Laser hair removal.

We are in a state of evolution in long-term hair removal. Safe and effective technology is now available. Lasers will always become smaller, faster, and perhaps more effective. For those interested in offering this procedure, evidence indicates that we are beyond the experimental phase. The treating physician should carefully review current available technology and receive proper training specific to that system.

Complications concerning free rectus abdominis muscle flaps in patients with portal hypertension.

A high level of suspicion is required when treating patients with a history of esophageal bleeding and portal hypertension. The preoperative workup must be extensive; if the reconstructive surgeon is considering the use of a rectus abdominis muscle transfer, noninvasive studies and an exhaustive physical examination are required. Factors affecting the microcirculation might also influence the patency rates of the venous anastomosis and require further study. When treating these patients, the surgeon must be aware that portal hypertension can exist without clinical evidence.

A comparison of survival at different degrees of hemorrhagic shock in germ-free and germ-bearing rats.

We have previously reported superior survival after one level of hemorrhagic shock in germ-free (GF) rats compared with germ-bearing (GB) rats. The objective of this study was to determine the effect of the GF state on survival at different degrees of hemorrhagic shock. GF and GB rats were bled to a mean arterial blood pressure of 30 mmHg. Shock was terminated after 10, 20, 40, or 80% of the maximum shed blood volume was reabsorbed spontaneously. Both shock time and time to decompensation were significantly longer in GF rats (p < .05). Comparative survival was greater for GF rats at most levels of shock (p < .01). This superiority in survival was greatest at moderate shock levels and decreased at severe shock levels. There may be several reasons for the increased tolerance of GF animals to hemorrhagic shock such as metabolic or immunologic variations. It is hard to avoid the fact, however, that the most notable difference between the GF and GB rat is the presence or absence of bacteria.

Enucleation of parotid lymphoepithelial cyst in patients who are human immunodeficiency virus positive.

The incidence of benign lymphoepithelial lesions of the parotid gland in patients afflicted with HIV has increased. Enucleation is a safe and effective procedure that provides the patient with complete removal of the cyst and a low recurrence rate. Enucleation of these parotid cysts should be considered in treating these patients.

The role of sigmoidoscopy in the management of gunshot wounds to the buttocks.

The charts of all patients (n = 70) admitted over 26 months after sustaining a gunshot wound to the buttocks were reviewed to assess the role of physical examination, routine radiologic studies, and sigmoidoscopy in the evaluation of these patients. There were 68 men and 2 women. Sixteen patients underwent sigmoidoscopy, which demonstrated a rectal injury in 7. Six of these patients had other abnormalities on either physical examination or plain pelvic radiographs that would have otherwise led to operation. There were no missed injuries and no morbidity in the remaining patients that were managed without sigmoidoscopy. Indications for sigmoidoscopy were gross blood on rectal examination in 2, bullet path with proximity to the rectum in 13, and persistent abdominal pain in 1. All patients with gross blood on rectal examination (n = 5) and blood at the urethral meatus (n = 2) had visceral injuries. One patient underwent celiotomy for an injury at 15 cm that was noted on sigmoidoscopy performed because the bullet trajectory was in proximity to the rectum. Sigmoidoscopy can be performed selectively in patients sustaining a gunshot wound to the buttocks when the proximity of the wound to the rectum is in doubt.

Monocyte activation in acquired immunodeficiency syndrome.

The monocyte plays a key role in the pathophysiology of AIDS and ARC. This preliminary report adds insight into monocyte activation associated with HIV seroconversion, by comparing recalcification times in healthy controls and HIV-positive patients.

Cold-induced hypercoagulability in vitro: a trauma connection?

Injury severity score and hypothermia can lead to a high level of mortality when combined clinically. In acute trauma, the presence of a coagulopathy is difficult to treat and the aim is prevention. Aliquots of whole blood from healthy human volunteers (n = 9) were added to saline (control) and saline plus endotoxin (activated). The control and activated groups were divided and subjected to 60 minutes of normothermia (24 degrees C) or hypothermia (0 degrees C). The samples were returned to 37 degrees C; then the recalcification times were determined using fibrin formation and the viscous drag as the determining factors. The activated hypothermic group showed a decreased recalcification time of 345 (+/- 48.9) seconds compared to 405 (+/- 60.8) for the activated normothermic group (P less than 0.001). When the normothermic and hypothermic groups were compared without endotoxin added, the differences were not significant. The authors conclude that the effects of endotoxin on clotting time are worsened by hypothermia in vitro and act synergistically to possibly cause the coagulopathy seen in trauma patients.