bluuebunny/crossref_metadata_2025 huggingface dataset:
In the Wake of the MTA: Charting a New Course for the Study and Treatment of Children with Attention-Deficit Hyperactivity Disorder
Authors: Cunningham Charles E
Published: January 2017

This paper considers 3 questions addressed by the National Institute of Mental Health's Collaborative Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, of pharmacological and behavioural interventions for 7- to 9-year-old ADHD children. First, do behavioural interventions represent a viable treatment option for families of children with ADHD? Second, what are the relative benefits of behavioural and pharmacological interventions? Finally, are there advantages to combining behavioural and pharmacological interventions for children with ADHD? In the absence of secondary analyses, the MTA's primary intent-to-treat analyses released to date are difficult to interpret. While behavioural interventions represented a viable option for many families, the doses achieved via systematic titration and follow-up medication-management protocols yielded larger effect sizes on unblinded primary symptom reports than did behavioural treatments or the medication management used by most families in the community control conditions. Finally, while combined medication and behavioural management demonstrates some benefits, a more definitive conclusion awaits a detailed presentation of secondary analyses and follow-up data.
The Treatment of Attention-Deficit Hyperactivity Disorder: An Annotated Bibliography and Critical Appraisal of Published Systematic Reviews and Metaanalyses
Authors: Jadad Alejandro R , Booker Lynda , Gauld Mary , Kakuma Ritsuko , Boyle Michael , Cunningham Charles E , Kim Marie , Schachar Russell
Published: January 2017

Context:

The Agency for Health Care Policy and Research charged the McMaster Evidence-based Practice Center with conducting a comprehensive systematic review of the literature on the treatment of attention-deficit hyperactivity disorder (ADHD), with input from various groups of stakeholders. One strategy used to avoid duplication of work included a critical appraisal of existing systematic reviews and metaanalyses.

Objective:

To identify and appraise published metaanalyses and systematic reviews on the treatment of ADHD and to produce an annotated bibliography.

Data Sources:

Medline, Cumulative Index in Nursing and Allied Health (CINAHL), Healthstar, Psycinfo, and Embase were searched to September 1998; the Cochrane Database (1998 issue 3), selected Internet sites, and the files of investigators were also reviewed.

Study Selection:

Review articles described as systematic reviews or metaanalyses or including a Methods section were identified independently by 3 reviewers.

Data Extraction:

Two reviewers extracted, by consensus, relevant information on the name, methodological quality, ADHD-related aspects (comorbid disorders, family characteristics) of those reviews; data on the population, study setting, interventions, and outcomes evaluated by the reviews were also retrieved.

Results:

Thirteen reviews, published from 1982 to 1998, were included. Eight included metaanalysis and 5 a qualitative review. Non-pharmacological treatments were mentioned in 6 reviews and combination therapies in 3. One review focused on the treatment of adults. Forty-seven drugs and 20 adverse effects were mentioned. Most reviews had major methodological flaws.

Conclusions:

Most published systematic reviews and metaanalyses on the treatment of ADHD have limited value for guiding clinical, policy, and research decisions. A rigorous, systematic review following established methodological criteria is warranted.
Aggressive Behaviour in Children with Tourette Syndrome and Comorbid Attention-Deficit Hyperactivity Disorder and Obsessive—Compulsive Disorder
Authors: Stephens Robyn J , Sandor Paul
Published: January 2017

Background:

Aggressive behaviour, defined as sudden, explosive outbursts of rage, has been reported as a clinical problem in approximately 23% to 40% of Tourette syndrome (TS) patients (1–5). Attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) are also reported in 50% to 70% of TS patients (6).

Objective:

To investigate whether aggressive behaviour was associated with TS directly or found primarily in TS with comorbid ADHD or OCD.

Method:

Aggressive behaviour in 33 nonmedicated patients with TS (ages 6 to 14 years) and 6 healthy control subjects (ages 7 to 12 years) was examined by semistructured interview and multiinformant questionnaires.

Results:

Aggression subscales on Achenbach's Child Behavior Checklist (CBCL) completed by parents and Teacher's Report Form (TRF) completed by teachers distinguished the TS-only and control groups from the group with TS + Comorbidity (P < 0.046, and P < 0.016) after adjusting for tic severity and age. The conduct disorder subscale on the Conners Parent Rating Scale (CPRS) was also significantly higher (P < 0.005) in the TS + comorbidity group than in the TS-only or control groups, with more problems reported in the older children.

Conclusions:

These findings provide additional evidence that aggressive behaviour observed in children with TS may be associated with comorbid ADHD or OCD (6), independent of tic severity or age. This is consistent with the clinical observation that most TS patients have only minimal symptoms, which do not interfere with their daily functioning.
Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial
Authors: Corkum Penny , Rimer Pearl , Schachar Russell
Published: January 2017

Objective:

This study examines the relationship between parents' knowledge of attention-deficit hyperactivity disorder (ADHD) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD.

