Use of Polylactic Acid Implants to Correct Facial Lipoatrophy in Human Immunodeficiency Virus 1–Positive Individuals Receiving Combination Antiretroviral Therapy
Objective: To assess the efficacy, safety, and tolerability of facial injections of polylactic acid for human immunodeficiency virus (HIV) 1–associated facial lipoatrophy, which commonly affects HIV-1–infected patients receiving combination antiretroviral therapy.
Design: A cohort of 50 consecutive HIV-1–infected outpatients with moderate to severe facial lipoatrophy who were receiving antiretroviral therapy were recruited in one institutional center and followed up for 12 months. Patients received the compound subcutaneously at baseline and on days 30, 45, and 60 of the study, for a total of 4 sets of injections; if necessary, 2 additional sets of injections were allowed on days 75 and 90. At enrollment and during follow-up, data on patients' characteristics, facial ultrasonography, and iconography were assessed. Data for 2 questionnaires, on self-perception of severity of facial lipoatrophy and on quality of life measured by the Medical Outcomes Study-HIV, were also obtained.
Results: Polylactic acid injections led to a significant improvement in facial lipoatrophy, confirmed by the patients' facial lipoatrophy self-perception and by the ultrasonographic evaluation. The mean total cutaneous thickness of each cheek increased significantly between baseline and after completing the polylactic acid injection sessions (4.3 mm [range, 2.7-6.2 mm] [P<.001] and 4.4 mm [range, 2.7-6.1 mm] [P<.001] on the right and left cheeks, respectively) and persisted significantly until month 12 of follow-up (3.4 mm [range, 2.3-4.9 mm] [P<.001] and 3.3 mm [range, 1.6-5.0 mm] [P<.001] on the right and left cheeks, respectively). In addition, a significant (P<.01) improvement in overall quality of life was observed between baseline and the end of the study. No patients discontinued treatment because of toxic effects, and subcutaneous micronodules at the site of injection were never observed.
Conclusions: Polylactic acid injections can be considered an effective, safe, and simple procedure in HIV-related facial lipoatrophy. The overall improvement of quality of life was clearly associated with the correction of lipoatrophy, reflecting the positive effect of this strategy on patient well-being.
Cattelan AM, Bauer U, Trevenzoli M, Sasset L, Campostrini S, Facchin C, Pagiaro E, Gerzeli S, Cadrobbi P, Chiarelli A
A Comparative Study of Primary and Secondary Hemifacial Spasm
Background: Hemifacial spasm (HFS) is a common movement disorder.
Objective: To evaluate possible differences in the demographic and clinical features between primary and secondary HFS.
Design: In-person interview using a standardized questionnaire to collect demographic and clinical data.
Setting: A multicenter study that included patients with HFS attending 3 Italian academic centers.
Patients: Two hundred fourteen patients with HFS.
Main Outcome Measure: A complete neurological examination assessed the current muscle distribution of spasm and the presence of synkinetic movements between upper and lower facial muscles.
Results: The study sample comprised 214 patients with HFS, 81 men and 133 women, having a mean ± SD age of 65.9 ± 12.3 years; 164 patients were classified as having primary HFS and 50 patients (48 postparalytic and 2 symptomatic cases) were classified as having secondary HFS. Patients with primary and those with secondary HFS had similar mean ± SD ages at onset (54.9 ± 13.5 vs 57.0 ± 12.8 years), male-female ratios (63:101 vs 18:32), right-sided–left-sided HFS (77:86 [1 bilateral] vs 21:28 [1 bilateral]), and frequencies of familial cases (2.9% vs 2.0%), respectively. Most patients (65.0%) with primary HFS had initial symptoms of periocular muscle contractions alone and had subsequent involvement of the lower facial muscles. Most patients (72.0%) with secondary HFS reported initial involvement of the upper and lower facial muscles simultaneously. Signs of synkinesis were present in primary (43.3%) and secondary (58.0%) HFS.
Conclusions: Patients with primary and those with secondary HFS share common demographic and clinical features, including sex distribution, age at onset, affected side of HFS, synkinesis, and rarity of familial cases. Signs of synkinesis were present in significant proportions of patients with primary or secondary HFS. The 2 forms differed in clinical presentation.
Colosimo C, Bologna M, Lamberti S, Avanzino L, Marinelli L, Fabbrini G, Abbruzzese G, Defazio G, Berardelli A
Relief of Upper Airway Obstruction With Mandibular Distraction Surgery: Long-term Quantitative Results in Young Children
Objective: To evaluate the long-term benefits of mandibular distraction on sleep-related upper airway obstruction in young children with mandibular hypoplasia.
Design: Cross-sectional study. Subjects were examined for sleep-disordered breathing using medical history, physical examination results, and a written questionnaire. Subjects underwent standard overnight polysomnography, during which measures of sleep-disordered breathing were collected.
Setting: Tertiary care hospital.
Patients: Five children with upper airway obstruction from craniofacial anomalies treated with mandibular distraction, with a minimum follow-up of 12 months.
Main Outcome Measures: Apnea-hypopnea index, oxygen saturation nadir, and peak end-tidal carbon dioxide value.
Results: Of the 5 children, 3 were cured of upper airway obstruction as documented by polysomnography, with an apnea-hypopnea index of less than 1.5 and no snoring. The fourth child had primary snoring without apnea. The fifth child had severe obstructive sleep apnea, with an apnea-hypopnea index of 20.2.
Conclusions: Most children who undergo mandibular distraction for upper airway obstruction associated with mandibular hypoplasia demonstrate significant clinical improvement of obstructive sleep apnea. However, those children who continue to have symptoms of sleep-disordered breathing after surgery should undergo polysomnography for evaluation of persistent obstructive sleep apnea.
Lin SY, Halbower AC, Tunkel DE, Vanderkolk C
Women in Surgery: Do We Really Understand the Deterrents?
Hypothesis: Women are deterred from a surgical career owing to a lack of role models rather than lifestyle considerations.
Setting: University teaching hospital.
Participants: Surgery and obstetrics/gynecology attending physicians, residents, and medical students.
Main Outcome Measures: Potential deterrents to a surgical career.
Results: Men and women had a similar interest in a surgical career before their surgical rotation (64% vs 53%, P = .68). A similar percentage developed a mentor (40.0% vs 45.9%, P = .40). Women were far more likely to perceive sex discrimination (46.7% vs 20.4%, P = .002), most often from male attending physicians (33.3%) or residents (31.1%). Women were less likely to be deterred by diminishing rewards (4.4% vs 21.6%, P = .003) or workload considerations (28.9% vs 49.0%, P = .02). They were also less likely to cite family concerns as a deterrent (47.8% vs 66.7%, P = .02) and equally likely to be deterred by lifestyle during residency (83.3% vs 76.5%, P = .22). However, women were more likely to be deterred by perceptions of the “surgical personality” (40.0% vs 21.6%, P = .03) and the perception of surgery as an “old boys' club” (22.2% vs 3.9%, P = .002).
Conclusions: Men and women are very similar in what they consider important in deciding on a surgical career. Women are not more likely to be deterred by lifestyle, workload issues, or lack of role models. However, the perceived surgical personality and surgical culture is a sex-specific deterrence to a career in surgery for women.
Gargiulo DA, Hyman NH, Hebert JC
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2006;8(5):350-351. doi: