nose plastic surgery

2006-01-17T06:08:00.000-05:00

Byline: Julie Deardorff

As a special holiday-season promotion, the first 200 people who lined up outside the trendy Chicago nightclub Reserve on a recent frigid weeknight received $500 off liposuction or breast-augmentation surgeries from a local cosmetic-surgery practice.

In some ways, the pretentious dance club was the perfect place to randomly peddle surgeries that aren't medically necessary. The use of cosmetic surgery, which has become more affordable for the masses in recent years, is skewing toward a younger demographic. And inside crowded, deafening hot spots like Reserve, visible first impressions are really all that matters.

But in the wake of increasing demand for cosmetic surgery by both men and women, physicians have started offering discounts or trying other aggressive marketing incentives. Cut rates, early-bird specials, gift certificates and contests now make a serious medical procedure such as liposuction look like the sale of a handbag.

This raises ethical and safety concerns, ones that reality television shows such as "Extreme Makeover" have been able to gloss over, because the donated services aren't technically considered a prize. But the two major plastic surgery groups in the United States _ the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) _ have policies to protect people with unrealistic hopes from being preyed upon. Both groups expect members to refrain from offering surgeries as prizes at charity raffles or fundraisers or in other ways that bypass an initial evaluation by a doctor.

Last spring the Condell Medical Center in Libertyville, Ill., found this out the hard way. They offered their own version of an Extreme Makeover, which included free services from nine specialists, including a cosmetic surgeon. Candidates only had to be a U.S. citizen, a Lake County, Ill., resident, at least 25, have six weeks available for treatment and have a home support system.

Shortly after the newsletter advertising the contest was mailed, Condell officials discovered their embarrassing mistake; the cosmetic surgeon quickly pulled out and the promotion fizzled. "Without a plastic surgeon, it wasn't much of a makeover," said Donna Zradicka, Condell's marketing manager. "We'd hoped to make a difference for someone whether they were in an accident or living in a woman's shelter, but we couldn't find a way to deliver it (without violating the ethics code)."

The main problem with offering surgery as a door prize, a gift certificate or at a discount to partygoers is that it could compel someone who wasn't considering it to embark on an unnecessary procedure. It ignores the important first step in patient safety. That step involves an interview, physical exam and discussion of the benefits and risks to see if the patient is a good candidate. In some cases, a client might need to lose weight before surgery, or psychiatric care might be a better option than cosmetic surgery.

If every plastic surgeon were qualified, these marketing incentives might not be so problematic. But anyone with a medical degree can call himself a plastic surgeon. Academies provide weekend courses where dermatologists, gynecologists and even oral surgeons can get official-looking wall certificates. And they're not necessarily bound by the same rules and code of ethics as board-certified plastic surgeons.

To protect yourself, ask your doctor three questions: Are you board-certified? By which certifying body? And what is your specialty? (When asking your doctor about his area of expertise, a good answer is "plastic surgery." A not-so-great answer is "gynecology.") You can check their honesty with the American Board of Medical Specialty (www.abms.org), an entity comprising 24 medical specialty boards; the ABMS oversees physician certification in the U.S.

Though it's the season for gift giving, the ASAPS warns that surgeries should be self-motivated. Don't do it because you received a discount coupon or because someone else thinks your breasts should be perkier. If you must give someone a gift certificate, make it for one of the top five non-surgical procedures: Botox injections ($399 national average cost), a deep facial cleaning ($220), collagen injection ($399), laser hair removal ($382) or a chemical peel ($825).

Whether you want a straighter nose or a tummy tuck, the second word in cosmetic surgery is "surgery." If you're not satisfied, there is no 30-day return policy.

___

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2006-01-17T06:06:00.000-05:00

The Atlanta Journal and Constitution

08-31-2005

New face, new future Ga. surgeons offer hope to Zambian girl

Byline: TUCKER MCQUEEN

Edition: Home

Section: Atlanta & The World

Beatrice hid her face behind her fingers. The slight child slowly peeled back her fingers, revealing her eyes, mouth and nose. Her doctors smiled at the startling transformation.

The 8-year-old orphan from Zambia wasn't so sure. She had dreamed about having a nose, like other children, since she came to Atlanta for reconstructive surgery. As her team of doctors surrounded her for a final consultation Aug. 17, she wasn't comfortable with the new look.

She had lived without a nose since surgery for a tumor on her face as an infant left her with a hole where her nose and upper lip had been. Her appearance has always been more startling to others than the little girl with the upbeat personality.

Beatrice looked around the room at speech pathologist Kara Kenkle and Doctors Jack Thomas and Joseph Williams. She had known Williams the longest and gave him an approving glance and hug.

Williams, a pediatric craniofacial surgeon, praised the group responsible for the child's new face. The 9-member team, at Children's Healthcare of Atlanta at Scottish Rite, included two pediatric plastic surgeons and speech pathologists, a pediatrician, dentist, orthodontist, prosthodontist and audiologist. All donated their time.

"Our goal has always been to get Beatrice to a point where she is comfortable enough to enjoy being a child," said Williams.

Childspring International, an Atlanta-based organization that finds medical treatment for children, mostly from Third World countries, brought Beatrice to Atlanta 15 months ago. Helen Shepard, Childspring development director, said that in a few months, Beatrice will return to live at Emma's Kids, a Church of God ministry and school that helps street children in Zambia.

Her doctors say Beatrice will come back to Atlanta for future surgeries. Williams is happy with changes in his young patient but won't be totally satisfied until he can do another operation in about a year to bring her jaw forward. That will increase space in her head, improving her speech and appearance. When she is a teenager, she will have more work to build an upper lip and a permanent nose.

During the first procedure a year ago, Williams and Dr. Mark Deutsch took a flap of skin and vein from the child's right forearm and created a palate and platform for an upper lip by pulling the skin around a titanium plate.

In January, Williams took bone from her hip and transplanted it into her jaw. He also worked on bringing in the corners of her mouth.

In early August, Beatrice received a prosthetic nose, an acrylic appliance to cover the roof of her mouth, and a partial denture attaching new teeth to existing teeth in the back of her mouth.

Thomas, a pediatric dentist, said the piece allows Beatrice to speak easier and normalizes the mouth and nose by separating them.

"She has a normal-looking smile now. She looks tremendous," he said. "This has made her more social and confident."

After her second surgery, Beatrice moved from a home in Smyrna to live with a family in Alpharetta. Her temporary guardian, who doesn't want to be named, said the little girl has adapted well to her two children, a houseful of animals and a busy life in suburban Atlanta.

When Beatrice started kindergarten a few weeks ago, she decided to leave her new nose at home. Her caregivers think having a nose was a more dramatic change than the little girl anticipated, and it will take awhile for her to adjust.

"We aren't through yet, but we are close," said Williams. "What we wanted was to give her a chance for a normal life. In a lot of ways, we've done just that."

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice shyly covers her face with both her hands.

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice covers half her reconstructed face with one hand.

CAPTION: ANDY SHARP / Staff 8-year-old Zambian orphan Beatrice reveals her reconstructed face to the camera.

CAPTION: ANDY SHARP / Staff "We wanted . . . to give her a chance for a normal life," said Atlanta craniofacial surgeon Dr. Joseph Williams of his huggable little patient, 8-year-old Zambian orphan Beatrice.

(Copyright, The Atlanta Journal and Constitution - 2005)

2006-01-12T16:26:00.000-05:00

Larger cutaneous defects of the face and cheek can be a particular challenge to reconstructive surgeons. By combining multiple surgical techniques in a planned multistage reconstruction, maximum scar camouflage can be achieved.

A 65-year-old man presented with a 22-mm defect of the left cheek following Mohs surgery (figure 1, A). Given the patient's age, the relaxed skin tension lines (RSTLs) of the face were easy to delineate (figure 1, B). The design of the initial reconstruction (figure 2) was based on two principles. First, a 30[degrees] elliptical excision and closure was designed along the axis of the RSTLs. Second, a geometric broken-line closure (GBLC) was designed into the tails of the excision.

[FIGURES 1-2 OMITTED

Four weeks postoperatively, as scar contracture began, a small irregularity was seen along the inferior edge of the closure (figure 3, A). This was reexcised and closed during a minor procedure.

[FIGURE 3 OMITTED]

The patient was allowed to heal for 6 weeks, and then a left cheek dermabrasion was performed (figure 3, B). The final result was a very well-camouflaged scar, given the extent of the original defect (figure 4).

[FIGURE 4 OMITTED]

The result of combining multiple surgical modalities--in this case, an elliptical excision along the RSTLs, a GBLC, a small touch-up procedure, and dermabrasion--was a well-camouflaged scar, as well as a very pleased patient and surgeon.

From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City.

2006-01-08T01:37:00.000-05:00

The Tampa Tribune

10-09-2005

Paper Carrier Retires After Amazing Run

Byline: JUDY HILL

Edition: FINAL

Section: BAYLIFE

Sunday October 09, 2005

Section BAYLIFE

Page 1

Paper Carrier Retires After Amazing Run

By JUDY HILL

jhill@tampatrib.com

Except for a few during vacations, today is the first Sunday in 29 years that Al Lueck will get to sleep in.

Someone else will deliver 330 copies of The Tampa Tribune to subscribers in Northdale on what used to be Lueck's paper route.

Oct. 2 was his last day.

As someone who would rather have gum surgery without anesthesia than get up before dawn, I have boundless admiration for all who do -- particularly those who do it seven days a week.

Given my almost pathological aversion to early wake-up calls, the first question I asked Lueck was: "What time did you get up?"

He laughed.

His morning usually began before 3:30 -- earlier on Sunday, when it takes longer to put the paper together.

Carriers insert all the supplements -- advertising sections and so forth -- to the news sections. They also put the papers into plastic bags that keep them from getting wet.

Lueck's first job of the day often ended by 6:30 a.m., giving him plenty of time for job No. 2. He worked in the pest control industry for years and still has a couple of customers.

Subscribers No. 1

Lueck -- pronounced "luck" -- will be hard to replace.

Customer service was his top priority, says Tribune circulation division manager Dave Miller, who worked with Lueck 13 years.

"He accommodated special subscriber requests, including taking the paper to the door for the disabled. He won several awards through the years for his outstanding service. He delivered during the hurricanes last year without a problem. He's delivered sample bags with soap, cereal, lotion, razors, perfume, trash bags, breakfast bars and candy."

Lueck also distributed the weekly Carrollwood News to nonsubscribers along his route in northern Hillsborough County.

Miller added that Lueck's reliability was outstanding.

"It's hard to find people of his character who would stick with a job seven days a week, and you never had to worry about his route. He was a loyal, conscientious carrier who will be missed by the Tribune and our subscribers."

Dedicated Duo

Lueck, whose wife, Karen, also worked as a carrier and route supervisor -- her Tribune career lasted 23 years -- is an "aw- shucks" kind of guy who shies away from compliments.

But he is proud of his service.

"Except for the times I went on vacation, I never missed," he said.

"I did it when I was sick. I did it when I had a broken foot, a broken ankle, stitches in my finger. Just like the mailman, I was always there."

At one point, when both Al and Karen were throwing papers, they worked eight years straight without a day off. The couple came to Tampa from Nebraska for the warm weather in the 1970s.

They became avid scuba divers; delivering papers gave them plenty of daylight hours for diving.

Karen became a carrier after Al -- and quit before him. She now works at USAA.

Al estimates that in 29 years on the job, he delivered 1,740,000 papers, drove 350,000 miles and went through 15 to 20 vehicles.

He would still be throwing Tribunes but for rotator cuff injuries that required surgery this year. Throwing 7-pound Sunday papers got to be too much, he said.

On this first Sunday off, he may sleep a little later than usual. He has taken to snoozing till 5:30 a.m. since his retirement.

Why still so early?

"I fix Karen's coffee."

Copyright (c) 2005, The Tampa Tribune and may not be republished without permission. E-mail library@tampatrib.com

Illustrations/Photos:

Caption: </CAPTION>;

Copyright (c) 2005 The Tampa Tribune. All rights reserved.

2005-12-23T10:38:00.000-05:00

QUESTION: Are waterborne infections a common concern in health care facilities? Can our water supply contribute to infection transmission? How does the transmission occur? What types of microbes cause waterborne infections? Which patients are most at risk? How can health care facilities reduce the risk of waterborne infections?

ANSWER: Water supplies can contribute to infection transmission. Microbe survival in a hospital's water supply was first identified more than 30 years ago. (1) The water supply also is one of the most controllable sources of nosocomial microbes in health care settings. (1) Health care providers and administrators may believe they do not have a problem in their facility, but they may not be performing the correct type of sampling and culturing of their water. (2)

Waterborne infections transmission comes from the buildup of biofilm on and corrosion of water supply lines and lining of the water tank. Increased water use or construction during summer months increases the possibility that stagnant water in the lines will loosen organisms from biofilm, which then enter the water supply. (1) Water tap aerators that have become corroded also can collect biofilm. (3)

Exposure can occur when a patient showers, bathes in, or drinks the water. Transmission also may occur via equipment that becomes contaminated with the tap water used to rinse or wipe equipment or by health care workers contacting contaminated equipment. (1) Aerosolization of contaminated water sources also may be a means of waterborne infection transmission. (2)

Gram-negative bacilli identified as causing waterborne infections are

* Acinetobacter species,

* Burkholderia cepacia,

* Chryseobacterium species,

* Ewingella species,

* Legionella species,

* Pseudomonas species,

* Serratia marcescens, and

* Stenotrophomonas maltophilia.

Pseudomonas aeruginosa, a well-known pathogen that causes nosocomial outbreaks, (4) does well in moist and humid environments where it can grow in large numbers with hardly any sustenance. (3) For example, Pseudomonas aeruginosa can grow in endoscopes and spray bottles.

Fungi also can cause hospital-acquired infections that may be linked to a hospital's water supply. Examples of fungi cultured from shower heads include Aspergillus species and Fusarium. These fungi also can be transmitted to patients via aerosolization. Aspergillus fumigatus can cause pneumonia and, in certain circumstances, surgical site infections.

Mycobacterium species, excluding Mycobacterium tuberculosis, may be found in the water supply. Some Mycobacterium species can survive and grow in water temperatures greater than or equal to 45[degrees]F (7.2[degrees]C). Nontuberculous mycobacterium has caused infections in cardiac and plastic surgery procedures, as well as dialysis and injection sites. Nontuberculous mycobacterium are resistant to some disinfectants, including chlorine, glutaraldehyde, and formaldehyde. (4)

Immunosuppressed or immunocompromised patients are at higher risk for contracting waterborne infections. Patients who may be reasonably immune and who exposed to water that has microbes with a high level of virulence also may be at risk. These patients may have had an invasive or diagnostic procedure (eg, laparoscopy, colonoscopy, endoscopy). (5)

One step in preventing waterborne infections is using filters that remove bacteria. The Centers for Disease Control and Prevention recommends that the water filters have 0.2 micrometer filtration capability. Filters are successful in filtering bacteria and can be placed easily on faucets and showers. (2) Cleaning of faucets and aerators should include removing corrosion, although this may not be an effective method for decreasing buildup of microbes. (5) An alternative method would be to remove the aerators and place a filter on the faucets. (2) Chemical disinfection (eg, adding chlorine to the water) can be used but may change the taste of the water and possibly could lead to development of multiple resistant strains of microbes. Running water that is heated to 75[degrees]F (24[degrees]C) for 60 minutes may be another measure for filtration but is difficult to accomplish in a health care setting. (5)

Waterborne infections are a serious concern. Protecting patients from acquiring a waterborne infection is key to decreasing the potential for infection. Good environmental cleaning and use of water filtration systems helps provide a barrier to transmission of waterborne infections.

QUESTION: Frequently, we have to take cultures of the surgical wound during surgery. We usually use a cotton swab to collect drainage or fluid present in the wound. Is this an appropriate method for obtaining a wound culture? Does this give an accurate report of what is growing in the wound? What are some identified problems with specimen collection? What are essential steps for safe handling of specimens?

ANSWER: Using a cotton swab is not always the appropriate method for collecting a wound culture. Anaerobic cultures should be collected by aspirating the fluid using a sterile syringe and needle to ensure that atmospheric oxygen does not come in contact with the specimen. Surface lesions must be cleaned and then opened to obtain a sample of the margin. When collecting aspirated material or material with a needle and syringe, the specimen should not be placed on a swab.

Collected aspirates should be placed in a sterile tube or vial. (6)

Specimens should be chosen that reflect the disease process occurring in the patient. Specimens frequently arrive in the laboratory mislabeled or without appropriate labeling. Following are a few examples of errors that can occur during specimen collection and labeling.

* Wound specimens--Identifying a specimen as "wound" is inadequate. The actual wound site should be specified. The paperwork should state whether the culture was taken at the superficial level or deeper. Exudate by itself does not give an accurate culture result because it may only show contaminants.

* Ear specimens--These specimens usually are obtained from patients with otitis media. Swabbing material from the ear canal is not appropriate. The fluid should be obtained by using a small-gauge needle and syringe. Swabbing a specimen should only be performed if the tympanic membrane has ruptured.

* Sputum specimens--These specimens very often are contaminated with oropharyngeal flora. A bronchoalveolar lavage or a transtracheal aspirate would provide a more appropriate sample for culturing. (6)

The essentials for safe handling of specimens include

* using an appropriate container for the specific type of specimen being collected;

* labeling specimen containers correctly on and off the field;

* identifying the patient, tissue, and specimen source correctly;

* verifying the type of specimen and appropriate patient information before transferring the specimen off the sterile field;

* handing the specimen off the sterile field safely;

* transferring the specimen safely to the point of use;

* ensuring that a tracking mechanism for the specimen is in place and used correctly;

* documenting verbal and written instructions on the laboratory form and patient record and within the tracking system;

* ensuring appropriate storage and maintenance of specimens before they are sent to the laboratory; and

* transferring specimens to the laboratory safely. (7) Using the correct method to obtain a wound culture should provide an accurate culture result.