Method:

Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups. The mothers completed a modified version of the ADHD Knowledge and Opinion Scale (AKOS) prior to receiving diagnostic feedback and prior to the families' decisions to participate in a 12-month randomized trial (medication [methylphenidate or placebo] and parent groups [training or support]). Treatment enrolment and adherence were monitored over the 12-month trial, and families who remained in the study at 12 months completed another modified AKOS.

Results:

A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication. Moreover, parents who were more knowledgeable about ADHD were more likely to enrol in both pharmacological and nonpharmacological treatments. Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment.

Conclusion:

Parents' knowledge of ADHD and opinions of treatments play a significant role in enrolment in treatments for their children with ADHD. Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrolment and hence treatment adherence.
Impact of Repealing the Newspaper Preservation Act
Authors: Lacy Stephen
Published: January 2017

Most JOA cities would lose one of their daily newspapers if the Newspaper Preservation Act were repealed. The result would be decreased competition for news, and readers less well served by the surviving newspaper than they are now by two newspapers operating jointly.
The Relationship between Newspaper Costs & Predation Lawsuits
Authors: Picard Robert G.
Published: January 2017

Newspaper managers must be aware of the costs of producing their papers if they are to make informed decisions in setting prices and avoid charges of “predatory pricing” from competitors. Here are some suggestions for figuring price structures.
Staff Consolidation: A Newsroom with a View
Authors: Kochersberger Robert C.
Published: January 2017

In 1987, plans were announced to merge the editorial staffs of the Raleigh Times and the News & Observer. This study of reactions by the two newspaper staffs both before and after the merger suggests some ways management can ease the transition. Last November, after the study was complete, the Raleigh Times ceased publication altogether.
Eliminating Money Damages in Defamation: The Chilling Effect of Non-Economic Sanctions on Willingness to Publish
Authors: Renas Stephen , Hartmann Charles , Walker James
Published: January 2017

Editors seem to like a proposal for delaratory judgmnents in libel cases, aimed at reducing the “chilling” effect of possibile litigation on newspapers, but they say a new system wouldn't affect whether they'd run stories on controversial topics.
How Staff of Youth Programs Respond to Culture-Related Incidents
Authors: Gutiérrez Vanessa , Larson Reed W. , Raffaelli Marcela , Fernandez Mariela , Guzman Sandy
Published: January 2017

Incidents in which program leaders confront issues of culture and race occur regularly in many youth programs. These incidents are important because they reflect powerful dimensions of youth’s lived experience and bring issues of injustice and program inclusiveness to the fore. This study examined these culture-related incidents and how leaders responded to them. Interviews were conducted with 50 leaders from 27 programs serving primarily Latino, African American, and European youth. Half the programs served middle school–aged teens and half high school–aged teens. Qualitative analyses identified four categories of incidents, each presenting distinct considerations for leaders. Two ( offensive remarks and discrimination) involved inappropriate speech and unjust actions. Two ( discomfort with intercultural contact and cultural identification and identity) involved youth’s expression of negative attitudes toward others’ or own group. Leaders differed in their responses to incidents. A universalist, race-blind group asserted that culture did not matter in their program and reported virtually no incidents. A second group reported culture-related incidents but described limited responses because they lacked confidence or skills. A third group appeared to represent best practices: These leaders engaged directly with the incidents and facilitated reflective dialogue in which youth drew on experiences, analyzed situations, and learned through collective discussion. Implications for practice are drawn.
Rhytidectomy Complicated by a Postauricular Enterococcal Infection
Authors: Roessler Mark L. , Devlin Michael , Almony Jeffrey
Published: January 2017

Introduction:

Facial rejuvenation and body contouring procedures are becoming more and more common. The patient seeking these types of operations will often undergo multiple procedures at one time. Procedures performed about the facial region are often classified as clean-contaminated cases. In light of the above-stated facts, postsurgical infection can be a concern. In 2001, postsurgical infections were approaching 500 000 per year among an approximate 27 million operations. Complication rates in surgery will vary depending on the type, length, and number of procedures. Cervicofacial rhytidectomy complications can range from hematoma and nerve damage to incision irregularities and infection. Postrhytidectomy infection has a complication rate of ≤1%. Staphylococcal and streptococcal variants are the typical bacteria found. Postrhytidectomy infections typically are cellulitic but can progress to abscess formation. We present an unusual case of a postrhytidectomy infection caused by an enterococcal variant in the postauricular region.

Materials and Methods:

A healthy 61-year-old woman sought treatment for facial rhytidosis, brow ptosis, hypoplastic lips, and trunkal adiposity. She subsequently underwent a rhytidectomy, endoscopic brow lift, fat transfer to the lips, perioral dermabrasion, a 35% trichloroacetic acid peel to her lower eyelids, and liposuction to the abdomen and flanks. The procedures were all carried out during one trip to the operating room over a 5-hour time span.

Results:

The patient subsequently developed postauricular infection on postoperative day 7. Despite antibiotic therapy, the left postauricular region became fluctuant and required incision and drainage. Antibiotics were manipulated until the cultures revealed she had developed an enterococcal infection sensitive to levafloxacin. The patient had a prolonged recovery after her rhytidectomy because of the enterococcal infection. She recovered and had acceptable scarring.

Discussion:

Although infection after rhytidectomy is ⩽1%, it can still prolong recovery. Performing a face-lift along with other procedures allows for increased operating time and the possibility of an increased risk of infection. The possibility of contamination with other bacterial variants also broadens when multiple body sites are addressed. Bacteria not typically seen with rhytidectomy infections need to be considered when caring for these complications. Attention to the events that occur pre-, intra-, and postoperatively can help us better care for possible postoperative complications. Prompt perisurgical care can help us maximize our outcomes.
Current Management of the Asymmetric Nose
Authors: Stupak Howard D. , Ramirez Alexander L. , Maas Corey S.
Published: January 2017

The deviated or asymmetric nose poses multiple challenges to the cosmetic and reconstructive surgeon. Diagnosis, surgical planning, and execution are presented in this article in the ordered form of a surgical algorithm. The algorithm utilizes the external rhinoplasty approach to address asymmetries in the following structures in an individualized yet systematic fashion: nasal septum, upper and lower lateral cartilages, the bony dorsum, and the skin/soft-tissue envelope. A number of techniques are discussed here, some restoring native anatomy, others providing simple camouflage. With experience, excellent functional and cosmetic results can be obtained by following this algorithm.
Occlusal Plane Correction to Maintain an Esthetic Labiomental Curve
Authors: Hatzis Gregory P. , Stella John Paul
Published: January 2017

Introduction:

Facial surgeons commonly treat chin deformities with implants, osteotomies, or osteoplasties. The soft tissue of the chin, specifically the labiomental curve seldom receives attention. The placement of a chin implant or osteotomy to move chin projection to an ideal position can cause an excess labiomental curve or unesthetic labiomental fold. Likewise, a reduction genioplasty to decrease chin projection can adversely flatten an ideal labiomental curve. Rotating the maxillary occlusal plane with orthognathic surgery can prevent this undesirable result or operated-on look.

Methods:

During treatment planning of patients with “micro or macrogenia” the labiomental curve is assessed. Patients are diagnosed with a normal, low, high and/or dual occlusal plane. Standard cephalometric analyses and evaluation of profile photographs are used to determine ideal chin projection. Patients undergo bimaxillary orthognathic surgery to achieve optimal occlusion, tooth exposure with smiling, and ideal paranasal and lip esthetics without adversely affecting the labiomental curve.

Results:

Rotation of the maxillomandibular complex by manipulating the occlusal plane has resulted in optimal chin esthetics. The preoperative favorable labiomental curve is unaffected, thus preventing the adverse flat or excess labiomental curve or fold and operated-on look.

Conclusions:

In order to present chin esthetics in patients who have an ideal labiomental curve, surgeons should consider altering the occlusal plane with orthognathic surgery.
A Retrospective Analysis of the Postoperative Course of Patients Receiving Suction-Assisted Liposuction versus Laser Lipolysis
Authors: Lack Edward B.
Published: January 2017

Background and Objective:

The popularity of laser lipolysis has continued to increase, and with this, a proliferation of instruments from various manufacturers has occurred. This study is a retrospective analysis comparing 28 patients who underwent laser lipolysis vs. 18 patients who had suction-assisted liposuction (SAL) alone.

Materials and Methods:

One hundred patients who had liposuction procedures between October 2006 and August 2008 were randomly selected to receive a patient questionnaire that investigated each person's postoperative course. Fifty patients had SAL alone and 50 patients had laser lipolysis in addition to SAL. Results were tabulated and compared.

Results:

28 patients who had received laser lipolysis and 18 patients who had received SAL alone completed the questionnaire. Postoperative morbidity seen as swelling, pain, ecchymoses, and dysesthesias was reported more commonly and to a greater degree in laser lipolysis patients. Final results and patient satisfaction were rated higher in patients who received laser lipolysis.

Conclusion:

Laser lipolysis is increasing in popularity, and reports of risks and benefits will be forthcoming. Although morbidity of patients treated with laser lipolysis appears to be greater when compared with patients undergoing SAL alone, patients who experienced laser lipolysis were more likely to describe greater satisfaction with their results, would tend to undergo the procedure again if needed, and would tend to refer a friend for this procedure.
Intraoral Injection Technique of Synthetic Fillers and Autologous Fat for Facial Soft-Tissue Augmentation: Patient Satisfaction
Authors: Sobel Alexander W. , Jonov Craig R.
Published: January 2017

Objective:

To determine patient satisfaction with the technique of intraoral injection of synthetic fillers and autologous fat for facial soft-tissue augmentation.

Study Design:

A total of 50 patients, presenting over a 16-month period, who underwent soft-tissue augmentation with synthetic filler or autologous fat via intraoral route were surveyed for satisfaction. Sixteen patients returned surveys; all charts were reviewed for complications.

Results:

With the intraoral technique, all patients reported no more than mild bruising while 88% indicated no more than mild edema. Regarding satisfaction, 81% of patients responded that they would be willing to undergo the procedure again; the same number would encourage others to seek intraoral injection over the transcutaneous approach. Of those who had previously undergone transcutaneous augmentation, 91% of patients preferred the intraoral technique to their prior injection.

Conclusion:

This approach for injection for facial soft-tissue augmentation using synthetic fillers and autologous fat is well tolerated and affords good patient satisfaction.
Three Cases of Severe Ecchymoses following Laser Lipolysis
Authors: Lack Edward B.
Published: January 2017

Background and Objective:

Although laser lipolysis has been reported since 1990, it did not become popular with physicians and the public until recently. As more cosmetic surgeons begin to use this technique, the risks and benefits of the procedure will have to be reported. This is a report of 3 cases among 44 procedures performed over a 3-month period in which extensive ecchymoses occurred postoperatively.

Materials and Methods:

Forty-four patients underwent laser lipolysis during a 3-month span from March to May of 2008. The technique surrounding the procedure is described.

Results:

Three of 44 patients developed severe ecchymoses of the thighs. Patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and all healed unremarkably.

Conclusion:

Laser lipolysis is increasing in popularity, and reports of risks and benefits will be forthcoming. The sharp fiber that is used to deliver laser energy is capable of piercing blood vessels and ultimately of causing bleeding and ecchymoses.
Video-Computer Facial Profile Analysis
Authors: Shippert Ronald D.
Published: January 2017

Cosmetic surgery is a field that has mushroomed far beyond the mere existence that was seen less than 10 years ago. This change has come about for many reasons, including improved instruments, improved techniques, more thorough training of physicians, extended experience and a positive media exposure. Because of the spectacular growth and more competition, more demands have been placed on the surgeon to produce better results, to communicate more, to involve the patient in the planning, to devise methods to more efficiently analyze the features, and plan the surgery. With modern computer and video technology available to us it is natural to use these advances to aid us. Three methods of facial analysis are discussed. All methods involve the use of a computer to alter features. The author prefers the videotape to the computer method because it is the most effective, most flexible, and still allows excellent documentation and computerized alteration of facial profile as needed.
Demonstration by Immunofluorescence That Host Collagen Replaces Dermal Microimplants of Bovine Collagen
Authors: Burke Karen E. , Naughton Gail
Published: January 2017

It has previously been demonstrated with sequential biopsies analyzed by standard histological stains, immunofluorescence, and electron microscopy that an injectable form of type I bovine dermal collagen (Zyderm® Collagen Implant, or ZCI) in the human dermis stimulates a host response. This host response results in implant degradation and replacement by newly generated host collagen. However, definitive proof that the human collagen is deposited directly on the bovine collagen implants is lacking. This study reports for the first time simultaneous labeling of the ZCI with fluorescein and the host collagen type III with rhodamine. These experiments show that human collagen type III is synthesized directly on the bovine collagen implants.
Injectable Autologous Dermis (Autoderm): Its Application in Facial Cosmetic Surgery
Authors: Everton Dennis M. , Novia Michael V. , Lee Henry W. H. , Hirohata Edson T. , Bryant Gordon H.
Published: January 2017

Morsellized autologous dermis is a filling agent which may be utilized to obliterate facial wrinkles (rhytides), folds, and acne scars.

An animal investigation was undertaken to evaluate morsellized dermis as an autologous “liquid” graft. The grafted dermis (injected beneath the epidermis with a fine-gauge needle) was free of infection and cyst formation in the experimental animal (pig) study.

This technique has been performed for several patients. No clinically apparent complications, i.e., cyst formation, have resulted.
Unified Breast Reduction Technique for All Degrees of Breast Hypertrophy
Authors: Castillo Guillermo D.
Published: January 2017

The different techniques for breast reduction surgery are legion. The recommendations and applications in the medical literature of specific techniques are in many instances not only confusing but misleading and fraught with danger. A good result can be achieved with any technique; however, the ability to achieve a consistently good result must be based on the surgeon's familiarity and experience with one technique. For the last nine years, the author has utilized the same basic technique for reduction of small, medium, and large breasts with uniformly excellent results judged by breast position, shape, patient satisfaction, and the absence of frequent complications.

The ability to apply the same basic technique to all breasts sizes allows for the development of confidence, speed, and versatility in the successful treatment of this relatively complex problem.
The Use of GoreTex in Reconstruction of the Inframammary Fold
Authors: Tobin Howard A. , Goffas George T.
Published: January 2017

Inferior displacement of breast implants is a relatively common complication of breast augmentation. The authors describe the use of GoreTex® in the repair of a case that failed after a previous attempt at correction. Possible mechanisms that might lead to this complication are reviewed along with a discussion of the anatomy of the region of the inframammary fold
Methodical Block Technique for Better Results with Liposuction
Authors: Brandy Dominic A.
Published: January 2017

