breast plastic surgery

2006-01-18T07:31:00.000-05:00

ATLAS MEDIA

(212) 714-0222

ALL YEAR ROUND WITH KATIE BROWN

(A&E) EXP, Bruce David Klein; CO-EXP, Maria Lane; SUPR PROD, Cheryl Houser, Jessica Winchell-Morsa; PROD, Barbara Fight.

BEHIND THE BASH (PILOT)

(Food Network) EXP, Bruce David Klein; CO-EXP, Maria Lane; SUPR PROD, Suzanne Levy, Annie Sundberg; PROD, Amanda Hulsey.

BREAKING VEGAS

(History) EXP, Bruce David Klein; CO-EXP, Maria Lane; SUPR PROD, Cheryl Houser; PROD, Ken Wiederhorn.

DR. G: MEDICAL EXAMINER

(Discovery Health) EXP, Brace David Klein; SUPR PROD, Maria Lane, Craig Coffman; PROD, Bill McClane, Jerry Tully.

FORECAST EARTH

(Weather) EXP, Brace David Klein; CO-EXP, John B. Drimmer; SUPR PROD, Suzanne Levy; PROD, Anne Jones, Amanda Hulsey.

HISTORY ROCKS (PILOT)

(History) EXP, Bruce David Klein; SUPR PROD, Bill McClane.

PSYCHIC HISTORY (PILOT)

(History) EXP, Bruce David Klein; CO-EXP, Maria Lane; SUPR PROD, Jim Mullen; PROD, Jacqueline Gares.

SIX DEGREES OF FRANCIS BACON (PILOT)

(History) EXP, Bruce David Klein; SUPR PROD, Cheryl Houser; PROD, George Ratliff.

TOOLBOX

(History) EXP, Bruce David Klein; SUPR PROD, Cheryl Houser, Jessica Winchell-Morsa; PROD, Amanda Hulsey.

YOUNG, SEXY & ...

(WE) EXP, Bruce David Klein; SUPR PROD, Cheryl Houser, Jessica Winchell-Morsa; PROD, Simonette Rossi.

BARN PRODS.

(323) 671-4161

THE SHIELD

(FX) (in assn w/Fox Television Studios and Sony Pictures Television) EXP, Shawn Ryan, Scott Brazil; CO-EXP, Glen Mazzara, Charles Eglee; SUPR PROD, Scott Rosenbaum, Kurt Sutter; PROD, Adam Fierro, Dean White, Michael Chiklis, Kevin Cremin; CO-PROD, Liz Craft, Sarah Fain; DIR, Scott Brazil; CASTING, Wendy Weidman (323) 671-4700.

BIG TICKET TELEVISION

(323) 860-7400

JUDGE JOE BROWN

(synd) (in assn w/Paramount Domestic TV) EXP, John Terenzio; SUPR PROD, Lou Dennig; PROD, Belinda Jackson, Richard Velasquez, Kathy Card, Amy Diamond, Jeffrey Pitts, Margot Foley, Debbie Alpert; DIR, Jerry Kupcinet.

BLACK ENTERTAINMENT TELEVISION

(818) 655-6700

COMING TO THE STAGE

(BET) SUPR EXP, Gina Holland; EXP, Marilyn Gill; CO-EXP, T Faye Griffin; PROD, Jamie Balthazar, Theresa Moore King, Mitchell Marchand; DIR, Tony McCuin; CASTING, Nu Opp (323) 860-7880, Coleman Connection (310) 854-6531.

BRENTWOOD COMMUNICATIONS INTL.

(818) 487-5666

* OVERHAULIN'

(TLC) SUPR EXP, Bud Brutsman; PROD, Veronica Tortes; CO-PROD, Bethany Landing; DIR, Andrew Robinson.

* RIDES

(TLC) EXP, Bud Brutsman; SUPR PROD, Jennifer Shields; PROD, Dennis Zerull; DIR, Steve Beebe.

CARSEY-WERNER PRODS.

(818) 655-5598

PEEP SHOW (Fox) EXP, Jackie Filgo, Jeff Filgo, Marcy Carsey, Tom Werner; PROD, Stephen Grussman; CASTING, G. Charles Wright.

THAT '70S SHOW

(Fox) EXP, Marcy Carsey, Tom Wemer, Caryn Mandabach, Jackie Filgo, Jeff Filgo; CO-EXP, Dean Batali, Rob Des Hotel, Mark Hudis, Gregg Mettler, Philip Stark, Dave Schiff; PROD, Melanie Patterson, Bonnie Turner, Terry Turner, Mark Brazill, Kristin Newman, Bryan Moore, Chris Petersnn; DIR, David Trainer; CASTING, G. Charles Wright.

CBS PRODS.

(323) 956-5000

CSI: CRIME SCENE INVESTIGATION (CBS) (CBS Prods./Alliance Atlantis in assn w/Jerry Bruckheimer Television) EXP, Jerry Bruckheimer, Carol Mendelsohn, Ann Donahue, Anthony E. Zuiker, Danny Cannon, Jonathan Littman, William Petersen, Cindy Chvatal, Naren Shankar; CO-EXE Josh Berman, Judith McCreary; PROD, Louis Milito, Richard J. Lewis; CASTING, Robert J. Ulrich, Eric Dawson, Carol Kritzer (818) 623-1818.

CSI: MIAMI

(CBS) (CBS Prods./Alliance Atlantis in assn w/Jerry Bruckheimer Films) EXP, Jerry Bruckheimer, Ann Donahue, Carol Mendelsohn, Anthony E. Zuiker, Danny Cannon, Jonathan Littman; SUPR PROD, Elizabeth Devine, Steve Maeda; PROD, Scott Shiffman; CASTING, Nan Dutton.

CSI: NY

(CBS) (CBS Prods./Alliance Atlantis in assn w/Jerry Bruckheimer Television) EXP, Jerry Bruckheimer, Ann Donahue, Carol Mendelsohn, Anthony E. Zuiker, Danny Cannon, Jonathan Littman, Andrew Lipsitz; PROD, Bob Simon, Deran Sarafian, Eli Talbert, Bruce Golin; CO-PROD, Pam Veasey; CASTING, Risa Bramon Garcia, Brennan Dufresne.

COMEDY CENTRAL

(310) 407-4700

THE DAILY SHOW WITH JON STEWART

(Comedy Central) (Mad Cow Prods. in assn w/Comedy Central) EXP, Jon Stewart; CO-EXP, Stewart Bailey, Ben Karlin; SUPR PROD, Kahan Corn, DJ Javerbaum; DIR, Chuck O'Neil.

SOUTH PARK

(Comedy Central) EXP, Trey Parker, Matt Stone, Anne Garefino.

COURTH TV

(212) 973-7573

CATHERINE CRIER LIVE

(Court TV) EXP, Emily Barsh; SUPR PROD, Shawn Giangeruso; DIR, Dominic Palumbo.

FORENSIC FILES

(Court TV) (in assn w/Medstar Television) SUPR EXP, Ed Hersh; EXP, Lori Siegel, Paul Dowling.

HIGH STAKES WITH BEN MEZRICH

(Court TV) EXP, Steve Rivo, Joshua Brown; PROD, Jennifer Langheld; CO-PROD, Christopher Tetens; DIR, Steve Rivo.

MUGSHOTS

(Court TV) (in assn w/Parco Prods.) EXP, Anthony Horn; SUPR PROD, Ed Hersh.

* PARCO P.I.

(Court TV) EXP, Mark Efman, Mark Farrel, Robyn Hull; CO-EXP, Mark Fichaudler; CO-PROD, Madelyn Brudner.

* PSYCHIC DETECTIVES

(Court TV) EXP, Andreas Gutzeit, Steven Miller, Lisa Jackson, Robyn Hutt.

TAKEDOWN: CASINO

(Court TV) SUPR EXP, Ed Hersh, Lynne Kirby; EXP, Jim Milio, Melissa Jo Peltier, Mark Hufnail, Chris Hammond, David Schnepp; SUPR PROD, Kelly McPherson.

DAVID E. KELLEY PRODS.

(310) 727-2200

BOSTON LEGAL

(ABC) (in assn w/20th Century Fox Television) EXP, David E. Kelley, Bill D'Elia, Scott Kaufer; CO-EXP, Mike Listo, Peter Ocko; SUPR PROD, Steve Robin, Jonathan Shapiro; PROD, Janet Knutsen; CASTING, Ken Miller, Nikki Valko.

DIGITAL RANCH

(818) 817-9690

A DANGEROUS GAME

(Court TV) EXP, Robert Kirk, Rob Lihani; SUPR PROD, Rob Beemer; PROD, Jon Taylor, Peter Hankwitz; DIR, David Cargill.

THE FIRST WORLD FLIGHT

(History) EXP, Robert Kirk, Rob Lihani; SUPR PROD, Rob Beemer; PROD, Arthur Drooker; CO-PROD, Martha Sloan; DIR, Arthur Drunker.

E! ENTERTAINMENT TELEVISION

(323) 964-2400

DR. 90210

(E!) EXP, Donald Bull; SUPR PROD, Carmen Mitcho; PROD, Jen Morton.

HOTSPOT

(E!) EXE, Lisa Berger; PROD, Brant Zacky.

HOWARD STERN

(E!) EXP, Robin Radzinski; PROD, Doug Goldstein, Mike Gange; DIR, Scott DePace.

IT'S GOOD TO BE

(E!) EXP, Sue Nadell; SUPR PROD, Erin Zelle.

101

(E!) EXp, Gary Socol; PROD, Carmen Mitcho, Gina Sirico, Kerry Carlock.

TRUE HOLLYWOOD STORY

(E!) EXP, Bill Neal; SUPR PROD, Andreas Kanonenberg, Gretchen Goldsmith; PROD, Dan Isaacson, Michael Hacker, Ashley Adams, Christopher Hines, Wendy Quinn, Michael Lynn, Emily Puk.

WILD ON

(E!) SUPR PROD, Dan Barton; PROD, Gary Millman, Chad Gajadhar, Kristen Giordano.

ESPN PRODS.

(212) 916-9200

AROUND THE HORN

(ESPN) (in assn w/Wolff Prods.) EXP, Mark Shapiro, Jim Cohen; PROD, Bill Wolff.

DREAM JOB

(ESPN) (in assn w/Jumbolaya Prods.) EXP, Mark Shapiro.

PARDON THE INTERRUPTION

(ESPN) (in assn w/Atlantic Studio) EXP, Mark Shapiro, Jim Cohen; PROD, Erik Rydholm.

ROME IS BURNING

(ESPN) (in assn w/Mandt Bros. Prods.) EXP, Mark Shapiro; SUPR PROD, Mike Antinoro; PROD, Michael Mandt, Nell Mandt.

EVERWOOD UTAH

818-954-6000

EVERWOOD

(WB) (in assn w/Warner Bros. Television) EXP, Greg Berlanti, Mickey Liddell, Rina Mimoun; CO-EXP, Andrew A. Ackerman, Michael Green; SUPR PROD, Bruce Miller; PROD, Tom Luse; CO-PROD, Anna Fricke, Scott Swanson; CASTING, Patrick Rush Casting.

