bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of the Psychobiology and Pharmacotherapy of Posttraumatic Stress Disorder
Authors: Katz Laurence , Fleisher William , Kjernisted Kevin , Milanese Paul
Published: January 2017

Objective:

To review the literature on certain psychobiologic elements of posttraumatic stress disorder (PTSD) as they pertain to possible pharmacotherapeutic interventions.

Method:

The literature pertaining to the neuroanatomical, neurochemical, and cellular elements was reviewed. As well, both controlled and uncontrolled studies of pharmacotherapy in PTSD were analyzed.

Results:

The literature suggests that the stress response triggers certain neuromodulators with subsequent psychoneurological restructuring; that various antidepressants have been demonstrated to be effective for treatment of criterion B symptoms; that, to date, a single antidepressant has been demonstrated to be effective in a controlled trial for criterion C symptoms; and that, to date, in controlled trials, antidepressants and a benzodiazepine have proved effective for criterion D symptoms.

Conclusion:

Currently, a comprehensive approach requires multimodel understanding and multimodal treatment.
A Double-Blind, Multicentre Study of Paroxetine and Maprotiline in Major Depression
Authors: Schnyder Ulrich , Koller-Leiser Annemarie
Published: January 2017

Objective:

This study was performed to compare the clinical efficacy, side effects, and safety of paroxetine and maprotiline, the latter being the most frequently prescribed antidepressant in Switzerland.

Method:

Seventy-one patients (in and outpatients) with major depression were randomly allocated to treatment with paroxetine (20 to 40 mg daily) or with maprotiline (50 to 150 mg daily). Efficacy was measured by means of the Hamilton Psychiatric Rating Scale for Depression, the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression, and the Hopkins Symptom Checklist.

Results:

The 2 components showed a similar efficacy. The adverse effect profile was comparable in the 2 treatment groups, although the findings showed a nonsignificant trend pointing in the direction of lower side effects with paroxetine.

Conclusion:

In the moderate dose regimens tested, the 2 components seemed to be of similar efficacy, with comparable profiles of side effects and safety.
Neuroleptic Dosing in Chronic Schizophrenia: A 10-Year Follow-up
Authors: Remington Gary J , Prendergast Peter , Bezchlibnyk-Butler Kalyna Z
Published: January 2017

Objective:

To evaluate neuroleptic dosing patterns in individuals with schizophrenia over a 10-year interval.

Method:

Changes in neuroleptic dosing between 1980 and 1990 were followed in 65 patients with a diagnosis of chronic schizophrenia.

Results:

According to more recent dosing guidelines, doses were already high at the time of initial evaluation, yet overall they continued to increase during the next decade of treatment for both males and females. Patients were almost equally divided, however, by those who underwent an increase (n = 33) and those whose dose remained stable (n = 4) or was decreased (n = 28).

Conclusion:

A considerable number of patients with schizophrenia appear to receive progressively higher neuroleptic doses over the course of their illness, despite a lack of empirical data to support such an approach. Results are discussed in terms of current dosing recommendations and factors influencing dose changes.
Rediscovering General Psychiatry: Creation of an Academic Division
Authors: Goldbloom David S , Buckingham Robert A , Voore Peter
Published: January 2017

Objective:

To describe the rationale, origins, and goals of a newly created academic division of general psychiatry within a university setting.

Method:

Literature review, observation, and description.

Results:

Within 2 years of its inception, the General Psychiatry Division of the University of Toronto has begun to realize some of its goals and further elucidate specific objectives.

Conclusions:

In an era of increasing academic subspecialization, the preservation of core skills in psychiatry and the recognition of the continuing public need for psychiatric generalists must be enshrined within academic training programs.
Evaluating the Effectiveness of Interventions in Child Psychiatry
Authors: Fonagy Peter
Published: January 2017

Objective:

To review the nature of outcome measures used to evaluate psychosocial treatment in children.

Method:

Recent research findings that highlight the importance of outcome data and justify randomized controlled trials (RCTs) are reviewed.

Results:

Outcome measures of child therapy can focus on changes in the child's symptoms, adaptation to the psychosocial environment, cognitive or emotional capacities, and changes in interaction with others. They can also assess service utilization, related costs, and the suffering of those associated with the child before and after treatment. RCTs remain the optimal methodology, notwithstanding current critiques.

Conclusion:

Studies assessing the effectiveness of psychosocial treatment must include a definition of various outcomes and use appropriate methodologies to measure them.
Posttraumatic Stress Symptoms and Medical Procedures in Children
Authors: Wintgens Anne , Boileau Bernard , Robaey Philippe
Published: January 2017

Objective:

To focus on posttraumatic stress symptoms after childhood diseases such as cancer, organ transplantation, and severe burns.

