bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Improvement of Photodamaged Skin after a Single Intense Pulsed Light Treatment
Authors: Nootheti Pavan K. , Pettit Kimberly A. , Yosowitz Gail , Goldman Mitchel P.
Published: January 2017

Background and Objectives:

Photoaging is clinically characterized by irregular pigmentation (freckling, lentigines, persistent hyperpigmentation), dryness/roughness, telangiectasia, wrinkling, elastosis, and inelasticity. Currently available medical literature documents using intense pulsed light (IPL) 3 to 5 times to achieve satisfactory improvement.

Study Design/Materials and Methods:

Twenty patients of Fitzpatrick skin types I–III, each with components of photodamaged skin including telangiectasias, dyschromia, skin roughness, enlarged pore size, and/or rhytides—participated in the study and were treated with a single Lumenis One IPL. Pretreatment and posttreatment photographs were graded by 2 independent physicians as to percent improvement.

Results:

After 1 treatment with the Lumenis One IPL, results showed an average improvement of 40% in resolving telangiectasias, dyspigmentation, and fine wrinkling.

Conclusions:

The present study demonstrates that as much as a 40% improvement in the overall appearance of photoaging can be obtained after a single treatment with the Lumenis One IPL. Previous studies with IPL using the Lumenis Photoderm, Vasculite, or Quantum systems found that 3 to 5 treatments were needed to obtain a similar improvement. These IPL systems have a smaller spot size, a different energy output profile, and a cutaneous cooling mechanism that may explain their decreased efficacy compared with the Lumenis One.
Utilizing a Curved, Perialar Advancement Flap to Maximize Esthetic Outcomes in Nasal Reconstructions
Authors: Kouba David J. , Moy Lauren , Fincher Edgar F.
Published: January 2017

Introduction:

The closure of distal nasal sidewall defects greater than 1 cm has traditionally engendered limited reconstructive options. Because the defects are too large for primary closure and because skin grafting frequently yields suboptimal esthetics, flap reconstructions are commonly employed. For these, many surgeons tend to rely on either the bilobed flap or the larger Rieger dorsal nasal rotation flap. However, while these reconstructions yield excellent results, none of their suture lines are hidden in any natural creases.

Objective:

The objective of this article is to present the authors' experience in using a nasal advancement flap they frequently use in their practice that has an added advantage of camouflaging a large portion of its suture lines within the alar crease to enhance cosmesis.

Methods:

The authors review their results with 10 patients who, after Mohs micrographic surgery, were left with distal nasal sidewall defects and underwent reconstruction using the curvilinear perialar crescentic advancement flap.

Results:

All patients demonstrated excellent cosmetic outcome without pin cushioning deformities or tenting at the junction of the cheek and nose cosmetic subunits. There was no alar distortion, and all patients were satisfied with the esthetic outcome.

Conclusion:

The curvilinear perialar advancement technique is an excellent alternative to other commonly used nasal sidewall closures such as the bilobed double transposition and the Rieger flap and can effectively complement the reconstructive armamentarium of any reconstructive surgeon.
Balloon-Assisted Transaxillary Augmentation Mammoplasty: A Simplified 3-Step Approach
Authors: Kluska Michael S.
Published: January 2017

Introduction:

Transaxillary augmentation mammoplasty has been an approach used by plastic surgeons for more than 2 decades. Considered controversial because of the potential for incomplete dissection, implant malposition, and traumatic pneumothorax secondary to blind dissection, the current trends for transaxillary augmentation mammoplasty include use of an endoscope for the entire dissection. This review of the literature presents an alternative approach to the traditional endoscopic transaxillary augmentation mammoplasty. The balloon-assisted transaxillary augmentation mammoplasty (BAAM) uses a specific 3-step sequence, enabling adequate pocket dissection with minimal risk of trauma in an efficient and timely manner.

Materials and Methods:

In this series BAAM was performed on 56 patients over 18 months. Patients were selected according to 5 specific criteria, including desired location of the scar, degree of ptosis, desired implant size, and minimal breast asymmetry. Using these specified criteria allowed a technique to be developed that was consistent and easily reproducible from patient to patient.

Results:

Of the 56 patients that were included in the study, minimal complications were noted. At 18 months, 1 person (1.8%) developed a capsular contracture grade III. There were no appreciated hematoma formations or infections of the prosthesis. In addition, 1 patient (1.8%) developed an incisional infection of the right axilla, which resolved with oral antibiotics. Seven patients (12.5%) presented with high-riding implants, 6 of which resolved over a course of 3 to 6 months with superior breast implant massage. One patient (1.8%) was taken back to the operating room where a counterincision at the inframammary crease was used to create a new inframammary fold, thus lowering the implant. During the course of the study, no ruptures were appreciated. Finally, of the 56 patients, 7 (12.5%) experienced parasthesias of the nipple, all of which resolved over a 3-month interval.

