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Further studies are needed to confirm the potential of these drugs and also to determine if a subtype of patients or of psychotic features may be more likely to be improved by antidepressants.INTRODUCTION Serotonin syndrome is caused by excessive activation of serotonin (5-hydroxytryptamine [5-HT]) neurotransmission. Although the discontinuation of antipsychotics with 5-HT2 receptor antagonistic characteristics could theoretically result in serotonin syndrome, there have been very few reports on the syndrome thus far. CASE PRESENTATION A 75-year-old woman with somatoform disorder was transferred to our emergency room because of pyrexia, unconsciousness, and myoclonus with hyperreflexia. She had been taking milnacipran and perospirone for 10 years and had started taking duloxetine 2 months before the event. Thereafter, she suffered diaphoresis, gait disturbance, and tremor. Her psychiatrist advised her to stop taking perospirone, because of suspicion of extrapyramidal symptoms, a day before admission. The clinical diagnosis of serotonin syndrome was made based on her symptoms while using serotonergic agents. Her symptoms were so severe that she was transferred to the intensive care unit, where supportive care was successful. CONCLUSIONS Discontinuation of antipsychotics that are 5-HT2 receptor antagonists may lead to serotonin syndrome in patients who take serotonergic agents. As extrapyramidal symptoms and serotonin toxicity share some clinical features, detailed drug history and physical examination are necessary for successful treatment.Robin sequence with cleft mandible and limb anomalies, known as Richieri-Costa-Pereira syndrome (RCPS), is an autosomal recessive acrofacial dysostosis characterized by mandibular cleft and other craniofacial anomalies and respiratory complications. The aim of this cross-sectional study was to describe the hyoid and head posture of 9 individuals with RCPS using cephalometric measurements and provide a discussion about its implications in obstructive sleep apnea syndrome (OSAS). The study was conducted on lateral cephalograms of patients with RCPS and 9 selected age-matched controls in tertiary cleft center in Brazil. The cephalograms were digitized and analyzed on a software to obtain the vertical and horizontal hyoid position, its relationship with the mandible and the relation of the cranial base and postvertebral line. The t test was used for analysis of means and Levene's test for equality of variances.Cephalometric measurements H-S (vertical distance between hyoid bone and sella) (Supplemental Digital Content, Figure 1, http//links.lww.com/SCS/B247) and H-C4lp (horizontal position of the hyoid in relation to the post-pharyngeal space) showed statistically significant difference compared to controls (P  less then  0.05). Therefore, the hyoid bone was more inferiorly and posteriorly positioned in the study group compared with the control group. The vertebrae measurements did not present differences compared to controls. The described position of hyoid bone could be involved in the severe OSAS of RCPS patients.BACKGROUND A supratip deformity (SD) is an iatrogenic convexity that occurs in the cephalic region of the nasal tip. SD is still a major problem after rhinoplasty surgery. OBJECTIVES With the method we have described a ligamentous flap was used to create a supratip transition, with adjustable sharpness, while the refinements of the tip rotation and definition were ensured. The aim of the study is to present the results of this technique, which, to the best of our knowledge, has been described here for the first time. METHODS Our ligamentous flap technique was applied to 24 patients between August 2017 and March 2018. All of the patients were evaluated in terms of the formation of an SD, a hanging columella, tip projection, and the loss of rotation at the postoperative followups. IDF-11774 cost The photos of patients were evaluated by another independent plastic surgeon and patients themselves at 3 months after the surgery. RESULTS There were no early or late complications, such as an infection, excessive bleeding, or prolonged edema. Moreover, SDs, hanging columellas, tip projections, and rotational losses, which would require revisions, were not detected in any of the patients. Postoperative scores given by the patients and surgeons were significantly higher than the preoperative values (P less then 0.05). Only 2 patients required minor revisions due to dorsal irregularities in the upper 1/3 of the nasal segment. CONCLUSION The early results of this Pitanguy composite flap technique, which can be easily applied in every case with thin or thick skin in an open rhinoplasty, are promising. However, there is a need for an evaluation of the long-term results, as well as the advantages and disadvantages in a larger case series. LEVEL OF EVIDENCE Level IV.BACKGROUND To date, the impact of family history on diverticulitis outcomes has been poorly described. OBJECTIVE To evaluate the association between family history and diverticulitis recurrence after an episode of diverticulitis managed nonoperatively. DESIGN Retrospective cohort study with prospective telephone follow-up. SETTINGS Two McGill University-affiliated tertiary care hospitals in Montreal, Canada. PATIENTS All immunocompetent patients with CT-proven left-sided diverticulitis who were managed non-operatively from 2007-2017. INTERVENTION A positive family history for diverticulitis, as assessed by a detailed telephone questionnaire. MAIN OUTCOME MEASURES The primary outcome was diverticulitis recurrence occurring >60 days following the index episode. Secondary outcomes included a complicated recurrence and >1 recurrence (i.e., re-recurrence). RESULTS Of the 879 patients identified in the database, 433 completed the telephone questionnaire (response rate 48.9%). Among them, 173 (40.0%) had a positive family history of diverticulitis and 260 (60.0%) did not. Compared to patients with no family history, patients with family history had a younger median age (59.0 vs. 62.0 years, p=0.020) and higher incidence of abscess (24.3% vs. 3.5%, p1 recurrence (HR 2.03, 95% CI 1.13-3.65). LIMITATIONS Potential for recall and non-response bias. CONCLUSION Patients with a positive family history of diverticulitis are at higher risk for recurrent diverticulitis and complicated recurrences. See Video Abstract at http//links.lww.com/DCR/B215.