Abou Al- Shaar MD3, William T. Couldwell MD/PhD4, Fawaz Al-Mulfti MD1, Justin Santarelli MD1, Chirag D. Gandhi MD1, Meic H. Schmidt MD1, Christian Bowers MD1 1 Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 2 New York Medical College, Valhalla, NY 3 Department of Neurosurgery, Hofstra/Northwell, Manhasset, NY 4 Department of Neurosurgery, University of Utah, Salt Lake City, UT Background: The literature has been mixed regarding the potential benefit of reduced blood loss with preoperative meningioma embolization (ME). However, a comparison of embolization-associated costs with non-embolization meningioma (NE) patients has not been completed. Objective: To determine the potential benefits of ME in blood loss and its associated costs. Design/Methods: This is a retrospective case control study matched for tumor location, size, and radiographic appearance between two centers. We reviewed demographic and clinical data for 29 matched meningioma patients from each center. -
Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal
National Education Curriculum Specialty Curricula Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal Abdomen and Superficial Structures Including Introductory Pediatric and Musculoskeletal Table of Contents Section I: Biliary ........................................................................................................................................................ 3 Section II: Liver ....................................................................................................................................................... 19 Section III: Pancreas ............................................................................................................................................... 35 Section IV: Renal and Lower Urinary Tract ........................................................................................................ 43 Section V: Spleen ..................................................................................................................................................... 67 Section VI: Adrenal ................................................................................................................................................. 75 Section VII: Abdominal Vasculature ..................................................................................................................... 81 Section VIII: Gastrointestinal Tract (GI) .............................................................................................................. 91 -
Cirugía De La Mama
25,5 mm 15 GUÍAS CLÍNICAS DE LA ASOCIACIÓN ESPAÑOLA DE CIRUJANOS 15 CIRUGÍA DE LA MAMA Fernando Domínguez Cunchillos Sapiña Juan Blas Ballester Parga Gonzalo de Castro Fernando Domínguez Cunchillos Juan Blas Ballester Sapiña Gonzalo de Castro Parga CIRUGÍA DE LA MAMA CIRUGÍA SECCIÓN DE PATOLOGÍA DE LA MAMA Portada AEC Cirugia de la mama.indd 1 17/10/17 17:47 Guías Clínicas de la Asociación Española de Cirujanos CIRUGÍA DE LA MAMA EDITORES Fernando Domínguez Cunchillos Juan Blas Ballester Sapiña Gonzalo de Castro Parga SECCIÓN DE PATOLOGÍA DE LA MAMA © Copyright 2017. Fernando Domínguez Cunchillos, Juan Blas Ballester Sapiña, Gonzalo de Castro Parga. © Copyright 2017. Asociación Española de Cirujanos. © Copyright 2017. Arán Ediciones, S.L. Castelló, 128, 1.º - 28006 Madrid e-mail: [email protected] http://www.grupoaran.com Reservados todos los derechos. Esta publicación no puede ser reproducida o transmitida, total o parcialmente, por cualquier medio, electrónico o mecánico, ni por fotocopia, grabación u otro sistema de reproducción de información sin el permiso por escrito de los titulares del Copyright. El contenido de este libro es responsabilidad exclusiva de los autores. La Editorial declina toda responsabilidad sobre el mismo. ISBN 1.ª Edición: 978-84-95913-97-5 ISBN 2.ª Edición: 978-84-17046-18-7 Depósito Legal: M-27661-2017 Impreso en España Printed in Spain CIRUGÍA DE LA MAMA EDITORES F. Domínguez Cunchillos J. B. Ballester Sapiña G. de Castro Parga AUTORES A. Abascal Amo M. Fraile Vasallo B. Acea Nebril G. Freiría Barreiro J. Aguilar Jiménez C. A. Fuster Diana L. -
Greater Manchester EUR Policy Statement On: Aesthetic Breast Surgery GM Ref: GM006-GM010 Version: 3.5 (23 January 2019)
Greater Manchester EUR Policy Statement on: Aesthetic Breast Surgery GM Ref: GM006-GM010 Version: 3.5 (23 January 2019) Commissioning Statement Aesthetic Breast Surgery Policy Reconstructive surgery following cancer, trauma or another significant clinical event is Exclusions not covered by this policy and is routinely commissioned across Greater Manchester. (Alternative commissioning Treatment/procedures undertaken as part of an externally funded trial or as a part of arrangements apply) locally agreed contracts / or pathways of care are excluded from this policy, i.e. locally agreed pathways take precedent over this policy (the EUR Team should be informed of any local pathway for this exclusion to take effect). Our definition All surgery involving incision into healthy tissue, in this case a healthy breast whatever of Aesthetic its size and shape, is considered to be aesthetic. This includes cases where there are symptoms, external to the breast, that are attributed to, or exacerbated by, the size of the breast(s). Policy Breast Augmentation Inclusion All surgery involving incision into healthy tissue in this case a healthy breast whatever Criteria its size and shape is considered to be aesthetic. Surgery to augment the size and or shape of a breast(s) is not routinely commissioned, with the exception of proven amastia or amazia. There should be confirmation either in the form of a consultant letter or an ultrasound report that there is an absence of breast tissue. This policy applies equally to all women including those who have completed gender realignment. The period of oestrogen therapy on the realignment pathway is considered, for the purposes of this policy, to equate to the period of hormonal increase experienced in puberty. -
Olivia Ward: Winner of Season 11 of NBC's the Biggest Loser
Olivia Ward: Winner of season 11 of NBC's The Biggest Loser http://www.nbc.com/the-biggest-loser/contestants/olivia/ (8.5 million views, 22 weeks on the Biggest Loser Ranch) Professional Mezzo-Soprano Opera Singer Certified Spin Instructor; Triathlete Currently filming: The CW's Dr. Drew's Lifechangers http://www.lctv.com/ Highlighted recent press: Fitness Magazine, People Magazine, Prevention Magazine, Shape Magazine, US Weekly, TV Guide, OK! Magazine, Live with Regis and Kelly, NBC’s The Today Show, Access Hollywood, E! Twitter page: www.twitter.com/bl11olivia Facebook page: www.facebook.com/bl11olivia Unofficial wiki: http://en.wikipedia.org/wiki/Olivia_Ward Blog: www.myfitspiration.com Olivia's biggest motivation for going on NBC’s The Biggest Loser was being 261 pounds, 35 years old and diagnosed with Polycystic Ovary Syndrome (PCOS) and being told she would likely never have children if she didn't lose weight. As an opera singer, she was also tired of losing coveted roles to people who looked healthier - it wasn't enough to just have a great voice. She received a degree in vocal performance at the University of Alabama, and master's degrees in vocal performance and opera performance from the New England Conservatory of Music. A poor diet and no exercise led to her obesity, and the weight gain continued as she was diagnosed with PCOS when says she "completely gave up." After spending 22 weeks on the Biggest Loser Ranch, Olivia lost 129 pounds and gained a new happier and healthier life. Olivia continues to maintain that weight loss with 90 minute cardio work out 6 days a week and travels the country to speak about fitness, fashion and all things fun! Hannah Curlee: Runner up of season 11 of NBC's The Biggest Loser http://www.nbc.com/the-biggest-loser/contestants/hannah/ (8.5 million views, 22 weeks on the Biggest Loser Ranch) Director of Health Engagement for Hospital Corporation of America (HCA Wellness Affiliate H2U) Certified Spin Instructor; Triathlete Currently filming: The CW's Dr. -
Body Curves and Story Arcs