Methods:

Differential diagnoses, risk factors, and treatment aspects (psychological and pharmacological) are discussed.

Results:

The concept of adjustment problems in chronic or severe illnesses is widely used in pediatrics. Many aspects of severe childhood diseases are traumatic, as defined by the DSM-IV: severe illnesses are life-threatening, medical procedures threaten the child's physical integrity, and disorganized behaviour periods are common.

Conclusion:

This concept, which remains insufficiently investigated, is a promising area of investigation for prospective and prevention studies.
The Treatment of Conduct Disorder: Perspectives from across Canada
Authors: Moretti Marlene M , Emmrys Chuck , Grizenko Natalie , Holland Roy , Moore Ken , Shamsie Jalal , Hamilton Hayley
Published: January 2017

Objective:

To provide a synopsis of treatment programs for conduct-disordered children in Canada.

Method:

Five groups of authors from British Columbia, Ontario, Quebec, and New Brunswick describe their approaches to the treatment of children with conduct disorder.

Results:

All programs emphasize the needs to use multimodal treatment schemes, including day and short-term residential care, and to base programs on identified factors associated with the development of conduct disorder.

Conclusion:

Specific forms of treatment of conduct disorder are promising but are often hampered by social and political agendas.
Judicial Case Management and the Custody and Access Assessment: Melding the Approaches
Authors: Leverette John , Crowe Trish , Wenglensky Rose , Dunbar Justice Mary
Published: January 2017

Background:

The presence of the Unified Family Court, with procedures emphasizing judicial case management and settlement in custody disputes, provided an opportunity to combine these practices with those of a university hospital-based family court clinic experienced in the provision of custody assessments. Specifically, a process integrating the clinical custody assessment with the work of counsel and court procedures was developed. This format, incorporating the preparation of a clinical settlement conference brief, was then evaluated with emphasis on time management, outcome in relation to settlement or trial, and the effect of clinical assessment at critical points in the combined endeavour.

Method:

Seventy-two judicial referrals conducted using this format were reviewed. To assess efficiency, we determined time intervals to various points in the process and compared them to previous local practice. Settlement rates, recorded incrementally to mark each component's contribution, were compared with rates noted in the literature. Assessment functions were identified according to the point of resolution of the dispute and in a manner to facilitate comparison with previously published work.

Results:

The format resulted in 50% of cases settling without trial in under 5 months, a minimum settlement rate of 50%, and confirmed the ability of clinical assessment to contribute flexibly to dispute resolution in several conciliation venues and at trial.

Conclusions:

Combining legal and mental health efforts can result in more efficient use of resources and a substantial diversion of cases from continuing litigation. While altering the process of clinical assessments enhances such findings, further work is required to assure appropriate selection criteria for various intervention formats.
Mental Health Treatment in Ontario: Selected Comparisons between the Primary Care and Specialty Sectors
Authors: Parikh Sagar V , Lin Elizabeth , Lesage Alain D
Published: January 2017

Objective:

Epidemiologic research has demonstrated that the majority of mental illness in the community is not treated. Primary care physicians and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify the extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and specialty sectors. In particular, we are interested in both the relative numbers and the types—based on sociodemographic and severity indicators—of patients found in each sector, as well as in confirming the key role of primary care in the provision of mental health services.

Method:

Data were taken from the Mental Health Supplement to the Ontario Health Survey, a community survey of 9953 individuals. All subjects who met DSM-III-R criteria for a past year diagnosis of mood, anxiety, substance abuse, bulimic, or antisocial personality disorders were categorized by their use of mental health services in the preceding year—into nonusers, primary care only patients, specialty only patients, and both sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics.

Results:

Only 20.8% of subjects with a psychiatric diagnosis reported use of mental health services, but 82.9% of these same individuals used primary care physicians for general health problems. Among those who used mental health services, 38.2% used family physicians only for psychiatric treatment, compared with 35.8% who used only specialty mental health providers, and 26.0% who used both sectors. The 3 groups of users showed only modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexual and physical abuse. On specific disability measures, all 3 groups were similar.

Conclusion:

The vast majority of individuals with an untreated psychiatric disorder are using the primary care sector for general health treatment, allowing an opportunity for identification and intervention. Primary care physicians also treat the majority of those seeking mental health services, and individuals seen only by these primary care physicians are probably as ill as those seen exclusively in the specialty mental health sector. From a public health perspective, future policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to deliver psychiatric services.
Mental Health Practices of Ontario Family Physicians: A Study Using Qualitative Methodology
Authors: Craven MA , Cohen M , Campbell D , Williams J , Kates Nick
Published: January 2017

Objective:

To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care.

Method:

Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted.

Results:

Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician–patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services—accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services—were consistently identified as barriers to the delivery of optimal mental health care.