QUESTION: We have seen the ambulatory National Patient Safety Goats from the Joint Commission on Accreditation of Healthcare Organizations. We have heard that there are new hospital National Patient Safety Goals. What is new for 2006 and how will the new goats work in the perioperative areas?

ANSWER: Two new 2006 hospital National Patient Safety Goal requirements will involve perioperative patient care.

* Requirement 2E--Implement a standardized approach to "hand-off" communications, including an opportunity to ask and respond to questions. (8) An example of hand-off communications is the report given by the circulating nurse to the postanesthesia care unit (PACU) nurse when the patient is taken to the PACU after the surgical procedure is completed. This includes discussing

** a baseline assessment of the patient;

** the patient's skin condition and position during the procedure;

** the patient's skin condition and placement site for electrodes;

** irrigating fluids used in the wound;

** medications or dyes used during the procedure;

** types, numbers, and sites of implants, transplants, or explants;

** drains, stents, and dressings;

** any other information relevant to the patient's care; and

** family members and others present and their locations. (9)

* Requirement 3D--Label all medications, medication containers (eg, syringes, medication cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings. (8) AORN's guidance statement, "Safe medication practices in perioperative practice settings," addresses the need for labeling medications on and off the sterile field. (10) The essentials for safe medication practice include

** verifying that medication labels are accurate;

** delivering medications onto the sterile field in an aseptic manner;

** labeling medications on and off the sterile field and confirming each label;

** communicating the type of medication, strength, and dosage as the medication is passed to the person who will administer the medication; and

** knowing the dose limits and monitoring the patient for any untoward reactions to the medications. (10)

AORN's "Recommended practices for safe care through identification of potential hazards in the surgical environment" also addresses medications delivered to the sterile field. (11) As a precaution, all medication containers should remain available until the procedure is completed. (10) AORN has developed a Safe Medication Administration Tool Kit that offers a comprehensive approach for safely administering medications to promote good patient outcomes. The tool kit includes a CD ROM; a conversions and calculations pocket guide; and an herbal and dietary supplement poster that presents common indications, side effects, and herbal and dietary supplement medication interactions. For more information on the medication tool kit, call AORN at (800) 755-2676 x 1.

QUESTION: Our hospital is concerned about postoperative sternal infections after open heart surgery. The heart surgeon is using a vancomycin paste on the edges of the sternum before the sternum is wired closed at the end of the procedure. The vancomycin vial is sterilized by steam sterilization or by ethylene oxide sterilization and then placed on the sterile field where a paste is made of the contents and applied to the edges of the sternum. Is this an appropriate method of using vancomycin? Is this an appropriate method of achieving antibiotic prophylaxis?

ANSWER: Sternal infections after open-heart surgery are a concern. Vancomycin is not approved for topical use. It is only approved for use via oral and IV routes of administration. (12) The vancomycin material safety data sheet states that it can be irritating to eyes, mucous membranes, and the respiratory tract. Furthermore, vials should be stored at room temperature (59[degrees]F to 86[degrees]F [15[degrees]C to 30[degrees]C]) before they are reconstituted. (13)

The Centers for Medicare and Medicaid Services National Surgical Infection Prevention Project prophylaxis recommendations for cardiothoracic surgery is cefazolin or cefuroxime, 30 to 60 minutes before the incision is made. Vancomycin or clindamycin can be used if the patient has an allergy to beta lactams. If vancomycin is used, it should be administered two hours before the incision is made. (14) Vancomycin should be used according to the manufacturer's guidelines and the appropriate route should be used for prophylaxis.

QUESTION: We are concerned about vaginal prep solutions. What is AORN's recommendation for selecting a skin preparation product? Should chlorhexidine be used for vaginal preps?

ANSWER: AORN's Recommended practice for product selection," provides criteria to be used during product selection. These include

* safety,

* quality,

* effectiveness,

* purpose and use,

* ease of use,

* compatibility with other products,

* appropriate clinical outcomes, and

* efficacy. (15)

Evaluation should be performed with each new product selected. (15) AORN's "Recommended practices for skin preparation" states that the antiseptic agent selected should be used according to the manufacturer's guidelines. (16) Guidelines provided by the Association for Professionals in Infection Control and Epidemiology and the US Food and Drug Administration should be reviewed when selecting antiseptics.

Chlorhexidine gluconate may cause allergic reactions including irritation and sensitization when used in the genital areas. (16) After a product is selected, follow the manufacturer's guideline and AORN's "Recommended practices for skin preparation," when performing vaginal preps. (16,17)

QUESTION: We use disposable, cordless, battery-operated electrocautery hand pieces for some small surgeries. These are disposed of in the trash. Is there a potential fire hazard from disposing of them in this manner?

ANSWER: There is a potential for starting a fire if the tip of the cordless electrocautery hand piece is not removed and the cap is not replaced before it is put in the trash. The weight of trash placed on top of the electrocautery hand piece could activate the unit if the on/off switch is in the on position. This could cause the electrocautery wire to heat. It is important that all staff members be instructed in proper disposal of cordless electrocautery hand pieces. (18)

The safest practice when using a cordless electrocautery hand piece is to dispose of the electrocautery hand piece in a fire-rated sharps disposal container after the tip is removed and the cap is replaced. For additional resources on fire prevention, see the AORN "Position statement on fire prevention," at http://www.aorn.org /about/positions/pdf/Final%20PS %20on%20Fire%20Prevention .pdf and the "Guidance statement on fire prevention in the operating room" at http://www .aorn.org/about/positions/pdf/SEC TI-2e-firesafety.pdf.

Editor's note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices. from members and other interested individuals. When available, these proposed recommended practices appear on AORN Online at http://www.aorn.org. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling, the Center for Nursing, Practice at (800) 755-2676 x 334. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.