In liposuction several factors contribute significantly to a good result. Besides the selection of good candidates for the surgery, the author has found that strict organization, tumescent tightening, and keeping the skin on significant stretch are crucial to achieving an extremely good result. The author therefore presents a methodical block technique that utilizes these concepts for accomplishing more uniform fat removal and better results, even for patients with poor skin quality.
Prevention of Iatrogenic Complications in the Treatment of Varicosities
Authors: Leibaschoff Gustavo , Brizzio Eugenio , Ferreira Julio , Banfi Jorge
Published: January 2017

Varicose veins involving the lower extremities is a common malady and may cause physical symptoms as well as psychological distress because of the cosmetic appearance. Further distress can be caused by iatrogenic complications in the treatment of varicosities. The physician may fail to inform the patient of proper care following therapy, complementary tests may not be ordered, and the physician may not be adequately trained in the care and treatment of varicose veins.
Dermatography with Penta-Monogalloyl-Glucose as a New Treatment for the Removal of Color Pigments in Eyebrows
Authors: van der Velden Eddy M. , Oostrom Karine A. M. , Roddi Roberto , de Jong Bert D. , Vuzevski Vojislav , Baruchin Abraham M. , Hovius Steven E. R.
Published: January 2017

The removal of disfiguring tattooed eyebrows of 21 patients by means of dermatography is discussed. The color pigments were removed using penta-monogalloyl-glucose, a tannic acid. No side effects were found. Local anesthesia was not necessary. Biopsies of five patients with inflammatory reactions to the tattooed pigments were taken before treatment. A 5-year follow-up showed that the results were lasting and cosmetically satisfactory.
Simultaneous Forehead Lift and Upper Blepharoplasty Surgery
Authors: Castillo Guillermo D.
Published: January 2017

The plastic surgery literature universally recommends that forehead lift and upper blepharoplasty be carried out as separate surgical interventions, owing to the risk of secondary lagophthalmos, corneal exposure, or both.

Upper blepharoplasty after forehead lift is indicated for many patients because of upper lid laxity, steatoblepharon, or both. This approach requires a second surgical procedure, which incurs expense and time loss for patient and physician. For the past 8 years, patients of this practice undergoing upper facial rejuvenation with quantifiable laxity or steatoblepharon have had simultaneous forehead lift and upper blepharoplasty with excellent results and no lagophthalmos or corneal exposure.

The surgical procedure and the technique for evaluating the amount of tissue to be resected are described. The author recommends simultaneous forehead lift and upper lid surgery in upper facial rejuvenation.
Congenital Dorsal Nasal Dysplasia: An Autosomal Dominant Aplasia or Hypoplasia of Nasal Bones and Hyperplasia of the Cartilaginous Nasal Dorsum That Can Be Reconstructed Safely by an Open Approach
Authors: Bentkover Stuart H. , Townes Philip L. , Kozlicak Beth
Published: January 2017

Aplasia or hypoplasia of the nasal bones has been reported infrequently, and at least three reports demonstrate an autosomal dominant inheritance. These noses share a characteristic appearance indicative of an inherited dysplasia of not just the nasal bones (aplasia or hypoplasia) but also the cartilaginous dorsum (hyperplasia).

We studied a 42-year-old woman and her father with aplastic and hypoplastic nasal bones, respectively, and some other family members in two generations. Radiographic findings, family history, photographs of other family members, and operative findings are discussed. Their nasal anomalies probably result from a variably expressed autosomal dominant trait affecting the development of the nasal bones and cartilages in a very characteristic manner. We call this anomaly congenital dorsal nasal dysplasia.

In noses without nasal bones, the open approach optimizes surgical visualization in an effort to maximize the structural integrity of the septum and nasal dorsum. The quadrilateral cartilage–upper lateral cartilage unit provides most of the dorsal support to the upper two-thirds of these unusual noses and should be meticulously reconstructed. Gore-Tex® Soft Tissue Patch is useful for dorsal augmentation of the deep nasofrontal angle often found in these noses and for camouflage of irregularities.
Closed Suspension Mini-Cheek Lift to Reduce the Nasolabial Fold: A Preliminary Report
Authors: Su Nina N.
Published: January 2017

The author describes a new technique of repositioning sagging cheek skin based on the principle of suspending the affected skin with surgical sutures and fixating them to the distant deep temporalis fascia. Thus the incision site is hidden in the hairy scalp. The same principle and technique can be applied to lifting of the skin of the forehead and neck.
Abdominoplasty Using Nd-YAG Contact Tip Laser
Authors: Park Jung I.
Published: January 2017

Abdominoplasty is a relatively major cosmetic procedure with associated complications such as excessive bleeding, hematoma, seroma formation, infection, and pulmonary embolism, etc. Complete hemostasis and gentle tissue handling are of paramount importance to avoid stated complications. The application of laser technology had given us opportunities to achieve these goals by drastically reducing intraoperative and postoperative bleeding, by sealing the lymphatic capillaries and by allowing a gentle tissue dissection.