Conclusions:

This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.
Current Status of Genetic Studies of Gilles de la Tourette Syndrome
Authors: Barr Cathy L , Sandor Paul
Published: January 2017

Gilles de la Tourette syndrome (TS) is a familial, neuropsychiatric disorder characterized by chronic, intermittent motor and vocal tics. Despite strong evidence for a genetic basis of this disorder from family, twin, and adoption studies, no convincing evidence for genetic linkage has been reported. Numerous groups world-wide have searched for genetic susceptibility factors for TS, testing specific candidate genes in neurotransmitter systems as well as DNA markers with known locations. Several factors may complicate the search for genes for this disorder, including diagnostic uncertainties, definition of the TS phenotypic spectrum as it relates to genetic susceptibility, assortative mating, genetic heterogeneity, and unclear mode of inheritance. In this article, we review the evidence for the genetic basis of TS and the current status of genetic studies.
47,XYY Karyotypes and Pervasive Developmental Disorders
Authors: Nicolson Rob , Bhalerao Shree , Sloman Leon
Published: January 2017

Objective:

The presence of a 47,XYY karyotype in boys with pervasive developmental disorders (PDDs) has rarely been described in the past. Herein, 2 boys with PDDs and a supernumerary Y chromosome are presented.

Methods:

The case histories of the 2 patients are described along with the results of associated testing. The literature on psychosocial development as well as brain morphology and physiology in males with 47,XYY karyotypes is reviewed.

Results:

Both boys had presentations typical of PDDs, one with autistic disorder and the other with PDD not otherwise specified.

Conclusions:

The finding that, in a clinic for children with developmental disorders, 2 of 40 male referrals had 47,XYY karyotypes suggests that the rate of this sex chromosome anomaly may be increased in PDDs. An extra Y chromosome may be related to abnormal brain development, which may, in turn, predispose vulnerable males to PDDs.
Suicide and Suicidal Behaviours: Implications for Mental Health Services
Authors: Rhodes Anne E , Links Paul S
Published: January 2017

Objective:

To examine what is known about engaging and maintaining suicidal individuals in treatment and what can be learned from the randomized, controlled trials of psychosocial interventions concerning the reduction of suicidal behaviours.

Method:

Review of the relevant literature.

Results:

Treatment follow-through is low among those who attempt suicide. The evidence to date is inconclusive as to whether psychosocial interventions can reduce the repetition of suicidal behaviour.

Conclusions:

Certain groups may benefit from psychosocial interventions. Future research must overcome several methodological issues. As treatment relies on adequate follow-through, changes in the delivery of care may enhance treatment effectiveness.
Childhood Sexual and Physical Abuse and Adult Self-Harm and Suicidal Behaviour: A Literature Review
Authors: Mina Elaine E Santa , Gallop Ruth M
Published: January 2017

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.
Attempted Suicide among Inuit Youth: Psychosocial Correlates and Implications for Prevention
Authors: Kirmayer Laurence J , Boothroyd Lucy J , Hodgins Stephen
Published: January 2017

Objective:

To identify potential risk and protective factors associated with attempted suicide among Inuit youth, a population known to have a high rate of both attempted and completed suicide in recent years.

Method:

A secondary analysis of data on 203 Inuit youth (aged 15 to 24 years) from a random community survey conducted by Santé Québec in 1992. Factors previously identified in the literature and in clinical consultation and ethnographic research were tested with bivariate statistics and logistic regression models for each gender.

Results:

At the bivariate level, positive correlates included substance use (solvents, cannabis, cocaine), recent alcohol abuse, evidence of a psychiatric problem, and a greater number of life events in the last year. Regular church attendance was negatively associated with attempted suicide. Multivariate analysis indicated that a psychiatric problem, recent alcohol abuse, and cocaine or crack use were the strongest correlates of attempted suicide for females, while solvent use and number of recent life events were the strongest correlates for males.

Conclusions:

Suicide prevention programs can be targeted at youth who are using substances, particularly solvents, cocaine, and alcohol, have psychiatric illness, and have experienced recent negative life events. Involvement in church or other community activities may reduce the risk for suicide. Consideration of gender differences may allow more precise identification of those at risk for attempted suicide.
Risk and Protective Factors Scale: Reliability and Validity in Preadolescents
Authors: Looper Karl , Grizenko Natalie
Published: January 2017

Objective:

To describe the reliability and validity of a novel scale, the Risk and Protective Factors Scale (RPFS), in preadolescents. The RPFS is designed to predict the development of disruptive behaviour disorders (DBDs).

Method:

A controlled study of 120 children aged 6–12 years in DBD and normal groups. Measures include the RPFS and the Revised Child Behaviour Profile (RCBP).

Results:

Cohen κ for interrater reliability is 0.81, 92% agreement. Pearson correlation for test-retest reliability is 0.76, 94% agreement. Cronbach α for internal consistency is 0.89. Pearson correlation between the RPFS and RCBP is 0.82. The total scores and subscores of the RPFS discriminate significantly between DBD and control groups by student t-test.

Conclusion:

The RPFS has good internal consistency and interrater and test-retest reliability. It has concurrent validity to the RCBP and discriminant validity between DBD and normal groups. This scale may help identify children at risk for DBD, which would allow early intervention, but requires a longitudinal study to establish its predictive power.
Psychiatrie Residents' Views on Their Training and Experience regarding Issues Related to Child Abuse
Authors: Barnard-Thompson Kathleen , Leichner Pierre
Published: January 2017

Objective:

To explore the views of psychiatric residents regarding the prevalence and impact of child physical, sexual, and emotional abuse; the adequacy of their training in these areas; and the sufficiency of treatment resources for abused children and their abusers.

Method:

A 97-item survey questionnaire was distributed to 189 psychiatric residents as a section of the 1997 Coordinators of Postgraduate Education (COPE) self-assessment examination.

Results:

Estimations of prevalence of child sexual, physical, and emotional abuse among men and women in both general and psychiatric populations were generally accurate according to the literature. Residents appeared to be aware of the multifactorial nature of child abuse and identified the particular importance of social-environmental factors such as parental drug abuse and a violent social environment. Residents also recognized the significant association of posttraumatic stress disorder, borderline personality disorder, and dissociative disorders with child sexual abuse. Seventy-five percent of respondents felt that instruction on the topic of child abuse during their psychiatric residency was insufficient. Sixty-four percent of respondents felt that resources for the treatment of effects of child abuse were insufficient; 83% felt that treatment resources for child abusers were insufficient.

Conclusion:

Although psychiatric residents appear to be aware of the prevalence of child abuse and its varied effects on the victims' mental health, the majority felt that their medical training in this area had been insufficient. For this reason, medical school curricula and training experiences might require reevaluation. Increasing the profile of child abuse and its impact on mental health might also result in enhanced prevention programs and treatment resources available to abused children and their abusers.
Physicians Who Commit Sexual Offences: Are They Different from other Sex Offenders?
Authors: Langevin Ron , Glancy Graham D , Curnoe S , Bain J
Published: January 2017

Objective:

To determine if physician sex offenders differ significantly from other sex offenders by using a control group and assessing both groups with reliable and valid instruments.

Method:

Nineteen male physician sex offenders were compared with 19 male sex offender control subjects, matched on offence type, age, education, and marital status. Both groups were compared with a general sample of sex offenders (n = 2125). The 3 groups were compared on sexual history and preference, substance abuse, mental illness, personality, history of crime and violence, neuropsychological impairment, and endocrine abnormalities.

Results:

Physicians in this study were highly educated and older, forming a statistically significant subgroup of sex offenders. The majority of physician sex offenders suffered from a sexual disorder (68.4%), as did the other 2 groups. Physicians showed more neuropsychological impairment and endocrine abnormalities and less antisocial behaviour than did the general sample of sex offenders but did not differ from the matched control group. Physician offenders who sexually assaulted their patients did not differ from those who had nonpatient victims.

Conclusions:

Despite differences in age, education, and occupation between physician sex offenders and sex offenders in general, the same assessment procedures can be recommended for examining both groups. Although the sample size is small, results suggest that physicians who commit sexual offences should be scrutinized by phallometric assessment of sexual deviance and especially for neurological and endocrine abnormalities.
L'implantation du suivi intensif dans la communauté: Des leçons à tirer du passé
Authors: Benoit Frédéric , Lesage Alain D
Published: January 2017

Objectif:

Analyser différents enjeux de l'implantation d'un programme de Suivi intensif dans le milieu (SIM).

Méthode:

Des entrevues en profondeur ont été menées auprès de protagonistes d'un projet d'implantation du SIM qui s'est déroulé dans les années 1970. Une analyse qualitative a été effectuée qui évaluait les enjeux ayant empêché la généralisation de ce type d'approche ainsi que les aspects à observer lors d'implantations futures du SIM.

Résultats:

Des aspects sociaux, culturels, organisationnels, professionnels et économiques semblent avoir eu et auront une place déterminante dans l'intégration de ce type de programme. À l'époque, le projet d'implantation du SIM s'est développé en parallèle au mouvement de psychiatrie communautaire, sans jamais s'y arrimer. Actuellement, sur le plan social, des groupes d'entraide et de parents favorisent l'implantation de ce type de programme. L'aspect organisationnel décrit l'importance du type d'arrimage ainsi que la modification du SIM selon les services de soins en place. L'affiliation de ce type de projet à une équipe de recherche n'a pas été garante d'une implantation réussie. Un troisième théme aborde la formation ainsi que la motivation du psychiatre quant à la pratique de cette approche. Finalement, l'aspect économique se révèle de plus en plus comme étant un levier qui impose ce type d'approche.

