Emergency Treatment of Young People Following Deliberate Self-harm
Objective: To examine national patterns in the emergency department assessment and treatment during visits by young people, aged 7 to 24 years, who are seen following an episode of deliberate self-harm.
Methods: An analysis was conducted of a nationally representative sample of hospital emergency department visits from the 1997-2002 National Hospital Ambulatory Medical Care Survey focusing on visits by persons aged 7 to 24 years related to deliberate self-harm. National census data were used to derive population-based rates of emergency department visits for deliberate self-harm overall and stratified by sex, age, race, and ethnicity. Demographic, clinical, and treatment characteristics of the visits are presented including comparisons of visits that resulted in an inpatient admission with those that resulted in discharge to the community.
Results: Among young people aged 7 to 24 years, the annual rate of emergency visits with self-harm was 225.3 per 100 000. A mental disorder was diagnosed in 56.0% of these visits including depressive disorders in 15.1% and substance use disorders in 7.3%. Approximately one half of the visits (56.1%) resulted in an inpatient admission. As compared with visits resulting in discharge to the community, emergency department visits that resulted in inpatient admission were significantly more likely to result in the patients receiving a mental disorder diagnosis (63.8% vs 45.7%; P = .03), especially a depressive disorder (22.5% vs 5.8%; P = .005), and receiving psychotropic medications (18.0% vs 4.7%; P = .007), intravenous fluids (39.2% vs 22.3%; P = .02), gastric lavage (24.1% vs 9.8%; P = .02), and a specific antidote for poisoning (12.2% vs 1.3%; P = .02).
Conclusions: Mental disorders are diagnosed in roughly one half of emergency department visits by young people following an episode of deliberate self-harm. Systematic mental health assessments in the emergency department of young people following an episode of deliberate self-harm may improve detection of mental disorders.
Olfson M, Gameroff MJ, Marcus SC, Greenberg T, Shaffer D
The Surgeon and AIDS: 20 Years Later
Background: Since the first reports on indications and outcome for abdominal procedures in the HIV/AIDS patient were published 20 years ago, the epidemiology and presentation of surgical illness have changed remarkably with the advent of new antiviral regimens. A review of the now occasional, but still important, role of the surgeon in contemporary treatment of HIV/AIDS is presented.
Data Sources: Information was obtained by PubMed searches of medical journals, examination of reference lists, and Web resources.
Study Selection: Articles on operative indications, outcomes, precautions, source of transmission, and pathophysiology of HIV/AIDS were selected.
Data Extraction: Data was obtained from peer-reviewed articles and references.
Data Synthesis: The last 2 decades have seen a decrease in operative mortality from as high as 85% to approximately 15% with a corresponding improvement in morbidity. Surgical emergencies such as appendicitis occur in HIV patients with the same frequency as non-HIV patients and are treated with equivalent results. Concern about transmission of HIV in the operating room has lessened somewhat. Although still a hazard, the probability of HIV transmission with accidental exposure is low, with risks below 0.5% for percutaneous hollow-bore needles and less than 0.1% risk for mucus membrane exposure.
Conclusions: Improved surgical outcomes together with of accurate data on the modes and likelihood of accidental transmission of HIV to members of the surgery team have resulted in the treatment of HIV/AIDS patients becoming an accepted part of routine surgical practice.
Saltzman DJ, Williams RA, Gelfand DV, Wilson SE
Evaluation of Coleman Lipostructure for Treatment of Facial Lipoatrophy in Patients With Human Immunodeficiency Virus and Parameters Associated With the Efficiency of This Technique
Objective: To evaluate the efficiency of Coleman lipostructure in patients infected with human immunodeficiency virus (HIV).
Design: Open-label study and survey.
Setting: Ambulatory dermatosurgery department of a university hospital.
Patients: Thirty-three consecutive HIV-infected patients undergoing Coleman lipostructure between 2000 and 2001.
Interventions: Clinical examination, blood tests, and standardized photographs at baseline and 1 year after the lipostructure.
Main Outcome Measures: Efficiency was assessed by the agreement of 3 independent medical specialists on facial lipodystrophy improvement after surgery and by patient satisfaction.
Results: Facial lipoatrophy was improved in 12 patients (36%; 95% confidence interval, 20%-52%) as judged by all 3 evaluators. Quantity of fat injected (P = .01) and a low serum triglyceride level before surgery (P = .03) were significantly associated with improvement of facial lipoatrophy. Of the 33 patients, 14 (43%) were very satisfied, 17 (50%) were partly satisfied, and 27 (81%) had a better quality of life. The most common comment was that the patient looked better and appeared less ill.
Conclusion: Our 1-year evaluation of Coleman lipostructure for correction of facial lipoatrophy in HIV-infected patients proved the efficiency of this treatment when measured conservatively by agreement on improvement by 3 independent specialists and demonstrated a patient satisfaction rate of 93%.
Burnouf M, Buffet M, Schwarzinger M, et al
Topical 5-Aminolevulinic Acid Combined With Intense Pulsed Light in the Treatment of Photoaging
Background: The adjunctive use of 5-aminolevulinic acid (5-ALA) with intense pulsed-light (IPL) treatments has been suggested to increase the benefit of IPL for photoaging; however, to our knowledge, no controlled trials have been performed.
Design: A prospective, randomized, controlled, split-face study was designed. Twenty subjects participated in a series of 3 split-face treatments 3 weeks apart in which half of the face was pretreated with 5-ALA followed by IPL treatment while the other half was treated with IPL alone. Two additional full-face treatments (with IPL alone) were then delivered 3 weeks apart. Assessment of global photodamage, fine lines, mottled pigmentation, tactile roughness, and sallowness (on a scale of 0-4) was performed by a blinded investigator before each treatment and 4 weeks after the final treatment. Patients also completed an assessment at the conclusion of the study comparing their results with pretreatment photographs.
Results: All 20 volunteers completed the study. Pretreatment with 5-ALA resulted in more improvement in the global score for photoaging (16 [80%] subjects vs 9 [45%] subjects; P = .008) and mottled pigmentation (19 [95%] subjects vs 12 [60%] subjects; P = .008) than IPL treatment alone. More successful results were achieved on the side pretreated with 5-ALA compared with the side treated with IPL alone for fine lines (12 [60%] subjects vs 5 [25%] subjects; P = .008) and mottled pigmentation (17 [85%] subjects vs 4 [20%] subjects; P<.001). While there was noticeable improvement over baseline scores with respect to tactile roughness and sallowness, pretreatment with 5-ALA did not seem to enhance the results of the IPL treatment. The final investigator cosmetic evaluations (P = .0002) and subject satisfaction scores (P = .005) were significantly better for the 5-ALA-pretreated side. Both treatments were well tolerated, with little difference in the incidence or profile of adverse effects with or without 5-ALA pretreatment.
Conclusions: The adjunctive use of 5-ALA in the treatment of facial photoaging with IPL provides significantly greater improvement in global photodamage, mottled pigmentation, and fine lines than treatment with IPL alone, without a significant increase in adverse effects. This combination treatment enhances the results of photorejuvenation and improves patient satisfaction.
Dover JS, Bhatia AC, Stewart B, Arndt KA
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2006;8(2):141-142. doi: