Pediatric nasal injuries and management.

Although serious trauma injuries are uncommon in the pediatric population, nasal injuries are a more common problem. In this population, many physicians are uncomfortable managing these injuries. The evaluation and treatment of nasal trauma differ considerably in children compared with adult nasal fractures. Poor patient cooperation during the physical exam coupled with significant anatomic differences can present the nasal surgeon with a difficult diagnostic dilemma. The surgical management of pediatric nasoseptal injuries is not without controversy, as disturbing the nasal growth centers can have significant effect on future nasal and midfacial development. This article reviews the diagnostic and therapeutic challenges presented by these injuries for children and provides recommendations to successfully manage nasal injuries in this population.

Management of bite wounds in the head and neck.

An estimated 50% of people in the United States will incur an animal or human bite wound at least once in their lifetimes. Although the majority of these individuals do not seek medical attention, bite wounds to the head and neck are a common reason for emergency department visits. Facial bites are complex injuries due to the functional and cosmetic nature of the area, as well as the unique polymicrobial infection potential that exists. We present a review of the epidemiology and microbiology of bite injuries to the head and neck and provide evidence-based recommendations regarding surgical wound closure and antibiotic therapy.

Depression in the cosmetic surgery patient.

Studies show that patients seeking cosmetic surgery are more likely to suffer from depression than is the general population. Thus it behooves the cosmetic surgeon to be familiar with the diagnosis of depression and the unique challenges that it poses to a cosmetic practice. Does depression affect surgical outcomes? Could a surgical procedure improve or exacerbate depressive symptoms? When is referral to a mental health professional warranted? This article attempts to deal with these questions, and in doing so we suggest possible means for managing depression in the cosmetic surgery patient.

Psychological considerations in revision rhinoplasty.

Revision rhinoplasty is a unique challenge. In addition to the technical considerations that are inherently more difficult than those of primary cases, the surgeon must also be mindful of the psychological considerations that revision rhinoplasty presents. These patients are by definition unhappy with their prior rhinoplasty experience, and this perception of a suboptimal result is both legitimate and real, even if the surgeon is not in agreement. Tantamount to any intraoperative technique, the preoperative ability of the surgeon to sift through the myriad psychological and psychosocial issues is critical to achieving satisfactory outcomes for both patient and surgeon. Reasons for dissatisfaction with a primary surgery, reasons for seeking revision surgery, and the psychological profiles of revision rhinoplasty patients can differ from those related to other facial cosmetic procedures. This article attempts to provide the reader with a better understanding of the complex interplay of these issues and with this understanding help the reader to distinguish one who is a favorable surgical candidate from one who is best left unrevised.

Rapid testing strategies for HIV-1 serodiagnosis in high-prevalence African settings.

BACKGROUND: Nearly 30 million people in sub-Saharan Africa are infected with HIV. While recent commitment of resources from international donors is heartening, rational use of these resources for AIDS prevention and care will require a major scaling up of HIV diagnostic services in affected countries. OBJECTIVE: This paper considers the various settings and populations in which HIV testing might be implemented, and the goals to be achieved by that testing. It also defines the practical information that public health decision makers in sub-Saharan Africa should have in order to choose an appropriate test or combination of tests for use in a particular clinical setting. METHODS: Using a conditional probability model and published performance characteristics of rapid HIV serologic tests, the clinical effectiveness and costs of three major testing strategies are evaluated: (1) a single, highly sensitive test; (2) a serial algorithm, where positive results on a first test are confirmed with a more specific second test; and (3) a parallel algorithm, where each specimen is tested with two separate rapid tests, and discordant results are resolved with a third, different rapid test. This analysis was performed in 2003. RESULTS: We suggest that in any setting, both a serial and a parallel algorithm yield fewer incorrect results than does a single screening assay, but are more costly. A parallel testing algorithm yields fewer incorrect results than does a serial algorithm, but is more costly. CONCLUSIONS: We suggest that while a parallel testing algorithm has the advantage of avoiding indeterminate results, that strategy may be prohibitively costly for many developing world settings. Furthermore, we suggest that different testing algorithms are appropriate for different clinical settings.