Evolving Clinical Experiences in Aesthetic Hip Implant Body Contouring.

BACKGROUND: Hip augmentation increases the hip width utilizing fat transfer and/or subcutaneous implants, creating a more feminine hourglass shape. Custom hip implant surgery requires proper patient selection, correct body frame analysis, appreciation of hip aesthetics, understanding surgical anatomy, optimal aesthetic planning, a favorable implant design and fabrication, skilled surgical implant placement, diligent postoperative patient care, and proper complication management. OBJECTIVES: The authors sought to evaluate the pioneering clinical experience with cosmetic custom hip silastic implants. METHODS: A consecutive patient surgical series of patients seeking custom aesthetic hip implant surgery was tabulated. Similar hip analysis, implant design and fabrication, surgical technique, and postoperative follow-up were performed in 3 practices. RESULTS: The overall patient satisfaction rate (87%, 47 of 54 patients) was favorable. There was a total of 29 (54%) medical complications and 20 (37%) cosmetic complications (implant show). A total of 17 patients (31.5%) requested revision surgery secondary to implant show (n = 10) and an infected implant (n = 6). No patient experienced an acute implant infection, incisional scar hypertrophy, wound dehiscence, implant extrusion, parasthesias, muscle dysfunction, or hip joint injury. CONCLUSIONS: The utilization of hip implants represents a new type of body contouring implant that has some unique differences in anatomic location, implant design, and tissue pocket location. Their utilization is an evolving one in aesthetic body implants, for which clinical experience to date remains limited in number. The proper surgical placement, postoperative management, and treatment of complications to include revision surgery are essential to achieving a successful body contouring outcome.

Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence.

PURPOSE: To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used for insomnia. REVIEWERS: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee. METHODS: A search of the World Wide Web was conducted using the terms insomnia, herbal remedies, and alternative treatments to develop a list of therapies. Therapies in this review include passionflower, valerian, Jamaican dogwood, hops, California poppy, chamomile, lemon balm, St. John's wort, kava kava, wild lettuce, scullcap, Patrinia root, first-generation histamine-1-receptor antagonists, alcohol, calcium, vitamin A, nicotinamide, magnesium, vitamin B12, I-tryptophan, 5-hydroxytryptophan, dietary changes, Natrum muriaticum, and Yoku-kan-san-ka-chimpi-hange. A search of the PubMed database was conducted in October 2002 using MeSH terms insomnia and each product listed in this paper, including only articles published in English between 1980 and 2002. Additional relevant articles from reference lists were also reviewed. Given the paucity of pediatric publications, this age group was excluded from this review. RESULTS AND CONCLUSIONS: Although randomized, placebo-controlled studies were available for a few compounds, rigorous scientific data supporting a beneficial effect were not found for the majority of herbal supplements, dietary changes, and other nutritional supplements popularly used for treating insomnia symptoms. Nevertheless, such treatments are described as alternative remedies for insomnia. Studies are limited by small numbers of participants and, in some instances, inadequate design, lack of statistical analysis, and sparse use of objective measurements. Sparse or no scientific data were found to support the efficacy of most products as hypnotics, including chamomile and St. John's wort. There is preliminary but conflicting evidence suggesting Valerian officinalis L. and first-generation histamine-1-receptor antagonists have efficacy as mild hypnotics over short-term use. There are significant potential risks associated with the use of Jamaican dogwood, kava kava, alcohol, and I-tryptophan. Physicians may find this information useful in counseling their patients.

Radiofrequency techniques in the treatment of sleep-disordered breathing.

The current medical information reviewing the use of radiofrequency in tissue volumetric reduction in the upper airway for nasal obstruction, primary snoring, and sleep-disordered breathing is reviewed. Reviews of the pathophysiology of sites of obstruction of the upper airway, indications for radiofrequency, procedure, technique, results, limitations and potential complications for each procedure, with the author's recommendations, are presented. The radiofrequency procedures are technically simple, minimally invasive, are associated with reduced postoperative pain compared with traditional surgical approaches, and can be performed on an outpatient basis under local anesthesia with a low complication rate and generally good therapeutic results. Future studies will aid in delineating the specific role of radiofrequency in nasal obstruction and sleep-disordered breathing.

Nonprescription treatments of snoring or obstructive sleep apnea: an evaluation of products with limited scientific evidence.

PURPOSE: To evaluate the level of evidence regarding the safety and efficacy of nonprescription therapies used to treat snoring and obstructive sleep apnea, and form a consensus statement based on available data. REVIEWERS: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee. METHODS: A search of PubMed database using MeSH terms snore, apnea, and obstructive sleep apnea in August, 2002, including only articles published in English between 1990 and 2002 and of the World Wide Web, using Google search engine and the key words snoring and obstructive sleep apnea. Letters were sent to manufacturers of lubricant oral and nasal products requesting copies of scientific studies to support their claims. RESULTS AND CONCLUSIONS: Given the paucity and quality of scientific literature regarding the nonpharmacologic treatment of snoring and obstructive sleep apnea, members of the Clinical Practice Review Committee had insufficient information to develop standards of practice recommendations. Nevertheless, substantial publicity regarding such treatments is available to the general public. Very limited data are available to support a beneficial effect of these devices on snoring and minimal evidence is available to support their use in treating obstructive sleep apnea. Studies are limited by small numbers of participants and, in some instances, inadequate design, lack of statistical analysis, and sparse use of objective measurements. Many studies do not evaluate product safety, especially over extended use. Physicians may find this information useful in counseling their patients.

Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications.

PURPOSE: To help practitioners avoid adverse perioperative events in patients with obstructive sleep-disordered breathing. REVIEWERS: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee. METHODS: A search of MEDLINE database using MeSH terms apnea, obstructive sleep apnea and anesthesia was conducted in October 2001. This review focuses on articles published in English between 1985 and 2001 that pertain to non-upper airway surgery in obstructive sleep apnea patients. RESULTS AND CONCLUSIONS: Scientific literature regarding the perioperative risk and best management techniques for OSAHS patients is scanty and of limited quality. There is insufficient information to develop an AASM standards of practice recommendation. Therefore, the Clinical Practice Review Committee (CPRC) used the available data to make this statement based upon a consensus of clinical experience and published peer-reviewed medical evidence. Important components of the perioperative management of OSAHS patients include a high degree of clinical suspicion, control of the airway throughout the perioperative period, judicious use of medications, and appropriate monitoring. Further research is needed to define the magnitude of risk and optimal perioperative care.

Long-Term Results of Maxillomandibular Advancement Surgery.

Surgery is a major modality in the treatment of obstructive sleep apnea syndrome (OSAS), and maxillomandibular advancement (MMA) has been shown to be the most effective surgical option. However, despite the successful short-term (6-9 months) results reported by various investigators, little is known of the long-term clinical outcomes. A review of our long-term clinical results demonstrated that MMA achieves long-term cure in most patients. Aging and minor weight gain did not appear to have a significant adverse effect on the long-term results; however, major weight gain did seem to have a significant negative impact on the long-term outcomes. Therefore, long-term follow-up with proper counseling on weight maintenance or reduction is essential in improving long-term results.