Effect of dietary zinc and phytase supplementation on botulinum toxin treatments.

Purpose: To determine whether oral zinc supplementation might affect the efficacy and duration of botulinum toxin treatments.

Methods: In a double-blind, placebo-controlled, crossover pilot study, we examined the efficacy of three botulinum toxin preparations (onabotulinumtoxinA, abobotulinumtoxinA, and rimabotulinumtoxinB) following oral supplementation with zinc citrate 50 mg and phytase 3,000 PU, zinc gluconate 10 mg, or lactulose placebo in individuals treated for cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm.

Results: In seventy-seven patients, 92% of subjects supplemented with zinc 50 mg and phytase experienced an average increase in toxin effect duration of nearly 30%, and 84% of participants reported a subjective increase in toxin effect, whereas no significant increase in duration or effect was reported by patients following supplementation with lactulose placebo or 10 mg of zinc gluconate.

Optimizing pediatric interdental fixation by use of a paramedian palatal fixation site.

Condylar fractures are the most common injury seen in pediatric mandibular trauma. These injuries often cannot be adequately stabilized by conservative techniques such as splinting. The pediatric condyle fracture often requires a period of intermaxillary fixation.

The current state of health care reform: the physicians' burden.

Congress has passed expansive legislation to "fix" health care. US health care, however, is not "broken"; rather, it functions according to purpose. The legal standard sets health care's purpose as high-quality care, not care at a pervasive quantity or low cost.

A comparative, long-term assessment of four soft tissue substitutes.

Background: The ideal product for soft tissue replacement is durable, nonimmunogenic, and noninfectious. AlloDerm (LifeCell Corp., Branchburg, New Jersey), Enduragen (Stryker Corp.

Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta-analysis.

Background: Minimizing complications after rhinoplasty is a priority for every surgeon performing the procedure. Perioperative steroid administration has been shown to decrease postoperative edema and ecchymosis in a number of prospective randomized trials.

Objectives: In an effort to further elucidate the significance of the data and develop an evidence-based algorithm for steroid administration, the authors offer a meta-analysis of the existing literature.

General management considerations in pediatric facial fractures.

The treatment of pediatric facial fractures, although similar to that of adults, requires a separate and thorough understanding of the unique developmental issues inherent to this age group. The contribution of several of these factors allows for a large portion of these injuries to be managed more conservatively; however, operative indications still exist. The optimal form of management in these situations must balance the risks of impacting dentition or future skeletal growth versus obtaining acceptable stability and reduction for healing.

Exploring the role of religiosity and spirituality in amniocentesis decision-making among Latinas.

Given the complex array of emotional and medical issues that may arise when making a decision about amniocentesis, women may find that their spiritual and/or religious beliefs can comfort and assist their decision-making process. Prior research has suggested that Latinas' spiritual and/or religious beliefs directly influence their amniocentesis decision. A more intimate look into whether Latinas utilize their beliefs during amniocentesis decision-making may provide an opportunity to better understand their experience.

The subtarsal incision: where should it be placed?

Purpose: The subtarsal incision is a frequently used approach to orbital floor fractures. Compared with the subciliary incision, there is a lower rate of lower lid retraction. Unlike the transconjunctival incision, there is no need to perform a lateral canthoplasty to restore canthal integrity.

Genital herpes.

Introduction: Genital herpes is an infection with herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2), and is among the most common sexually transmitted diseases.

Methods And Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent sexual transmission of herpes simplex virus? What are the effects of interventions to prevent transmission of herpes simplex virus from mother to neonate? What are the effects of antiviral treatment in people with a first episode of genital herpes? What are the effects of interventions to reduce the impact of recurrence? What are the effects of treatments in people with genital herpes and HIV? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Oral rapamycin in the treatment of patients with hamartoma syndromes and PTEN mutation.

Bannayan-Riley-Ruvacalba syndrome (BRRS) belongs to the PTEN hamartoma tumor syndromes and is characterized by a high risk of malignancy in early adulthood added to local destructive effects of hamartomas in childhood. There is no standard treatment for this condition and patients are usually offered symptomatic surgical relief. Rapamycin has been reported to be effective in the management of other conditions associated with PTEN mutation.

Packing and postoperative rhinoplasty management: a survey report.

Background: Postoperative management following rhinoplasty varies greatly among aesthetic surgeons. Few studies have addressed practice trends in postoperative rhinoplasty care or questioned the frequency of packing and splinting. Many conventional postoperative techniques remain controversial (eg, packing).

The rationale for direct linear closure of facial Mohs' defects.

Background: Closing Mohs' defects is a challenging undertaking for surgeons. There are many methods, including linear repair, local flaps, and skin grafts. Traditionally, geometric flaps have been a mainstay, particularly in the cheek and forehead.

Is primary thinning of the anterolateral thigh flap recommended?

Background: Although primary thinning of the anterolateral thigh (ALT) flap has been successful in Asia, clinical and anatomic studies have demonstrated that this may be inadvisable in Western patients. Recent reports have demonstrated successful thinning of the ALT using smaller flaps. A systematic review was attempted, to assess whether ALT size affects the incidence of vascular compromise after primary thinning.

The submental fat compartment of the neck.

The anatomic understanding of the superficial compartments of the head and neck are evolving. Recently, studies have shown that the superficial fat is sequestered into separate "compartments"; however, the superficial anatomy of the submental region of the neck has yet to be defined, and improved understanding of this area may lead to advances in our ability to rejuvenate the neck. This cadaveric investigation revealed that there is one superficial fat compartment in the submental region.

Facial fat compartments: a guide to filler placement.

Advances in anatomic understanding are frequently the basis upon which surgical techniques are advanced and refined. Recent anatomic studies of the superficial tissues of the face have led to an increased understanding of the compartmentalized nature of the subcutaneous fat. This report provides a review of the locations and characteristics of the facial fat compartments and provides examples of how this knowledge can be used clinically, specifically with regard to soft tissue fillers.

Optimizing the surgical management of zygomaticomaxillary complex fractures.

Zygomaticomaxillary complex (ZMC) fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Like other facial fractures, the optimal management of operative ZMC fractures requires anatomic reduction of all fractures followed by rigid internal fixation. However, surgical treatment of these fractures can be quite challenging with the potential for high rates of complications.