The laser physics, its clinical application, the surgical procedure, and patient photographs are presented. The Nd-YAG contact tip laser allowed us to perform surgery with almost absolute hemostasis. Recovery from surgery has been rapid due to less postoperative pain. The expense of laser use has been reduced significantly by the introduction of a compact model with less wattage for office use.
How Safe are Silicone Nasal Implants
Authors: Fernandez Manuel O.
Published: January 2017

Augmentation rhinoplasty using a solid silicone implant has been and still is a very common procedure done in Asia. The desire to Westernize and or improve one's nasal profile is the reason for its popularity. The use of autogenous grafts in the U.S. is common but leaves much to be desired. Alloplastic implants have been used very successfully in Asia and other parts of the world. The risks of alloplastic implants appear to be exaggerated. Complications can be minimized by adhering to strict criteria on how to use the silicone nasal implant safely. The single most important factor is the thickness of the overlying nasal skin. Our results have survived the test of time.
Photographic Standards in Rhinoplasty
Authors: Kephart Richard E.
Published: January 2017

The difference between photography in general and photographic documentation is explored as a possible reason why standardized photographic documentation has been so elusive to cosmetic surgeons. Photographic documentation must employ the scientific experimental procedure wherein all of the elements that can affect the outcome of a photograph are held constant so that the one change, that performed by the surgeon, can be studied.

The adaptive nature of off-the-shelf cameras and lighting, targeted to the amateur photographer, defeats the principles of scientific documentation. Simple modifications to equipment already owned by the cosmetic surgeon and methods for standardizing the documentation of the rhinoplasty procedure are presented so that constancy and repeatability can be brought to pre- and postoperative documentation sessions and then be delegated to staff. These methods can be extrapolated for the documentation of other surgical procedures.

Photographs that illustrate the posing procedure and its effectiveness accompany the presentation.
Aesthetics of Liposuction
Authors: Gruner Clara Lieberman
Published: January 2017

Liposuction as such has the purpose of creating beauty by reducing the deformity of a human body through this scientific technique; therefore, it is essential to be aesthetically prepared to discriminate zones that deform or disfigure the human body. It is important to have a clear concept of what beauty is as such, through time and at present; to recognize the sense of proportion, cultural perspective, historical approach, customs, social objectivity, and artistic knowledge.

The obligation of incorporating into this specialty the art concept as a primordial component of the scientific training creates liposculpture of the human body and the knowledge that the final objective is to sculpt a human body with a scientific–artistic eye.
A New Method for Correcting Local Adipose Deposits through Soft Lipomodelling
Authors: Tagliabue Paolo
Published: January 2017

The author presents a new technique for aspiration of local adipose deposits using a new appliance which allows the perfusion of physiological solution and local anaesthesia and the subsequent suction of the adipositary membrane, previously liquefied. The extreme simplicity of the method, which is noninvasive, the absence of the dimpling residual after the operation, and the lack of collateral effects are advantages over the traditional liposuction technique. We treated about 30 patients with local pathologies affecting the lower limbs and the flanks. The pathologies improved cutaneously and the average volume of aspirated fat was 300 cc. Moreover, we could underline an energetic retraction on part of the subcutaneous tissue, which, by adhering to the underlying structures, prevents possible depressions. The operating technique is explained.
Multiple-Procedure Cosmetic Otoplasty Simplified
Authors: Gilmore Jim
Published: January 2017

Modern techniques in cosmetic otoplasty incorporate both historical procedures and recently developed combined procedures with laser assistance to correct protruding ear or “lop ear” deformity. The multiple-procedure technique is conceptually sound and uses simple, innovative methods to reduce surgery time and yield predictable outcomes for both young and older patients. Early indications are that complications and revision rates have been reduced with the introduction of lasers in otoplasty. Modern technology allows physicians to correct “lop ear” deformity and help amend patients' distorted self-images.
The Preoperative Consultation for Facial Rhytidectomy
Authors: Shiffman Melvin A.
Published: January 2017

The author presents a list and brief discussion of items that should be discussed with the patient before face-lift surgery. The author emphasizes the importance of the surgeon taking personal interest in assuring that the patient has assimilated all information prior to surgery and offers several steps the surgeon should take to insure the patient is adequately informed and able to offer informed consent as such would be defined by a legal court.
The Contact YAG Laser in Body Contouring Surgery
Authors: Carniol Paul J.
Published: January 2017

The contact Neodium: YAG laser has advantages over conventional cold-knife surgery of electrocautery in body contouring and reconstructive surgery. Clinically the Nd: YAG laser causes less damage to surrounding tissues than the electrocautery when used for dissection. It provides hemostasis simultaneously during surgery that is advantageous over conventional cold-knife surgery. Patients may have an easier recovery after surgery with the contact YAG laser than after surgery with the electrocautery.
Manufacture of Silicone Implants
Authors: Shiffman Melvin A.
Published: January 2017