FIND PRODS.

(212) 983-9898

FIND!

(PBS) EXP, Russell Morash; DIR, Morash; CASTING, Matthew Bueldey (978) 202-3022.

FIVE STAR STUDIOS

SUPERNATURAL (PILOT)

(TBA) (in assn. With Stargate Films) SUPR EXP, Sam Nicholson; EXP, Peter V. Ware, Sam Nicholson; CO-EXP, James Fitzpatrick; SUPR PROD, C. Gordon; PROD, Randolf Turrow; CO-PROD, Dana MacDuff; DIR, Sam Nicholson; CASTING, C. Laughlin.

FOX SPROTS NETWORK

(310) 369-1000

BEST DAMN SPORTS SHOW PERIOD

(FSN) EXP, George Greenberg, Robert Lifton; DIR, Jeff Winn.

BEYOND THE GLORY

(FSN) (in assn w/Asylum Entertainment) CO-EXP, Frank Sinton, Steven Michaels.

I, MAX

(FSN) EXP, George Greenberg; PROD, Willie Geist; DIR, Howard Lutt.

FREMANTLEMEDIA

(310) 265-4700

AMERICAN IDOL

(Fox) EXP, Nigel Lythgoe, Ken Warwick, Cecile Frot-Coutaz; CASTING, Kelly Brock.

THE PRICE IS RIGHT

(CBS) EXP, Bob Barker; PROD, Roger Dobkowitz; DIR, Bart Eskander.

PROPERTY LADDER

(TLC) EXP. Tracy Verna; CASTING, Doron Ofir, Alesia Cook.

GIRL GROUP CO.

(323) 860-8965

MAD TV

(Fox) EXP, David Salzman, Quincy Jones, Dick Blasucci; CO-EXP, Lauren Dombrowski, Scott King, Steven Haft, Bryan Adams, Steven Cragg, Michael Hitchcock; SUPR PROD, Bruce Leddy, Chris Cluess, John Crane; PROD, Scott Sites, Jennifer Joyce, Bruce McCoy, Tarai Sagher, Maiya Williams; CO-PROD, Jim Wise; DIR, Bruce Leddy; CASTING, Nicole Garcia (323) 860-8936.

GRAMMNET PROD.

323-956-5647/323-956-6840

KELSEY GRAMMER PRESENTS THE SKETCH SHOW

(Fox) EXP, Kelsey Grammer, Steve Stark, Jon Thoday, Richard Allen Turner, Dan Patterson; CO-EXP, Charlie Hanson; PROD, Lee Tucker; DIR, Richard Boden.

MEDIUM

(NBC) (in assn w/Grammnet Prods.) SUPR EXP, Glenn Gordon Caron; EXP, Kelsey Grammer, Steve Stark, Ron Schwary, Rene Echevar; CO-EXP, Michael Angeli; SUPR PROD, Moira Kirland; CO-PROD, Chris Dingess.

GRANADA AMERICA NEW YORK

(212) 905-1700

AIRLINE

(A&E) EXP, Charles Tremayne; CO-EXP, Chris Carey; PROD, Lee Servis; CO-PROD, Anita Shah.

CAUGHT!

(Court TV) EXP, Charles Tremayne; SUPR PROD, Nigel Bellis.

FIRST 48

(A&E) EXP, Charles Tremayne; SUPR PROD, John Kim; CO-PROD, Erin McCarthy, Jaime Wilson.

TCOB

(TLC) EXP, Charles Tremayne; SUPR PROD, Nell Cohen; CO-PROD, Kim White.

ULTIMATE TREEHOUSE

(Discovery) EXP, Charles Tremayne; SUPR PROD, Richard Vagg; CO-PROD, Alex Worrall.

GRB ENTERTAINMENT

(818) 728-7600

THE DAVID FOSTER PROJECT

(Fox) EXP, Gary R. Benz, Brant Pinvidic, Spencer Pratt; CO-EXP, Scan Travis; SUPR PROD, Paul Davidson; PROD, Andra Duke.

GROWING UP GOTTI

(A&E) (in assn w/Regan Media and Wild Bill Prods.) EXP, Gary R. Benz, Michael Branton, Victoria Gotti, Judith Reran, Bill Stanton; CO-EXP, Banks Tarver; SUPR PROD, Ken Druckerman, Greg Nash, Mark Rains; PROD, Harvey Wilson.

MONTGOMERY GENTRY'S MUSCLE GARAGE

EXP, Gary R. Benz, Brant Pinvidic; SUPR PROD, Mark Rains; PROD, Tiff Winton; CO-PROD, Carrie Riley-Paul; DIR, Tiff Winton.

ON THE TRAIL (PILOT)

(The History Channel) (in assn w/Peter Start Entertainment) EXP, Gary R. Benz, John Drimmer; SUPR PROD, Tim Prokop; PROD, Taramy Wood; DIR, Peter Starr.

PLAN B (PILOT)

(CMT) EXP, Gary R. Benz, Michael Branton; SUPR PROD, Mark Rains; PROD, Heather Urban, Tiff Winton; CO-PROD, Carrie Riley-Paul; DIR Heather Urban; CASTING, Sheila Conlin.

SECOND CHANCE

(TLC) EXP, Gary R. Benz, Michael Branton; SUPR PROD, Mark Rains, Bryn Freedman; CO-PROD, Andra Duke; CASTING, Trisha Kirk, Bess Hubbard.

SHOT FROM THE SKY

(History) SUPR EXP, Carl Lindahl; EXP, Gary R. Benz, John B. Drimmer; SUPR PROD, Debby Reid Levin, Tim Prokop.

UNTOLD STORIES OF THE ER

(TLC) EXP, Gary R. Benz, Michael Branton, John Drimmer; SUPR PROD, David Gullason, Mark Rains; PROD, Taramy Wood.

HBO ORIGINAL PROGRAMMING

(310) 382-3000

DEADWOOD

(HBO) EXP, David Milch, Gregg D. Fienberg; PROD, Davis Guggenheim, Scott Stephens; CO-PROD, Steve Turner; CASTING, Libby Goldstein, Junie Lowry-Johnson.

ENTOURAGE

(HBO) EXP, Mark Wahlberg, Doug Ellin, Stephen Levinson, Larry Charles; CO-EXP, Timothy Marx; PROD, Janace Tashjian; CO-PROD, Rob Weiss.

ROME

(HBO) EXP, Frank Doelger, Bruno Heller, William J. MacDonald, John Milius, Anne Thomopoulos, Gareth Neame; CO-EXP, Stanley Wlodkowski; PROD, Marco Valerio Pugini; CO-PROD, James G. Hirsch, Robert A. Papazian; CASTING, Nina Gold.

IRWIN ENTERTAINMENT

(212) 603-1813

BARELY FAMOUS

(CMT) EXP, John Irwin; CO-EXP, Damian Sullivan.

DEAD MAN'S HAND

(CMT) EXP, John Irwin; CO-EXP, Damian Sullivan.

JUDGE JUDY PRODUCTION OFFICE

(323) 860-0200

JUDGE JUDY

(synd) (in assn w/Paramount Domestic TV) EXP, Randy Douthit, Timothy Regler; SUPR PROD, Victoria Jenest; PROD, Shannon Weber-Arellano, Tina Nicotera, Jill Wilderman, May Johnson, Cybil Jordan-Malachi, Richard Russakoff, Jonathan Sebastien; DIR, Randy Douthit.

LIONS GATE TELEVISION

(310) 449-9200

THE DEAD ZONE

(USA) (in assn w/Paramount Intl. TV) EXP, Michael Piller, Lloyd Segan, Jack LoGiudice; CO-EXP, Tommy Thompson; SUPR PROD, Michael Taylor, Loren Segan, Christina Lynch.

LMNO PRODS.

(818) 380-8000

AMAZING MEDICAL STORIES

(TLC) EXP, Eric Schotz, Bill Paolantonio; CO-EXP, Ruth Rivin.

BABIES: SPECIAL DELIVERY

(Discovery Health) EXP, Eric Schotz, Bill Paolantonio, Bob Niemack.

EXTREME EVIDENCE

(Court TV) EXP, Eric Schotz, Bill Paolantonio; SUPR PROD, Steve Durgin.

FIRE ME ... PLEASE

(CBS) EXP, Eric Schotz, Bill Paolantonio; CO-EXP, Dan Funk.

I WANNA BE A SOAP STAR

(Soapnet) EXP, Eric Schotz, Bill Paolantonio, Lisa Bourgoujian.

SUPER SURGERY

(Discovery Health) EXP, Eric Schotz, Bill Paulantonio; CO-EXP, Bob Niemack.

TRAVEL CHANNEL SECRETS OF ...

(Travel Channel) EXP, Eric Schotz, Bill Paolantonio, Lisa Bourjougian.

TRAVEL CHANNEL WORLD'S BEST

(Travel Channel) EXP, Eric Schotz, Bill Paolantonio, Lisa Bourjougian.

WHO GETS THE DOG?

(Animal Planet) EXP, Eric Schotz, Bill Paolantonio, Marty Tenney; CASTING, Josh Figgs.

MG/PERIN

(212) 447-5600

(NBC) (in assn w/Constant c Prods. and Amblin Television) EXP, Christopher Chulack, Michael Crichton, John Wells, Dee Johnson; CO-EXP, David Zabel, Jonathan Kaplan; SUPR PROD, Joe Sachs, Julie Hebert; PROD, Richard Thorpe, Wendy Spence Rosato; CO-PROD, Yahlin Chang, Tommy Burns.

MINDLESS ENTERTAINMENT

(323) 960-4576

THE SURREAL LIFE

(VH1) EXP, Ben Samek, Chris Abrego, Mark Cronin; CO-EXP, James Rowley; CO-PROD, Christe Williams; CASTING, Kristen Prouty.

NASH ENTERTAINMENT

(323) 993-7384

FOR BETTER OR FOR WORSE

(TLC) EXP, Bruce Nash, Robyn Nash, Debra Weeks; SUPR PROD, Andrew Jebb; PROD, Dan Perry.

TOTALLY OUTRAGEOUS BEHAVIOR

(Fox) EXP, Bruce Nash, Robyn Nash, Don Weiner; CO-EXP, Todd Barton; SUPR PROD, Andrew Jebb.

WHO WANTS TO BE A SUPERHERO?

(MTV) (in assn w/POW! Entertainment) EXP, Bruce Nash, Stan Lee, Gill Champion, Scott Satin; CO-EXP, Arthur Borman, Gabriel Grunfeld; SUPR PROD, Andrew Jebb.

NBC UNIVERSAL TELEVISION

(818) 840-4444

AMERICAN DREAMS

(NBC) EXP, Jonathan Prince, Dick Clark; CO-EXP, Becky Hartman Edwards, Emily Whitesell, Jim Chory, Josh Reims; SUPR PROD, Rama Stagner; CASTING, Jason La Padura, Natalie Hart.