Conclusion:

Balloon-assisted transaxillary augmentation mammoplasty is the current method of choice for breast enhancement. In the 3-step sequence presented, the focus is on a simplified approach to achieve complete submuscular implant placement in an efficient and timely manor.
Bicipital Augmentation: A Retrospective Review of 94 Patient Cases
Authors: Chugay Nikolas V. , Chugay Paul N.
Published: January 2017

Objective:

Reality, documentary, and makeover programs have all helped to eliminate certain taboos previously associated with cosmetic surgical procedures. As a direct result of this phenomenon, men have expressed greater interest in cosmetic surgery. Over the past 5 years, Dr Chugay and colleagues have been working to promote the use of a bicipital prosthesis for aesthetic augmentation of the biceps muscle. This article is designed to further elucidate the complications that have been encountered with the procedure to date and changes in technique that have made this a viable option for male muscular enhancement.

Methods:

A retrospective review of prospectively collected data on 94 patients was undertaken to determine the cosmetic improvements and complications seen in the patient population. Silicone prostheses were placed below the biceps muscle in each case to provide greater definition and fullness in the region of the biceps.

Results:

Over a 5-year period, 94 patients underwent bicipital augmentation. Of those cases, there were 3 major complications. One patient developed a large seroma due to poor compliance with postoperative instructions for compressive garment use. A second patient suffered a dislodgement of the implant with protrusion of the implant from beneath the muscle. The third complication encountered was that of compartment syndrome in a patient who underwent both biceps and triceps augmentation.

Conclusion:

Despite the risks inherent in performing surgery in the upper extremity, the bicipital augmentation procedure is a means by which the male physique can be enhanced with minimal risk of complication when performed using our technique.
Soft-Tissue “Pollybeak” Deformity Avoidance and Management
Authors: Beekhuis G. Jan , Colton Jeffrey J.
Published: January 2017

A soft-tissue pollybeak deformity is aesthetically unattractive to the patient and to the surgeon. Its etiology and treatment is quite different than a cartilaginous pollybeak deformity. The main etiologic factor is an imbalance in the amount and thickness of the skin in the supratip lobule, and the amount and strength of the underlying cartilaginous structures. There is a potential dead space that fills with scar tissue, and this must be avoided by identifying the patients who are more prone to developing this problem by modifying the surgery and dressings accordingly and by using postoperative Triamcinolone injections. Revision surgery to remove excess scar tissue will sometimes be necessary.
Histological Study of Aspirated Fat
Authors: Vazquez-Barbe Alejandro , Ontiveros Sandro , Gonzalez Gerardo
Published: January 2017

The results of the histological study of samples from suction assisted lipectomy are presented, and the low diameter of the blood vessels found is related to the exceptional cases of hemorrhagic complications. The fact that a lot of the obtained fat cells are intact could orient this as the method to obtain material for free adipose tissue grafts.
Gynecomastia: Treatment by Lipo-Suction
Authors: Dolsky Richard L. , Fetzek John R.
Published: January 2017

The standard surgical techniques for the treatment of gynecomastia are deficient due to a high rate of complications, unsightly scars, and inadequate or overzealous excision of breast tissue. With the advent of lipo-suction as a reliable and safe technique, gynecomastia can be treated leaving a superior contour with a lower incidence of complications. Lipo-suction for gynecomastia should become the standard therapy for this common disorder. In a series of 34 patients treated by this method with 2 to 42 months follow-up, there have been no complications.
Abdominoplasty Technique for the Very Obese
Authors: Gunatillake Harold
Published: January 2017

An improved extended radical version of Castanares' abdominoplasty technique for very obese patients is described. Since Castanares described his mixed technique for the ablation of abdominal wall panniculus as a functional exercise, which was subsequently modified by Regnault, no further updated version has been published.
Total Circumferential Lower Extremity Lipoplasty
Authors: Botta Samuel A.
Published: January 2017

A technique is explained for total circumferential lower extremity liposuction, which extends from the lateral hip to the ankle. Description of the procedure begins with proper patient positioning, and moves on to skin markings which illustrate direction and areas of liposuctioning and location of all incision sites. This preliminary description is followed by details of the operative procedure. Results of the illustrative case are shown both qualitatively as well as quantitatively.

Many principles, including preoperative preparation, use of the tumescent technique, sufficient intraoperative and postoperative fluid replacement, autogenous blood administration, multiple drainage sites, and adequate postoperative compression contribute to the possibility of performing such an extensive procedure as a one-stage operation.
Compliance with the New OSHA Regulations
Authors: Tobin Howard A.
Published: January 2017

Compliance with the new OSHA regulations related to bloodborne pathogens is difficult and time consuming. There is considerable confusion as to the requirements of the individual surgeon. This article offers suggestions to those who have not yet come into compliance. Besides summarizing the most important requirements, it suggests consideration of a voluntary survey by a state OSHA representative who will guide the surgeon toward the necessary steps that must be taken to ensure compliance.
Polemics in Risk Management: Charting, the Art of Informed Consent, and other Basics
Authors: Ginsburg William H.
Published: January 2017

There is a subtle strandard of care that is never spoken about or referred to directly, yet it exists. It is the standard of care related to charting. Triers of fact like jurors, judges, and arbitrators have expectations regarding how a professional maintains charts and records, and, accordingly, that standard must be met. Failure to do so inevitably results in a twofold conclusion; professional negligence is easier to find for a plaintiff's attorney inductively looking for it in conjunction with his or her expert; and, the case is easier to ultimately prove to the trier of fact. Cosmetic surgeons must therefore raise the level of consciousness about charting.
Total Excision Techniques in Donor Area Harvesting for Hair Transplanting
Authors: Unger W. P.
Published: January 2017

The use of Total Excision Techniques (TET) in the donor area of hair transplant patients is described and recommended. Excision of scars from prior harvestings concomitant with new ones is also advantageous. Using this approach even multiple sessions will result in not more than 2 narrow scars in the occipito-parietal area and one in each of the two temporal areas. The less scar produced in the donor area the more grafts that can be removed without cosmetically overdepleting it. The author estimates that his graft yield has increased by at least 50% since he started using TET and considers it as important an advance in hair transplanting as the concepts of alopecia reduction and minigrafting.
Custom-Formed Splint for Septorhinoplasty
Authors: Still Eugene F.
Published: January 2017

The author has done extensive research into the problems associated with nasal packing and internal splinting following septorhinoplasty. In an effort to come up with a better splint, multiple media were tried and in different formats. The finished product has met all of the criteria for an acceptable nasal splint and has been tried successfully in over five hundred cases.
“Split” Umbrella Onlay Grafts for the Correction of Upper Lateral Cartilage Defects
Authors: Mignogna Frank V. , Garay Kenneth F.
Published: January 2017

Multiple techniques have been proposed to correct cartilaginous asymmetries and defects in the nasal pyramid. Some have proven to be more successful maneuvers than others. Among the more successful are the septal—upper lateral spreader grafts popularized by Sheen. However, some upper lateral defects have proven to be incompletely correctable by this technique. This is especially the case in secondary rhinoplasty, where excessive upper lateral cartilage may have been initially resected, resulting in a step-off defect vis-a-vis the nasal bone and a depression lateral to the dorsal profile, frequently associated with a defect in the nasal valve.

“Split” umbrella onlay grafts have proven to be a successful technique to correct these defects in our hands in over 350 cases performed from 1987 through 1992. Morselized alar or septal cartilage was employed to correct upper lateral defects in the primary rhinoplasty group. Contoured auricular cartilage grafts proved to be more successful in the secondary rhinoplasty or the badly traumatized nose. Valvular competence was maintained or improved in all cases. This easily performed technique is deserving of more widespread application.
An Alternative Attachment System for Osseointegrated Hair Prostheses
Authors: Pignataro Anthony S. , Schaaf Norman G.
Published: January 2017

The objective of this study was to find an alternative to the Zest abutment (Zest Anchors Inc., Escondido, California) for attachment of a hair-replacement prosthesis. Standard implantology and surgical techniques were used to place the craniofacial implants and subsequent abutments. The new ERA (APM-Sterngold, Attleboro, Massachusetts) abutments provided superb retention of the prosthesis. Indications are that the many forms of retention made possible by the various abutments available can provide multiple attachment alternatives.
Eyebrow Transplantation
Authors: Gandelman Marcelo
Published: January 2017

The author presents a summary of the operative and postoperative procedure for performing the transplantation of eyebrows using one-hair micrografting. Eyebrow deficits from various causes can be treated effectively using the micrografts of single hairs which are easily manipulated into a natural eyebrow design. About 140 hairs constitute a good eyebrow. The authors prefer to achieve this objective in two stages over four months. One of the planning aspects highlighted by the authors is donor site selection. Eyebrows are composed of fine hairs, so finding a donor site that can supply fine hair is important. Thick hair can result from roots with thick hair and may have to be removed from the transplanted eyebrow. The most common postoperative complaint is the itching of the grafts. In general, complications are infrequent and easily resolved.
The Physician on Trial: Flight or Fight
Authors: Shiffman Melvin A.
Published: January 2017

Forewarning is forearming. This article offers emotional armor to the physician enduring a malpractice suit for the first time. The author explains the most common emotions that assail the physician when a subpoena is first served and offers several practical ideas for bringing some order into the initial stages of a malpractice suit. These include: notify the malpractice insurance carrier immediately; gather and review the complete medical record, looking for errors in medical judgement; make a copy of the record for your attorney; summarize events for your attorney, and request all hospital records.
Less Expensive Skin Resurfacing by Longer Pulse CO2 Laser
Authors: Sharma Manorama
Published: January 2017

Resurfacing of the skin for eliminating defects like acne scars, wrinkles, keloids, etc. has traditionally been done by ultrapulse CO2 lasers in which there are very short pulses with high peak power in a repetitive fashion. The pulse duration may range from 0.1 to 200 per second with 1000 pulses per second. A short laser exposure with a high power density ablates the same volume of tissue as a longer exposure at a lower power. The high-power lasers are more expensive. A lower-power laser with longer pulse intervals provides a less expensive alternative. This paper describes the resurfacing results achieved with a lower-power and longer-pulse laser available at a fraction of the cost. The Luxar CO2 laser was used in pulse mode, with an exposure time of 20 milliseconds and a repetition rate of 20 times per second. The power level of 2–5 W pulse rate was evaluated on 69 patients using the following four metrics: (1) postoperative pain reported by the patient, (2) length of recovery period, (3) quality of achieved final result as measured by patient's satisfaction, and (4) complications. In each of these four regards the selected protocol was found to be very satisfactory and the results were comparable to those reported by the ultrapulse lasers.
Treatment of Capsule Contracture
Authors: Shiffman Melvin A.
Published: January 2017

