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author:("muramic, A")
2.  Phenylketonuria - genetic, clinical and therapeutic aspects 
BMC Proceedings  2012;6(Suppl 4):P6.
PMCID: PMC3426141
3.  Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study 
Archives of Plastic Surgery  2014;41(5):576-583.
Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid.
A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel.
There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected.
Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.
PMCID: PMC4179364  PMID: 25276652
Blepharoplasty; Ptosis; Dry eye syndromes
4.  Single-incision Laparoscopic Cholecystectomy at Community Hospitals in Honolulu, Hawai‘i: A Case Series 
This study aims to demonstrate the feasibility of implementing single-incision laparoscopic cholecystectomy in a community hospital setting. Minimally invasive surgical approaches for cholecystectomy achieve equivalent outcomes to the open surgical approach with less post-operative pain, improved cosmesis, shorter hospital stays, and decreased complications. Surgeons are attempting to reduce incisional trauma further by decreasing the number of incisions. A retrospective chart review was conducted for demographics, operating time, blood loss, conversion rate, length of stay, and presence of operative complications on patients undergoing single-incision laparoscopic cholecystectomy at two community hospitals between 2008 and 2011. One hundred and three patients (79 females and 24 males) underwent single-incision laparoscopic cholecystectomy. The mean age was 49.8 years (range 18-88). Ninety-six patients (93.2%) underwent elective procedures while 7 patients (6.8%) underwent urgent procedures. The mean operating time was 89.7 (± 28.3) minutes and the average blood loss was 33.7 (± 27.4) milliliters. Ninety-five (92.2%) of the procedures were successfully completed with a single-incision approach and 8 (7.8%) were converted to a multi-incisional approach, while none were converted to an open approach. The median length of stay was 4.75 hours. The post-operative complication rate was 7.4% (7/95) and included four superficial wound infections, one bile leak, one acute renal failure, and one urinary tract infection. These outcomes for single-incision laparoscopic cholecystectomy are comparable to other case series reported in the literature, and this retrospective review illustrates that single-incision laparoscopic cholecystectomy is feasible in a community setting.
PMCID: PMC3872920  PMID: 24377077
5.  Treatment of Median Arcuate Ligament Syndrome Via Traditional and Robotic Techniques 
Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. This is the second ever report of this approach. Both patients recovered without complications and experienced resolution of their symptoms. A discussion of the pathophysiology, literature review, and multispecialty treatment approach are presented.
PMCID: PMC3848179  PMID: 24349891
median arcuate ligament syndrome; celiac artery compression syndrome; celiac axis syndrome; Dunbar syndrome
6.  Prescription Drug Cost Reduction in Native Hawaiians After Laparoscopic Roux-en-y Gastric Bypass 
Native Hawaiians (NH) represent a unique population where socioeconomic factors have contributed to higher incidence rates of obesity and related comorbidities than in the general population resulting in substantial prescription medication costs. Studies demonstrate that laparoscopic Roux-en-y gastric bypass (LRYGB) surgery results in significant weight loss, improvement of comorbidities, and decreased costs for prescription medications in Caucasians. This study aimed to analyze the effects of LRYGB surgery on Native Hawaiians and their prescription drug costs.
Demographics, baseline body mass index (BMI), comorbidities, preoperative, and postoperative data were analyzed for NH patients who underwent LRYGB between January 2004 and April 2009. Medication costs were determined using the online pharmacy . Generic drugs were selected when appropriate, while vitamins and nutritional supplements were not included in this study.
Fifty (14 Men, 36 women) NH patients had sufficient data and follow-up for analysis. Average preoperative BMI was 49 kg/m2, while at one year follow-up it decreased to 33 kg/m2 (P<.001). This correlates to an average of 61% excess body weight lost (P<.001). The average number of prescription medications decreased from 3.5/patient preoperatively to 1.1/patient at one year (P<.001), equating to a monthly cost savings of US $195.8/patient (P<.001).
LRYGB provided substantial weight loss for morbidly obese NH patients, resulting in significantly less prescription medication use and substantial cost savings. Thus, bariatric surgery for weight management has the potential to improve the overall well-being and lower the financial burden of medical care in socioeconomically disadvantaged communities such as the NH.
PMCID: PMC3585497  PMID: 23467573
Native Hawaiians; bariatric surgery; laparoscopic rouex-en-y gastric bypass; prescription costs
7.  Dry Eye Syndrome Due to Botulinum Toxin Type-A Injection: Guideline for Prevention 
Dry eye syndrome is a potential complication of botulinum toxin type-A injection (BTX-A) into the lateral canthal rhytids (crow's feet). The early manifestations of this syndrome are subtle and are rarely reported to the treating physician. A guideline for early detection of dry-eye state is proposed, in order to avoid more troublesome adverse effects that may develop with repeated injections of BTX-A into the crow's feet region. If suspected early, clinical manifestations remain minor and are reversible. However, delayed diagnosis may lead to troublesome and persistent symptoms. A novel and practical grading scale of lower eyelid snap-back and distraction tests is offered that helps in documenting patient's clinical progress and in deciding when BTX-A injections should be delayed or discontinued.
PMCID: PMC3360079  PMID: 22737648
Botulinum toxin and dry eye syndrome; causes of dry eye syndrome; prevention of botulinum toxin type-A adverse effects; guideline in the use of botulinum toxin; Botox complications; snap-back test; distraction test; botulinum toxin and tearing; ectropion and botulinum toxin; classification of snap-back and distraction tests
8.  Subcutaneous Emphysema, Pneumopericardium, Pneumomediastinum and Pneumoretroperitoneum Secondary to Sigmoid Perforation: A Case Report 
A 50-year-old woman presented with chronic epigastric abdominal pain and constipation. She underwent diagnostic upper and lower endoscopy for further evaluation. Several hours following the procedure, she developed chest and subcutaneous emphysema of her upper chest, neck, and face. A chest X-ray demonstrated marked subcutaneous emphysema, pneumopericardium, and pneumomediastinum. A CT scan revealed a small leak at the rectosigmoid junction. Because the patient did not have peritoneal signs, she was treated conservatively and discharged on hospital day seven. The complications of both esohagogastroduodenoscoy, and colonoscopy are discussed, with an emphasis on perforations.
PMCID: PMC3313767  PMID: 22454817
pneumopericardium; pneumomediastinum; subcutaneous emphysema; pneumoretroperitoneum
9.  Case Report and Management of Suspected Acute Appendicitis in Pregnancy 
Hawaii Medical Journal  2011;70(2):30-32.
Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population.
PMCID: PMC3071211  PMID: 21308644
10.  The encapsulation effect of UV molecular absorbers into biocompatible lipid nanoparticles 
The efficiency of a cosmetic product depends not only on the active ingredients, but also on the carrier system devoted to improve its bioavailability. This article aims to encapsulate two couples of UV molecular absorbers, with a blocking action on both UV-A and UV-B domains, into efficient lipid nanoparticles. The effect of encapsulation on the specific properties such as sun protection factor and photostability behaviour has been demonstrated. The lipid nanoparticles with size range 30-350 nm and a polydispersity index between 0.217 and 0.244 are obtained using a modified high shear homogenisation method. The nanoparticles had spherical shapes with a single crystallisation form of lipid matrices characteristic for the least ordered crystal structure (α-form). The in vitro determination of photoprotection has led to high SPF ratings, with values of about 20, which assure a good photoprotection and filtering about 95% of UV radiation. The photoprotection effect after irradiation stage was observed to be increased more than twice compared to initial samples as a result of isomerisation phenomena. All the results have shown that good photoprotection effect and improved photostability could be obtained using such sunscreen couples, thus demonstrating that UV absorbers-solid lipid nanoparticles are promising carriers for cosmetic formulations.
PMCID: PMC3212221  PMID: 21711592
11.  Isolation and Characterization of the First Microsatellite Markers for the Endangered Relict Mussel Hypanis colorata (Mollusca: Bivalvia: Cardiidae) 
Hypanis colorata (Eichwald, 1829) (Cardiidae: Lymnocardiinae) is a bivalve relict species with a Ponto-Caspian distribution and is under strict protection in Romania, according to national regulations. While the species is depressed in the western Black Sea lagoons from Romania and Ukraine, it is also a successful invader in the middle Dniepr and Volga regions. Establishing a conservation strategy for this species or studying its invasion process requires knowledge about the genetic structure of the species populations. We have isolated and characterized nine polymorphic microsatellite markers in H. colorata. The number of alleles per locus ranged from 4 to 28 and the observed heterozygosity ranged from 0.613 to 1.000. The microsatellites developed in the present study are highly polymorphic and they should be useful for the assessment of genetic variation within this species.
PMCID: PMC3039963  PMID: 21339997
Monodacna; Ponto-Caspian; invasive species; population genetics; repetitive elements; genetic diversity
12.  Sinanodonta Woodiana (Mollusca: Bivalvia: Unionidae): Isolation and Characterization of the First Microsatellite Markers 
Sinanodonta woodiana (Lea, 1834) is a large Unionid species with a real invasion success. It colonized Europe, Central America, the Indonesian Islands and recently North America. The species life cycle involves a larval parasitic stage on freshwater fish species which contributes to the spread of the mussel. In this paper we describe, for the first time, eight polymorphic microsatellite loci for the species Sinanodonta woodiana. The genetic screening of individuals confirmed that all loci were highly polymorphic. The number of alleles per locus ranged from 7 to 14 and the observed heterozygosity ranged from 0.650 to 0.950. These loci should prove useful to study the species population genetics which could help to infer important aspects of the invasion process.
PMCID: PMC3179163  PMID: 21954356
invasive species; microsatellite; population genetics; range expansion; native area
13.  Splenic Rupture: A Case of Massive Hemoperitoneum Following Therapeutic Colonoscopy 
Hawaii Medical Journal  2010;69(6):140-141.
Colonoscopies are usually regarded as safe procedures with low complication rates and are recommended for anyone over the age of fifty for colon cancer screening. Splenic rupture is a rare complication of colonoscopy with few reported cases in the English literature. We present the only reported case of such a complication in the state of Hawai‘i and the 44th reported case in the English literature. Physicians need to be more aware of the possibility of splenic rupture following colonoscopy to avoid delay of diagnosis and treatment of this life-threatening complication.
PMCID: PMC3118014  PMID: 20535686

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