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Charlottesville, VA, United States

Basu C.B.,Private Practice
Plastic and reconstructive surgery | Year: 2012

Despite advances in breast implant surgery, capsular contracture remains a challenging sequela of reconstructive and cosmetic breast implant surgery. Although there are established modalities for treatment, most recently, acellular dermal matrix products have been suggested to have a role in preventing or diminishing the pathologic process of capsular contracture. In this article, the author presents a review of the literature to highlight the level of evidence on the role of acellular dermal matrices in the treatment of capsular contracture. Source

Porst H.,Private Practice
Journal of Sexual Medicine | Year: 2011

With increasing interest and clinical research in male sexual disorders, it has become clear that not only psychological but also organic, neurobiological, and genetic factors may play an important role in premature ejaculation (PE). Aim. This article provides an overview of the different treatment options both for lifelong (primary, "congenital") and acquired (secondary) PE. Methods. Review of the literature. Main Outcome Measures. Currently used treatment options for PE. Results. Treatments reviewed include psychological/behavioral/sexual counseling therapy, topical anesthetics, dapoxetine, and other selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and phosphodiesterase-5 (PDE-5) inhibitors. Conclusions. Before starting any therapy for PE, correct diagnosis has to be made considering the patient's reported intravaginal ejaculatory latency time (IELT) and the duration and type of PE. Concomitant erectile dysfunction (ED) should be either ruled out or proven by appropriate means. In uncomplicated cases of PE with stable partnerships, medical treatment represents the first-choice option with a high likelihood of success. Dapoxetine, where available, or other SSRIs provide suitable therapeutic options with a good risk/benefit profile for patients. In complicated ("difficult-to-treat") PE patients, a combination of medication and sexual counseling should be considered the first treatment option. Combination therapies of PDE-5 inhibitors and PE-related medications should be offered to patients suffering from comorbid PE and ED, with ED treatment starting first. In those patients with severe PE-IELTs of <30-60 seconds or anteportal ejaculation-combination therapy of topical and oral medications can be offered and may considerably increase IELT, compared with either monotherapy. © 2011 International Society for Sexual Medicine. Source

Beard M.K.,Private Practice
Current Medical Research and Opinion | Year: 2012

Objective: To review current use of bisphosphonates as first-line therapy for osteoporosis, with an emphasis on the importance of patient compliance and persistence. Methods: The US National Library of Medicine was used to obtain the relevant information on current bisphosphonate treatment for osteoporosis management, and patient compliance and persistence with treatment. Results: Bisphosphonates have demonstrated efficacy in fracture risk reduction, although differences may exist with respect to both onset of action and the site of fracture risk reduction. Good compliance and persistence with osteoporosis therapy is needed to reduce fracture risk, but currently the willingness of patients to conform to their prescribed course of treatment is suboptimal. Intermittent dosing schedules have been developed to facilitate ease of medication-taking in order to help improve rates of compliance and persistence. When primary care physicians provide patients with information about the established efficacy and safety of medications, as well as clarifying the crucial link between continued, consistent treatment and fracture risk reduction, patients are more likely to understand the importance of taking their medications consistently in order to maximize the effectiveness of the therapy. Conclusions: A therapy that provides vertebral and nonvertebral efficacy, is well-tolerated, and offers a flexible dosing regimen is likely to enhance patient compliance and persistence, and provide optimal fracture protection. Numerous studies have consistently demonstrated that medication compliance and persistence are well-correlated with fracture risk reduction. © 2012 Informa UK Ltd. Source

Petok W.D.,Private Practice
Fertility and Sterility | Year: 2015

Men with infertility represent a significant percentage of the infertile population. However, public awareness of this fact is limited at best. Literature and other media have neglected the male component of reproduction other than its sexual nature. Men's emotional reactions to a diagnosis of infertility have been studied far less than those of women. However, there is a growing body of research indicating that men do feel the loss associated with a failure to conceive and have unique methods of adapting. At the same time resources available for infertile men are limited or underutilized. Several factors contribute to the underutilization, including narrow awareness, lack of high-visibility individuals willing to speak about the problem, and male avoidance of mental health services. Suggestions for improving this situation are offered. © 2015 American Society for Reproductive Medicine. Source

Hamori C.A.,Private Practice
Aesthetic Surgery Journal | Year: 2013

Aesthetics of the female genitalia have come under increasing scrutiny with the popularity of Brazilian waxing trends and media promotion of sheer fashions. Women seek to have a clean and youthful appearance of the vaginal region, with minimal if any labial minora show beyond the labia majora. Labiaplasty by edge resection of the redundant labia minora tends to be the preferred method of treating labia minora hypertrophy by most gynecologists and plastic surgeons. This technique is effective in removing the excess circumferential rim of the labia minora, thus decreasing bulk and protrusion from the introitus. However, in select patients with redundant clitoral hood tissue, edge trim techniques may result in an imbalanced postoperative result where the hood actually looks larger. These patients complain of a prominence of the clitoral hood not present prior to their labiaplasty. In this case report, the author describes 2 cases of excess clitoral hood prominence after free-edge resection labiaplasty. Both patients were unhappy with the result of their labiaplasties and sought surgical correction. Presentation, anatomical findings, options for treatment, and avoidance of such deformity are discussed. © 2013 The American Society for Aesthetic Plastic Surgery, Inc. Source

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