Research and development of breast implant manufacturing technology continues with the dual objectives of finding better processes for manufacturing implant shells and finding better filler solutions or gels. The Mentor HIS manufacturing process exemplifies improved techniques of implant shell production and quality control. The process is described in detail, and the Mentor HIS and McGhan processes of manufacturing breast implants are compared. Recognized shell weaknesses include thin spots, valve malfunction, rupture because of overfilling, and folding and leakage because of underfilling. All implants are inspected. Smooth implants are inspected 22 times while textured implants are inspected 23 times.
Treatment of the Ptotic Chin in the Young Patient
Authors: Kennedy Brent D. , Hiranaka David K.
Published: January 2017

There is a subset of younger patients who display a ptotic chin. These patients often present with a deficiency in the anteroposterior chin projection, decreased chin height, heavy submental, upper, and lateral neck fat, and accentuation of the submental crease, as well as localized jowl fat and pre-jowl sulcus. A method of treatment that combines correction of both the hard- and soft-tissue deformities is presented.
Histological Study of the Skin with Gold Thread Implantation
Authors: Rondo Wilson , Vidarte Gladys , Michalany Nilceo
Published: January 2017

A histological study was done on the skin biopsies of 10 female patients, 4 months after the implantation of at least two gold threads, introduced in the anterior subdermal region of the arm. The presence of a tuberculoid granuloma around the gold thread was evident. As there was considerable production of reticulin in the tuberculoid granuloma, the authors suggest that the presence of this tuberculoid granuloma in a dermoepidermic position which forms a “sleeve-like coating” around the thread would be responsible for skin support and consequent wrinkle reduction.
Nd-Yag Laser Use in Face-Lift Surgery
Authors: Park Jung I.
Published: January 2017

The use of the Nd-Yag laser with contact tip for face-lift surgery has significantly reduced postoperative ecchymosis. The Nd-Yag laser causes less tissue damage than electrocautery, and has a better ability to coagulate blood vessels than the CO2 laser. This paper describes laser physics and the mechanics of the Nd-Yag laser contact tip and the clinical applications, and shows results of patients who have had the procedure done with the Nd-Yag laser contact tip. There was very little evidence of ecchymosis postoperatively, which enables patients to return to social activities and/or work rapidly.
The Occipital-Parietal Flap Method in the Treatment of Male Baldness
Authors: Ezaki Tetsuo
Published: January 2017

The hair transplant technique to use for correcting male baldness is chosen based on the type of baldness, the condition and direction of the donor hair, and the favored hairstyle. In the occipital-parietal flap technique presented here, a flap is raised on one side of the occipital part. The flap is 4 cm wide and stretches toward the lower part of the parietal. After 1 week, the flap is transplanted from the top of the head to the frontal area using general anesthesia. Light pressure is applied to the transferred flap with a tie-over dressing. With this technique the hair grows downward and covers both the front and top parts of the head. It is important to use this technique in a manner appropriate for the baldness pattern. This technique is most successful for cases with type IV and V baldness patterns, although it will also yield good results for other patterns.
Body Contour Resculpturing after Massive Weight Loss following Gastric Bypass: A Report of 40 Consecutive Cases and a Review of the Literature
Authors: Benmeir P. , Sagi A. , Cassutto D. , Oz M. , Haruzi I. , Rosenberg L.
Published: January 2017

Forty morbidly obese patients had plastic surgery to remove redundant tissues after gastric bypass surgery (GBP). The average weight reduction was 62 kg (range 29–95 kg) and the average age at operation was 36.5 years. Abdominoplasty was the most common procedure and no mortalities were recorded. The postoperative complications were related mostly to wound healing. The average hospitalization time was 8 days (range 5–11 days) and the patient's new body image was satisfactory.
Reconstruction of the Helical Rim Using Porous Polyethylene Alloplastic Implant
Authors: Ziccardi Vincent B. , Oswley Todd W. , Rosenthal Marc S. , Ochs Mark W.
Published: January 2017

High-density porous polyethylene has been used successfully as an alloplastic implant in orbital reconstruction and as an onlay implant in the augmentation of the facial skeleton. This paper describes the utilization of the polyethylene implant in the reconstruction of an ear that was partially avulsed from a dog bite. Complications arising from the use of a firm implant material in this auricular reconstruction occurred. Management of this difficult posttraumatic reconstruction is presented.
Medical Malpractice Trial: Use of Evidence of Uncharged Misconduct
Authors: Shiffman Melvin A.
Published: January 2017

Evidence of uncharged misconduct may be offered at a malpractice trial to prove motive, opportunity, intent, preparation, plan, knowledge, identity, or absence of mistake or accident, but not to prove that a person acted in conformity with other wrongs or acts on a particular occasion.

The author offers a summary of the general rules of evidence and analyzes the doctrine of Uncharged Misconduct, narrowing the discussion to the admission of uncharged evidence in medical malpractice trials in particular. Physicians should be aware that his/her practice may be scrutinized for prior charged malpractice as well as recurring incidents of medical mistakes that have remained uncharged.
The Breast Implant and Disease: An Observed Association or a Verdict of Causation? Part I
Authors: Discoe Tony A.
Published: January 2017

The issue presented in breast implant litigation, whether breast implants cause harm, graphically displays the frontiers of the interface of law and medicine, and the complex method of evaluating causal relationships in medicine. Should the law wait for an answer?