COMMITTED

(NBC) EXP, Eileen Heisler, DeAnn Heline; CO-EXP, Rob Bragin; SUPR PROD, Rodney Rothman; PROD, Werner Walian, Bill Daly, Katy Ballard; CASTING, Debby Romano, Brett Benner.

COMPLETE SAVAGES

(ABC) (in assn w/Nothing Can Go Wrong Prods. and Icon Prods.) EXP, Mike Scully, Julie Thacker-Scully, Mel Gibson, Bruce Davey; CO-EXP, Brian Scully, Andy Gordon; PROD, Coral Hawthorne, Nancy Cotton, Lissa Levin; CASTING, Sally Stiner, Barbie Block.

CROSSING JORDAN

(NBC) (in assn w/Tailwind Prods.) EXP, Tim Kring; CO-EXP, Dennis Hammer, Alan Arkush, Kathy McCormick, Scott Williams; SUPR PROD, Robert Rovner, Jon Cowan, Linda Gase; PROD, Andi Bushell, Sharon Lee Watson; CO-PROD, Skip Beaudine, Lori Motyer; CASTING, Jason La Padura, Natalie Hart (818) 733-4660.

HOUSE

(Fox) (in assn w/Heel and Toe Prods.) EXP, Paul Attanasio, Katie Jacobs, David Shore, Bryan Singer; CO-EXP, John Mankiewicz; SUPR PROD, Matt Witten, Tommy Moran; PROD, Gerrit van der Meet; CASTING, Amy Lippens.

KOJAK

(USA) (in assn wGEP Prods.) EXP, Tom Thayer, Steve Feke; CO-EXP, Ving Rhames; PROD, Clara George; CASTING, Mary Jo Slater, Steve Brooksbank.

LAS VEGAS

(NBC) (in assn w/DreamWorks Television) EXP, Gary Scott Thompson, Gardner Stem, Justin Falvey, Darryl Frank, Scott Steindorff; CO-EXP, Matt Pyken, Michael Betas, Kim Newton; CASTING, Liberman Patton Casting (323) 462-9175.

LATE NIGHT WITH CONAN O'BRIEN

(NBC) (in assn w/Broadway Video Entertainment) EXP, Lorne Michaels, Jeff Ross; DIR Allan Kartun.

LAW & ORDER

(NBC) (in assn w/Wolf Films) EXP, Dick Wolf, Matthew Penn, Eric Overmyer, Peter Jankowski, Roz Weinman; CO-EXP, Richard Sweren, Peter Giuliano, Wendy Battles, Arthur Fomey, William Fordes; SUPR PROD, Gary Karr; PROD, Lois Johnson, Nick Santora; CASTING, Lynn Kressel.

LAW & ORDER: CRIMINAL INTENT

(NBC) (in assn w/Wolf Films) EXP, Dick Wolf, Rene Balcer, Fred Beruer, Peter Jankowski; CO-EXP, Marlane Gomard Meyer, Warren Leight, Arthur Forney, Gerry Conway; SUPR PROD, Michael Kewley; PROD, John L. Roman, Stephanie Sengupta; CO-PROD, Mary Rae Thewus, Tim Deluca, Diana Son; CASTING, Lynn Kressel (212) 414-2941.

LAW & ORDER: SPECIAL VICTIMS UNIT

(NBC) (in assn w/Wolf Films) EXP, Dick Wolf, Ted Kotcheff, Neal Baer, Peter Jankowski; CO-EXP, Patrick Harbinson, Arthur Forney, Robert Nathan, Dawn DeNoon, Lisa Marie Peterson, Roz Weinman, Jonathan Greene, Michele Fazekas, Tara Butters; SUPR PROD, Randy Roberts; PROD, David DeClerque, Peter Leto; CO-PROD, Amanda Green, Jose Molina, Gaff Barringer; CASTING, Jonathan Strauss, Lynn Kressel.

LAW & ORDER: TRIAL BY JURY

(NBC) (in assn w/Wolf Films) EXP, Dick Wolf, Walon Green, Peter Jankowski; CO-EXP, Arthur Forney, Richard Pearce; SUPR PROD, Rick Eid; PROD, Barry Berg, Chris Levinson; CO-PROD, Tim Deluca, Tony Phelan, Joan Rater; CASTING, Lynn Kressel.

MONK

(USA) (in association with Mandeville Films and Touchstone Television) EXP, David Hoberman, Andy Breckman, Tony Shalhoub; CO-EXP, Fern Field; SUPR PROD, Tom Scharpling; PROD, Anthony Santa Croce, David Breckman.

PASSIONS

(NBC) (in assn w/Outpost Farm Prods.) EXP, Lisa de Cazotte; SUPR PROD, Richard Schilling; PROD, Mary-Kelly Weir; DIR, Peter Brinckerhoff, James Sayegh, Gary Tomlin, Karen Wilkens, Phideaux Xavier; CASTING, Jackie Briskey (818) 655-5601.

THE TONIGHT SHOW WITH JAY LENO

(NBC) (in assn w/Big Dog Prods.) EXP, Debbie Vickers; SUPR PROD, Larry Goitia, Patti M. Grant; DIR, Ellen Brown.

WILL & GRACE

(NBC) (in assn w/KoMut Entertainment and Three Sisters Entertainment) EXP, James Burrows, Alex Herschlag, Dave Flebotte; CO-EXP, Tim Kaiser, Tracy Poust, Jon Kinnally, Gary Janetti, Bill Wrubel, Greg Malins, Kirk Rudell; SUPR PROD, Gail Lerner; PROD, Bruce Alden, Peter Chakos, Steve Sandoval, Sally Bradford; DIR, James Burrows; CASTING, Tracy Lilienfield (818) 655-5652.

NELSON PAGE ENTERTAINMENT

(323) 860-5030

WORLD CUP COMEDY

(Pax) (in assn w/Grammnet Prods.) SUPR EXP, Wayne Nelson Page, Kelsey Grammer; CO-EXP, Steve Stark, Dan O'Connor, Adam Peck; SUPR PROD, Richard King; CO-PROD, Steve Atinsky, Jeff McCarthy; DIR, Michael Dimich; CASTING, Matthew Skrobalak, Marisa Ross (323) 956-5975.

NORTHSOUTH PRODS.

(212) 414-8670

IN A FIX

(TLC) EXP, Charlie DeBevoise, Mark Hickman; SUPR PROD, Nick O'Gorman; PROD, Thorn Hinkley.

MAKE ROOM FOR BABY

(Discovery Health) EXP, Charlie DeBevoise, Mark Hickman.

SUPER AGENTS

(TLC) EXP, Charlie DeBevoise, Mark Hickman; SUPR PROD, Blaine Hopkins.

A WEDDING STORY

(TLC) EXP, Charlie DeBevoise; CO-EXP, Mark Hickman; SUPR PROD, Blaine Hopkins.

ORIGINAL PRODS.

(818) 295-6966

ALASKAN CRAB FISHING DOCUMENTARY 2005 (Discovery) SUPR EXP, Thom Beers; SUPR PROD, Dean Ollins; CASTING, Danya Berman.

MONSTER GARAGE

(Discovery) EXP, Thom Beers; CO-EXP, Tod Mesinow, Tracy Green; PROD, Ryan Senter, Brian Lovett, Joe Mulcrone; CASTING, Danya Berman, (818) 295-6397.

MOTORCYCLE MANIA III

(Discovery) SUPR EXP, Hugh King; EXP, Thom Beers; SUPR PROD, Jesse James; CO-PROD, Dave Eberts.

PLASTIC SURGERY: BEFORE AND AFTER

(Discovery Health) EXP, Thom Beers; CO-EXP, Janice Engle; PROD, Daniel Fisher, Dawn Fitzgerald, Mary Glenn.

PARAMOUNT NETWORK TELEVISION

(323) 956-5000

JAG

(CBS) (in assn w/Belisarius Prods.) EXP, Donald P. Bellisario; CO-EXP, Chas. Floyd Johnson, Stephen Zito, Dana Coen; SUPR PROD, Julie Watson, Don McGill; PROD, Larry Moskowitz, David Bellisario, Avery Drewe, Peter Dunne, Darcy Meyers, Chip Vucelich, Megan Mascena; CASTING, Susan Bluestein, Camille St. Cyr (323) 468-4562.

LIFE ON A STICK

(Fox) EXP, Victor Fresco; CO-EXP, Mike Teverbaugh, Miriam Trogdon, Maggie Bandur, Michael Ross.

MEDICAL INVESTIGATION

(NBC) (in assn w/NBC Studios) EXP, Bob Cooper, Scott Vila, Laurence Andries, Marc Buckland; CO-EXP, Jason Horwitch, Mark Israel, Barry Schkolnick, Jim Hart; SUPR PROD, Dan Arkin.

NCIS

(CBS) (in assn w/Belisarius Prods.) EXP, Donald P. Bellisario; CO-EXP, Chas. Floyd Johnson, Mark Horowitz, Gil Grant; SUPR PROD, Roger Director; PROD, John Kelly, Frank Military, Frank Cardea & George Schenck, Mark R. Schilz, Julie Watson, David Bellisario, Avery Drewe; CASTING, Susan Bluestein (323) 468-4562.

NUMBERS

(CBS) (in assn w/Scott Free Prods.) EXP, Ridley Scott, Tony Scott, Brooke Kennedy, Alex Gansa; CO-EXP, Nick Falacci, Cheryl Heuton, David Zucker; SUPR PROD, Andy Dettmann; CASTING, Mark Saks (323) 785-2229.

PIE TOWN PRODS.

(818) 255-9300

$40 A DAY

(Food Network) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton; SUPR PROD, Kim Pflieger.

DESIGNERS' CHALLENGE

(HGTV) EXP, Tara Sandler, Jennifer Davidson Scott Templeton, Eric Black; SUPR PROD, Stacy Schneider; PROD, Eric Mathis, Shawn Power, Laura Patterson, Mike Noble, Marisa Tarabornini.

DESIGN ON A DIME

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Ellen Bauman-Kennedy, Vicky B. Landin; PROD, Terri Davis, Linda Nelson, Jerry McNutt, Jaclyn Dalton.

DESIGNED TO SELL

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Beth Suskind; PROD, Alicia Conway, Jamie Biggs.

HEAD2TOE

(Lifetime) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Cater Lee; SUPR PROD, Ginger Simpson; PROD, Ann Nakamura.

HOMES ACROSS AMERICA

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Drew Hallmann.

HOUSE HUNTERS

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Betsy Allman; PROD, Nathaniel Hamlin, Susan Hull, Mike Ballestero, Selene Kassin.

I HAVE NO TASTE

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Roberta White; PROD, Melissa Overholt.

LANDSCAPERS' CHALLENGE

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Sharon Gilmore-Reilly; PROD, Amy Arthun, Kelly Weinhart, Monica Ramone.

OPEN HOUSE USA

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Jake Gibson.

RACRAEL'S TASTY TRAVELS

(Food Network) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton; SUPR PROD, Wade Sheeler.

REDESIGN

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Maxine Gray.

TAKE IT OFF!

(Food Network) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton; SUPR PROD, Margaret Hussey.

TAKE MY KIDS, PLEASE!

(WE) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton; SUPR PROD, Lesley Mayer, Roberta White.

WEEKEND WARRIORS

(HGTV) EXP, Tara Sandler, Jennifer Davidson, Scott Templeton, Eric Black; SUPR PROD, Andrea Pilat; PROD, Renee Hambley, Demir Mahmood, Susie Gibson, James Jauregui.

PRODUCTION PARTNERS

(818) 556-5065

FAT ACTRESS

(Showtime) EXP, Kirstie Alley, Brenda Hampton, Sandy Chanley; SUPR PROD, Tom Bull; PROD, Scott Butler; DIR, Keith Truesdale; CASTING, Vicki Huff (323) 634-1260.

RDF MEDIA

(818) 817-5200

FAKING IT

(TLC) EXP, Shauna Minoprio; SUPR PROD, Kathey Leverton; PROD, Nathaniel Grouille; CASTING, Shana Kemp (818) 432-4657.

SILVER PICTURES TELEVISION

(818) 954-6000

VERONICA MARS

(UPN) (in assn w/Warner Bros. Television) EXP, Joel Silver, Rob Thomas; CO-EXP, Jennifer Gwartz, Danielle Stokdyk, Jed Seidel, Diane Ruggiero; PROD, Paul Kurta; CO-PROD, Dan Etheridge; CASTING, Mary Buck, Wendi Matthews, DeeDee Bradley, D. Candis Paule.

SONY PICTURES TELEVISION

(310) 202-1234

* BEAUTIFUL PEOPLE

(ABC Family) EXP, Paul Stupin, Michael Ranch; CASTING, Julie Tucker, Mara Casey, Jamie Rudofsky.

JOAN OF ARCADIA

(CBS) EXP, Barbara Hall, Jim Hayman, Stephen Nathan; CO-EXP, Peter Schindler; SUPR PROD, Tom Garrigus; CASTING, Vicki Rosenberg (310) 369-3448.

KING OF QUEENS

(CBS) EXP, Michael J. Weithorn, Tom Hertz, Kevin James, Tony Sheehan, Jeff Sussman; CO-EXP, David Bickel, Ilana Wernick, Chris Downey, Rob Schiller; PROD, Annette S. Davis; CO-PROD, Erin Braun; CASTING, Meg Liberman, Cami Patton.

RESCUE ME

(FX) (in assn w/Apostle, Cloudland Co. and DreamWorks Television) EXP, Denis Leary, Peter Tolan, Jim Serpico; PROD, Kerry Orent; CASTING, Julie Tucker.

STRONG MEDICINE

(Lifetime) EXP, Whoopi Goldberg, Tammy Ader; CO-EXP, John Flynn, Jim Stanley, Dianne Messina Stanley; PROD, Joe DeOliveira; CASTING, Judith Holstra, Lori Sugar (818) 981-6755.

THE YOUNG AND THE RESTLESS

(CBS) (in assn w/Bell Dramatic Serial Co.) SUPR EXP, William J. Bell; CO-EXP, John F. Smith; SUPR PROD, Edward Scott; PROD, Kathryn Foster; DIR, Mike Denney, Sally McDonald, Noel Maxam; CASTING, Marnie Saitta (323) 575-2532.

SPELLING TELEVISION

(323) 965-5860

CHARMED

(WB) EXP, Aaron Spelling, E. Duke Vincent, Brad Kern; CO-EXP, James L. Conway; SUPR PROD, Mark Wilding; PROD, Jon Pare, Holly Marie Combs, Alyssa Milano, Peter Chomsky, Curtis Kheel, Henry Alonso-Myers, Rob Wright; CO-PROD, Debra J. Fisher, Erica Messer, Jeanine Renshew; CASTING, Leslee Dennis.

RUSH

(TNT) EXP, Aaron Spelling, E. Duke Vincent, Jorge Zamacona; CO-EXP, Robert Palm; PROD, Mel Efros; CO-PROD, Kim Clements; CASTING, Jeanie Bacharach, (323) 965-5700.

7TH HEAVEN

(WB) EXP, Aaron Spelling, E. Duke Vincent, Brenda Hampton; CO-EXP, Sue Tenney; SUPR PROD, Chris Olsen, Jeff Olsen; PROD, Lindsley Parsons III; CO-PROD, Shawn Kostanian, Jeff Rodgers; CASTING, Vicki Huff (323) 634-1260.

SUMMERLAND

(WB) EXP, Aaron Spelling, E. Duke Vincent, Remi Aubuchon; SUPR PROD, Jack Clements, Shane Brennan; PROD, Lori Loughlin, Joan Binder Weiss, Linda McGibney; CO-PROD, Katie Botel; CASTING, Jason La Padura, Natalie Hart.

THE STYLE NETWORK

(323) 954-2400

BRINI MAXWELL

(Style) (in assn w/Termite Art Prods.) EXP, Erik Nelson; CO-EXP, Ben Sander; PROD, Dave Harding, Amy Briamonte.

CLEAN HOUSE

(Style) EXP, Gina Rubinstein.

DIARY OF AN AFFAIR

(Style) EXP, Linda Ellman; SUPR PROD, Jennifer Daly.

GUESS WHO'S COMING TO DECORATE

(Style) (in assn w/True Entertainment) EXP, Steven Weinstock, Glenda Hersh; SUPR PROD, Phil Eigner.

HOW DO I LOOK?

(Style) EXP, Deana Delshad Schwartz; SUPR PROD, Tracey Benger, Lisa Tatum.

THE LOOK FOR LESS

(Style) EXP, Jennifer Ferraro.

PULLED OVER

(Style) EXP, Steve Harvey, Rushion McDonald, Damon Harman; CO-EXP, Jonathan Nixon; SUPR PROD, Raphael Srabian.

STYLE STAR

(Style) EXP, Ruth Rafidi; SUPR PROD, Sarah Massaro; PROD, Caroline Murphy, Kelly Shacklett, Tiffany Watkins, Sandra Boscarino.

WHOSE WEDDING IS IT ANYWAY?

(Style) EXP, Ann Lewis, Nick Catliff, Catherine Scheinman, Tony Tackaberry; PROD, Suzanne Westhall, Jackie Raphael, Shura Davison.

TMC ENTERTAINMENT

(310) 806-4400

ABRAHAM--A JOURNEY TO THE HEART OF THREE FAITHS

(PBS) (in assn w/Maya Vision Intl.) SUPR EXP, Drew S. Levin; EXP, Jim Coane; CO-EXP, Bruce Feller; PROD, Rebecca Dobbs.

WALKING THE BIBLE

(PBS) (in assn w/Maya Vision Intl.) SUPR EXP, Drew S. Levin; EXP, Jim Coane; CO-EXP, Bruce Feller; PROD, Rebecca Dobbs.

TOUCHSTONE TELEVISION

(818) 560-1000

ACCORDING TO JIM

(ABC) EXP, Suzanne Bukinik, Tracy Newman, Jonathan Stark, Marc Gurvitz; CO-EXP Nastaran Dibai, Jeffrey Hodes, Howard J. Morris, Bob Nickman; SUPR PROD, Bob Heath, John D. Beck, Ron Hart; PROD, David Feeney; CASTING, Jeff Greenberg (323) 956-4886.

ALIAS

(ABC) EXP, J.J. Abrams, Jeff Melvoin, Ken Olin; CO-EXP, Jesse Alexander, Laurence Andries, Jeffrey Bell, Jeff Pinkner; PROD, Sarah Caplan, Lawrence Trilling; CASTING, April Webster Casting (818) 526-4238.

DESPERATE HOUSEWIVES

(ABC) EXP, Marc Cherry, Michael Edelstein, Tom Spezialy; CO-EXP, Kevin Murphy; PROD, George Perkins, Larry Shaw, Patty Lin, Tracey Stern, Alexandra Cunningham; CO-PROD, David Schulner; CASTING, Junie Lowry Johnson, Scott Genkinger (310) 369-1296.

HOPE & FAITH

(ABC) EXP, Emile Levisetti, Joanna Johnson: CO-EXP, Peter Murrieta, David Rosenthal; SUPR PROD, Jenna Brace; PROD, Alysse Bezahler, Tod Himmel; CO-PROD, Bobby Gaylor; CASTING, James Calleri (212) 564-1235 x3110.

KEVIN HILL

(UPN) EXP, Bruce Davey, Nancy Cotton, Alex Taub; CO-EXP, Jorge A. Reyes, David Solomon SUPR PROD, Dee Harris-Lawrence, Todd Kessler; PROD, Michael J. Maschio, Abe Hoch, Taye Diggs, Adam Armus, Kay Foster; CO-PROD, Shana Fischer Huber; CASTING, Shana Landsburg, Teri Fiddleman (818) 981-4995.

LOST

(ABC) EXP, J.J. Abrams, Damon Lindelof, Bryan Burk, Jack Bender, Carlton Cuse; CO-EXP, David Fury; SUPR PROD, Javier Grillo-Marxuach; PROD, Jean Higgins; CO-PROD, Leonard Dick, Jennifer Johnson; CASTING, April Webster (818) 526-4242.

MY WIFE AND KIDS

(ABC) EXP, Damon Wayans, Don Ran, Dean Lorey; CO-EXP, Kevin Rooney; SUPR PROD, Craig Wayans, Kim Wayans; PROD, Damien Wayans, Susan Crank, Rodney Barnes; CO-PROD, Anne Tabor, Annice Parker; DIR, Andy Cadiff; CASTING, Kevin Scott (818) 754-5412.

SCRUBS

(NBC) EXP, Bill Lawrence; CO-EXP, Tim Hubert, Matt Tarses, Eric Weinberg; PROD, Randall Winston; CASTING, Debby Romano, Brett Benner (818) 623-1880 ext. 142.

20TH CENTURY FOX TELEVISION

(310) 369-1000

AMERICAN DAD

(Fox) EXP, Seth MacFarlane, Mike Barker, Matt Weitzman; CO-EXP, David Zuckerman, Rick Wiener, Kenny Schwartz, Dave Hemingson; SUPR PROD, Carter Bays, Craig Thomas; PROD, Kara Vallow; CASTING, Linda Lamontagne (323) 857-8841.

ARRESTED DEVELOPMENT

(Fox) EXP, Run Howard, Brian Grazer, David Nevins, Mitchell Hurwitz; CO-EXP, Richard Rosenstock, Jim Vallely; CASTING, Deborah Barylski (818) 655-6022.

THE BERNIE MAC SHOW

(Fox) (in assn w/Regency Television) EXP, Peter Aronson, Warren Hutcherson; CO-EXP, Bernie Mac, Rich Appel, Marc Abrams, Michael Benson, Teri Schaffer; PROD, Steven Greener, Michael Petok; CASTING, Eileen Mack Knight (818) 753-9585.

FAMILY GUY

(Fox/Cartoon) (in assn w/Fuzzy Door Prods.) EXP, Seth MacFarlane, David Goodman, Chris Sheridan; PROD, Kara Vallow; CASTING, Linda Lamontagne (323) 857-8841.

JUDGING AMY

(CBS) (Barbara Hall/Joseph Stern Prods. in assn w/20th Century Fox Television) EXP, Joseph Stem, Amy Brennemnn, Connie Tavel, James Frawley, Carol Barbee; CASTING, Vicki Rosenberg (310) 369-3448.

KING OF THE HILL

(Fox) EXP, Greg Daniels, Mike Judge, Michael Rotenberg, Howard Klein, John Altschuler, Dave Krinsky; CO-EXP, Norm Hiscock, Dan McGrath, Michael Jamin, Sivert Glarum, Garland Testa; CASTING, Julie Mossberg

NORTH SHORE

(Fox) (in assn w/Brancato/Salke Prods.) EXP, Chris Brancato, Albert Salke; CO-EXP, Peter Elkoff, Ken Biller; PROD, Liz Heldens, Harry Bring.

POINT PLEASANT

(Fox) EXP, Marti Noxon, Neal Moritz, Marty Adelstein, John McLaughlin, Dawn Parouse; PROD, Kelly Manners; CO-PROD, David M. Burns.

QUINTUPLETS

(Fox) (in assn w/Imagine Television) EXP, Brian Grazer, David Nevins, Mark Reisman; PROD, Jessie Ward, Jennifer Fisher, Dan Singer; CASTING, Rick Millikan.

REBA

(WB) EXP, Kevin Abbott, Mindy Schultheis, Michael Hanel, Matt Berry; CO-EXP, Pat Bullard, Chris Case, Donald R. Beck, Reba McEntire, Patricia Carl Lara Runnels; PROD, Jason Schubb; CO-PROD, Sabrina Wind; CASTING, Greg Orson (323) 848-3615.

THE SIMPSONS

(Fox) (in assn w/Gracie Film Prods.) EXP, James L. Brooks, Matt Groening, Al Jean; CO-EXP, Ian Maxtone-Graham, Matt Selman, Tim Long, Dan Greaney, Caroline Omine, John Frink, Don Payne, Dana Gould, Kevin Curran, Brian Kelley, Stewart Burns, Michael Price; SUPR PROD, Larina Adamson, Marc Wilmore, Bill Odenkirk; PROD, George Meyer, Run Hange, Mike Reiss, David Mirkin, Max Pross, Tom Gammill, Joel Cohen, Jon Vitti, Richard Sakai, Denise Sirkot, Richard Raynis, Bonnie Pietila; CASTING, Bonnie Pietila.

STILL STANDING

(CBS) EXP, Diane Burroughs, Joey Gutierrez, Tim Doyle; CO-EXP, Regina Stewart, Ed Yeager, Ben Wexler; PROD, Randy Cordray; CASTING, Deborah Barylski (818) 655-6022.

(Fox) (in assn w/Imagine Television) EXP, Brian Grazer, Joel Surnow, Robert Coehran, Howard Gordon; CO-EXP, Evan Katz, Jon Cassar, Michael Loceff, Stephen Kronish, Peter M. Lenkov, Kiefer Sutherland; CASTING, Pagano/Manwilier Casting (818) 615-2146.

WARNER BROS. TELEVISION

(818) 954-6000

CENTER OF THE UNIVERSE

(CBS) (in assn w/CBS Prods. and Tannenbaum Co.) EXP, Alan Kirschenbaum, Mitchel Katlin, Nat Bernstein, Eric Tannenbaum, Kim Tannenbaum; CO-EXP, Eric Zicklin, Crete Baer, Dave Finkel; PROD, Bar( Halle; CASTING, Nikki Valko, Ken Miller.

COLD CASE

(CBS) (in assn w/CBS Prods. and Jerry Bruckheimer Television) EXP, Jerry Bruckheimer, Meredith Stiehm, Jonathan Littman; SUPR PROD, Scan Whitesell, Tyler Bensinger, Chris Mundy; PROD, Perry Husman; CO-PROD, Jay Beattie, Dan Dworkin, Erin Mitchell; CASTING, Rebecca Mangieri (818) 954-3496.

EVE

(UPN) (in assn w/Greenhlatt/Janollari Studio) EXP, Meg DeLoatch, Robert Greenblatt, David Janollari; CO-EXP, David Duclon, Troy Carter, Eve; SUPR PROD, Torian Hughes, Trish Baker; PROD, Jim Tripp-Haith; CASTING, Wendi Matthews, Liz Melcher, Holly Powell.

GEORGE LOPEZ

(ABC) (in assn w/Fortis Films and Mohawk Prods.) EXP, Bruce Helford, Deborah Oppenheimer, Robert Borden, Sandra Bullock, George Lopez, Dave Caplan, Paul A. Kaplan, Mark Torgove; CO-EXP, Jim Hope, Rick Nyholm; PROD, Luisa Leschin, John R. Morey, Frank Pace; CO-PROD, Mea Yharra, Brenda Bus; CASTING, Mary Buck.

GILMORE GIRLS

(WB) (in assn w/Dorothy Parker Drank Here Prods. and Hofflund/Polone) EXP, Amy Sherman-Palladino, Daniel Palladino, Gavin Polone; CO-EXP, Bill Prady; PROD, Rebecca Kirshner, Patricia Fass Palmer, Helen Pai; CO-PROD, Jessica Queller.

JACK & BOBBY

(WB) (in assn w/Berlanti/Liddell Prods. and Shoe Money Prods.) EXP, Greg Berlanti, Miekey Liddell, Thomas Schlamme; CO-EXP, Vanessa Taylor, Andrew A. Ackerman; SUPR PROD, Mare Guggenheim, Jonathan Lisco; PROD, Paul F. Marks; CO-PROD, Steve Cohen, Brad Meltzer; CASTING, Ulrich/Dawson/Kritzer Casting.

JOEY

(NBC) (in assn w/Bright-San Prods. and Silver and Gold Prods.) EXP, Kevin Bright, Shana Goldberg-Mechan, Scott Silver; CO-EXP, Sherry Bilsing, Ellen Plummer; SUPR PROD, Robert Carlock, Brian Buckner; PROD, Todd Stevens; CO-PROD, Brian Kelley, Jon Pollack; CASTING, Brian Myers.

JONNY ZERO

(Fox) (in assn w/John Wells Prods.) EXP, John Wells, R. Scott Gemmill, Llewellyn Wells, Mimi Leder; PROD, Andrew Steam; CO-PROD, Mere Smith; CASTING, John Levey, Kim Miscia, Beth Bowling.

THE OC

(Fox) (in assn w/Hypnotic and Wonderland Sound & Vision) EXP, McG, Josh Schwartz, Bob DeLaurentis; CO-EXP, Stephanie Savage; SUPR PROD, Ian Toynton; PROD, John Stephens; CASTING, Patrick Rush Casting.

ONE TREE HILL

(WB) (in assn w/Tollin/Robbins Prods.) EXP, Mike Tollin, Brian Robbins, Joe Davola, Mark Schwahn, Mark Perry; CO-EXP, Greg Prange; SUPR PROD, Jennifer Cecil; PROD, David Hartley; CO-PROD, Lee Fleming; CASTING, Debby Ramano, Crete Benner, Blyth Nailling.

SMALLVILLE

(WB) (in assn w/Tollin/Robbins Prods.) EXP, Al Gough, Miles Millar, Ken Horton, Mike Tollin, Brian Robbins, Joe Davola, Greg Beeman; CO-EXP, Steve DeKnight; SUPR PROD, Jeph Loeb, James Marshall; PROD, Bob Hargrove, Darren Swimmer, Todd Slavkin, Brian Peterson, Kelly Souders, Tim Scanlan; CO-PROD, Luke Schelhaas; CASTING, Dee Dee Bradley (Los Angeles), Coreen Mayrs (Canada).

THIRD WATCH

(NBC) (in assn w/John Wells Prods.) EXP, John Wells, Christopher Chulack, Ed Bemem; CO-EXP, Janine Sherman Barrois; PROD, Andrew Steam, Kristin Harms, Charles S. Carroll, Simon Mirren, Siobhan Byrne O'Connor, Vicki Tupa; CO-PROD, Glenn Kershaw, Grant Anderson; CASTING, John Levey, Kim Miscia, Beth Bowling (818) 954-4080.

TWO AND A HALF MEN

(CBS) (in assn w/Chuck Lorre Prods. and Tannenbaum Co.) EXP, Chuck Lorre, Lee Aronsohn, Erie Tannenbaum, Kim Tannenbaum, Kim Tannenbaum, Mark Burg, Oren Koules; CO-EXP, Don Foster, Jeff Abugov, Eddie Gorodetsky; SUPR PROD, Susan Beavers; PROD, Michael Collier, Mark Roberts; CO-PROD, Joe Bella; CASTING, Nikki Valko & Ken Miller.

THE WEST WING

(NBC) (in assn w/John Wells Prods.) EXP, John Wells, Christopher Misiano, Alex Graves; SUPR PROD, Carol Flint, Peter Noah, John Sacret Young; PROD, Michael Hissrich, Kristin Harms, Eli Attie; CO-PROD, Mindy Kanaskie, Patrick Ward; CASTING, Mary V. Buck, John Levey, Tony Sepulveda, Laura Schiff, Beth Bowling, Kim Miscia.

WITHOUT A TRACE

(CBS) ( in assn w/CBS Prods. and Jerry Bruckheimer Television) EXP, Jerry Bruckheimer, Hank Steinberg, Jonathan Littman; CO-EXP, Jennifer Levin, Greg Walker, Jan Nash, David Amann, Timothy Busfield; PROD, Scott White, Allison Abner; CO-PROD, Nancy Van Doornewaard; CASTING, Mary Buck (818) 954-7645.

Worldwide Pants

(212) 975-5300

THE LATE, LATE SHOW WITH CRAIG FERGUSON (CBS) EXP, Todd Allan Yasui; DIR, Brian McAloon.

THE LATE SHOW WITH DAVID LETTERMAN

(CBS) EXP, Maria Pope, Barbara Gaines, Rob Burnett; DIR, Jerry Foley.

PRODUCTION CHART KEY

Abbreviations: SUPR EXP-Supervising executive producer(s); EXP-Executive producer(s); CO-EXP-Co-executive producer(s); SUPR PROD-Supervising producer(s); PROD-Producer(s); CO-PROD-Co-producer(s); DIR-Director(s); CASTING-Casting director, Affiliated production companies indicated when applicable in parentheses after show title. Anthology titles follow show title. Unless a specific director is noted, show uses various directors.

* Bulleted items indicate new entry to the chart.

2006-01-17T06:06:00.000-05:00

St. Louis Post-Dispatch

03-18-2005

Voting on stem cell funding advances

Byline: KATE THAYER; Post-Dispatch Springfield Bureau

Edition: Illinois Five Star Lift

Section: Metro

SPRINGFIELD, Ill. --

A state Senate committee on Thursday approved letting Illinois voters decide whether the state should pay for stem cell research.

The Health and Human Services Committee sent the measure to the Senate floor on a 7-4 vote along party lines, with Democrats in favor and Republicans opposed.

The measure would also need House approval. If approved, voters will decide in November next year if the state should borrow $1 billion in bonds to issue stem cell research grants. A 6 percent tax on elective, cosmetic surgeries would pay back the bonds.

"My sense is that an overwhelming majority of people who live in Illinois want to help researchers find cures to (diseases)," said state Sen. Jeff Schoenberg. The Evanston Democrat is sponsoring Hynes' proposal.

Some believe stem cell research could lead to cures for several diseases and spinal cord injuries. The issue is controversial because the cells often must be harvested from embryos.

Plastic surgeons are against the tax, saying it is unfair because most of their patients are women. They also say determining which procedures are medically necessary and which are solely cosmetic is difficult.

"You've got to find a better, more stable way (to fund research)," said Jeffrey Poulter, a Bloomington plastic surgeon who attended a Senate hearing on the issue.

Poulter and other physicians say patients will travel to other states to avoid paying the tax.

However, Hynes said patients base decisions on where to have surgery on the location of a doctor they trust, not on the tax.

"Nobody's going to travel 100 miles to avoid a $24 fee on a Botox injection," he said.

The proposed 6 percent tax would add more than $300 to the price of a typical nose job, which costs between $5,000 to $7,500. Botox injections are about $390, according to Hynes.

Hynes added a cosmetic surgery tax is not a "sin tax" and he is not trying to punish those who get cosmetic surgery.

"The money (cosmetic surgery patients) pay will help save lives. That is a miraculous thing and a sensible thing," he said.

Many religions are against funding embryonic stem cell research because they believe an embryo is just as "human" as a human being.

Embryonic stem cell research "divides the human species into humans and nonhumans," said Monsignor Stuart Swetland of the Catholic Conference of Illinois.

Hynes said he thinks the debate on whether or not embryonic stem cell research is moral will continue as he pushes for the measure.

"I really believe (the financial issues) can be addressed, and that would leave us only to the issue of whether this is the type of research the state should invest in -- whether it is ethical and moral," he said. "I believe this is research that can save lives and do so in a moral and ethical way and a responsible way."

(Copyright (c) 2005 The Post-Dispatch)

2006-01-16T18:00:00.000-05:00

2006-01-16T03:06:00.000-05:00

AP Online

08-31-2005

Dateline: ST. LOUIS

Fourteen-month-old Quinn Sliment, is shown in a photo before his cleft palate surgery, left, and after the procedure, right. Quinn is the first child in the world to have his cleft palate repaired using the bone morphogenetic protien procedure. The procedure was performed by plastic surgeon Dr. Michael Carstens. (AP Photo/Tom Gannam)

Quinn Sliment was born with a cleft palate, a defect that caused his lip to merge into his nostril on the right side of his face. But on Tuesday, the 14-month-old was all smiles at SSM Cardinal Glennon Children's Hospital in St. Louis, showing just a ghost of a scar.

He is the first child in the world to undergo a new type of surgery for his cleft palate and lip repair, the hospital said.

The plastic surgeon who performed the surgery, Dr. Michael Carstens, was born with a cleft lip and palate himself. He used a new technique on the child from Waterloo, Ill., requiring two surgeries, rather than the normal five to seven over several years.

Unlike the traditional surgery, no bone graft was used to repair the gap. And the new technique should allow a child such as Quinn to be done with treatment before beginning kindergarten.

"It's amazing. It's wonderful," Quinn's mother Judee Sliment, 36, said of the surgery results.

Quinn's father, Tom, 34, said the family had expected it would take years for surgery and healing, based on other children's experiences.

The parents were thrilled that most of their son's defect seems repaired. "We almost feel guilty, but not too guilty," Judee Sliment said.

Carstens performed a surgery in November focusing on Quinn's lip and another in March to repair the palate. In the months since, the boy has been able to heal and his growth has helped improve his appearance.

Carstens used a type of genetically engineered protein, called bone morphogenetic protein, that was placed on a collagen sponge and inserted into a gap that Quinn had between his nose and gum line. "It's like putting a keystone in an arch," Carstens said.

Cells migrate to the sponge and grow into new bone.

"Bone doesn't grow itself. It is produced by the soft tissue around it," he explained.

A plastic surgeon in Charlotte, N.C., Dr. David Matthews, said the technique could lead to "improved appearance, improved bone structure, fewer surgeries and better growth" in patients. He also said the surgery will help children regain a normal appearance.

Carstens will be the keynote speaker at upcoming cleft palate medical conferences in Mexico, Brazil and India.

___

On the Net:

Cardinal Glennon Children's Hospital: http://www.cardinalglennon.com

Copyright 2005, AP News All Rights Reserved

2006-01-10T19:45:00.000-05:00

Tucson, Ariz. -- A deep, elongated superficial muscular aponeurotic system (SMAS) flap with a novel inverted L-shape design produces significant cheek elevation besides reducing sagging in the lower face and neck, according to Robert M. Dryden, M.D., F.A.C.S. and Craig Davis, D.D.S., M.D.

Instead of initiating the apex of the SMAS flap at the traditional point 1 cm below the zygomatic arch, or cheekbone, Drs. Dryden and Davis start the apex 1 cm superior to the zygomatic arch.

A solid understanding of SMAS anatomy underlies the new approach, designed by Dr. Dryden. As a layer of fibrous and muscle tissue located deep to the skin, the SMAS, which is used like a handle to move the fatty tissue of the face, is more substantial above the zygomatic arch than in the midface, says Dr. Davis, a cosmetic surgery fellow of Dr. Dryden's at Arizona Centre Plastic Surgery, Tucson, Ariz.

The connective tissues of the SMAS in the temple area fuse before reaching and entering the zygomatic arch. In the midface however, the SMAS is thinner, composed of wisps of connective tissue. Lengthening the SMAS flap by initiating it in a higher position incorporates the weaker midfacial SMAS into the body of the flap, which the surgeons then suspend over the zygoma. Attaching the suspension and fixation sutures here lodges them in one of the sturdiest areas of the SMAS.

Placing the apex of the SMAS flap above the zygoma instead of below it takes advantage of these anatomic features. The higher flap attachment produces the marked cheek elevation that characterizes this technique.

The SMAS can be brought forward and attached by either plication or imbrication. Plication involves folding the overlapping portion of the SMAS in on itself and fixing it with buried suspension sutures. The imbrication technique removes the SMAS overlap and uses buried suspension sutures to fix the remaining edges. Plication is thought to offer less chance of facial nerve branch injury, but according to Dr. Dryden, "imbrication results in cleaner contours and a more natural appearance, since there's no underlying excess tissue left to bunch up under the skin."

The risk of facial nerve damage increases with imbrication and the dissection of tissues in a deeper plane, but Drs. Davis and Dryden reduce the risk by dissecting the SMAS flap with a monopolar cutting current that passes through a Colorado needle.

"As the dissection plane nears these fibers, an electric current stimulates twitching of nearby innervated muscles. By carefully observing the operative field and juxtaposed tissues, we're warned of impending danger to vital structures," Dr. Dryden says.

The sharp tungsten tip of the needle allows the surgeons to use very low wattages, substantially reducing bleeding and minimizing tissue damage. They can then extend the SMAS flap over the zygomatic arch and into the temporal area despite the density of facial nerve fibers there.

Patients receive sedation or general anesthesia. The surgeons make standard rhytidectomy skin incisions around the ear after injecting local anesthesia and infusing tumescent solution. After initiating the skin flap 1 cm above the zygomatic arch, they elevate it, extending it anteriorly for 2 to 3 cm and inferiorly 2 to 3 cm beneath the mandible-- making it 1 to 2 mm thick.

"The flap should be as thin as possible, staying superficial to the seventh nerve fibers," Dr. Dryden says.

After lifting the flap up and back, about 1 cm of SMAS can usually be overlapped and removed superiorly at the posterior base. Closing sutures are directed up and back to enhance cheek lift.

The technique has been used on approximately 100 patients treated from 2002 through the present, and frequently combined with brow elevation, blepharoplasty, chin augmentation or laser resurfacing. Patient ages ranged from 26 to 85.

The cheek elevation, positioned higher than in traditional facelifts or mini-facelifts, decreases the nasolabial fold and its underlying crease. These results have been variable but present in all patients, Dr. Dryden says.

Complications were minimal, with no incidences of hematoma, motor nerve palsy, skin flap necrosis, infection, or SMAS flap fatigue. Two or three patients had transient seventh nerve palsies that resolved postoperatively.

"The inventive design of this SMAS flap produces superior cheek elevation, and it's a safe and effective way to rejuvenate the lower two thirds of the face" Dr. Dryden says. CST

For more information: Campiglio, GL, Candiani P. Anatomical study on the temporal fascial layers and their relationship with the facial nerve. Aesth Plast Surg. 1997:21;69-74

2006-01-09T18:35:00.000-05:00

AP Worldstream

01-27-2005

Dateline: TAKUA PA, Thailand

In Thailand, a mostly Buddhist country, people suffering personal problems or tragedies _ from a broken marriage to a death in the family _ often go to their temple seeking consolation through prayer and meditation, or a quiet word with their local monk.

Tapping into this tradition, some monks trained in psychology are combining their Buddhist religion with medical science to help victims of Asia's tsunami.

Never have so many Thais been in need of counseling as in the aftermath of the Dec. 26 disaster, which killed more than 5,000 people in Thailand and left 3,100 missing and presumed dead.

In a refugee camp housing more than 3,500 Thais left homeless in the battered southern beach resort of Takua Pa, monks are seeking out tsunami victims to counsel them. In a country where many people believe that psychologists and mental health workers are only needed to treat the insane, the practice is turning some heads.

"We are both psychologists and monks," said Rapin Buddhasaro, one of 20 psychology students at Maha Chulalongkorn, a university for monks in Bangkok, the Thai capital, who traveled to Takua Pa to help tsunami victims.

"The approach we use is a mixture of Western psychology and Buddhism. We let them vent their sadness and suffering, and give counseling based on Buddhist teachings," he said.

Like the other students, Rapin was going from hut to hut in the overcrowded refugee camp to counsel tsunami survivors and keep close tabs on their recoveries.

At one point, three of the monks, with shaved heads and yellow robes, stopped to talk to Wallapa Hongkhao, 28, who was weaving a basket with plastic rope, a new vocational skill being taught at the refugee camp.

Sitting outside her hut, cross-legged on a bamboo stretcher, monk Chaleao Chetawan began asking about her well-being.

Wallapa recalled the day tsunami struck.

Her two daughters, aged 10 and 6, were staying home in their beach-side village, while she worked as a chef's helper at a hotel in the luxury resort area of Khao Lak. Her husband was aboard a fishing boat nearby.

When Wallapa saw the killer wave coming, she ran for a hilly area and survived. Her husband's boat was overturned, but he firmly held on and was safely swept ashore.