NOTES

(1.) E Anaissie et al, "The hospital water supply as a source of nosocomial infections: A plea for action," Archives of Internal Medicine 162 (July 8, 2002) 1483-1492.

(2.) J Schraag, "Waterborne pathogens: What's lurking in your facility's pipes?" Infection Control Today 9 (July 2005) 14-19.

(3.) M Trautmann et al, "Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism," American Journal of Infection Control 33 Suppl 1 (June 2005) S1-S49.

(4.) G Orotolans et al, "Hospital water point-of-use filtration: A complementary strategy to reduce the risk of nosocomial infection," American Journal of Infection Control 33 Suppl 1 (June 2005) S1-S19.

(5.) C Squier et al, "Waterborne nosocomial infections," Current Infectious Disease Reports 2 (December 2000) 490-496.

(6.) J M Miller, A Guide to Specimen Management in Clinical Microbiology, second ed (Herndon, Va: American Society of Microbiology Press, 1999) 5-6.

(7.) "Safe specimen identification, collection, and handling in perioperative practice settings," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 205-207. Also available at http://www.aorn.org/about/positions /pdf/SECTI-2e-spechandling .pdf (accessed 20 July 2005).

(8.) "2006 critical access hospital and hospital National Patient Safety Goals," Joint Commission on Accreditation of Healthcare Organizations, http://www.jcaho .org/accredited+organizations/patient +safety/06_npsg/06_npsg_cah_ hap.htm (accessed 20 July 2005).

(9.) N Phillips, Berry & Kohn's Operating Room Technique, 10th ed (St Louis: Mosby, 2004) 585.

(10.) "Safe medication practices in perioperative practice settings," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 196-198.

(11.) "Recommended practices for safe care through identification of potential hazards in the surgical environment," Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 389-390.

(12.) G Spratto, A Woods, PDR Nurse's Drug Handbook (Clifton Park, NY: Thomson Delmar Learning, 2004) 1225-1227.

(13.) "Vancomycin hydrochloride for injection," Eli Lilly and Company, http://www.ehs.lilly.com /msds/msds_vancomycin_hydrochlo ride_for_injection.html (accessed 21 July 2005).

(14.) D Bratzler, P Houck, "Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project," Clinical Infectious Diseases 38 (June 15, 2004) 1706-1715.

(15.) "Recommended practices for product selection in the perioperative practice setting," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 433-436.

(16.) "Recommended practices for skin preparation of patients," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 445-451.

(17.) "Hibiclens antiseptic/antimicrobial skin cleanser," Regent Medical, http://www.regentmedical.com/americas/hibiclens_information.html (accessed 25 July 2005).

(18.) S Beumer, "Potential fire threat at medical offices," (memorandum to Aurora, Colo, Fire Department personnel) Aurora, Colo, June 29, 2005.

JOAN BLANCHARD

RN, MAOM, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

2005-12-15T19:37:00.000-05:00

New Pittsburgh Courier

01-23-2005

Over the last decade, plastic surgery has become a mainstay in our society.

Not only have celebrities such as Joan Rivers, comedienne Kathy Griffith

and Carnie Wilson become self-professed plastic surgery advocates, but

average men and women jumped on the cosmetic surgery bandwagon, as

aesthetic enhancements have become a regular fixture in our culture.

Programs about cosmetic surgery such as ABC's "Extreme Makeover" and MTV's

"I Want A Famous Face" have perpetuated the trend making that used to be a

dirty little secret, something that people now regularly boast about having

done.

The American Society for Aesthetic Plastic Surgery, the leading national

organization of board-certified plastic surgeons that specialize in

cosmetic surgery has announced their plastic surgery trend predictions for

2005. Below is a summation of those predictions.

* Hello restalyne, goodbye collagen: New, long lasting soft tissue fillers

for facial wrinkles and creases will challenge collagen for the number one

spot among injectable cosmetic treatments.

* Facial rejuvenation: Endoscopic (arthroscopic) facial rejuvenation

procedures will increase in popularity. Suture suspension techniques that

promise facial rejuvenation with minimal downtime will also be a popular

trend. There will be many patients who will still opt for traditional

facelifts or endoscopic procedures with more predictable and lasting

results.

* Total body surgery: The number of total body lifts, including torso,

breasts and for some patients, face and neck will increase, as post

bariatric surgery patients seek plastic surgery to rid themselves of excess

skin left hanging after massive weight loss.

* Biggest buzz: A new generation of breast implant fillers and coatings,

advanced lasers that rejuvenate the skin from the inside out, new products

for scar management and keloid prevention.

* Lifestyle assessment referrals: After receiving plastic surgery, doctors

will refer their patients to other health and beauty professionals

including specialists in nutrition, weight management and cosmetic

dentistry.

* Emphasis on nostalgia & elegance: More cosmetic surgery patients will

express a preference for classical facial features embodied by celebrities

like Nicole Kidman and icons like Grace Kelly.

* Ethnic minorities: Cosmetic surgery for racial and ethnic minorities in

the United States will increase.

* Patient safety: National attention will result in more stringent

requirements for physician credentials to perform cosmetic surgery.

* Non-invasive fat removal: Experimental techniques that will offer a

non-invasive alternative to liposuction will be tested in clinical trials.

* "Reality" TV: The long term psychological effect of undergoing a dramatic

change in appearance from simultaneous multiple-procedures, as is common

for participants of reality shows, may surface in 2005.

Article copyright the New Pittsburgh Courier Publishing Company.

2005-12-14T03:37:00.000-05:00

Birmingham Post

05-24-2005

Now teenage boys want nip/tuck

Edition: FIRST

Section: News

A quarter of teenage boys would consider plastic surgery to try to match the looks and physiques of their celebrity idols, says research published today.

The study - of 2,000 boys aged about 15 - found young males agonised about their appearance just as much as teenage girls. And they crave the winning smile of Brad Pitt or the 'six-pack' stomach muscles of David Beckham.

Researchers said ten per cent believe they will definitely go under the knife for plastic surgery and26 per cent said they would possibly have cosmetic operations. Just 13 per cent of teenage boys said they were happy with their bodies.

