Major Academic Medical Centers Research Articles

The Use of Expanded Polytetrafluoroethylene (Gore-Tex) in Rhinoplasty: A 6-Year Experience

To determine the safety and efficacy of expanded polytetrafluoroethylene (Gore-Tex soft-tissue patch, W. L. Gore & Assoc Inc, Flagstaff, Ariz) as an implant in rhinoplasty. A retrospective study of 137 patients who underwent rhinoplasty including augmentation with Gore-Tex over a 6-year period. A review of the medical literature concerning the use of Gore-Tex as an implant in the head and neck was also conducted. Two major academic medical centers and two private office surgical centers. One hundred thirty-seven consecutive patients who received Gore-Tex implants in the course of rhinoplasty. Sixty-nine patients presented for primary rhinoplasty; the remaining 68 presented for revision surgery. All received Gore-Tex nasal implants to augment the nasal dorsum and/or base. The grafts ranged from 1 to 6 mm in thickness. Follow-up ranged from 6 to 80 months, with an average of 25 months. Clinically noted complications and patient satisfaction. Three (2.2%) of 137 grafts became infected and were removed. One graft was removed 5 months post-operatively because of excessive augmentation. None of the patients who underwent implant removal required subsequent augmentation. All 137 patients are pleased with their results. Gore-Tex is a safe and effective implant material to use in primary and revision rhinoplasty when augmentation is needed and autogenous material is not available or desirable.

Clinical Pulmonary Medicine

<i>Clinical Pulmonary Medicine</i>, a journal for both pulmonologists in clinical practice and critical care specialists, was created to provide concise and easy-to-read review articles encompassing recent advances in pulmonary medicine. The bimonthly issues include one or occasionally two review articles in each of seven subspecialty areas: obstructive airway disease; respiratory infections; interstitial, inflammatory, and occupational diseases; clinical practice management; critical care; and two more general departments, "Colleagues in Respiratory Medicine" and "Topics in Pulmonary Medicine." Each issue also includes summaries and commentary on three or four recent articles from other clinical journals. This format, if it can be maintained, promises to provide a comprehensive but focused educational tool for keeping practitioners current on major developments affecting pulmonary practice. The editorial board, led by editor-in-chief Michael S. Niederman, includes an elite group of US clinical practitioners, representing a cross-section of major academic medical centers. The review articles themselves are solicited by

Alcohol, drugs, and urban violence in a small city trauma center.

Substance abuse and urban trauma go hand in hand. But research focuses on large cities served by major academic medical centers. Do small cities face the same problems? Two hundred thirty-three urban trauma inpatients from a metro area of 250,000 were studied using patient interviews and medical records. As in large cities, one half used alcohol or drugs when attacked. Seventy percent were likely to be young, male, poor African-Americans. Only 3% were gang members, but demographic characteristics failed to explain substance abuse as they have for larger cities. A culture of violence pervades the small city, as it does in large urban ghettos. Two fifths were repeat urban trauma victims. Two fifths witnessed assaults in the past year. One third carried a knife or gun. Fifteen percent used a weapon on another person in the last year. Contextual variables, like being hurt in a bar, were related to drinking and drugs. The best predictor of present substance abuse and urban trauma was medical history of substance abuse. The need for (a) toxicology screens for all trauma victims, (b) referrals to substance abuse programs, (c) targeting at-risk populations for prevention, and (d) eliminating environments fostering violence and substance abuse is supported.

Adolescent Acquired Immunodeficiency Syndrome

The human immunodeficiency virus (HIV) epidemic may portend disaster or may become an opportunity for learning some of the basic lessons of medicine for those entering the ranks of health care workers in the 1990s. At present, a small cadre of health care professionals have dedicated themselves exclusively to the care of HIV-infected people. Although their number has increased in the past 8 years, they still represent a tiny fraction of total health care professionals. As they age or burn out, who will be there to take their places? 1 Major academic medical centers on the East and West coasts have not filled residency training slots with the candidates of their choice for the past several years. One of the reasons given by candidates and feared by training directors is the acquired immunodeficiency syndrome (AIDS) epidemic. The muchpublicized strain on existing resources, the emotional drain caused by caring for terminally

White paper on hospitalization for psoriasis care

Psoriasis is a common, chronic skin disorder that is conservatively estimated to affect between 1% and 2% of the population in the United States, not including mild cases. Despite the fact that psoriasis is one of the more common skin conditions requiring medical attention, it is poorly understood by the general public. This lack of information or misinformation on the part of health care administrators and insurers can affect the medical treatment of psoriasis and concomitant reimbursement in a manner that may be inappropriate and/or inadvertently deleterious to the patient's health care. The Committee on Psoriasis of the American Academy of Dermatology has sought to address this void. The Committee on Psoriasis is comprised of several dermatologists from the major academic medical centers in the United States. The combined expertise of this group reflects decades of experience in research, diagnosis, and treatment of psoriasis, as well as other skin diseases. This group has approved the “White Paper on Hospitalization for Psoriasis Care” as a straightforward, accurate, and well-documented source of information on psoriasis and psoriasis care. The purpose of this document is to explore the relevant medical aspects of the disease, its treatment modalities and their associated risks, and the outcomes of care.