Body Curves and Story Arcs: Weight Loss in Contemporary Television Narratives ! ! ! Thesis submitted to Jawaharlal Nehru University and Università degli Studi di Bergamo, as part of Erasmus Mundus Joint Doctorate Program “Cultural Studies in Literary Interzones,” in partial fulfilment of the requirements for the degree of ! Doctor of Philosophy ! ! by ! ! Margaret Hass ! ! ! Centre for English Studies School of Language, Literature and Culture Studies Jawaharlal Nehru University New Delhi - 110067, India 2016 ! Table of Contents !Acknowledgements !Foreword iii Introduction: Body Curves and Story Arcs Between Fat Shame and Fat Studies 1 Liquid Modernity, Consumer Culture, and Weight Loss 5 Temporality and Makeover Culture in Liquid Modernity 10 The Teleology of Weight Loss, or What Jones and Bauman Miss 13 Fat Studies and the Transformation of Discourse 17 Alternative Paradigms 23 Lessons from Feminism: Pleasure and Danger in Viewing Fat 26 Mediatization and Medicalization 29 Fictional Roles, Real Bodies 33 Weight and Television Narratology 36 Addressing Media Texts 39 Selection of Corpus 43 ! Description of Chapters 45 Part One: Reality! TV Change in “Real” Time: The Teleologies and Temporalities of the Weight Loss Makeover 48 I. Theorizing the Weight Loss Makeover: Means and Ends Paradoxes 52 Labor Revealed: Exercise and Affect 57 ! Health and the Tyranny of Numbers 65 II. The Temporality of Transformation 74 Before/After and During 81 Temporality and Mortality 89 Weight Loss and Becoming an Adult 96 I Used to Be Fat 97 ! Jung und Dick! Eine Generation im Kampf gegen Kilos 102 III. Competition and Bodily Meritocracy 111 The Biggest Loser: Competition, Social Difference, and Redemption 111 Redemption and Difference 117 Gender and Competition 120 Beyond the Telos: Rachel 129 Another Aesthetics of Competition: Dance Your Ass Off 133 ! IV. -
A Case Report of the Three-Years-Old Girl with Unilateral Amastia
Case Report INTERNATIONAL JOURNAL OF WOMEN'S HEALTH AND REPRODUCTION SCIENCES http://www.ijwhr.net doi: 10.15296/ijwhr.2013.06 A Case Report of the Three-Years-Old Girl with Unilateral Amastia Zahra Ghanbari¹*, Rana Shokouhmand² Abstract Article History: Since breasts are the symbol of femininity, Received March 2013 Accepted April 2013 deformation or lack of the breasts greatly impairs Available online May 2013 the mental quality of life for the female patients. Psycho-sociological importance of this issue, has Keywords: caused many studies to work on breast implants Amastia, (1,2,3,4). Amastia is a rare condition where the Breast breast or nipple is absent. Amastia can be due to: Congenitally congenital, teratogen exposure, injuries sustained during thoracotomy, Chest tube placement, and Corresponding Author: Zahra Ghanbari, General inappropriate biopsy of the breast and radiotherapy Physician, Islamic Azad University of severe burns. Unilateral amastia is often Tabriz Branch, Iran associated with absence of the pectoral muscles. Tel: +989143057376 Bilateral amastia is associated in 40%of cases with Email: [email protected] multiple congenital anomalies involving other parts of the body as well .We had a rare case of a patient with unilateral amastia, where, in spite of the right- side of the breast being intact, the left-side of the breast was absent. The present article presents the case with reference to past reports of amastia. A three-years-old girl with unilateral of breast tissue,areolea and nipples . No other anomalies were noted. Investigation done during the hospital stay including ultrasonography of the chest wall, abdomen and pelvic were all normal. -
Breast Lesions in Children and Adolescents
Pictorial Essay | Pediatric Imaging https://doi.org/10.3348/kjr.2018.19.5.978 pISSN 1229-6929 · eISSN 2005-8330 Korean J Radiol 2018;19(5):978-991 Breast Lesions in Children and Adolescents: Diagnosis and Management Eun Ji Lee, MD, Yun-Woo Chang, MD, PhD, Jung Hee Oh, MD, Jiyoung Hwang, MD, Seong Sook Hong, MD, PhD, Hyun-joo Kim, MD, PhD All authors: Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography. -
Aesthetic Breast Surgery GM Ref: GM006-GM010 Version: 4.3 (16 Sept 2020)
Greater Manchester EUR Policy Statement on: Aesthetic Breast Surgery GM Ref: GM006-GM010 Version: 4.3 (16 Sept 2020) Commissioning Statement Aesthetic Breast Surgery Policy Reconstructive surgery following cancer, trauma or another significant clinical event is Exclusions not covered by this policy and is routinely commissioned across Greater Manchester. (Alternative commissioning Treatment/procedures undertaken as part of an externally funded trial or as a part of arrangements apply) locally agreed contracts / or pathways of care are excluded from this policy, i.e. locally agreed pathways take precedent over this policy (the EUR Team should be informed of any local pathway for this exclusion to take