AIDS at the medical college of georgia—A study in institutional ethics

100 encoded blood flow data to be displayed simultaneously on a structural image. This technique represents an alternative to invasive vascular studies, such as venography and arteriography. Previous reports have described the successful use of CD1 in imaging normal orbits and in pathologic conditions of the orbit, such as vascularity in intraoccular tumors and orbital lesions. The authors used CD1 in the evaluation of one patient with a traumatic. high blood-flow carotid cavernous fistula (CCSF) and two patients with spontaneous, low blood-flow dural cavernous arteriovenous malformations (DCAVMs). In the first patient. CDI was the primary diagnostic tool used to explore the clinical diagnosis of CCSF. Computed tomographic and magnetic resonance imaging, as well as carotid angiography. confirmed the diagnosis. The patient underwent embolization of the fistula and CD1 was used postoperatively to verify occlusion of the fistula. In the second and third patients, CD1 was successfully used for the preliminary diagnosis of DCAVM. which was confirmed by arteriography. CD1 is a noninvasive imaging tool that has advantages over computed tomography and magnetic resonance imaging in that it can be performed quickly and inexpensively and that it is dynamic without requiring contrast media. CD1 will not eliminate the need for angiography before embolization therapy, but does show great promise in the diagnosis and monitoring of orbital vascular anomalies.K. H. PESKIN Reprint requests to Dr Sergott: Neuro-ophthalmology Service. Wills Eye Hospital, Ninth and Walnut Sts, Philadelphia. PA 19 107. AIDS at the Medical College Of Georgia-A Study In Institutional Ethics. Koelbl JJ. J Dent Educ 55:235, 1991 A recent case of an HIV-positive dental student at the Medical College of Georgia has raised questions concerning rights and responsibilities of professional health care personnel who are HIV positive or suffering from AIDS. Issues raised include the difference in handling the situation if the affected is a freshman, a senior, or an oral surgery resident. Given that the HIV-positive student has rights as a legally handicapped individual, the question is raised whether or not an “otherwise qualified individual” can be accommodated in dental school. The author addresses issues including risk of transmission, confidentiality, informed consent, Association guidelines, and alternatives to patient care. The risks to patients operated on by HIV-positive surgeons is quite low, and disclosing any HIV-related information about a patient is prohibited by law without authorization. Weighing the risks and benefits, a patient may choose another practitioner if the patient knows the HIV status of the practitioner prior to informed consent. The American Dental Association board of trustees adopted an interim policy calling on HIV-infected health care professionals to refrain from performing invasive procedures or to disclose their seropositive status “until the uncertainty about transmission is resolved.” The ASDA resolution 36s states that a dental school’s policy should include completion of the dental degree or an alternative degree for infected individuals.-D. P. MUELLER Reprint requests to Dr Koelbl: Loyola University School of Dentistry, 2160 S First Ave. Maywood, IL 60153. Mersilene Tip Implants in Rhinoplasty: A Review of 98 Cases. Fanous N. Plast Reconstr Surg 87:662, 199 1 Reshaping the nasal tip can be performed with the use of Mersilene implants. Mersilene mesh is a multifilament Dacron with two important properties: First, the soft, pliable

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nature of the implant allows it to be easily shaped and it is difficult to detect by skin palpation. Second, the mesh form of the implant allows surrounding connective tissue invasion. thereby preventing its displacement. A total of 98 patients were reviewed. The most significant complication was infection which was encountered in eight cases (8.3%). The success of this alloplastic mesh implant is enhanced by several guidelines: the subcutaneous pocket should be large, at least twice the size of the implant. the implant should be at least 3 mm from the incision. the shape should be in the form ofa lozenge with an average thickness of two to three pads. and the rim incision should be long enough (2 to 3 cm) to allow for good exposure and easy introduction of the implant. Since Mersilene shows no resorption. aesthetic results can be very predictable.-R. A. CHIMEL Reprint requests to Dr Fanous: I Westmount Square, Suite 1380, Westmount, P.Q., Canada H3Z 2P9. Studying Whole-Mounted Sections of the Paranasal Sinuses to Understand the Complications of Endoscopic Sinus Surgery. Rontal M. Rontal E. Laryngoscope IO]:36 1, 199 1 In this study, whole-mounted microscopic sections of the paranasal sinuses and related orbit from human cadaver heads were used to correlate the complications of endoscopic sinus surgery. The complications of endoscopic ethmoid/sphenoid surgery can be categorized according to the wall on which they occur. On the superior wall, the most dangerous complication is cerebrospinal fluid rhinorrhea. If excessive torque is applied to the perpendicular plate of the middle turbinate or to the ethmoid roof, fracture can occur. The cribriform plate may be thin at the level of the superior turbinate. Aggressive removal of mucosa medial to the turbinate will result in injury to the olfactory fibers passing through the ctibrifonn plate. Laterally, removal of media1 orbital bone near the anterior ethmoidal artery (AEA) may cause laceration of the vessel and lead to an expanding orbital hematoma. Diplopia can result from injury to the media1 or superior rectus muscles from the removal of lateral ethmoid wall at the level of AEA. Another complication that can occur on the lateral wall is lacrimal duct injury. This is caused by aggressive dissection through the thick bone anterior to the maxillary ostium and into the lacrimal duct. The posterior wall of the nasopharynx serves as a landmark beyond which exposure and damage to the optic nerve can occur in the sphenoid sinus. The authors conclude that in times of doubt, the above-mentioned landmarks serve as a limit of dissection to prevent surgical complications.-T. WONG Reprint requests to Dr Rontal: 28500 Orchard Lake Rd, Suite 200. Farmington Hills, MI 480 18. Fatal and Other Major Complications of Endoscopic Sinus Surgery. Maniglia AJ. Laryngoscope 10 I :349, I99 I Endoscopic sinus surgery has become more and more popular in the United States for the treatment of chronic sinus disease. This article reports five major complications from endoscopic sinus surgery. Orbital complications involved in two of the five cases. In one case, intraorbital invasion of the endoscope caused injury to the media1 rectus muscle that led to permanent diplopia. In the second case, the patient awoke from general anesthesia with bilateral total blindness due to damage to both optic nerves, with complete severance on one side. The remaining three cases involved intracranial complications. Damage to the cribriform plate with brain injury and intracerebral hematoma occurred in