Conclusion:

Cette étude nous renseigne sur différents enjeux de l'implantation d'un programme de suivi intensif dans la communauté. Ces résultats représentent autant d'hypothèses à vérifier en ce qui concerne l'implantation du SIM autant au Québec qu'ailleurs au Canada.
Child Psychiatry Practice Patterns in Ontario
Authors: Steele Margaret M , Wolfe Vicky Veitch
Published: January 2017

Objectives:

To examine the demographics, training, distribution, venues of practice, remuneration patterns, and professional affiliations of child psychiatrists in Ontario.

Method:

In July 1997, questionnaires were sent to 229 Ontario psychiatrists. A second mailing was sent to nonresponders in the fall of 1997. The overall response rate was 66.8%.

Results:

Compared with other research regarding the ratio of child psychiatrists to children with mental health problems, Ontario fares relatively well (1:6148). Generally, Ontario child psychiatrists report having received formalized training in the speciality. Child psychiatrists are disproportionately concentrated in Toronto and in midsize cities with medical schools compared with rural regions. Outreach services to smaller communities are provided by 30% of child psychiatrists, but it is not clear whether the services are sufficient and equitably available. Approximately 50% of current psychiatrists will be aged 65 years or older in 15 years, and it is unclear whether sufficient numbers will replace them. The profession appears to be reaching an equitable gender representation. Most child psychiatrists belong to the professional organizations that support the profession; however, they are least likely to belong to the Ontario Psychiatric Association (OPA).

Conclusions:

An optimal ratio of child psychiatrists per population served still needs to be determined, with special consideration given to the needs of rural communities. The small ratio of child psychiatrists to the population of children with mental health needs highlights the importance of collaborating with other medical and mental health professionals. Recruiting and retaining child psychiatrists will need to be monitored. Child psychiatrists in Ontario need a unified voice to address these issues.
Imaging of Autism: Lessons from the Past to Guide Studies in the Future
Authors: Goldberg Jeremy , Szatmari Peter , Nahmias Claude
Published: January 2017

Objective:

To review the scientific literature on the imaging of autism with a view to understanding how imaging can contribute to future studies.

Methods:

Medline was searched, and bibliographies from retrieved articles were reviewed. Inclusion criteria were a diagnosis of autism according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, third edition or later, and a control group without autism.

Results:

The field suffers from a lack of replication studies and poor methodology in terms of not controlling for confounding variables. Enlarged brain size, particularly in the temporoparietal brain region, and decreased size of the posterior corpus callosum are the only findings that have been independently replicated.

Conclusion:

Future imaging studies should attempt to investigate more homogeneous subgroups of patients such as those with “the lesser variant of PDD” and high-functioning patients with PDD who do not have comorbid medical conditions. A different approach, examining the individual behaviours that constitute the PDD spectrum and exploring these separately along with other associated variables such as neuropsychological deficits, structural and functional brain abnormalities, and genetic information could help identify biological mechanisms that do not follow diagnostic boundaries.
Obits for Presidential Primary Campaigns
Authors: Culbertson Hugh M. , Chen Ni
Published: January 2017

National, prestige papers gave more balanced, interpretative coverage to presidential primaries than did two local dailies in this study, more focus on issues and greater attention to the positive as well as negative aspects of campaigns and candidates that faltered.
Gender Representation in Newspaper Business Sections
Authors: Greenwald Marilyn S.
Published: January 2017

Women in that traditional male bastion, the newspaper business section, are underrepresented as sources and subjects of stories, even when the business staff writers or editors are women.
“We Only Speak English Here”
Authors: Gast Melanie Jones , Okamoto Dina G. , Feldman Valerie
Published: January 2017

Past research suggests that community after-school programs (ASPs) are crucial sites for culturally relevant programming for minority and immigrant youth; yet, we know little about how ASPs address language in their programming. Using an ethnographic fieldwork approach, we examine the goals and practices of ASP workers serving immigrant youth with diverse ethnic and language backgrounds in San Francisco, California. We find that, despite the best intentions regarding culturally relevant programming, ASP workers faced funding mandates, capacity issues, and increasingly diverse youth populations, and they adopted English-only policies or simply placed little priority on native-language usage. Ultimately, we observed competing processes related to English dominance: a lack of support for English language learners (ELLs) and bilingual youth, and the use of English as a bridge language across racial and ethnic lines. While staff sought to support and empower immigrant youth, ELL youth were often left on the sidelines and had limited opportunities to develop social capital in ASPs. Without reworking funding and institutional systems for language programming, English dominance may continue as a normalized method of practice in city youth programs.
Comprehensive Glabellar Anatomy for the Cosmetic Surgeon
Authors: Burkat Cat N. , Lucarelli Mark J. , Lemke Bradley N.
Published: January 2017

Introduction:

The purpose of this study was to clarify controversies in motor innervation to the glabellar muscles in order to create a comprehensive guide of anatomic relationships within the glabella for the cosmetic surgeon performing surgery or injections in this aesthetic region.

Methods:

Microdissection was performed on 28 sides of 14 preserved cadaver heads and 10 sides of 5 fresh-frozen cadaver heads. Dissection proceeded anterograde from the main trunk of the facial nerve to its terminal branches in the glabellar muscles. Measurements were made with calipers to record the locations of the motor nerve entry into the corresponding muscle and the locations of the sensory nerves, vessels, and orbital landmarks.

Results:

The temporal branch of the facial nerve did not terminate after supplying the posterolateral transverse corrugator muscle but continued medially to innervate the oblique head of the corrugator muscle, entering 4 mm inferior to the superior edge (range 2–6.5 mm). This pattern was identified in 26 of 38 dissections (68.4%). In 74% of specimens, a small artery coursed with the nerve toward the corrugator muscle that should be anticipated to avoid bleeding. In 4 specimens (10.5%), the temporal facial nerve supplied a branch to the depressor supercilii, which continued to enter the posterior surface of the procerus muscle. In the remaining specimens, the small terminal branches were lost after entering the oblique corrugator muscle. The supratrochlear nerve exited between, rather than lateral to, the 2 heads of the corrugator supercilii muscle near the muscle origin before dividing into 2–3 branches and measured 17 mm from midline. A sensory branch entered the procerus muscle 5 mm inferior to the motor nerve entering the muscle. The supraorbital notch and foramen was 26 mm from midline. Prominent angular vessels were located between the heads of the corrugator supercilii muscle and between the heads of the depressor supercilii muscle.

Conclusions:

With a thorough understanding of the anatomic relationships of the muscles to their associated innervation and vascular supply, complications such as prolonged paresthesia or dysesthesia from sensory nerve injury, eyebrow asymmetry from motor nerve damage, traumatic neuromas, and visual loss from vascular emboli from cosmetic injections may be avoided.
The Tab Flap Technique Brachioplasty: Prevention of Contour Deformities
Authors: Haass E. Aron L. , Foglietti Mark A. , Generalovich Brock
Published: January 2017

Brachioplasty is defined as the contouring of the proximal upper extremity via excision of skin and underlying subcutaneous tissues. This procedure has become more commonly performed with the rise of bariatric and obesity-related surgery. A number of techniques have been described in the past, each with potential shortcomings, the most vexing of which are contour deformities or irregularities and constrictions such as the Michelin man deformity and short skin problems. The technique described makes it easier to avoid these complications and may be used alone or in conjunction with other techniques. The procedure begins with elliptical preoperative markings from the medial epicondyle to the axilla, centered on the medial inner arm. The initial incision is performed on the medial aspect of the preoperative markings. Flaps are then raised from medial to lateral. Once adequate undermining is completed, the skin and subcutaneous tissue are excised in a sequential segmental fashion to ensure the appropriate excision amount. This technique provides an excellent and reproducible result with outstanding upper extremity contour.
Percutaneous Suture Suspension Brow Lift
Authors: Thomas Mohan , Menon Hari , D'Silva James Allan , Bandekar Nitin
Published: January 2017

Background:

Endoscopic brow lift and brow suspension have been combined to create a new minimal access brow lift that addresses key elements in forehead rejuvenation. Anatomical studies have focused on the importance of lateral brow repositioning and maintenance of the medial retaining ligaments to create a natural, appealing brow lift.

Method:

The authors describe the percutaneous suture suspension brow lift (PSSBL) technique for upper periorbital rejuvenation and their experience using the technique. The PSSBLs were performed in 25 patients during a 2-year period. Twelve patients had a brow lift in conjunction with an upper blepharoplasty. Of these, 3 patients had only a periorbital rejuvenation by brow lift and blepharoplasty. Twelve cases had only a brow lift for rejuvenation of the periorbital region along with other facial rejuvenation procedures. One patient had a unilateral brow lift to correct posttraumatic asymmetry.

Results:

All patients were seen for at least 3 postoperative visits extending to an average of 12 months postoperatively. Two patients underwent a redo procedure because of breakdown of sutures. There were no cases of postoperative brow asymmetry except in those in whom a redo had to be performed.

Conclusions:

The PSSBL is a safe and technically simple technique that helps achieve optimal esthetic results in brow lift with few complications and a high patient acceptance rate.
Heterotopic Bone Formation around a Solid Silicone Chin Implant
Authors: Johnson Christopher T.
Published: January 2017

Objective:

Solid silicone implants have been used successfully with few complications in facial cosmetic surgery since the mid 1960s. The objective of this paper is to report an unusual sequela associated with a solid silicone implant placed for chin augmentation.

Methods:

Case Report

Case Presentation:

A 28-year-old Caucasian female presented with complaints of changes in her chin appearance for the past 2 years. She had a mandibular solid silicone implant placed 11 years prior and was happy with the results for 9 years when she began to notice enlargement of the right inferior border which progressed over 2 years prompting a consult at my office. Clinical examination revealed a mild enlargement of the right anterior mandibular border when compared with the left. She had good chin projection and no noticeable mobility of the implant. Radiographic studies revealed a heterotopic bone along the right anterior border of the mandible. Under intravenous sedation and local anesthesia, the inferior mandible and implant were exposed via the previous extra-oral approach. The bone was exposed and removed from the chin implant, which was stable, and without infection. The wound was closed and the patient was discharged and did well at her postoperative appointment.

Discussion:

Solid silicone facial implants have been used with great success for a few decades by different specialties. A variety of complications have been reported, such as displacement, early and late infections, patient dissatisfaction with the result, bony resorption, and prolonged edema. This is the first reported case of heterotopic bone formation around a solid silicone implant to this author's knowledge.

Conclusion:

Heterotopic bone formations around a solid silicone implant likely result from an intact periosteum in conjunction with the nature of the silicone capsules.
External Ultrasound-Assisted Liposuction of the Abdomen: A Report of our Experience
Authors: Nease Carey J. , English Jim L.
Published: January 2017

Introduction:

Ultrasound-assisted liposuction (UAL) is currently an accepted and commonly used method, although the incidence of complications is noteworthy. In 1997, Silberg introduced the concept of external ultrasound-assisted liposuction (XUAL) to facilitate the standard technique with an expected decreased incidence of complications when compared with UAL. This article reports our experience with XUAL of the abdomen at a single cosmetic surgery center over a 1-year period.

Methods:

Two groups of 15 patients each underwent abdominal liposuction. Group 1 received the tumescent technique, and Group 2 received external ultrasound treatment, again using the tumescent technique. Ultrasonic energy was applied to the entire abdominal area in a standard fashion using the Intellect Legend Combo 2-C ultrasound unit set to 1.5 watts/cm2 continuous pulse for 10 minutes immediately following infusion of the tumescent solution. Patients were evaluated postoperatively for adverse events. Adverse events were defined as excessive edema, ecchymosis, seroma greater than 50 cc, hematoma, infection, and wound breakdown.

Results:

No cases of adverse events occurred in any patient in the immediate postoperative period. However, at the first postoperative appointment, it was notable that 2 of 15 patients in group 1 (13%) had developed a significant (>50 cc) lower abdominal seroma. Both patients were successfully treated with a single closed drainage procedure in the office via needle aspiration. In group 2 at the first postoperative visit, it was notable that 5 of the 15 patients (33%) presented with a significant (>50 cc) lower abdominal seroma. All patients in group 2 were successfully treated with drainage of the fluid via needle aspiration or by opening the midline lower port and placing a passive drain (in several cases). An average of 2.5 drainage procedures was required for resolution of the seromas in group 2.

Discussion:

The incidence of seroma formation was clearly linked to higher body mass index (BMI) and total fat volume removed. Consistent variables included tumescent volume infused, amount of ultrasound energy delivered, and cannula size used during the tumescent infusion and aspiration procedure. In most patients, the flanks and low back were also sculpted with the liposuction technique; however, the abdomen was the only area treated preoperatively with ultrasound. It is notable that the only area to develop a seroma was the abdomen, which suggests that the ultrasound could be related to seroma formation. The cause of seroma formation remains unknown; however, the possibilities of septal breakdown, lymphatic and venous damage, and cavity formation are reasonable.

