Rejuvenating the Face: An Analysis of 100 Absorbable Suture Suspension Patients.

Background: Absorbable suture suspension (Silhouette InstaLift, Sinclair Pharma, Irvine, CA) is a novel, minimally invasive system that utilizes a specially manufactured synthetic suture to help address the issues of facial aging, while minimizing the risks associated with historic thread lifting modalities.

Objectives: The purpose of the study was to assess the safety, efficacy, and patient satisfaction of the absorbable suture suspension system in regards to facial rejuvenation and midface volume enhancement.

Methods: The first 100 treated patients who underwent absorbable suture suspension, by the senior author, were critically evaluated.

What Neurotoxins Have Taught Us About the Brow: The Reintroduction and Review of the Transpalpebral Browpexy.

Introduction: The use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators.

Methods: A retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis.

A Rare Case of Malignant Transformation of Oral Lichen Planus of the Mandible.

Oral lichen planus (OLP) is an immune-mediated mucocutaneous disease associated with an increased risk in oral squamous cell carcinoma (OSCC). Nearly all cases of malignant transformation have been reported in patients >40 years old. We report the case of a 37-year-old woman with a 5-year history of erosive OLP who presented with malignant transformation to OSCC.

Transorbital endotracheal intubation: a nonstandard approach to a difficult airway.

We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His course was also complicated by severe radiation trismus, for which he was scheduled to undergo bilateral mandibular coronoidectomies. Given his limited mouth opening, the surgeon requested a nasal endotracheal tube.

Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury: preliminary results of a randomized controlled trial.

Background: After traumatic brain injury (TBI), catecholamines (CAs) may be needed to maintain adequate cerebral perfusion pressure (CPP), but there are no recommended alternative vasopressor therapies. This is an interim report of the first study to test the hypothesis that arginine vasopressin (AVP) is a safe and effective alternative to CAs for the management of CPP in patients with severe TBI.

Methods: Since 2008, all TBI patients requiring intracranial pressure monitoring at this Level 1 trauma center have been eligible for a randomized trial to receive either CA or AVP if vasopressors were required to maintain CPP greater than 60 mm Hg.

PT symmetry in classical and quantum statistical mechanics.

PT-symmetric Hamiltonians and transfer matrices arise naturally in statistical mechanics. These classical and quantum models often require the use of complex or negative weights and thus fall outside the conventional equilibrium statistical mechanics of Hermitian systems. PT-symmetric models form a natural class where the partition function is necessarily real, but not necessarily positive.

Effect of hetastarch bolus in trauma patients requiring emergency surgery.

Unlabelled: If blood products are not available, current military guidelines recommend a hetastarch bolus (HEX, Hextend 6% hetastarch in lactated electrolyte buffer, www. hospira.com) for initial treatment of hypovolemic shock in the field.

Emergent cricothyroidotomies for trauma: training considerations.

Background: Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons.

Methods: We conducted a retrospective analysis of all emergent cricothyroidotomies for trauma presentations performed at 2 large level I trauma centers over 10 years.

Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients.

Background: Reduced heart rate variability (HRV) reflects autonomic dysfunction and can triage patients better than routine trauma criteria or vital signs. However, there is questionable specificity and no consensus measurement technique. The purpose of this study was to analyze whether factors that alter autonomic function affect the specificity of HRV for assessing traumatic injury.

Pediatric facial trauma: a review of guidelines for assessment, evaluation, and management in the emergency department.

Approximately 22 million children in the United States sustain traumatic injuries every year, the etiologies of which vary with age as well as social and environmental factors. If not managed properly, these injuries can have a significant impact on future growth and development. Evaluation of facial injuries presents a unique diagnostic challenge in this population, as differences from adult anatomy and physiology can result in vastly different injury profiles.

Bispectral index to monitor propofol sedation in trauma patients.

Background: This study tested the hypothesis that the bispectral index (BIS) is reliable relative to clinical judgment for estimating sedation level during daily propofol spontaneous awakening trials (SATs) in trauma patients.

Methods: This was a prospective observational trial with waiver of consent conducted in the intensive care unit of Level I trauma center in 94 mechanically ventilated trauma patients sedated with propofol alone or in combination with midazolam. BIS, Richmond Agitation Sedation Scale (RASS), electromyography, and heart rate variability, as a test of autonomic function, were measured for 45 minutes during daily SATs.

Quark confinement and the renormalization group.

