Faculty Bibliography

Two fundamental determinants of men's health are confronted-racism and sexism-that the authors believe underlie many of the health disparities documented between women and men and place men of color at particular disadvantage in U.S. society. In doing so, the authors contend that race and gender, as well as racism and sexism, are social constructs and, therefore, amenable to change. They hope to allay concerns that gains in the health of men will come at the expense of continued advances in the health of women. Instead, by better understanding how the harsh intersections of racism and sexism have contorted roles for men of color and damaged their social ties, a healing process in intimate relationships, extended families, and entire communities may be fostered. Only by reforming historical injustices and reuniting men with their partners, families, and communities will sustained improvements in their health and well-being be realized.

BACKGROUND: Extended abdominoplasty in the patient with massive weight loss has traditionally been performed as an inpatient procedure. To date, there has been no report on the safety of outpatient extended abdominoplasty in the patient with massive weight loss. OBJECTIVE: The authors sought to evaluate the safety of outpatient abdominoplasty in this growing population of patients. METHODS: A retrospective chart review was performed of all the senior author's (C.M.B.) patients with massive weight loss who underwent extended abdominoplasty from November 2004 to August 2006. Each case was evaluated for demographic information, patient weight (pre-gastric bypass, pre-contour), body mass index (pre-gastric bypass, pre-contour), weight of specimen, anesthesia type, estimated blood loss, operating room time, length of stay, and drain management. The complications were compared with historical control subjects. RESULTS: A total of 19 patients, 16 female and 3 male, underwent extended abdominoplasty after massive weight loss. The average weight loss was 142 pounds. The average pre-gastric bypass body mass index was 52 kg/m(2). The average pre-contour body mass index was 29 kg/m(2). The average operative findings were as follows: estimated blood loss, 130 mL; specimen weight, 3288 g; and operative time, 132 minutes. There was no perioperative blood transfusion. All patients (100%) were discharged the same day. Overall complications in 5 patients (26%) included stitch abscess (5%), partial umbilical necrosis (5%), superficial wound dehiscence (10%), and seroma and bleeding (5%) in the same patient. CONCLUSIONS: With appropriate patient selection and operative techniques, outpatient extended abdominoplasty can be performed safely in the patient with massive weight loss

It is unclear whether Filipinos with sincipital encephaloceles have true orbital hypertelorism or just telecanthus. Knowing this determines whether orbital osteotomies or medial canthoplasty are more appropriate corrective procedures. To evaluate this, 56 sequential Filipino sincipital encephalocele patients (28 female and 28 male, average age 66.6 months, age range 4 days to 21.8 years) were evaluated for orbital width. Soft tissue measurements of inner and outer canthal position and CT measurements of medial and lateral orbital wall position were obtained. Normative data curves by age and sex for orbital bony and soft tissue distances in normal Filipino children were developed. Data was plotted on these curves and analyzed to determine if encephaloceles were associated with medial widening alone or true hypertelorism. Inner canthal measurements for male were approximately +2.8 standard deviation (SD) and female +2.3 SD wider than average. Medial orbital wall dimensions were wider for male +1.5 SD and female +1.4 SD. Lateral orbital measurements for both male and female clustered around the normative mean (males -0.5 SD and females -0.8 SD). Female outer canthal measurements also clustered around the normative mean (+0.6 SD wider) while male outer canthal measurements averaged approximately +1.1 SD wider than mean. As expected, measurements were wider medially when compared to normative data. However, lateral bony and soft tissue widening was minimal or approached normative averages. This suggests the problem is medial widening only and less invasive procedures such as medial canthoplasty or nasal bony contouring may be the most appropriate surgical management

BACKGROUND: The adaptive response of bone to mechanical strain, for which angiogenesis is required, is underscored during fracture healing. Vascular endothelial growth factor (VEGF) and transforming growth factor beta-1 (TGF-beta1) are critical regulators of angiogenesis. The purpose of this study was to examine the effect of strain on the production of VEGF and TGF-beta1. STUDY DESIGN: MC3T3-E1 mouse osteoblasts underwent cyclic strain (low, 0.1 Hz, or high, 0.2 Hz) for 24 or 48 hours. VEGF and TGF-beta1 protein levels were determined by ELISA, and Northern blot analysis was performed for VEGF mRNA. Alkaline phosphatase (an osteoblast differentiation marker) activity was determined by functional enzymatic assay. All measurements were standardized for cell number by crystal violet colorimetric assay. Statistical significance was determined by t-test, ANOVA, and the Tukey-Kramer test. RESULTS: Protein production of VEGF and TGF-beta1 was dose-dependently elevated by strain (p < 0.05); alkaline phosphatase did not rise significantly. Northern blot analysis of strained osteoblast cells demonstrated increased VEGF mRNA. Cyclic strain was found to be progressively destructive in a dose-dependent manner, causing 51% and 70% decreases in cell number under low and high strain, respectively (p < 0.01). CONCLUSIONS: We demonstrated simultaneous, dose-dependent increases in VEGF and TGF-beta1 protein production by osteoblastic cells in response to increasing strain. VEGF mRNA also increased in response to strain. This strain-induced increase in angiogenic cytokines suggests a potential mechanism by which injured bone may recruit a new blood supply. But we also found increasing strain to increase cellular toxicity, suggesting that cyclic mechanical strain may select for a subpopulation of osteoblasts

A 66-year-old man with silent sinus syndrome, resulting in progressive enophthalmos and subclinical chronic maxillary sinusitis, presented after several failed attempts at reconstruction with conventional methods. A free fibula osteoseptocutaneous flap was used to recreate the orbital floor, obliterate the maxillary sinus, and augment the periorbital contour deformity in a single stage. This is a novel approach for the treatment of Silent Sinus Syndrome in a single stage.

BACKGROUND: A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. METHODS: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. RESULTS: All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. CONCLUSIONS: Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure

Using their personal experience, the authors identify three key components to successfully completing a nursing doctoral program. The first component is asking the right questions to determine the doctoral degree best suited for the potential student. The second component is having a strategic plan that includes aspects such as financial considerations (research costs and potential financial support) and the development of a strong support system (specifically study pairs). The third component is the development of a systematic approach to completing the research, writing the dissertation, and completing the oral requirements. Addressing these areas will help students balance the many demands of doctoral study.

BACKGROUND: The aim of this study was to determine the incidence, outcomes, and risk factors for synechia formation after endoscopic sinus surgery (ESS) and middle turbinate medialization with and without FloSeal. METHODS: A retrospective review was performed of patients who underwent primary ESS with middle turbinate medialization, with or without the placement of FloSeal. Medialization was performed with the placement of an absorbable conchopexy suture and silastic splint. Operative variables and outcomes were analyzed to identify risk factors for synechia formation. RESULTS: One hundred thirty-five patients underwent medialization alone and 37 patients underwent medialization with placement of FloSeal. Overall, synechia formation was noted in 16 patients (9.3%). A statistically significant higher incidence of synechia formation was noted in patients who underwent middle turbinate medialization with the placement of FloSeal versus medialization alone (18.9% versus 6.7%). The incidences of intraoperative complications (6.2% versus 4.7%) and postoperative complications (6.2% versus 7%) were similar between patients with and without synechia, respectively. Patients experiencing synechia, however, underwent a statistically significant higher rate of revision procedures (25% versus 5.1%). CONCLUSION: Despite adequate prevention with middle turbinate medialization, synechia formation after ESS may result in higher rates of revision procedures. The placement of FloSeal in conjunction with middle turbinate medialization may result in a higher incidence of synechia formation