Various methods have been used to try to prevent or to reduce the rate of capsule contracture following breast augmentation. Methods commonly used to prevent contracture that have shown some success include the use of low-dose steroids in the implant pocket, antibiotics, implant manipulation with smooth-shelled saline implants, textured implants, and placing the implant in the submuscular position. An excellent means of treating capsule contracture is with partial or total capsulectomy followed by placement of a textured saline implant on the opposite side of the pectoralis major muscle, creating a new implant pocket.
Ectopic Bone in Retained Fibrous Capsule
Authors: Shiffman Melvin A.
Published: January 2017

Mammographic breast mass, cyst, calcified mass, papable mass, or hematoma are the possible consequences of leaving some fibrous capsule in place when a breast implant is removed or changed. Indications for total capsulectomy include: calcified fibrous capsule, polyurethane implant, symptoms of autoimmune disease, plans for replacement with a textured implant in the same pocket, ruptured implant, and patient fear of developing autoimmune disease. The decision to perform capsulotomy, partial capsulectomy, or total capsulectomy is up to the operating surgeon according to the facts of the case and the surgeon's experience after consultation with the patient.
Current Alloplastic Materials in Augmentation Genioplasty
Authors: Ziccardi Vincent B. , Johns Francis R. , Demas Peter N. , Braun Thomas W.
Published: January 2017

Alloplastic materials are widely used in augmentation genioplasty. They are readily available and routinely placed through intraoral incisions, resulting in optimal cosmesis. There has been an evolution in the materials used for this purpose, resulting in an exclusion of some of the earlier materials and development of more scientifically sound biomaterials. The purpose of this paper is to describe some of the currently popular alloplastic implant materials and elaborate on individual inherent benefits and disadvantages, as well as to discuss the treatment planning procedures for alloplastic augmentation genioplasty.
Anesthesia in Liposuction Surgery
Authors: Shiffman Melvin A.
Published: January 2017

Three types of anesthesia, local, general, or intravenous sedation, are available for patients undergoing liposuction. The tumescent technique surpassed all other methods of suction-assisted lipectomy in reduction of blood loss and may be used with local, general, or intravenous anesthesia. The difficulties associated with each type of anesthesia include lenghthiness of the procedure under local, the longer recovery time with general anesthesia, and the risks of intravenous medications and general anesthesia. After the difficulties are discussed with the patient, the patient makes the choice of the type of anesthesia to be administered. The author prefers the use of general anesthesia because it allows the tumescent technique to be performed quickly and efficiently.
Application and Approach to Hair Transplantation in Females
Authors: Cotterill Paul C.
Published: January 2017

Hair transplantation for females has become a much more viable treatment option because of recent improvements in technique employing micrografts and minigrafts as well as multiple-strip donor harvesting. The author describes how these new techniques are applied to the various types of transplantation in women, such as for androgenetic alopecia, traction alopecia, eyebrows, inactive inflammatory dermatosis, hair loss, and postrhytidectomy scarring. “Pearls,” to emphasize the contrast in the approach to the treatment of women with that of their male counterparts and the importance of assessing for realistic expectations, are described. A review of 827 females seen in consultation over the last 10 years showed that 70% of women with androgenetic alopecia were candidates for hair transplants.
Different Grafts for Different Purposes
Authors: Unger Walter P.
Published: January 2017

There is a trade-off between the density of hair growth and the size of graft that must be considered when graft types are being chosen for hair transplanting. The author uses smaller grafts, such as micrographs, for the production of low density hair and at the other extreme (in properly selected patients) a combination of micrografts, minigrafts, and standard size grafts when the objective is greater density. The reasons for his choice of graft and density objectives are discussed.
Mini-Blades and a Mini-Blade Handle for Hair Transplantation
Authors: Arnold James
Published: January 2017

Mini-blades are particularly useful in creating incisional pockets as recipient sites for hair transplants. With the aid of a special mini-blade handle, the length and depth of each incision can be accurately controlled. Surgeons can rapidly produce multiple uniform incisions with the technique described. Mini-blades are thicker than other blades and partially dilate each incision. Graft insertion is simplified by the partial dilation. More substantial dilation of the larger miniblade incisions can be produced with a twisting motion imparted to the mini-blade during the incisional process.
The Evolution of Liposculpture
Authors: Fischer Giorgio
Published: January 2017

Technique, correct instruments, skin elasticity, consistency of the adipose tissue, muscular tone, force of gravity, and the surgeons' ability are factors that determine the quality of liposculpture. As liposuction has evolved, the instruments and techniques have been refined and complications have lessened. This paper discusses historical aspects of the development of liposculpture.
Ultrasound Lipolysis and Suction Lipectomy for Treatment of Obesity
Authors: Palmieri Beniamino , Bosio Pierangelo , Palmieri Gaspare , Gozzi Glauco
Published: January 2017