The family home was demolished, killing their youngest daughter and leaving the other one missing.

"I have dreamed many times of my elder daughter coming to see me," Wallapa told the monks as she cried.

The body of the youngest daughter was found and cremated. The couple has often visited nearby Yan Yao temple, where many of the unidentified bodies of tsunami victims are being kept refrigerated stored for autopsies. But they have found no sign of their older daughter.

Her voice trembling, Wallapa told the monks that she had bought a piece of cake last Sunday, the birthday of her missing daughter, to honor her. "What is still troubling me so much is that I have not found her," the mother said.

"Don't stay alone. If you can't sleep, do whatever you can to distract yourself. Your new practice of weaving a basket may help," Chaleao told her.

With unusual frankness, Wallapa said she had undergone surgery just before the tragedy that would make it impossible to ever bear another child.

"You should calm your mind by meditation. ... The incident has passed, and there is nothing you can do about it. You should conduct small Buddhist ceremonies for your late daughters to put their spirits at rest and to make sure they are reincarnated in a better life," the monk told her.

Ending their 45-minute meeting, the three monks gave her small handbooks about meditation and Buddhist teachings about death, and a few amulets for her protection, in keeping with Thai tradition.

As psychologists, they also kept a record of her case that said Wallapa was suffering "severe" psychological trauma and would require more visits.

"Buddhist monks have long served as spiritual leaders in Thai society," said Dr. Thaweesin Wisanuyothin, a spokesman of the Health Ministry's Department of Mental Health. "When people are born, fall sick and die, or have problems in their lives, they think of monks before Western-trained psychologists."

Thaweesin said his ministry plans to help train more Buddhist monks as psychologists who can do outreach, rather than waiting for followers to come to their temples.

If Wallapa and other tsunami victims who met with the monk-psychologists at the refugee camp are any indication, it could take time for that dual role to be accepted.

"I prefer talking to monks. I am not insane," Wallapa said after her meeting with the monks, explaining that the holy men can help ensure that her daughters' spirits rest in peace.

She said she had thrown out the anti-stress medication they had left her.

(rp/twx/djk)

Copyright 2005, AP News All Rights Reserved

2006-01-02T07:54:00.000-05:00

Spreader graft placement is indicated to: (1) correct internal valve collapse; (2) bridge and strengthen a long, narrow middle vault in patients with short nasal bones; (3) correct a lack of dorsal support of the lateral nasal walls; (4) widen the middle one-third of the nose; (5) straighten or stabilize a high dorsally deviated septum; and (6) create straight dorsal aesthetic lines (figure 1). Additionally, the spreader graft can be placed to extend past the anterior septal angle as a caudal extension graft to lengthen a short nose.

[FIGURE 1 OMITTED]

Placement of an endonasal spreader graft begins with the infiltration of 1% lidocaine with 1:50,000 epinephrine into the submucoperichondrial plane along the dorsal cartilaginous and osseous septum. Next, a 4- to 5-mm vertical incision is made approximately 2 to 3 mm caudally to the internal valve. A Freer elevator is placed through the incision and used to create a pocket that extends just past the osseocartilaginous junction (figure 2). The pocket should be made only 1 to 2 mm wider than the width of the Freer elevator to create a snug pocket for the spreader graft; too large a pocket will predispose the graft to slipping. If a septoplasty is being performed concurrently with spreader graft placement, a bridge of mucoperichondrium should be left attached to the septum at the inferior edge of the spreader pocket. It is preferred that the septoplasty dissection and the spreader grail pocket remain unconnected. The grafts are then fashioned from harvested cartilage.

[FIGURE 2 OMITTED]

After the creation of bilateral pockets, the graft is placed by grasping the cartilage at its distal tip with a pair of DeBakey forceps (figure 3). The graft is grasped at its distal edge to ensure that its leading edge is not bent or broken during placement. The graft should fit snugly into the pocket. Countertraction is provided during placement by having a surgical assistant retract the mucoperichondrial flap laterally with a tiny double-pronged hook. Immediately following placement, the lateralizing effect of the spreader graft can be visualized as an increase in the angle of the internal nasal valve as the upper lateral cartilage flares away from the septum.

[FIGURE 3 OMITTED]

A critical factor for the success of the operation rests with maintaining the connection between the upper lateral cartilage and the dorsal septum. The spreader graft fits into the angle between the upper lateral cartilage and the septum and exerts a cantilever effect. After graft placement, the incisions are closed with two interrupted 5-0 chromic sutures.

Suggested reading

Rohrich RJ, Muzaffar AR, Shemshadi H, Adams WP, Jr. Component osseocartilaginous hump reduction: A graduated approach to the dorsum. In: Gunter JP, Rohrich RJ, Adams WP, Jr., eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. St. Louis: Quality Medical Publishing, 2002:482.

Sheen JH. Spreader graft: A method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984;73:230-9.

From the Department of Facial Plastic and Reconstructive Surgery, Williams Center for Excellence, Latham, N.Y. (Dr. Pontius and Dr. Williams), and the Section of Facial Plastic and Reconstructive Surgery, Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Albany (N.Y.) Medical Center.

2005-12-27T02:37:00.000-05:00

Have a scar that keeps you from showing a little skin this summer? A nationwide survey by the makers of Neosporin found that one in four women have avoided an activity, such as attending an event, because they were embarrassed about a scar. Many report they have even avoided going to the beach or buying a particular outfit because of scar shame.

Audio News Feature

You can reach the story directly by going to http://www.newstream.com/home.aspx?story=30706

This multimedia news story is for free and unrestricted use on your news information site (and for print or broadcast too). Visit http://www.newstream.com to download video, audio, text, graphics and photos.

If you have any questions about the story, or about Newstream.com, please write to us at info@newstream.com.

2005-12-10T23:36:00.000-05:00

Klippel-Trenaunay syndrome (KTS) is a rare disorder that consists of a triad of capillary vascular malformation, venous malformations and/or varicose veins, and soft tissue and/or bony hypertrophy. Pain is a real and debilitating problem in these patients. We have observed 9 common causes of pain in KTS: (1) chronic venous insufficiency, (2) cellulitis, (3) superficial thrombophlebitis, (4) deep vein thrombosis, (5) calcification of vascular malformations, (6) growing pains, (7) intraosseous vascular malformation, (8) arthritis, and (9) neuropathic pain. The management of pain in patients with KTS depends on its cause. These patients are best evaluated initially in a center with an experienced multidisciplinary team that includes a primary health care provider, surgeons, and ancillary staff. The ongoing care of a patient with KTS often depends on a local provider who is more readily accessible to the patient but may not have the expertise of a large center to manage the complications of KTS. The purpose of this communication is to review the common causes of pain in these patients to provide local health care providers and patients and their families with appropriate management strategies. Pediatrics 2005;115:744-749; pain, pain management, Klippel-Trenaunay syndrome, vascular malformation, chronic venous insufficiency.

ABBREVIATIONS. KTS, Klippel-Trenaunay syndrome; DVT, deep vein thrombosis.

Klippel-Trenaunay syndrome (KTS) is a rare disorder that comprises the triad of (1) capillary vascular malformation, (2) varicose veins and/or venous malformation, and (3) soft tissue and/or bony hypertrophy. (1-4) It is a mixed malformation with soft tissue and bony malformations and is associated with predominantly venous, lymphatic, and capillary vascular malformations, with involvement of usually I of the lower limbs. Chronic lymphedema will frequently aggravate the clinical presentation. The manifestations of KTS are protean, and, in many patients, pain is a frequent and debilitating problem. We previously (5) reported that 38% of patients had significant pain, and Baskerville et al (6) found that 88% of their patients had pain. The lower extremity is most often affected in KTS, and pain is a great problem in these patients compared with those whose upper extremity is affected.

Over the past 25 years, we have collectively had the opportunity to evaluate and treat >300 patients with KTS. (5,7-13) On the basis of this experience, we have observed several different patterns and causes of pain. It has become clear that to deal appropriately with pain in patients with KTS, one first must define the exact cause of the pain. The purpose of this communication is to share our experiences so that patients with this rare problem receive the best possible care.

THE MAYO MODEL OF CARE FOR VASCULAR MALFORMATIONS

At Mayo Clinic Rochester, we use a multidisciplinary approach to the evaluation and treatment of patients of all ages with vascular anomalies, including KTS. The core of this team includes a pediatrician/family physician or internist and vascular, orthopedic, and plastic surgeons. In addition, the expertise of vascular internists of the Gonda Vascular Center, radiologists, physiatrists, pain management specialists, and dermatologists are employed. Periodically, formal reviews of our experience are conducted and published. The basis of this communication is the cumulative experience of this multidisciplinary team.

CAUSE OF PAIN IN KTS

We believe that there are 9 common causes of pain in KTS. Some patients may have only 1 cause of pain, but others may have several causes of pain.

Chronic Venous Insufficiency

Venous abnormalities are a hallmark of KTS. Superficial varicosities; persistent large superficial embryonic veins, usually in the lateral position in the leg; and deep venous valvular incompetence, aneurysmal dilation, hypoplasia, or aplasia are common. Varicose veins become more prominent and problematic with increasing age. Ambulatory venous hypertension is a well-defined entity because of increasing venous pressure after exercise as a result of valve incompetence or outflow obstruction. The discomfort that results from generalized venous congestion is poorly understood, but clearly, varicosities and venous malformations are more painful when distended with venous blood. The discomfort associated with venous incompetence is usually described as a "dull, achy" sensation and typically is more noticeable as the day progresses because of venous pooling of blood.

Varicose veins have been thought to result from primary valvular incompetence. Recent theories propose that decreased elasticity of vein walls cause dilation of the walls, leading to separation of the valve leaflets. (14) Others have shown that varicosities can result even without valvular incompetence. (15) Persistence of embryonic veins that normally regress during gestation is clearly a major cause of varicosities in KTS. Another plausible explanation that has been proposed for increased venous congestion is inefficient calf pump function. However, Baskerville et al (6) compared foot volumetry in normal patients and KTS patients and found no significant differences in reduction of foot volumes during exercise to suggest inefficient calf pump in limbs of patients with KTS.

Chronic venous congestion can lead to pigmentation, eczema, lipodermatosclerosis, varicosity, atrophy blanche, corona phlebectatica, and, ultimately, breakdown of the skin and ulcerations. It has been found that the severity of the skin ulceration correlates with the degree of ambulatory venous hypertension. (16,17) Patients with ambulatory venous pressure <40 mm Hg had a lower incidence of skin ulcers than patients with ambulatory venous pressure >80 mm Hg. (18)

The mainstay of treatment of this type of pain and discomfort is external compression of the venous system. It can be treated with elastic or nonelastic compression garments. It usually is best to use a closed-toe compression garment. The length of the garment is dictated by the extent of leg involvement. However, we have found that if the entire leg is involved, then a full-length pantyhose-type garment works best. This type of garment is least likely to drift downward while worn and also can provide compression to the groin and buttocks. The greatest pressure that the patient can tolerate should be used. Most patients can tolerate compression of 40 to 50 mm Hg. However, some patients cannot tolerate this level of pressure and will need compression of 30 mm Hg. Foot and leg overgrowth can present a challenge to fitting appropriately a support garment and a challenge to the patient to put on the garment. In some patients, it will be impossible to design a garment that can be applied because of a very large foot. These patients will have to be instructed in methods of wrapping the extremity with compression bandages. In rare cases of complete deep vein obstruction, patients with large superficial veins do not tolerate compression garments. Duplex evaluation of the venous anatomy in these patients is very important.

