Surgical rhinoplasty after prior hyaluronic acid based nose remodeling.

BACKGROUND: Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients. OBJECTIVES: The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans. METHODS: We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections. RESULTS: Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme. CONCLUSION: Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

[Treatment of burns in infants]. / Traitement des brûlures du nourrisson.

Because of the potential severity of their residual deformities, burn injuries in infants justify an early management in specialized centres when they cover more than 5% of body surface and in every case when hands, face, or external genitalia are concerned. Cooling with cold water is the first aid treatment to be performed as early as possible after the injury. The treatment in specialized centres must be both general and surgical. General treatment includes fluid and electrolyte therapy, temperature control, appropriate nutrition and pain suppression. Pain suppression is a major part of the treatment and morphine must be largely used. Surgical treatment starts as soon as the patient arrives in the centre and is eventually performed under general anesthesia: all the burned areas are covered with occlusive dressings. Infections are prevented by systematic cultures and adjusted antibiotic therapy. A vigorous rehabilitation program must be instituted as soon as possible: massages, compressive clothes, splints, physical therapy, plastic surgery. Primary prevention by sustained parental education is important in order to reduce the frequency of burn injuries in infants.

[Interactive relations between sexual behavior and post-menopausal replacement hormone therapy: a survey]. / Relations interactives entre comportements sexuels et hormonothérapie substitutive post-ménopausique: enquête SOFRES.

A study carried out in 1988 using a representative sample of the French male and female population aged between 52 and 70 provides information concerning one of the presumed motivations for the use of replacement hormone therapy: to "always be a woman". In 1988 the sexual activity of French couples decreased on average after the age of 50 or thereabouts in a proportion identical to that seen in 1970. The chief limiting factor is reduced libido in women, far more than simple dyspareunia or relative male impotence. The majority of women interviewed did not wish to react against this fall in sexual activity, had abandoned "seductive" behaviour, would not use treatment which would increase sexual appetite even if it were ideally active and free of side-effects and did not consider that the menopause had any influence whatsoever on their behaviour. Eighty per cent of women had never sought to use replacement hormone therapy. A minority, 17 p. cent of those interviewed, had used postmenopausal hormone therapy for a time at least. This sub-group had a far higher level of sexual activity, attached greater importance to their personal appearance, took more physical exercise and controlled their weight better. The group was also more educated and better informed regarding the possible consequences of the menopause. Differences in life style and dietary behaviour between spontaneous non-users and users of hormone replacement therapy could falsify the interpretation of a non-randomised epidemiological study.