The most commonly coveted procedures were liposuction, penis enlargement and a nose job.

About 84 per cent of the teenagers believed a better body would improve their life. They said pressure from girls (42 per cent), celebrity pictures (28 per cent) and comment from other men (24 per cent) had fuelled their loss of self-confidence. Respondents to the study, commissioned by weekly teenage magazine SNEAK, hinted that they ignored traditional taboos about using beauty products - with almost three-quarters saying they would use fake tan, hair dye and moisturiser.

More than three-quarters (76 per cent) said they have been depressed about their looks, six out of ten claimed they worry about their body size and shape at least twice a week and more than a quarter (28 per cent) said they had concerns every day

(Copyright 2005 Birmingham Post and Mail Ltd.)

2005-12-11T16:45:00.000-05:00

2005-12-05T02:13:00.000-05:00

Byline: Donna Halvorsen; Staff Writer

Marjorie Therres got a new left hip on a Wednesday, and she was walking with a walker outside her hospital room the next day.

"You surprised everyone," said Dr. Mark Heller, the orthopedic surgeon who implanted the hip in the 77-year-old Minneapolis woman.

Everyone, that is, except Heller, a champion of minimally invasive hip surgery. Therres was one of the first Minnesotans to have the new type of surgery, which is done to get people back on their feet faster, with shorter hospital stays, less pain and fewer narcotic pain relievers.

Therres was able to travel to her lake home three days after surgery, and the next week when she saw Heller, she was taking only Tylenol for pain. She was still using a walker, but Heller said she was doing well.

"I think the only reason you're using the walker now is that that knee is so bad," he told her, adding that he'll replace the severely arthritic knee whenever she's ready.

But the new hip was fine. Therres said she had some stiffness but couldn't really feel that it was there.

Minimally invasive hip replacement surgery requires two small incisions instead of one large one and folds muscles and tendons back rather than cutting through them.

Experts say it's the cutting that creates pain and requires a longer hospital stay, perhaps some time in a nursing home and then weeks of recovery at home before the patient can do any serious walking.

In Chicago, many patients of Dr. Richard Berger, a pioneer of the minimally invasive approach, go home the same day.

A new standard

Heller, who is affiliated with the Minnesota Orthopaedic Specialists in Edina, performs 150 hip surgeries a year. He said that same-day standards will probably be the norm here, too, once physicians have had more experience with the procedure. He was trained in it earlier this year and has been using it about four months. The new procedure makes up only 10 percent of his practice so far, but he expects it to grow to 90 percent.

The new procedure is controversial in medical circles. In the June issue of the Journal of Arthroplasty, Dr. David Hungerford of Johns Hopkins University in Baltimore said that while conventional hip surgery has been studied extensively, the minimally invasive technique has not. "For this to be widespread, you have to convince skeptics like me," Hungerford said at the March meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

Berger, of Chicago, told the gathering that his early patients stayed in the hospital three or four days but recuperated faster, using crutches for an average of five days or a cane for eight days. He then decided to shorten the hospital stay and discharged 92 of 100 patients the same day. Before being discharged, they had to receive physical therapy and show they could get out of bed by themselves, stand up from a chair, walk 100 feet and go up and down stairs. None of the patients had complications, Berger said.

While surgeons haven't flocked to the procedure, arthroscopic knee surgery wasn't popular when it began 25 years ago, either.

"People didn't want to have it done; surgeons didn't want to perform it," Heller said. But after five years, "everything was arthroscopic, and that's what's going to happen here." In 10 years, he predicted, nearly all hip replacement surgery will be minimally invasive.

"It's more difficult now, just like arthroscopy was 25 years ago," he said. But as time goes by, the procedure, like arthroscopy, will be adapted and adopted, he said. "It's the direction we need to go."

About 168,000 people nationwide will have hip surgery this year; it's unknown how many of the procedures will be minimally invasive. Patients typically are 60 to 75 years old, according to the American Academy of Orthopaedic Surgeons, but baby boomers, unwilling to give up their mobility as their bones deteriorate, are bringing the age down.

Heller said that in the first five years of his nine-year surgical practice, most people having hips replaced were older than 65. Since then most have been younger than that. That coincides with a trend toward greater durability of implanted hips. With improved materials, Heller said, hips that once lasted 10 or 12 years could last 20 years or more.

Damage from arthritis, both osteoarthritis and rheumatoid arthritis, develops over time. It is the most common reason for hips to deteriorate. The diseases either wear away or damage the cartilage that cushions the hip bones. The result is that hips become stiff and painful. Walking and everyday activities can be difficult.

Heller is convinced that not only is the minimally invasive procedure better for patients, but also has benefits for surgeons. "When I walk out of a room having done a minimally invasive hip, I'm actually more confident than I am when I have the hip opened up," he said. "The reason is that I have my X-ray machine there."

The X-ray machine looms above the surgical site, and a screen in front of Heller showed his every move as he operated on Therres at Fairview-University Medical Center's Riverside campus.

Therres was a good candidate for surgery, he says, because she has good bone structure and had gone through conventional hip surgery - twice - on the other hip. In June Heller redid a replacement in her right hip because it was crumbling even though it was only six years old. It was a hip system that was popular in the 1990s but had a high failure rate, he said.

A not-so-minimal process

With Therres, Heller used the same parts used in conventional surgery - stem, ball, socket and a cartilage replacement. The main difference was that he put them in through two small incisions.

He began by making a 2 1/2-inch cut in the groin area through which he did most of his work. In conventional hip surgery, the incision is 10 to 12 inches long. The smaller incision helps avoid cutting muscle and reduces damage to tissue.

The hip bones are too big to come out of the small incision in one piece, so Heller uses a tiny power saw to remove the bones in pieces. There's no room for error. If he makes the first cut too high, one leg will be shorter than the other. If he makes it too low, he won't be able to get the new hip into place.

"If there's any part of this where you have to take your time and work it out, this is it right here," Heller said.

Therres' bones came out with relative ease - "You could spend two hours getting that out" - and he attributed the effort as much to her anatomy as to his skill as a surgeon.

Next he pushed a chromium cobalt shell, the "socket," tailored for the smaller incision, through the incision and pounded it into place. He took time to make sure that he removed all of the arthritis, that there was no space between the socket and the bone, that the socket was locked into place, that the alignment of Therres' legs was right. The socket's surface is rough to allow bone to grow into it.

Heller then placed two screws in the socket - that step, he said, helps surgeons sleep at night, confident that the replacement is solidly in place. Next, Heller snapped the new "cartilage" - a polyethylene cup-like device - into the socket.

For the final stage of the surgery, Heller made a 1 1/2-inch cut in the buttock to place the replacement stem into the femur, or thigh bone. Like the socket, the stem is designed to allow bone to grow into and around it. Last, the chromium ball is pushed through the small incision, positioned to length and inserted into the socket.

The leg was tested over and over to make sure the socket worked right, and then the surgery is finished. It took one hour and 25 minutes, a time he said would be reduced with experience.

A week later Therres, mother of eight, grandmother of 27 and great-grandmother of 10, and her husband, Jim, were relieved that they would be able to go to Florida for the winter as planned, returning to the mobile home that was spared by Hurricane Charley.

Therres said she has had enough surgery for a while, but would have the minimally invasive surgery again if the time comes.

That surgery isn't for every patient or doctor, Heller said, and it may take time for it to become the gold standard for hip surgery. For now, he said, "I know this is new because nobody has said they've seen it on the Learning Channel."

Donna Halvorsen is at dhalvorsen@startribune.com.

A new way to replace hips

A new minimally invasive hip surgery technique is likely to speed a patient's recovery time by reducing blood loss and tissue damage. Here's a look at the new procedure.

1. For the minimally invasive procedure, a 2.5-inch incision is first made in the groin area. Tendon and muscle tissue are spread apart. The thigh bone (femur) is pulled away from the hip socket.

2. A tiny power saw cuts the head of the femur into small pieces that are removed one by one. Some soft, interior bone tissue may also be removed.

3. The hip socket is scraped to remove damaged material. A bowl-shaped metal implant is placed in the socket and held there by friction or screws. To smooth joint movement, a plastic liner is snapped into the socket implant.

4. A 1.5-inch incision is made in the buttocks (see diagram above). A metal stem is inserted through this incision into the femur's marrow cavity and is held in place by friction. If the ball portion of the implant is separate, it is attached to the stem at this point. 5. The attached ball is positioned into the socket, soft tissue is readjusted and the incisions are sewn up.

Sources: Zimmer Inc.; Minnesota Orthopaedic Specialists P.A.

2005-11-26T04:44:00.000-05:00

Byline: Compiled by: Lynne Michelle

WhatOs the most youOve ever spent on a face cream? Not much. I donOt think price matters, youOve just got to find something that suits your skin and stick to it. How can a face cream be worth pounds 1,000? ItOs ridiculous. For that, IOd want a face lift.

WhatOs your beauty extravagance? Spas. I love to try out new treatments I the last one was a dry float which involved being wrapped in detoxing seaweed and put on a water bed. It was all warm, dark and squishy, but lovely I the closest thing to being back in the womb.

And your idea of beauty heaven? My last pampering holiday in the Maldives. The hotel spa was right on the water and had a glass floor, so I could see the fish swimming while I was being massaged.

WhatOs your worst beauty crime? IOm very hairy and often forget to pluck my eyebrows and look like a monster. My make-up artist will take one look at me and attack me with her tweezers.

Are you high-maintenance? No. LifeOs too short to cleanse, tone and moisturise every single night, so I donOt give myself a hard time if I forget. When IOm on holiday, IOm especially lazy. My hair grows so fast in the sun and I donOt bother shaving my legs. But youOve got to let things be natural sometimes.

YouOre 34 now I how do you feel about ageing? IOd like to think IOll grow old gracefully, and I hope every single wrinkle on my face tells a story. IOm not going to get paranoid about getting older because IOve still got lots to do with my life.

Would you ever have plastic surgery? I think weOre in a phase where itOs acceptable, but personally IOm scared about going under the knife for something that isnOt medically necessary. But in 20 years I might say, OGosh I look awful, surgery would really make me happy.O

Are you careful about the sun? People say, ODonOt go in the sunO, but I think it makes you feel great, and if youOre sensible, why not enjoy it? I like to tan, but I donOt burn and I get my moles checked. I donOt think thereOs anything wrong with ending up looking a bit weathered I you look like youOve spent your whole life on holiday. What could be better than that?

How do you cope with a bad face day? I exfoliate to scrub away the greyness, then I slap on an intensive moisturising mask and drink loads of water.

How do you stay in shape? IOve got a personal trainer three times a week. If I stop exercising, I soon know about it I IOm low on energy and feeling untoned and podgy. Especially here (prods stomach). My mumOs just like me I if she puts on weight, her arms and legs stay the same, but her middle goes like a barrel.

Is there anything you would like to change about your body? Without wanting to sound smug, IOm pretty happy with myself at the moment.

So you donOt have any weight worries then? Oh, I have to work at it. IOve had fat times where IOve thought, OGod IOm never going to shift this before I start filmingO, but if I put my mind to it, I always can. My attitude is, donOt moan about it, be proactive and sort it.

Do you have cellulite? Everyone has some cellulite somewhere. If I clench my bum I can definitely find some, donOt you worry.

Have you ever done a detox? Every few months I do a detox where I drink a horrible tea that smells like camel poo, but itOs good to give my insides a rest every now and again. I do believe in a good clear-out. IOd love to go to one of those detox places in Thailand where they flush you right out with a week of colonics.

Are you shocked by how thin some celebs are? Being onscreen really does put pounds on you, so celebrities who look OK on TV often look horribly skinny when you see them in real life. ItOs all good for your work, but then youOve got to walk round all day looking that spindly and unhealthy.

So would you turn into an LA lollipop for your dream role? If the role was right, yes, but IOd always come back to the real me afterwards. But IOd slim down through exercise, not through some dangerous extreme diet.

WhatOs your diet like? Pretty healthy I I eat lots of salad, fruit, vegetables, fish, chicken and pasta. I donOt really eat desserts because I donOt have a sweet tooth I IOd rather eat a bowl of garlic-marinated olives than a Toblerone.

YouOre involved in AvonOs new breast cancer campaign I has it made you more health-conscious? ItOs made me realise how important early detection is, so IOm making the effort to check my breasts regularly. Kate Thornton actually showed me how to do it properly I she interviewed me for a programme she was making on breast cancer and she taught me which bits I had to feel.

The campaignOs called Shake It I whenOs the last time you had a good old boogie? IOm always dancing I itOs my way of throwing off a bad day. When IOm out, IOm always the first on the dance floor. IOll be up on the table if thereOs no other room. IOm very embarrassing. When IOm 80, IOm going to be the awful old granny who turns up to weddings and grinds away with all the young men.

To find out about Avon products, call 0845 601 4040 or log on to www.avon.uk.com. The Shake It! CD is a compilation of celebritiesO favourite dance tracks and costs pounds 6.99 I proceeds go to the Avon Breast Cancer Crusade. See www.avoncrusadeshakeit.co.uk

MY FIVE BEAUTY ESSENTIALS

Dermalogica Multivitamin Power Firm Lip & Eye Cream, pounds 22.75 This makes my skin feel really smooth and instantly softens lines. If my skinOs feeling tired, IOll treat myself to a Dermalogica facial.

Jo Malone Orange Blossom Bath Oil, pounds 35 If IOm relaxing at home, thereOs nothing nicer than a long soak in a bath full of this.

Acqua Di Parma Colonia, pounds 49.95 My signature scent I a gorgeous mix of citrusy and herby smells.

Avon Planet Spa Shea Butter Foot & Elbow Cream, pounds 4 So moisturising, and it smells gorgeous I like butterscotch. People always tell me, OMmm, you smell like a sweetie.O

Avon Face Pearls, pounds 7 These catch the light beautifully and are great for sweeping over cheekbones.

2005-11-19T19:59:00.000-05:00

SAN MATEO, Calif. -- BioForm Medical to File Radiesse(TM) for Facial Soft Tissue Approval

BioForm Medical, Inc., announced today that 100% of patients enrolled in a clinical study of Radiesse(TM) to correct facial wasting reported a significant improvement in their appearance at 12 months post treatment. The results of the landmark study showed that one year after initial treatment 84% of patients were Very Much Improved or Much Improved according to the Global Aesthetic Improvement Scale (GAIS) and the remaining 16% were rated as Improved. The research findings were published in a special supplement of the September 2005 issue of "Plastic Surgery Journal."

Facial wasting is a common problem for HIV patients treated with highly active antiretroviral therapy (HAART). The condition gives patients a "hollowed-out" look and is a visible sign that they have HIV.

"Our study results demonstrate the long-lasting benefits of Radiesse to achieve dramatic improvements in the appearance of facial wasting," noted clinical investigator Joseph A. Eviatar, MD, FACS, a prominent plastic surgeon and surgical director of Chelsea Eye and Cosmetic Surgery Associates in New York, NY. "This improvement, which generally lasts one to two years, favorably impacts these patients' quality of life without subjecting them to an invasive procedure."

Further, Quality of Life data collected at 12-months follow-up indicated that 100% of patients found that Radiesse treatment had been beneficial. Additionally, 99% of patients said they were more confident about their appearance after treatment with Radiesse and would recommend treatment to others.

No serious adverse events were reported in the study.

The multi-site study was conducted by BioForm under an Investigational Device Exemption (IDE) for marketing clearance of Radiesse to assess the safety and efficacy of Radiesse injections for restorative treatment of HIV-associated facial lipoatrophy. One hundred patients were enrolled at three sites: two centers in New York City and one in San Francisco.

All study patients received an injection of Radiesse, a new augmenting and contouring substance, during their initial visit. Patients were seen one month following their initial visit and given a second touch up injection if required for optimal correction. Follow-up visits were conducted at three and six months, measured from the first date of treatment if no touch-up injection was received, or from the date of the touch-up injection if one was received.

"Facial wasting has a devastating effect on the self-esteem of patients because of the stigma attached to it. I had one patient who was so concerned about how he looked that he stuffed cotton balls in his mouth to make his cheeks look more full," said Dr. Stacey Silvers, lead investigator and executive partner, Madison ENT & Facial Plastic Surgery in New York, NY. "I have been treating people with this condition for eight years and find that Radiesse provides consistently excellent results."

The study results were presented at the recent meetings of the American Society of Plastic Surgery (ASPS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

"I had been on HIV medications for some time and was doing great. My prognosis was good and I didn't feel sick. The problem was that anyone on the street could tell I had HIV. I didn't want to go out of the house, and basically lived the life of a hermit," said a patient in the study. "After I had treatment with Radiesse I couldn't believe the difference. I felt like I had finally won the war against HIV because I looked as healthy as I felt."

About Radiesse

Manufactured and distributed in the U.S. by BioForm Medical, Inc., Radiesse is an injectable filler used in various cosmetic, reconstructive and therapeutic applications to augment and contour folds, depressions and defects of the facial area. Composed of tiny, smooth calcium hydroxylapatite (CaHA) particles suspended in a water-based gel carrier, Radiesse(TM) has been proven safe and biocompatible in numerous soft tissue applications. It has been used in more than 100,000 procedures worldwide with an excellent safety record. Among the product's many advantages, Radiesse treatment allows steady growth of collagen matrix, produces virtually instant results and lasts one to three years.

About BioForm Medical, Inc.

Headquartered in San Mateo, CA, BioForm Medical, Inc., is a privately-held medical device company developing and commercializing injectable implant products for soft and hard tissue augmentation and topical preparations for dermatological conditions. The Company is dedicated to improving patients' lives by providing high quality, innovative, safe and effective medical products for use in the plastic surgery, dermatology, urology, and ENT markets. For more information, please visit www.radiesse.com.