Permanent soft tissue fillers.

As our youth-oriented society ages, interest in nonsurgical aesthetic techniques has generated a dramatic rise in the use of filling agents for facial rejuvenation. Backed by multiple published studies documenting safety and efficacy, soft tissue fillers are often viewed as treatments with minimal recovery time and limited risk of complications when compared with traditional surgical interventions. This has led to a genuine demand for fillers with similar safety profiles but ever increasing longevity in their aesthetic corrections. This review addresses many of the permanent soft tissue fillers that are commercially available worldwide as well as important concerns regarding their complications.

Large needle suction aspiration of permanent fillers.

Temporary injectable fillers have become so widely accepted within the cosmetic medical industry that permanent fillers with longer lasting effects are fast gaining popularity. Both patients and physicians alike have eagerly sought a product to minimize the inconvenience and cost of repeated injections. However, the fear is that the use of permanent fillers may lead to permanent problems. We describe here an in-office technique to remove permanent injectable fillers that achieves consistent, natural results with minimal risk of scarring.

Estradiol-mediated tumor neo-vascularization.

Neo-vascularization is essential for tumor growth and metastasis and is presumably initiated by bone marrow-derived endothelial progenitor cells (BM-EPCs). These cells predominantly reside in the bone marrow and are recruited at sites of inflammation, tissue damage and tumors. The tissue-specific factors responsible for recruitment of BM-EPCs and neo-vascularization are the subject of intense investigation. Using bone marrow cells from Tek/green fluorescent protein (GFP) transgenic mice, we analyzed the effect of estrogen on the mobilization of BM-EPCs to orthotopically implanted cancer cells in estrogen- and non-estrogen-supplemented ovariectomized mice. The donor marrow cells were unique as they were fluorescently tagged, allowing for the tracking of their migration to the tumor tissues. Results showed that GFP + BM-EPCs were incorporated within the tumor vasculature in comparison to the sham injections. Notably, estrogen supplementation enhanced the mobilization of BM-EPCs to the tumor site. This elevation shows that estrogen may affect tumor neo-vascularization by inducing the mobilization of BM-EPCs. Understanding and characterizing the mechanism involved in the estrogen-induced mobilization of BM-EPCs may serve as a 'Trojan horse' in the delivery of bio-molecules that may disrupt tumor vasculogenesis and induce the targeted killing of tumor cells.

Cost analysis of asymmetric sensorineural hearing loss investigations.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to critically evaluate the typical cost of asymmetrical sensorineural hearing loss (ASNHL) work-up, and to compare the positive predictive value from this common presenting symptom. STUDY DESIGN: Retrospective chart review from two major otolaryngology centers. METHODS: We reviewed charts from patients presenting to New York Eye and Ear Infirmary between January 1, 2006 and December 31, 2006, and the University of Minnesota between December 1, 2002 and November 30, 2007 with ASNHL. Diagnostic information included magnetic resonance imaging (MRI) and serum laboratory values (antinuclear antibodies, erythrocyte sedimentation rate, Lyme, rapid plasma reagin, and thyroid-stimulating hormone). We calculated positive rate according to each item of diagnosis. To estimate cost-benefit, we further calculated the average cost for identifying a patient with a positive result. RESULTS: The total cost was $263,535, whereas the average cost for identifying a positive patient was $146,40.81. The total lab cost was $16,935 and the total imaging cost was $246,600. The average cost for identifying a positive patient based on MRI was $61,650 and $2,109 based on lab values. Of the 247 patients, only six patients (2.4%)-one patient with acoustic neuroma, two patients with syphilis, and three patients with Lyme--were identified with treatable pathology. CONCLUSIONS: A comprehensive ASNHL work-up may not be applicable to all patients. Laboratory serologic tests are highly cost effective in diagnosing treatable causes of ASNHL, such as syphilis and Lyme. Although radiographic imaging with MRI is not as cost effective, its value in detecting for acoustic neuroma is undeniable.

Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study.

OBJECTIVE: To evaluate three current tonsillectomy techniques--intracapsular microdebridement, intracapsular coblation, and traditional extracapsular electrocautery dissection--comparing surgical parameters, efficacy, and morbidity in the treatment for obstructive sleep disordered breathing in children. STUDY DESIGN: Prospective, double-blinded study with follow-up by telephone interview. METHOD: From February 2004 to July 2006, a total of 156 patients between the ages of 6 months and 22 years scheduled for adenotonsillectomy were randomly assigned to electrocautery, coblator, and microdebrider groups. OUTCOME MEASURES: 1) Patient demographics; 2) Intraoperative time; 3) Surgeon's perception of difficulty; 4) Indicators of postoperative morbidity: pain, use of pain medication, return to diet, and activity level; 5) Complications; 6) Cost. RESULTS: Microdebrider technique produced the shortest total surgical time, averaging 16 minutes. Use of coblation resulted in 2 less days of pain medication compared to electrocautery. Patients in the coblator and microdebrider groups returned to a normal diet 1.51 days and 1.77 days earlier, respectively, than in the electrocautery group. They also returned to preoperative activity levels 1.85 days and 2.06 days earlier than in the electrocautery group. Of all three methods, the microdebrider was the most cost effective. The coblator and microdebrider did not differ significantly from each other in all other parameters. The three techniques showed no statistically significant difference in assessment of difficulty, average pain scores, or postoperative complications. CONCLUSIONS: Postoperative recovery following intracapsular adenotonsillectomy in children with obstructive sleep apnea is significantly earlier with use of either the coblator or microdebrider versus traditional extracapsular tonsillectomy with electrocautery. Microdebrider and coblator were comparable in all other areas except for shorter operative time and less cost for the microdebrider.