Minimally invasive facial rejuvenation endolaser mid-face lift.

Endolaser mid-face lift was performed on patients in a multi-center study over a 36-month period (Feb. 1998 to Feb. 2001). It permits significant facial rejuvenation through small incisions. This technique achieves aesthetic results and wider rejuvenation while being less traumatic and creating minimal morbidity. Combined with other procedures, it rejuvenates the face by three strategic methods: soft tissue suspension, reversal of photo aging, and correction of the depletion of volume. To achieve this triple result, the mid-face lift is performed by endoscopic approach, and in every case is combined with the endoscopic lift of the frontal area. Laser resurfacing was used to reverse skin photo damage. The Ultrapulse CO2 laser and/or the Ultrafine Erbium YAG(Coherent, Inc, Palo Alto, CA) were used. The third combined procedure was the introduction of fat graft to compensate the atrophy/ptosis of fat and the depletion of bone mass (other filling materials besides fat may be used, depending on the preference of the surgeon). Our method of fixation using the Casagrande Needle (an evolution of Reverdin Needle) makes the mechanical purchase on the tissues to be suspended much easier, permitting the intra-oral and/or infra-orbital incisions to be eliminated. The present study of the technical evolution of the endolaser mid-face lift method allows us to conclude that a very satisfactory outcome has been reached, offering patients a minimally invasive procedure, which can be performed under local anesthesia, with low morbidity, imperceptible incisions, and an excellent long-term result.

General and job-related alcohol use and correlates in a municipal workforce.

We examined the prevalence and correlates of both general and workplace-related drinking measures using data from a telephone survey of 673 workers in a large municipal bureaucracy and tested the hypothesis that observed differences across job categories can be explained by compositional difference in terms of demographic variables known to be related to drinking behavior. Results suggest such factors account for much of the variation in general drinking measures (prior-28-day quantity, CAGE score, indicating risk for dependence), but that significant variation in a workplace-related drinking measure (times ever drank before, during, or just after work) remains even after such factors are controlled. Implications of these findings for existing theories of workplace effects on drinking are discussed, along with a consideration of appropriate levels of analysis for future studies.

Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

CONTEXT: High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. OBJECTIVES: To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. DESIGN AND SETTING: A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. INTERVENTIONS: Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. MAIN OUTCOME MEASURES: Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. RESULTS: Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. CONCLUSION: A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.

Gender, acculturation, and alcohol consumption among Mexican Americans.

OBJECTIVE: This study examines the relationship between level of acculturation and drinking status among Mexican American males and females in three northern California cities. METHOD: The data analyzed were collected through the use of a telephone survey. The sample size is 932. RESULTS: Our results show that acculturation has a direct effect on drinking status for women in the sample but not for men. At low levels of acculturation, our results show the expected difference in drinking status by gender; with high abstention rates for women and low abstention rates for males. At high levels of acculturation there is a convergence in drinking status with females approximating the proportion of male drinkers in the sample. Additionally, acculturation was associated with "heavier" drinking for females while place of birth was associated with "heavier" drinking for males. CONCLUSIONS: Studies of drinking patterns and related problems need to consider these factors.

Tissue adhesives and applications in plastic and reconstructive surgery.

The search for the perfect surgical "glue" is ongoing. Throughout the centuries, surgeons and scientists have sought an ideal sealant and adhesive: one that is safe, biologically compatible, effective, and affordable. A tissue sealant with these attributes would have unlimited applications in the field of plastic and reconstructive surgery. Simple wound closure, sealing of cavities, attachment of graft and flaps, and decreasing of bleeding, bruising, and edema are problems that all aesthetic and reconstructive surgeons face every day in their practice.

A community prevention trial to reduce alcohol-involved accidental injury and death: overview.

The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.

A community-wide Responsible Beverage Service program in three communities: early findings.