Surgical treatment of obesity is a challenging problem. In one approach, miniinvasive laparoscopic gastric banding has been attempted to reversibly reduce gastric volume and, thus, food intake. That, as well as other more aggressive interventions on the gastrointestinal tract, is quite effective, but several side effects and appreciable morbidity and mortality have been reported. The aesthetic outcome of weight loss after these procedures is relatively poor. Two hundred five obese patients with 30–60% excess body weight had surgical treatment combining ultrasound lipolysis and liposuction of subcutaneous fat. Large amounts of intracellular lipids were extracted, after subdermal infiltration of saline solution containing vasoactive agents, with combined ultrasound lipolysis and liposuction. The slimming achieved has been satisfactory, and the metabolic repercussions of the procedure are promising. Moreover, cosmetic improvements strongly motivate the patient to undertake a strict weight control program.
Ultrasonically Assisted Liposculpturing: Physical and Technical Principles and Clinical Applications
Authors: Di Giuseppe Alberto
Published: January 2017

The physical and technical principles of ultrasonically assisted liposculpturing (UAL) are described, and clinical experience through 4 years (1992–1996) of use of this procedure is presented.

The technique relies on the surgical use of ultrasonic energy, which allows the selective destruction or emulsification of adipose tissue, producing a “cream,” which is then aspirated. The procedure produces less edema and bruising than does traditional liposuction and allows a great degree of skin retraction due to “stimulation” of the dermis of the treated areas.

Clinical application of ultrasonically assisted liposculpturing is for lipodystrophy, secondary cases, and difficult areas such as the inner thigh, circumferential thigh, calf, and abdomen. There is little blood loss, and a greater volume of fat tissue can be removed in one session. UAL can be used to treat obesity.

This method has been applied to surgery of the breast for volume reduction of the adipose components in the fatty breast (mostly in juvenile breast) and for skin retraction after dermis stimulation for correction of minor-degree ptosis. This technique chiefly relies on the selective destruction of mainly the fluid fraction of the adipose tissue, which represents nearly 90% of all the adipose tissue's volume. Contrary to traditional liposuction, which mechanically attacks and destroys all the structures of the dermis that may have undesired side effects, UAL selectively destroys only the target adipocytes and spares the supporting structures of the skin and dermis, such as vessels, nerves, collagenic matrix, and elastic fibers, thus conserving the elasticity of the treated areas.
Frozen Fat—Does it Work?
Authors: Jackson R. F.
Published: January 2017

The use of frozen fat as an adjunct to fat transplantation following liposuction has been used by the author for the past 4 years with relatively good results. The background of this procedure, its evolution, and the technique for use will be described. My experience with three rather unusual patients in whom frozen fat was used to augment will be presented and the results obtained will be discussed.
Rate of Temperature Change in Human Fat during External Ultrasound: Implications for Liposuction
Authors: Draper David O. , Abergel R. Patrick , Castel J. Chris
Published: January 2017

This paper will introduce a third type of ultrasonically assisted liposuction. This is a surface-applied technique, but instead of using only the mechanical effects of ultrasound, it focuses on thermal effects to heat fat prior to liposuction of small pockets of fat, such as those in the upper arm or under the chin. This information would be valuable to cosmetic surgeons, who recently have been using external ultrasound prior to liposuction. Previous data have been published regarding the rate of ultrasound heating in muscle and tendon; however, this rate has not been recorded for fat tissue. This study was performed to determine if ultrasound could vigorously heat fat and to note the frequency, intensity, and treatment duration required. Ten females (mean age of 38 ± 1.4 years) volunteered to participate in the investigation and signed informed consent waivers. The left tricep was cleansed with a Betadine scrub while the subject was supine. A 1-cc injection of 1% lidocaine (Xylocaine) buffered with sodium bicarbonate was administered subcutaneously to anesthetize the area. Next, a 23-gauge thermistor micro-probe connected to a monitor was inserted into the adipose tissue covering the left tricep muscle belly. After ultrasound gel was applied to the area, we administered ultrasound at the following parameters: continuous mode; 3-MHz frequency; 1 W/cm2; 10-minute duration; and treatment size = 2 times the size of the effective radiating area. Temperature was recorded every 60 seconds. At the end of each 10-minute application, we recorded the per-minute rate at which the temperature dropped for 10 minutes. The rounded mean baseline temperature was 33°C, and the temperature peaked at 40.5°C (average increase from baseline to peak = 7.5°C). The fat temperature dropped 4.0°C and 5.5°C, respectively, at 5 and 10 minutes postinsonation. Our protocol resulted in vigorous heating of adipose tissue.
Reinforced Swan-Neck, Flexible Shaft, Beveled Liposuction Cannulas
Authors: Weber Paul J. , McKerrow Kevin , Wulc Allan E. , Oleson Gale , Popp Jeffrey , Dryden Robert , Weber Robert G.
Published: January 2017

Introduction:

Traditional liposuction cannulas and ultrasonic liposuction cannulas have had the feature of relative rigidity in common. Herein we introduce a new design that allows a patient's entrance wound to act as a fulcrum, enabling the surgeon's guiding hand to redirect cannulas with long, flexible shafts and highly reinforced swan necks. The nonultrasonic version of this cannula system includes a highly beveled tip adjacent to a triport (Accellerator III) set of openings. The new cannulas easily penetrate fibrous fat, reach fat deposits distant from the entrance wounds, and curve within the subcutaneous tissue below the dermal envelope, thereby reducing the need to move a patient's body position intraoperatively. A novel Teflon entrance wound insert that resembles the shape of a calla lily aids in the use of the system, thereby reducing cannula friction inside the insert and maximizing friction via projections on the outside of the insert. This friction outside of the insert maintains the insert's position in the wound during cannula backstroke.