Conclusion:

The incidence of seroma formation may be increased with XUAL of the abdomen. Additional studies are needed to prove that the benefits of XUAL treatment provided preoperatively outweigh the risk for adverse events.
The Hair Transplant Story
Authors: Webster Richard C. , Fuleihan Nabil S. , Smith Richard C.
Published: January 2017

In the lifetimes of many of us, essentially all of the developments of hair transplant surgery have occurred. Now, with the introduction of micro- or minigrafting, even the hairlines can be made to look natural or normal; and the various combinations of other techniques with these tiny grafts are providing the overall quality of excellence desired. The refusal to accept results short of perfection shows how specialism in hair transplant surgery has led to one improvement after another. Politicians, however, are trying to convince the public that generalists, not specialists, are what the public needs. If the specialists' side is to be told, we will have to tell it and promptly. Selected steps in the hair transplant saga, showing what our quest for excellence finally led to, will begin the telling of the cosmetic surgeons' story.
Radix Grafting to Maintain Dorsal Height
Authors: Gilbert Scott E.
Published: January 2017

Over the past 25 years, the trend for rhinoplasty has been toward higher dorsums. This emphasis on the more aesthetically prominent nose has led to examination of augmenting the radix to achieve this higher dorsum. Traditionally, augmentation of the radix has been limited to those cases where the radix is disproportionately low. While it is true that augmentation due to low radix disproportion is the major criterion for radix grafts, radix augmentation may benefit many patients who do not fit into that category.

It is well known that the dorsum will rise after lateral osteotomies and nasal bone infracture. Without reduction this can create a hump. Integrity of the dorsal projection achieved with the infracture can be maintained by implementation of the radix graft procedure which overcomes the appearance of a dorsal hump.

A retrospective review of 52 patients who underwent radix grafting was performed. Some were augmented due to low radix disproportion and some were augmented to maintain the aesthetic line of the higher dorsal projection. This review examined the following criteria: type of cartilage graft used; cartilage morselization; cartilage tiering, complications; and, revisions of radix graft implants.

This study examines the use of radix grafting in those instances where a high profile cannot be otherwise achieved. A broader utility of radix grafting is encouraged to maintain dorsal height in aesthetic rhinoplasty.
Revision Rhinoplasty and Frontal Prefabricated Island Flap in Partial Nasal Reconstruction
Authors: Meyer R.
Published: January 2017

Frequent late complications in partial nasal reconstructions are pinched nose and alar collapse. Both are managed by extra-mucosal dissection of the lining in the upper and lower lateral cartilage area and by supporting the alae with cartilage or composite grafts.

For surgical management of septal perforation up to 4 cm in diameter, the mucoperichondrium and the mucoperiosteum are dissected like a sleeve, facilitating suture of the perforation in both flaps. The procedure ends with the interposition of a dryed sheet of parietal fascia. For perforations larger than 4 cm in diameter, I advocate a three-stage procedure with a spoon-shaped compound buccal flap.

At the present time, the flaps I prefer are the compound forehead island flap, the frontotemporal flap, the fronto-parieto-postauricular occipital flap, and the oblique forehead flap. The frontotemporal and the compound island flap are already modeled as much as possible at the donor area using skin, mucosa, and cartilage grafts for prefabrication of the structures of tip alae and columella before transfer to the defect.
Treatment of the Heavy Upper Lid
Authors: Castillo Guillermo D.
Published: January 2017

The patient presenting with a heavy, curtain-like upper lid in the third or fourth decade of life poses a real surgical challenge and often receives excessive treatment and an unflattering outcome. These patients almost always have a pleasing but crowded upper lid and are frequently overoperated with a radical blepharoplasty. The crowded but pleasing horizontally based lid is thus changed to an unnaturally round lid and eye, which causes a disturbing change of character of the upper face. The author recommends treating such patients with a forehead lift and a very limited resection of skin and orbicularis strip. This modality preserves the horizontal characteristic of the lid and the three-dimensional harmony of the region, reducing the heaviness and curtain-like appearance and avoiding the creation of an unnatural, overoperated, round lid and eye.
Use of a Make-it-Yourself Sutured-in-Place Scalp Extender
Authors: Bridenstine James B.
Published: January 2017

A make-it-yourself scalp extender can be constructed by bonding a small strip of dacron-reinforced silicone sheeting to a long strip of plain silicone sheeting. Two or three such strips about 1.5 × 5 cm can be sutured to the galea at the time of standard scalp reduction and replaced if necessary after 4 weeks with proportionately shorter extender strips. To prevent adhesion of the galea to the periosteum between the strips, a large sheet of plain silicone sheeting is loosely placed or sutured to the periosteum between the strips and the periosteum. The use of such devices should allow twice as much bald scalp to be excised in half the time as conventional scalp reductions.
Post Peeling Dressing: The Advantages of the Omiderm Skin Substitute
Authors: Benmeir P. , Weinberg A. , Neuman A. , Cassuto D. , Wexler M. R.
Published: January 2017

Coverage of wounds after deep chemical peeling varies from exposure treatment with antibiotic ointment to coverage with mask tape and gauzes. We report here our experience with 20 patients who were treated by chemical peeling either as part of a rejuvenation procedure or because of recurrent superficial tumors in sun-damaged skin. The skin substitute Omiderm was used as an occlusive transparent tape mask. Omiderm is described and its advantages are emphasized. The relevant literature is reviewed.