Evidence accumulating over the past 10 years or so suggests that commercial servers of alcoholic beverages will intervene to reduce levels of impairment among their patrons and will refuse service to intoxicated customers. While some Responsible Beverage Service (RBS) programs have had significant effects on server and patron behavior, others have not. This leads us to consider issues of implementation and program effectiveness. In the current paper, a community-wide RBS program is described in some detail. The program was comprised by a larger comprehensive community intervention project in three sites across California and South Carolina. Process evaluation data, to track program implementation and proximal effects, provide early findings. Expressed support for RBS principles was high for both the public and the hospitality industry in all sites. A telephone survey of managers also suggests that prevention policies at bars and restaurants are beginning to show up, but a direct measure of server intervention with heavy drinkers does not yet demonstrate a program effect.

Summing up: lessons from a comprehensive community prevention trial.

This paper presents the findings and lessons from a community prevention trial involving three experimental communities in the United States to reduce alcohol-involved trauma. The paper provides recommendations for other community prevention efforts. Effectiveness was demonstrated by: (a) 78 fewer alcohol-involved traffic crashes as a result of the Drinking and Driving Component alone (approximately a 10% reduction); (b) a significant reduction in underage sales of alcohol, i.e. off-premise outlets sold to minors about one-half as often as in comparison communities; (c) increased implementation of responsible beverage service policies by bars and restaurants; and (d) increased adoption of local ordinances and regulations to reduce concentrations of alcohol outlets.

Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma.

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.

Evaluating specific community structural changes. Examples from the assessment of responsible beverage service.

Responsible Beverage Service (RBS) refers to the idea that bars and restaurants may be able to have a significant impact on the levels of deaths and injuries associated with alcohol consumption including, but not limited to alcohol-impaired driving. After a brief background on RBS as a prevention strategy, the authors review the different measures, protocols, and designs that have been employed in evaluations of responsible service programs with attention paid to the strengths and limitations accompanying each choice. This article concludes by describing the Prevention Research Center's Community Trials Project design as it relates to evaluating its RBS component, and some of the unique considerations that influenced the measures and protocols employed. In so doing, the authors discover how the larger project serves as an interesting case study in action research.

Summing up. Recommendations and experiences for evaluation of community-level prevention programs.

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.

Fibrin sealant.

Fibrin sealant consists of fibrinogen and thrombin solutions, which generate a crosslinked fibrin clot in a process that mimics the last stage of the physiologic coagulation system. Fibrin sealants have been used widely in Europe in the past two decades for hemostasis, sealing, and as a vehicle for drugs and growth factors, and as a biologic glue. This review discusses the various types of fibrin sealants (autologous, homologous, commercial), their composition, mechanism of action, functional characteristics, experimental and clinical uses, limitations, complications, adverse reactions, and viral safety.

Combining methods to identify new measures of women's drinking problems. Part II: The survey stage.

This is the second of a two-part report on a study aimed at investigating novel indicators of drinking problems among women drinkers. The study was motivated by the suspicion that most measures of drinking problems grew out of studies of male populations with the likelihood that such measures would be less relevant for female drinkers. The first part of this report describes the background for the study and the steps that were taken to generate a short list of "novel" indicators which were then incorporated into an instrument for a general population survey. Using several measures of alcohol consumption as criteria for evaluating the indicators, this paper reports on which indicators may uncover dimensions of alcohol problems not already subsumed by a standard population screen, the CAGE. In particular, results suggest that indicators of "high capacity for alcohol", "seeking out a 'wet' environment", and "planning opportunities to drink" are promising for both women and men, with more qualified support for less "frequent illness" (for women) and "excessive behavior" (for men). These results must be viewed within the context of an exploratory study and indicate avenues for further research.

Combining methods to identify new measures of women's drinking problems. Part I: The ethnographic stage.

In recent years, some researchers in the alcohol survey field have raised concerns about the shortcomings in severity/frequency scales for drinking and drinking problems used for both clinical and household survey purposes, especially with regard to women. This article reports on Part I of a two-part study that used ethnographic and survey methods to assess indicators of drinking problems among women across various US subcultures. Methodology for the ethnographic component consisted of three steps: analysis of findings in literature on indicators of women's drinking problems, and analysis of indicators addressed in the most commonly used standard instruments for alcohol assessment; semi-structured interviews with 12 specialists in treatment and/or research who focused on alcohol problems of women; and semi-structured interviews with 65 women from four ethnic populations who were clients in alcohol treatment centers. Analysis of these data from the ethnographic component produced a taxonomy of indicators of women's drinking problems and fourteen novel indicators that are not included or are inadequately examined in the most commonly used alcohol assessment instruments. The novel indicators were then incorporated into a questionnaire used for a county-wide survey of men and women that assessed indicators of drinking problems. Report of findings from the survey are presented in the second paper of this series.