Materials and Methods:

Reinforced swan-neck, flexible shaft, triport bevel cannulas (RSFSTBCs) have been used successfully in hundreds of liposuctions performed by one of us (P.J.W.). P.J.W. has also used the Capistrano cannula tip with success. Capistrano cannulas and RSFSTBCs of 2.5 mm and 3.5 mm diameter were compared in 12 patients (eight female and four male) on contralateral but otherwise identical fat deposits.

Results:

No adverse effects were noted with either system; no indentations, inordinate bruising, seromas, or infections occurred. The reinforced swan-neck cannulas penetrated tissue with greater ease, and the flexible shafts allowed the operator to arc the cannulas to greater distances within the body. Thus the operator could reach more areas with fewer entrance wounds and less movement of patients on the operating table. Novel cannula motions occurred as a result of using the patient's entrance wound as a fulcrum and redirecting the distal shaft and tip of the cannula with an opposing hand.

Discussion:

The long, flexible shafts of the RSFSTBC system allow for a reduction in the need for cannula entrance wounds. The beveled tip provides for ease of penetration, even in fibrous tissues. The reinforced swan neck, in combination with the flexible shaft, enables the use of both mildly and highly arced cannula paths via several mechanisms.
Noggin Blocks Osteoinductive Activity of Porcine Enamel Extracts
Authors: Iwata T. , Morotome Y. , Tanabe T. , Fukae M. , Ishikawa I. , Oida S.
Published: January 2017

Enamel extracts induce biomineralization such as osteogenesis and cementogenesis, but the molecular component responsible for this activity remains uncertain. We fractionated enamel extracts from developing pig teeth and isolated the osteoinductive fraction. Proteins from pig enamel scrapings were extracted under alkaline conditions (pH 10.8) and fractionated with the use of a Sephadex G-100 (size exclusion) column. The ability of each fraction to enhance alkaline phosphatase (ALP) activity was assayed in ST2 cells, a mouse bone marrow stromal cell line. The osteoinductive fraction of enamel extracts (OFE) was found in fractions 44 and 45, which induced ST2 cells to express the phenotype of bone-forming osteoblasts, and to form mineralized nodules. Furthermore, the ALP activity of ST2 cells exposed to OFE was reduced by noggin, an antagonist of BMPs, and OFE reacted with BMP-2/4 antibody in dot-blot analysis. These results indicate that OFE contains BMPs that contribute to the induction of biomineralization.
Controversial Treatment of Spasticity: Exploring Alternative Therapies for Motor Function in Children With Cerebral Palsy
Authors: Rosenbaum Peter
Published: January 2017

The treatment and management of children with cerebral palsy is an ever-evolving story. In the past 20 years, a number of exciting innovations in treatment have expanded the opportunities to help children. At the same time, the field has experienced a remarkable proliferation of “alternative” therapies—approaches based on ideas about the biologic basis of neurodevelopmental disabilities and their management that differ considerably from conventional thinking in Western medicine. Professionals working with children with cerebral palsy and their families are frequently asked for an opinion about or even endorsement of these new and “promising” approaches to therapy. These can be very difficult to provide when the evidence is limited, peer-reviewed reports are scarce, and the primary source of information is the World Wide Web. The purposes of this article are to discuss briefly why it can be difficult to ascertain whether any treatment—conventional or alternative—does more harm than good, and to consider what rules of evidence can be applied to make a sound judgment about a new treatment. The article then discusses several current controversial alternative therapies, reviewing the available literature and offering a critical appraisal of each. Topics addressed include hyperbaric oxygen therapy, conductive education, the Adeli suit, and therapeutic (subthreshold) electrical stimulation because these approaches have been applied to children with cerebral palsy. (J Child Neurol 2003;18:S89—S94).
A Model Program for Translational Medicine in Epilepsy Genetics
Authors: Smith Lacey A. , Ullmann Jeremy F. P. , Olson Heather E. , Achkar Christelle M. El , Truglio Gessica , Kelly McKenna , Rosen-Sheidley Beth , Poduri Annapurna
Published: January 2017

Recent technological advances in gene sequencing have led to a rapid increase in gene discovery in epilepsy. However, the ability to assess pathogenicity of variants, provide functional analysis, and develop targeted therapies has not kept pace with rapid advances in sequencing technology. Thus, although clinical genetic testing may lead to a specific molecular diagnosis for some patients, test results often lead to more questions than answers. As the field begins to focus on therapeutic applications of genetic diagnoses using precision medicine, developing processes that offer more than equivocal test results is essential. The success of precision medicine in epilepsy relies on establishing a correct genetic diagnosis, analyzing functional consequences of genetic variants, screening potential therapeutics in the preclinical laboratory setting, and initiating targeted therapy trials for patients. The authors describe the structure of a comprehensive, pediatric Epilepsy Genetics Program that can serve as a model for translational medicine in epilepsy.
Carnitine in Human Immunodeficiency Virus Type 1 Infection/Acquired Immune Deficiency Syndrome
Authors: Mintz Mark
Published: January 2017

There is an increasing body of evidence that subgroups of patients infected with human immunodeficiency virus type 1 possess carnitine deficiency. Secondary carnitine deficiencies in these individuals may result from nutritional deficiencies, gastrointestinal disturbances, renal losses, or shifts in metabolic pathways. However, tissue depletion precipitated by drug toxicities, particularly zidovudine, is a major etiology and concern. Carnitine deficiency may impact on energy and lipid metabolism, causing mitochondrial and immune dysfunction. There are convincing laboratory data showing the in vitro ameliorative effects of L-carnitine supplementation on zidovudine-induced myopathies and lymphocyte function. Studies measuring the impact of L-carnitine supplementation on clinical characteristics are ongoing. (J Child Neurol 1995; 10(Suppl):2540-2544).
Sensory Rhizotomy for the Treatment of Childhood Spasticity
Authors: Abbott Rick
Published: January 2017

Sensory rhizotomy in the treatment of spasticity has been evolving over the past century since its first use in 1888. This paper reviews its historical evolution, current physiologic basis, range in current surgical technique, and the outcome, along with complications seen over the past decade since its repopularization. (J Child Neurol 1996;11(Suppl 1):S36-S42).
Physical Therapy Interventions for Patients With Movement Disorders due to Cerebral Palsy
Authors: Barry Margaret J.
Published: January 2017

The purpose of this paper is to present evidence on the efficacy of physical therapy interventions for patients with cerebral palsy and identify goals for these patients. Studies suggest that neurodevelopmental treatment and Vojta techniques improve postural control. Little evidence supports the efficacy of early intervention, but researchers have not yet studied effects on the family. Strengthening, electrical stimulation, the use of orthoses, and seating show positive effects in studies of small numbers of subjects. For severely involved children, ease of care and comfort are important goals, as well as prevention of deformity, which is important for all children. To the extent possible, therapy should prepare a child for independent adult life. In early intervention through school age, therapy focuses on promoting communication, self-care, and mobility. Independence is a key issue for adolescents transitioning into adulthood. The rehabilitation and health needs of adults with cerebral palsy need to be addressed. Research needs to determine the effects of physical therapy not only on impairment but also on function and disability. (J Child Neurol 1996 ;11(Suppl 1):S51-S60).
Dysphagia: Populations at Risk and Methods of Diagnosis
Authors: Perlman Adrienne L.
Published: January 2017

Dysphagia has been recognized as a variable that increases hospital length of stay and influences patient outcome. Additionally, in young children, it can seriously affect physical and intellectual development. Issues regarding the safety of swallowing relate to both airway protection and adequate nutritional intake. The likelihood of a dysphagic patient regaining the ability to return to oral intake is improved if the underlying variables resulting in the dysphagia are adequately diagnosed and if the patient is able to participate in a program of swallowing rehabilitation. Diagnosis of the pathophysiological or anatomical variations that result in swallowing dysfunction generally requires examination beyond that which can be performed with the clinical examination. The chosen method of assessment is dependent on the clinical questions that are asked. Clinical indicators of dysphagia, frequent etiologies for disordered deglutition, and various methods for assessment are discussed.
Surgical Management of Oropharyngeal Dysphagia
Authors: Shapiro Jo
Published: January 2017

There are several types of oropharyngeal dysphagia that are amenable to surgical correction. This article discusses the following topics: the role of cricopharyngeal myotomy in various forms of dysphagia, the surgical approaches to Zenker's diverticulum, and various surgical options in the management of chronic aspiration.
Textural Property Considerations of Food for Dysphagia
Authors: Tymchuck Don
Published: January 2017

Food and liquid textures play very important roles in the care of people with dysphagia. However, a major source of frustration for those involved with the patient is how to determine, describe, and deliver the proper textures of foods and liquids. The science of food rheology offers the potential to establish standardized food textures using objective measurement techniques. This article covers the basic physical forces of chewing and swallowing, standard food‐texture terminology, textures of interest in dysphagia, selection of physical measurement methods and instruments, and techniques to determine the boundaries between the levels of the dysphagia diet.
Vernon, Connecticut's Juvenile Curfew: The Circumstances of Youths Cited and Effects on Crime
Authors: Males Mike A.
Published: January 2017

Despite widespread adoption of juvenile curfews, little research evaluates their effectiveness in reducing crime and promoting juvenile safety. This study examines Vernon, Connecticut's nighttime curfew of youths younger than 18. Connecticut and FBI Uniform Crime Reports are used to compare Vernon's Part I crime trends to those of similarly sized Connecticut cities (including those without curfews), Connecticut as a whole, and 600 similarly populated cities nationwide. The results show that after the curfew took effect in 1994, Vernon experienced a smaller decline in Part I crime than did comparable cities or the state. Furthermore, examination of 410 individual curfew stop citations issued by Vernon police for 1995-1998 showed only seven of the cited youths were involved in criminal or suspicious activities; none were intoxicated or endangered. The curfew's main effect was to occupy police time removing law-abiding youth from public, creating emptier, less policed streets, and possibly enhanced opportunities for crime.
The Religious Freedom Restoration Act and Prisons and Jails: An Assessment and a Proposal
Authors: Call Jack E. , Samarkos Charles
Published: January 2017

In November of 1993, the Religious Freedom Restoration Act (RFRA) was signed into law by the President. Its purpose was to overrule a 1990 Supreme Court decision and require government to satisfy a compelling interest test when its laws or actions place a substantial burden on an individual's exercise of personal religious beliefs. This article explores the impact of RFRA on prisons and jails. Since there was a failed effort in Congress to exempt prisons and jails from the strictures of RFRA, there is no question that RFRA applies to these institutions. The article begins by explaining the law on the free exercise of religion prior to RFRA. Then the provisions of RFRA and its legislative history are explored briefly. An assessment is made of the likely effect of RFRA on prisons and jails and its constitutionality. The article concludes with a recommendation for amending RFRA designed to insure that the free exercise rights of inmates are adequately protected, while not unduly hampering the ability of corrections administrators to run their prisons and jails safely and efficiently.
Secondary World
Authors: Hanford Ina
Published: January 2017

…Packaging…product…fact…fiction?
Self-development
Authors: Gray Harry
Published: January 2017

True leadership reverses conventional wisdom
A Head's Month
Authors: Adam Derek
Published: January 2017

More evidence of the hectic life of a head teacher
Focus on Scotland
Authors: Mackenzie Malcolm L.
Published: January 2017

Schools are unwilling victims in the middle of the argument for strategic or local power
Evaluation
Authors: Davidson Gill , Parsons Carl
Published: January 2017

This article takes a worried look at the current state of evaluation and proposes ways in which it might become more credible and effective
Focus on Scotland
Authors: MacKenzie Malcolm L.
Published: January 2017

Lesson from Churchill and Orwel
Focus on Northern Ireland
Authors: North Reg
Published: January 2017

Investment in management is required if the themes are to have substance
Management Topics
Authors: Montgomery Will
Published: January 2017

Some education industry contrasts
Boundary Issues
Authors: Johnson Daphne
Published: January 2017

Will a climate of choice have harmful effects?
Focus on Scotland
Authors: MacKenzie Malcolm L.
Published: January 2017

An alternative to the National Curriculum
Strategies for Improving Examination Results
Authors: Harrison Christine
Published: January 2017

How a school operating in the midst of urban deprivation is attempting to elevate student achievement — a seemingly forlorn task, but one founded in optimism and hope.
Schools are Great Places
Authors: Gilliland Richard
Published: January 2017

Thoughts and passions about school leadership and hope for our schools conclude this series on celebrating achievements.
Seeking Comfort
Authors: Bunkers Sandra Schmidt
Published: January 2017

This article introduces a concept inventing paper on feeling comfortable. The introduction describes a personal experience of seeking comfort, which includes serene calm amid distracting unrest.
Ethics and Reverence for the Discipline of Nursing
Authors: Milton Constance L.
Published: January 2017

Healthcare disciplines, including nursing, are emerging sciences that contain discipline-specific theories that guide the activities of research, practice, and education. The term nursing science calls forth meaning that has long been accepted and referred to as the extant nursing theories undergirded with philosophy of science. Recent writings dispute the purposes and future usage of nursing theoretical frameworks in the science of nursing. The author of this article proposes new thinking about the importance of reverence and ethical implications for the future of formal inquiry in nursing science.
Caring Science Conscious Dying
Authors: Rosa William , Estes Tarron , Watson Jean
Published: January 2017

Caring science is an extant theory of human relationship, guiding the profession of nursing with the understanding and application of a moral-ethical praxis that promotes, protects, and provides human dignity throughout the life continuum. Over the past 30 or more years, caring science has transformed nursing by calling for a heightened ethical perspective of human dignity in how nurses practice, educate, research, and evolve the profession. Conscious dying is a framework rooted in a human caring ontology, which strives to deepen the nurse healer’s awareness in tending to a patient’s dying and death, returning death to its sacred place in the cycle of life. Reflective inventories are self-reflection tools that have been used to encourage nurses’ personal growth and development and may be utilized in individual or group settings. The purpose herein is to introduce an emerging metaparadigm that links self to system, interweaving and integrating the teachings of caring science and conscious dying through the use of reflective inventories for both the individual nurse and collective of nursing.
Thoughts About Nursing Conceptual Models and the “Medical Model”
Authors: Fawcett Jacqueline
Published: January 2017

This essay, written to celebrate the 30th anniversary of Nursing Science Quarterly, focuses on the distinctions between the discipline of nursology and the trade of medicine. The distinctions are drawn from content found in nursing conceptual models and from literature about the elusive content of the so-called “medical model.”