This paper provides a system for evaluating the results of studies in the area of breast implant litigation, in terms of the extent to which those results support or refute a causal relationship.

The concept and characteristics of causation and the reliability of cases, reports, descriptive studies, and anecdotal cases as evidence of causation are discussed. Because of the current media and medical legal environment, recommendations for the care and treatment of patients with breast implants are being made without careful thought. The consequences of widespread litigation may be the determining factor in attempting to resolve the question of the potential harm of the silicone-gel breast implant.
Combined Action of Bovine Collagen and Glycolic Acid in Soft-Tissue Augmentation
Authors: Sito Giuseppe , Sorrentino Laura
Published: January 2017

Bovine collagen and glycolic acid have been used in recent years to rejuvenate skin. Both stimulate new endogen collagen synthesis in the host. The authors have worked out a protocol based on a contemporary use of the two substances in progressive steps in order to prove a synergistic action of bovine collagen and glycolic acid used in combination, giving better and longer lasting aesthetic results.

Studies were performed on 48 Sprague-Dawley female rats and clinically on 60 carefully informed female human volunteers. Bovine purified American collagen conjugated with glutaraldehyde and unbuffered glycolic acid in gel form, combined with fluorescein, at pH 0.95 and at 70% was utilized. Evaluations of histological aspects were carried out on macroscopic and microscopic levels in animals.

At the second month, the collagen implant treated with glycolic acid was observed to be more voluminous and better preserved than the untreated implant. On a clinical level, the group undergoing the “Protocollo Sito” obtained far more satisfactory results than the two control groups.
Skin Resurfacing and Lesion Ablation with the Ultrapulse® CO2 Laser
Authors: Fulton James E.
Published: January 2017

Although CO2 lasers have been available to the cosmetic surgeon for more than 20 years, it is only recently that the ultrapulse mode has made the laser user-friendly. Now, tissue can be vaporized without significant charring. To shorten our learning curve with this treatment modality, various skin lesions were ablated with variable spot sizes and energy settings. Our results are presented as personal guidelines. Large and small areas may be resurfaced. If occlusive dressings are used, rapid reepithelization occurs across previous skin lesions or scars. This results in the appearance of rejuvenation. The only troublesome sequela has been persistent erythema similar to that seen after a phenol peel.
Latex Glove Allergy and the Cosmetic Surgeon
Authors: Tombros James R.
Published: January 2017

Allergy to the latex protein in surgical gloves has become a major occupational hazard among physicians and cosmetic surgeons over the last few years. Reactions to latex range from urticaria to contact dermatitis to anaphylaxis. The latex proteins bound to cornstarch powder added as a donning agent can become aerosolized and inhalation of the powder can trigger bronchospasm and/or anaphylaxis. Continued exposure to latex by health care personnel increases the possibility of developing an allergy to the substance. Nonlatex alternatives have been developed to eliminate the problem of latex allergy.
Total Facial Rejuvenation with Ambulatory Techniques
Authors: Lieberman Clara , Cohen Joseph A.
Published: January 2017

Today's patients who undergo cosmetic surgery for facial rejuvenation demand no scars, no sequelae, and excellent long-lasting results without changes in their physiognomy. Some conventional techniques may produce an unnatural appearance. Simple ambulatory procedures can achieve complete facial rejuvenation. Closed face-lifting, autologous collagen/fat grafting, blepharoplasty, neck liposuction, platysmaplasty, and skin peeling used individually or in combination can produce facial improvement without any conspicuous scars and with minimal edema or ecchymosis, and allow the patient to return to everyday activities within a few days. These ambulatory techniques provide both patients and surgeons with excellent long-lasting results. This is a retrospective study of 50 patients who underwent one or more procedures for facial rejuvenation. Pre- and postoperative photographs are shown.
The False Claims Act: Health Care as the New Battleground
Authors: Trucco Michael T.
Published: January 2017

The author provides a legislative history of the False Claims Act and discusses the potential impacts of the April 1993 amendments to the False Claims Act on the health care industry. The False Claims Act allows any private citizen with knowledge that a false claim had been submitted to the government for payment to bring a civil action in the name of the government to recover any damages suffered by the government. As an incentive, the person is entitled to a “bounty” plus costs. False claims in the health industry take three principal forms: nondelivery of services, delivery of unnecessary services, misrepresentation of services, charges, or costs. The author emphasizes that no specific intent to defraud is required. Items billed by a hospital in deliberate ignorance or reckless disregard for the truth or falsity of a bill are the only proof necessary.
Has Technology Killed the Flap?
Authors: Epstein Jeffrey S. , Kabaker Sheldon S.
Published: January 2017

For over 25 years, scalp flaps have had a role in the treatment of male pattern baldness. Advantages of these procedures include rapid achievement of final results and hair density. Despite the technological advances made in other hair restoration procedures, scalp flap surgery continues to be indicated for motivated individuals who are appropriate candidates.