Abdominal wall reconstruction after temporary abdominal wall closure in trauma patients.

We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992. There were 10 deaths (28%) in the study population. Of the 26 survivors, 8 patients (31%) had primary fascial closure at initial hospitalization, whereas 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 have had ventral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operations including prosthetic reconstruction and eventual complex tissue transfer. Complications occurred in 3 patients (14%) and included two wound seromas, which were drained nonoperatively, and a wound infection necessitating removal of prosthetic material and subsequent reconstruction with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure can be done safely and promptly, with good functional and esthetic results.

Endoscopic harvest of the omental and jejunal free flaps.

Experimental and clinical cases document that the omentum and jejunum can be harvested successfully as a free flap using laparoscopic assistance. Our gross and microscopic findings attest to the viability of this approach. If the omentum is not needed in it entirety, one can safely custom design the free flap to match the defect size, leaving only a small abdominal scar, as illustrated in the partial omentectomy case. The long, large vessels can simplify the microanastomosis in difficult situations and avoid the use of vein grafts. The abdominal incision required in most of our cases was minimal, with an inconspicuous donor site scar. The procedure has been well tolerated by the patients, and the postoperative course has been unremarkable. Although some modifications already have been presented to the original technique of laparoscopic jejunal and omental harvesting, more cases are necessary before one can reach definitive conclusions about whether the endoscopic approach is significantly better than the classical open technique.

The impact of alcohol beverage container warning labels on alcohol-impaired drivers, drinking drivers and the general population in northern California.

Using data collected in a random-digit dial telephone survey in a northern California county, an examination of the impact of alcohol beverage container warning labels was conducted. In a broadly conceived approach to the possible impact of warning labels, we examined recall and content as well as risk assessment and the use of warning labels as public policy to combat drunk driving. In a repeated measures pre- and post-design, respondents reported significantly higher recall of labels and their content in the post-introduction period. Evidence from a multivariate analysis of post-introduction data indicate that both drinking drivers and impaired drivers (based on self-reports) were more likely to recall the labels and their content, an indication that warning labels are reaching "at risk" individuals. In addition, increases in the perceived risk of driving and drinking are consistent with the notion that warning labels, as one part of a larger social movement, are helping to create an atmosphere in which drinking and driving is less acceptable. However, our findings also indicate that, at least among at risk drinking and impaired drivers, increased use of public policies such as warning labels in an effort to reduce the negative consequences of drinking and driving may generate a public opinion backlash.

Laparoscopically harvested omental free flap to cover a large soft tissue defect.

OBJECTIVE: The omentum has been a very important tool in the armamentarium of the reconstructive surgeon. It has lost much of its value because of the morbidity associated with laparotomy. Laparoscopic surgery has become a popular technique and allows operations to be performed with minimal morbidity. The possibility of harvesting the omental free flap with the laparoscope and its use in reconstructive surgery has been demonstrated. SUMMARY BACKGROUND DATA: Since the first laparoscopic cholecystectomy was performed, many surgeons have learned the procedure. Other surgical specialties have also benefited from this technique. The omentum provides a large amount of vascularized tissue and excellent wound coverage. It can be transferred as a pedicle flap, or as a free flap, using microvascular technique. METHODS: The procedure was developed and refined in an animal model. One team harvested the omentum with laparoscopic assistance, while the other team prepared the recipient vessels. After completion of the microvascular transfer, the dogs were observed for 14 days. At that time, the omental tissue was examined for gross and histologic changes. A clinical case is also presented. RESULTS: Gross and microscopic studies documented the viability of this approach. The patient tolerated the procedure well and had an unremarkable postoperative course. CONCLUSIONS: Experimental and clinical evidence shows that the omentum can be successfully harvested as a free flap using laparoscopic assistance. This technique may prove to be of clinical significance and very useful for reconstructive surgery with less morbidity.