Endoscopic-assisted midface lift utilizing retrograde dissection.

Endoscopic facial surgery is gaining wide acceptance, as results are providing comparable if not superior to the standard, superficial musculoaponeurotic system rhytidectomy, with minimal scarring. Frontal branch facial nerve injury remains a troublesome complication. The purpose of our study was to determine if a subciliary retrograde dissection would decrease facial nerve injury and allow for more accurate midfacial suspension. Fresh cadaver dissections were performed using endoscopic equipment. Anterograde temporal incisions in the scalp and retrograde subciliary incisions were studied. The anterograde temporal dissection was developed deep to the superficial layer of the deep temporal fascia. Retrograde subciliary dissection was subperiosteal. Forty-nine endoscopic-assisted midface lifts were performed. Midfacial suspension was accomplished with nonabsorbable sutures placed in the suborbicularis oculi fascia, anchored to the deep temporal fascia. Two of three endoscopic-assisted procedures done in the anterograde fashion, without a subciliary incision, experienced transient frontal branch injury, which resolved within 6 weeks. The remaining forty-six patients, operated with a combined subciliary and temporal approach, experienced no frontal branch injuries. We have found that the retrograde dissection through a subciliary incision substantially reduced the incidence of facial nerve injury, provided direct visualization of the suborbicularis oculi fascial layer (allowing more accurate midfacial suspension), and reduced total operative time.

Efficacy of immediate postirrigation culture in the treatment of upper-extremity abscesses.

A retrospective chart review of 192 patients of the musculoskeletal infection ward at the authors' facility was performed to assess the value of immediate postirrigation cultures in the treatment of acute soft tissue infections of the upper extremity. Twenty-two patients (11.5%) had postirrigation cultures with an organism that was not present in the preirrigation cultures. All of those organisms not previously found were gram-positive organisms, and no changes were necessary in the initial antibiotic regimes. Immediate postirrigation cultures did not prove to be effective in the information they provided related to treatment of acute soft tissue infections of the upper extremity.

Bat rabies in Illinois: 1965 to 1986.

From 1968 to 1986, Illinois (USA) citizens and agencies submitted 4,272 bats to the Illinois Department of Public Health for rabies testing. Of this number, 6% tested positive, a rate comparable to similar studies from other parts of North America. Due to sampling biases, the true infection rate among bats in Illinois is probably lower than 6%. Additional analysis relied on a subsample (n = 2,433) of the specimens collected from 1965 to 1986. Prevalences were significantly different among years, but no linear trends were found over the study period. Evidence for a local outbreak of bat rabies was found. Prevalences for the species with sample sizes adequate for statistical analysis were, from high to low: hoary bat (Lasiurus cinereus), 11%; red bat (L. borealis), 5%; silver-haired bat (Lasionycteris noctivagans), 4%; little brown bat (Myotis lucifugus), 4%; big brown bat (Eptesicus fuscus), 3%; Keen's bat (Myotis keenii), 2%; and evening bat (Nycticeius humeralis), 2%. The higher prevalences found among the non-colonial species (hoary, red and silver-haired bats) were consistent with similar studies. Considerable annual variation in prevalences was found within species, and the prevalence rankings of the species varied over the study period. Prevalences were significantly higher in females (6%) than in males (4%) when species were pooled, but no significant differences between sexes were found within species. In contrast to the other species analyzed, all of which had sex ratios favoring females, the big brown bat sample had a large majority of males. Prevalences were significantly higher in adults (6%) than in juveniles (3%) when species were pooled. Within individual species, significant differences between age groups were found only for hoary and red bats; in two species, juveniles had higher prevalences. Above average prevalences were observed in May and August to November. Southern Illinois had the highest prevalences; prevalences were intermediate in the north and lowest in the central region. Overall, the patterns of rabies prevalence among bats submitted by the public in Illinois from 1965 to 1986 were similar to those reported from other parts of North America.