Laser blepharoplasty: is it safe?

The complications of the "traditional" blepharoplasty have been well outlined; however, very little can be found on the safety of lasers when used for blepharoplasty. In this article, 20 consecutive patients undergoing laser blepharoplasty are examined preoperatively and postoperatively for eye function and ocular injury by an independent ophthalmologist. Follow-up examinations were performed at random times after surgery ranging from 4 to 60 days, with the majority of patients (17 of 20) seen between 4 and 17 days after surgery. Any changes from the preoperative examinations were recorded. Results demonstrated no complications associated with the use of lasers during blepharoplasty. Safety precautions and surgical procedures are outlined. An attempt is made to separate those hazards specific to the laser technique from the "traditional" blepharoplasty procedure.

HIV seropositivity in a burn center's population.

HIV infection in a patient with burn injuries complicates the care of both the patient and the treating burn team. In the patient, HIV slows wound healing and increases the complications seen with burns. For the treating team, HIV is a hazard that infects the large volume of bodily fluids to which the burn team is potentially exposed. At Saint Francis Memorial Hospital, a team of plastic surgeons, infectious disease specialists, medical internists, psychiatrists, social workers, and nurses was established for the care of patients with burn injuries who have HIV. To ascertain the baseline need for this specialized care, we interviewed 103 consecutive patients admitted to the Bothin Burn Center. Those found to be positive by history (3 of 103) were excluded from HIV testing. Of the remaining 100 consecutive patients, all consented to HIV testing. None of these patients, even those with known risk factors, was found to have undiagnosed HIV positivity. We conclude the occult incidence in the population tested is lower than expected, and continued testing is warranted.

Treatment of thromboembolic complications of fulminant meningococcal septic shock.

A patient report of fulminant meningococcal septic shock is described. The presentation, hospital course, and reconstructive efforts are outlined, and a brief review of meningococcal infection is included. Emphasis is placed on the algorithm used to determine treatment. A 19-year-old Hispanic male presented with all the hallmarks of Waterhouse-Friderichsen syndrome (WFS)-sudden onset, high fever, dyspnea with intermittent cyanosis, shock, disseminated intravascular coagulopathy, and the development of purpura. The pathognomonic feature of WFS-hemorrhage into the adrenal glands-if present, was not extensive, as he did not require steroid supplementation. Though cerebrospinal fluid latex agglutination was negative, his serum was positive for group C Neisseria and admission blood cultures grew Neisseria meningitidis. Thromboembolic complications were systemic with the highest morbidity peripherally in the lower extremities. Care for these injuries involved every rung of the reconstructive ladder-from local wound care and skin grafts to local flaps and microvascular transplantation.

Teaching aesthetic surgery at the resident level.

The field of plastic and reconstructive surgery continues to broaden its scope while other fields continue to narrow theirs. The inability to teach aesthetic surgery is often confounded by the absence of an aesthetic surgery clinic for the chief resident, a reduced number of procedures and cases available, and a lack of faculty staff involvement. A close examination of the 19 western United States-based plastic surgery programs was performed in order to determine the most useful methods in teaching aesthetic surgery. An aesthetic surgery survey was distributed to most recently graduated plastic surgery residents to evaluate their overall experience in aesthetic surgery during residency. Of the 40 residents' surveys, 31 were returned. As anticipated, greater than half (51.6%) of the western United States programs were without a chief resident aesthetic clinic. Also, greater than half of those surveyed (51.6%) felt that the quantity of aesthetic cases was insufficient. The residents' comfort in performing specific operations was quite variable. From data analysis it is apparent there is a greater requirement for "hands-on" experience with aesthetic surgical cases during residency training. Overwhelmingly, the responses indicated the need for a Chief Resident Aesthetic Clinic, greater faculty involvement, and an increased clinic population with attending staff assistance. A 6-month chief resident aesthetic surgery clinic rotation at Saint Francis Memorial Hospital has proven to be very beneficial in teaching all aspects including pre-operative evaluation, surgical technique, and postoperative care of the aesthetic patient.

Chronic hyperpigmentation from a heated mustard compress burn: a case report.

This is a case study of a woman who sustained a second-degree, partial-thickness burn of the midchest and medial breast distribution after the application of a heated mustard compress as a naturopathic remedy for a recent bout of pneumonia. This case study demonstrates the potential for hyperpigmentation and hypertrophic scarring associated with heated mustard burns. A photograph of the presenting burn with the region of hyperpigmentation 3 days after the injury is provided.

Performance improvement: one model to reduce length of stay.

Dedicated quality professionals are tired of quick fixes, Band-Aids, and other first-aid strategies that offer only temporary relief of nagging problems rather than a long-term cure. Implementing strategies that can produce permanent solutions to crucial problems is a challenge confronted by organizations striving for continuous performance improvement. One vehicle, driven by data and customer requirements, that can help to solve problems and sustain success over time is the storyboard. This article illustrates the use of the storyboard as the framework for reducing length of stay--one of the most important problems facing healthcare organizations today.

Personal protection devices: a case for noisemakers.

The author explores alternative methods for preventing and responding to an attempted assault and presents a convincing argument for the use of noisemakers.