effect). Our definition All surgery involving incision into healthy tissue, in this case a healthy breast whatever of Aesthetic its size and shape, is considered to be aesthetic. This includes cases where there are symptoms, external to the breast that are attributed to, or exacerbated by, the size of the breast(s). Policy Breast Augmentation Inclusion All surgery involving incision into healthy tissue in this case a healthy breast whatever Criteria its size and shape is considered to be aesthetic. Surgery to augment the size and or shape of a breast(s) is not routinely commissioned, with the exception of proven amastia or amazia. There should be confirmation either in the form of a consultant letter or an ultrasound report that there is an absence of breast tissue. This policy applies equally to all women including those who have completed gender realignment. The period of oestrogen therapy on the realignment pathway is considered, for the purposes of this policy, to equate to the period of hormonal increase experienced in puberty. -
Breastfeeding 101 for Pediatric Practices
BREASTFEEDING 101 FOR PEDIATRIC PRACTICES Jennifer A. Hudson, MD Medical Director, Newborn Services Greenville Health System SC Chapter of AAP, July 2018 Introduction Disclosures • I have no commercial interests or relevant relationships to disclose Objectives • Utilize basic strategies to support breastfeeding couplets in the outpatient setting • Observe and assess a breastfeeding session using a World Health Organization framework Why breastfeeding is important How breastfeeding works Assessing a breastfeed Observing a breastfeed Listening and learning Breast conditions Breastfeeding Counselling: A Training Course. World Health Organization. Breastfeeding Rates The American Academy YOU ARE HERE of Pediatrics recommends exclusive breastfeeding for 6 months. CDC Breastfeeding Report Card, 2016 Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. Breastfeeding and the Use of Human Milk. AAP, 2012 Those not breastfed experience more… minor, major, acute and chronic …health problems The Surgeon General’s Call to Action to Support Breastfeeding, 2011 National Goals Baby-Friendly 47.5% 23.7% Why Women Don’t Low education Formula Lack of role marketing models Lack of Work or experience school Hospital Embarrassed practices Modern Poor support lifestyle No confidence Formula • Inherent weaknesses – Nutrient degradation, expiration – Powder not sterile, requires clean water – Susceptible to manufacturing -
Bilateral Congenital Amazia: a Case Report and Systematic Review of the Literature
Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67,27e33 REVIEW Bilateral congenital amazia: A case report and systematic review of the literature Stephanie E. Dreifuss, Zoe M. MacIsaac, Lorelei J. Grunwaldt* Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA Received 17 April 2013; accepted 29 June 2013 KEYWORDS Summary Background: Congenital breast anomalies present challenging management deci- Congenital; sions to the plastic surgeon. One must consider the optimal age of reconstruction as well as the Breast; ideal surgical technique. Amazia, a very rare condition characterised by a complete lack of breast Amazia; tissue in the presence of a nipple areolar complex (NAC), is one such congenital breast anomaly. Reconstruction Methods: A comprehensive systematic review of the literature was performed to examine the various approaches to reconstruction of congenital breast anomalies. From this review, the data compiled included patient demographics and operative details, including type of reconstruction, treatment of the contralateral breast and treatment of the NAC. A case of bilateral amazia is also reported. Results: Of 178 articles, 13 ultimately met the inclusion criteria and 54 individual patient recon- structions were identified from these papers. At the time of reconstruction, the patients were in the range of 13e54 years, with an average age of 27.6 years. Prosthetic and autologous recon- structions were equally represented (19 patients each, 35.2%; Table 2). Autologous reconstruc- tion with prosthesis was slightly less common (15 patients, 27.8%). One patient was reconstructed using autologous lipo-augmentation only. Of the 36 cases in which the approach to the NAC was addressed, most (66.7%) were not recon- structed.