Closed Rhinoplasty

Closed or endonasal rhinoplasty has been practiced since the dawn of the modern rhinoplasty era, see Roe’s description in 1887 (Plast Reconstr Surg 45(1):78–83, 1970). In recent years there has been a growing enthusiasm for both teaching and practice of the open approach to rhinoplasty; this technique is both easier to teach and for the student to learn; however, there are small but significant prices to pay for this choice. The most significant is the presence of an external scar on the columella, which proponents of the technique claim to be near invisible but which a significant population of patients find unsightly. Also, despite the clear visibility of both cartilage and bone in the open technique, there is frequent irregularity of contour and of symmetry, especially in inexperienced hands. The authors prefer the closed technique for its precision, rapid recovery, and lack of external scarring. We also find the technique sympathetic to the frequent frustrations of the less experienced surgeon attempting the technique. For that reason we teach it to our fellows as a “beginner’s” technique until sufficient experience has been gained to graduate to the more technically demanding open procedure

HIV and AIDS Surveillance Among Inmates in Maryland Prisons

The prevalence of those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is higher among inmates of correctional facilities than among general population. This raises the need to identify inmates living with or at risk of HIV/AIDS and to provide counseling and appropriate services for HIV treatment and prevention. The Maryland Division of Corrections (DOC) offers voluntary testing to all inmates on entry and tests inmates when clinically indicated. We reviewed all 1998 HIV antibody tests and confirmed AIDS cases in the Maryland DOC. Inmate demographics, testing acceptance, rates of seropositivity, and AIDS cases and comparisons based on gender, race.ethnicity, and age were examined. Comparisons were also made to HIV testing and AIDS cases from the nonincarcerated Maryland population. Trends in DOC AIDS diagnoses and AIDS-related deaths over time were also examined. Of the inmates, 39% were voluntarily tested for HIV on entry to the Maryland DOC in 1998 (38% of males and 49% of females). Overall, HIV seropositivity was 3.3% (5% for females and 3% for males). The 888 cumulative AIDS cases diagnosed in the DOC inmate population were concentrated among males (90% vs. 77% statewide), African Americans (91% vs. 75% statewide), and among IDUs (84% vs. 39% statewide). Due to high rates of HIV and AIDS, inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts, especially women. Prison-based programs can identify significant numbers of HIV and AIDS cases and bring HIV prevention interventions to a population characterized by frequent high-risk behavior.https://link.springer.com/article/10.1093%2Fjurban%2F78.2.25

Comparison of Immediate Breast Reconstruction Outcomes in Patients With and Without Prior Cosmetic Breast Surgery

Skin-sparing (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) have significantly increased. There is limited information on complications of IBR in patients with prior cosmetic breast surgery (CBS). We compare IBR outcomes in patients undergoing SSM and/or NSM with and without prior CBS. Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complications were compared between mastectomy and IBR cases for breasts with and without prior CBS. Binary logistic regression analysis was performed to identify predictors of complications and reconstruction loss. 956 mastectomies were performed in 697 patients, with IBR performed for 545 mastectomies in 356 patients. Median age was 51 (range 19-83), 45.8% of patients were age < 50, 62.6% of mastectomies were performed for breast cancer. 95 mastectomies (17.4%) were performed in breasts with prior CBS and 450 (82.6%) without. NSM was more frequently utilized for breasts with prior CBS (P < .001). Complications occurred in 80 mastectomies (14.7%); reconstruction loss in 30 (5.5%). On multivariable analysis, age ≥ 50 (OR 1.76, 95%CI 1.01-3.09, P = .047) and NSM (OR 2.11, 95%CI 1.17-3.79, P = .013) were associated with an increased risk of any complication. Prior CBS was not associated with an increased risk of complications (OR 1.11, 95%CI 0.58-2.14, P = .743) or reconstruction loss (OR 1.32, 95%CI 0.51-3.38, P = .567). In this analysis of mastectomy and IBR, prior CBS was not associated with an increased risk of complications or reconstruction loss. In patients with prior CBS undergoing mastectomy, IBR may be safely performed. In patients undergoing skin-sparing or nipple-sparing mastectomy with immediate breast reconstruction, prior cosmetic breast surgery did not increase risk of surgical complications or reconstruction loss. Mastectomy and immediate breast reconstruction can be safety performed in appropriately selected patients who have had prior cosmetic breast surgery

Rare B-Cell Non-Hodgkin’s Lymphomas in Childhood and Adolescence

Non-Hodgkin’s lymphoma (NHL) results from malignant proliferation of lymphocytes and is generally restricted to lymphoid tissue such as lymph nodes, Peyer’s patches, and spleen. However, pediatric NHL can rarely and solely arise in other anatomical sites, such as the kidney, skin, lung, eye, bone, stomach, or cavities as an effusion. Adult-type lymphomas (chronic lymphocytic leukemia and multiple myeloma) have scarcely been reported in children. Understanding of these rare pediatric B-NHLs is mainly based on small pediatric case series or adult studies. Due to the limited number of cases the exact prevalence of the abovementioned NHL types cannot be easily estimated. Moreover, the index of suspicion is usually low because of the rarity, resulting sometimes in late diagnosis with a significant impact on prognosis. Since these NHL types are often more well-studied in adult population, adult-based therapeutic approaches are also applied in children. Prognosis in pediatric patients may be different from that of adults. So, more international collaborative efforts are needed in order to identify specific prognostic factors, including molecular and cytogenetic variables and define specific pediatric treatment protocols.</p