Recent approaches to quark confinement are reviewed, with an emphasis on their connection to renormalization group (RG) methods. Basic concepts related to confinement are introduced: the string tension, Wilson loops and Polyakov lines, string breaking, string tension scaling laws, centre symmetry breaking and the deconfinement transition at non-zero temperature. Current topics discussed include confinement on R(3)×S(1), the real-space RG, the functional RG and the Schwinger-Dyson equation approach to confinement.

Incidence and outcomes of extremity soft-tissue sarcomas in children.

Background: We studied the outcomes of pediatric extremity tumors on a population scale.

Methods: The Surveillance, Epidemiology, and End Results database (1973-2006) was queried for all patients under 20 y of age.

Results: Overall, 1175 patients were identified.

Predeployment mass casualty and clinical trauma training for US Army forward surgical teams.

Since the beginning of the program in 2002, 84 Forward Surgical Teams (FSTs) have rotated through the Army Trauma Training Center (ATTC) at the University of Miami/Ryder Trauma Center including all those deployed to Iraq and Afghanistan. The purpose of this study was to provide the latest updates of our experience with FSTs at the ATTC. Before deployment, each FST participates in a 2-week training rotation at the ATTC.

Emergency department assessment and management of facial trauma from war-related injuries.

Facial trauma related to combat injury is of increasing prevalence and complex in nature when associated with the multiply injured trauma victim. Although rarely life-threatening, the treating physician must be aware of the presence of facial trauma and its associated injuries to seamlessly treat the combat casualty in accordance to the Advanced Trauma Life Support protocol while maintaining the armed forces' ultimate goals of returning "the greatest possible number of soldiers to combat and the preservation of life, limb and eyesight in those who must be evacuated." To this end, the treating physician must maintain a high index of suspicion for injury and have various maneuvers available to handle immediate threats to life, limb, or sight.

First report on safety and efficacy of hetastarch solution for initial fluid resuscitation at a level 1 trauma center.

Background: For logistics, the US Army recommends Hextend (Hospira; 6% hetastarch in buffered electrolyte, HET) for battlefield resuscitation. To support this practice, there are laboratory data, but none in humans. To test the hypothesis that HET is safe and effective in trauma, we reviewed our first 6 months of use at a civilian level 1 trauma center.

A review of ureteral injuries after external trauma.

Introduction: Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma.

Heart rate variability as a triage tool in patients with trauma during prehospital helicopter transport.

Background: Prehospital triage of patients with trauma is routinely challenging, but more so in mass casualty situations and military operations. The purpose of this study was to prospectively test whether heart rate variability (HRV) could be used as a triage tool during helicopter transport of civilian patients with trauma.

Methods: After institutional review board approval and waiver of informed consent, 75 patients with trauma requiring prehospital helicopter transport to our level I center (from December 2007 to November 2008) were prospectively instrumented with a 2-Channel SEER Light recorder (GE Healthcare, Milwaukee, WI).

Surgery does not adversely affect survival in primary gastrointestinal lymphoma.

Objective: To evaluate the impact of surgery on gastrointestinal lymphoma.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1973 to 2005.

Results: A total of 17,222 cases of PGIL were identified.

Electrical burns of the upper extremity in the pediatric population.

Electrical burns of the upper extremity, particularly high-voltage injuries, are becoming more prevalent in today's society and are often times devastating to the patients' appearance and functionality. The basic tenants of flame burn reconstruction apply to electrical injuries. Namely, a patient should undergo basic trauma resuscitation, decompression and debridement within a reasonable timeframe, and definitive closure as soon as possible.

Burns of the developing breast.

Burns to the pediatric population are a prevalent problem that can have long-term if not fatal consequences. Although burns to the trunk have equally negative cosmetic effects from disfigurement for both boys and girls, burns to the trunk of the developing female, particularly those involving the breast, have an additional psychologic component due to the potential loss of femininity. This article aims to comprehensively review the proper management and treatment options for these patients based on mechanism of burn injury, both from an initial management and a staged reconstruction point of view.

Microbiology of burn wound infections.

One of the most complicated issues that surgeons face, in the care of burn patients, is infection. This includes both superficial and systemic infections. Systemic infection is the leading cause of death in this population.

Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach.

Background: Vacuum-assisted closure therapy has gained widespread use since its introduction in 1997. Previous studies have attributed significant benefit to its use for treatment of sternal wounds with or without mediastinitis. Management of sternal wounds with this therapy has been shown to decrease the number of dressing changes, reduce the time between débridement and definitive closure, and reduce costs associated with a protracted course of in-hospital dressing changes.