Frequent elevation of the extremity during the day is very important in reducing pain and the development of stasis ulcers. At all times, when it is possible to elevate the affected extremity, it should be done. We frequently recommend elevating the foot of the bed for good drainage of the venous system during the night. In severe cases, a patient may have to alter his or her occupation from a job that requires prolonged standing to one that allows the patient to sit and, preferably, elevate the leg.

In selected cases, surgical intervention, sclerotherapy, or endovascular laser ablation may be indicated in patients who are symptomatic with pain and edema. Asymptomatic patients are usually managed conservatively because of the high (50%) recurrence rate of varicosities. (9) In the highly selected group of patients who are considered for surgical procedures, a thorough assessment of the venous anatomy should be performed with duplex scanning, contrast phlebography, MRI, and magnetic resonance phlebography. Duplex scanning and ascending and descending phlebography are used to assess valvular incompetence of the deep, superficial, or perforator veins; discover deep venous anomalies and obstructions; and assess collateralization, respectively. Frequently, the abnormalities seen in KTS include persistence of embryonic veins, agenesis, hypoplasia, valvular incompetence, or aneurysms of deep veins.

The most common surgical treatment in patients with KTS is stripping of the veins and avulsion or excision of varicosities and vascular malformations. The primary goal of imaging is to confirm patency of the deep venous system before these procedures are performed. In a very rare subset of patients, removal of the tortuous but patent superficial venous system leads to venous hypertension if deep venous reconstruction is not also performed. Although most surgical procedures for varicosities are uncomplicated, it is often impossible to remove all varicosities because of the extent of involvement. Fifty percent of patients who have surgery will have some form of recurrent varicosities. Despite this, patients report subjective improvement in symptoms and an overall clinical improvement as reflected by a reduction in the clinical severity score after surgery. (9) Recurrent varicosities can and have been reoperated on if the benefits outweigh the risks of the procedure. Sclerotherapy of cavernous venous malformation with alcohol and foam sclerotherapy of the venous malformations have been used by others, with mixed results.

Cellulitis

Patients with KTS are prone to cellulitis, and whether this is attributable to an actual bacterial infection or an inflammatory response as a result of venous stasis, localized lymph accumulation, or thrombosis is not always clear. (19) Chronic lymphedema is clearly a major cause of cellulitis and lymphangitis. In our series, (5) 13% of patients had infectious cellulitis. These patients may be more susceptible to infection because of poor skin integrity or from venous pooling. Thus, it is imperative for patients to maintain excellent skin hygiene. Maintaining strict hygiene can be challenging because of hyperhidrosis associated with KTS that is accentuated by the use of stockings, shoes, etc. Particularly for patients with significant foot and toe involvement, thorough washing of leg, foot, and toes may be challenging. We encourage patients to wash the affected body parts thoroughly with soap and water twice a day. If the patient prefers showers to bathtubs, then we suggest that he or she place a stool in the shower so that he or she can sit and wash thoroughly between the toes. It is imperative that patients wear clean stockings every day and allow their shoes and feet to dry between shoe changes. These patients should avoid going barefoot.

For some patients, use of a compression garment will reduce the incidence of cellulitis, but in others, it may increase the risk for cellulitis because of the associated hyperhydrosis or because of abrasions of keratohemangiomas by the stocking. One must experiment with this to know which is best for individual patients.

If there is new-onset erythema, local discomfort, and warmth, then cellulitis always must be suspected. It is imperative to treat these patients with antibiotics as soon as the diagnosis is apparent.

Usually, patients who have had recurrent cellulitis are able to recognize the heralding symptoms of cellulitis up to 24 hours before the infection is clinically apparent. For these patients, we suggest that they have a 10-day supply of an appropriate antibiotic at home so that they can begin taking antibiotics at the first sign or symptom of cellulitis. In rare patients, this may not be enough to prevent serious recurrent cellulitis, and one must consider prophylactic antibiotics. We think that it is best in these situations to consult with an infectious disease expert to plan the most appropriate course of treatment for these rare situations.

Growing Pains

Growing pains are normal in healthy children. Children with KTS are just as likely to have growing pains as are healthy children. The muscles are affected more so than the joints, and the area is usually normal on examination with no evidence of erythema, skin ulceration, mass, or swelling. Compared with pain caused by other factors, that of growing pains is relieved by simple comforting measures such as holding, stroking, and massaging of the limb.

Thrombophlebitis

Inflammation of the superficial veins is common in KTS and, in our series, (5) occurred in 15% of patients. Aseptic inflammation probably results from venous stagnation in the lower extremity varicose veins. This type of pain is best treated with simple analgesics and antiinflammatory agents along with compression and elevation. If recurrent, then vein stripping, ligation, or injection sclerotherapy may be helpful. This should be undertaken only in a select group of patients in whom an intact deep venous system has been demonstrated. In patients with large embryonic veins or when the saphenous junctions are involved, anticoagulation should be considered.

When left untreated, superficial thromboses usually are a self-limiting problem. In 7 to 14 days, the pain subsides and a small knot may be palpable (the organized thrombus). These clots may calcify and become "phleboliths" that are apparent on radiographs. Treatment, if used, consists of nonsteroidal antiinflammatory agents and mild analgesics.

When a calcified phlebolith is on a weight-bearing surface (Fig 1), such as the plantar aspect of the foot, it can be painful when downward pressure is applied on the foot. Adding a pad to the insole will usually relieve this type of pain.

[FIGURE 1 OMITTED]

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is more common in patients with KTS than in those with normal varicose veins. (20) In our series, 11 (4%) of 252 patients had documented DVT. (5) It is important to diagnose and treat immediately any DVT with anticoagulation or, selectively, with thrombolytics if the DVT involves the large iliofemoral veins. Pain is a usual presentation, in addition to swelling and cyanotic discoloration of the leg.

We recommend that patients with KTS avoid estrogen-containing contraceptives and heed precautionary measures to prevent thrombosis during long periods of immobilization. Whether patients with KTS should receive prophylactic anticoagulation therapy or antiplatelet therapy is controversial. Certainly prophylactic anticoagulation therapy should be considered for patients who have had recurrent DVTs, particularly when complicated by pulmonary embolus. It is unclear whether prophylactic anticoagulation or antiplatelet therapy is effective in preventing superficial thrombophlebitis. Considering that spontaneous bleeding from superficial venular blebs can be problematic, one must consider this when contemplating chronic anticoagulation. Patients with recurrent DVT should be considered for placement of an inferior vena cava filter to prevent major pulmonary embolus.

Intraosseous Vascular Malformations

Rarely, patients with KTS can have intraosseous vascular malformations. (21) Although rare, they usually occur in long bones (Fig 2), but we have reported 1 patient (13) who had multiple osteolytic lesions of the calvarium (Fig 3). These lesions cause intense pain. When they involve long bones, there is an increased risk for fracture. A variety of analgesics can be tried, but in most cases, surgical removal of the malformation may be necessary. If the lesions cannot be removed, then management of the pain can be challenging. Some of these patients may require long-term opiates for pain control.

[FIGURES 2-3 OMITTED]

Calcified or Scarified Vascular Malformations

Calcified vascular malformations can be a source of pain if located around structures that are mobile, such as the ankle joint (Fig 4). We have seen this occur in natural calcification of a vascular malformation. We have also seen it as a result of sclerotherapy of a vascular malformation. If well localized, then surgical removal may relieve this type of pain.

[FIGURE 4 OMITTED]

Arthritis

In a study of 27 patients with purely venous malformations occurring within the extremities, it was found that 81% (13 of 16) of lower limb cases and 36% (4 of 11) of upper limb cases involved arthritis of the knee and elbow joint, respectively. In 7 of the 16 lower limb cases in this study, patients had to undergo surgical treatment for severe functional impairment, which consisted of synovectomy and excision of the venous mass. (22) In our experience, arthritis occurs in a very small number of patients with KTS, but in those patients, it is a major problem. Usually it involves the knee, but we have also treated patients with ankle involvement. MRI of the affected joint will establish the presence of intra-articular vascular malformation. Proliferative vascular synovitis and an associated joint effusion is the usual accompanying findings on MRI.

Destruction of cartilage occurs probably from recurrent hemarthrosis when the vascular malformation is within a joint (Fig 5). Alternatively or in addition, the presence of the vascular malformation may create a chronic synovitis. Patients with this have pain and, as a result, keep the knee flexed, and they can develop a flexion contracture.

[FIGURE 5 OMITTED]

Treatment includes analgesics and maneuvers to prevent the flexion contracture. This may involve physical therapy, passive stretching, and bracing. Synovectomy may be useful but is unproved at this time. If the flexion contracture is severe enough to prevent walking and the leg cannot be straightened, then amputation may be necessary to control the pain and allow the patient to walk (with a prosthesis).

Neuropathic Pain

Neuropathic pain results from damage or dysfunction of neuronal pathways and is a shooting, burning, aching (or a combination) pain that is poorly responsive to conventional analgesics. It often occurs in areas with altered sensation. We have evaluated 4 patients who have KTS with neuropathic pain. Their pain is disabling and associated with hyperesthesia. All 4 patients are adults, and all have KTS involving the leg. Three of the 4 had extensive surgical procedures on the leg, and in 2 of these, the pain occurred after the surgical procedures. We speculate that neuropathic pain can result from damage to nerves at the time of operation. Also, we think that this pain can result from effects of the venous abnormality on the nerve that shares the neurovascular bundle. It may result from direct compression of the nerve and/or abnormal venous pressure of the nutrient vascular system of the nerve.

The management of neuropathic pain is difficult as such pain responds poorly to conventional analgesics and less well to opioids. In the past 30 years, antidepressants and anticonvulsants have been the 2 major classes of drugs used to treat neuropathic pain. (23-25) Their mechanism of action relies on inhibition of excitatory pathways or enhancement of inhibitory pathways. Drugs such as carbamazepine, phenytoin, lamotrigine, and felbamate inhibit the excitatory sodium channels, whereas valproic acid increases the inhibitory pathways of [gamma]-aminobutyric acid. In this manner, the excess firing of neuronal pathways that lead to pain is dampened. The choice of which agent to use is a matter of trial and error as not one has been shown to be more efficacious than another. We tend to introduce 1 agent at a time at a low starting dose, titrate up to desired effect, and if not beneficial after a trial period of 2 to 3 weeks, we substitute another agent. More than 1 drug is sometimes necessary to control the pain. The short-term use of steroids (Prednisone) can also be used for acute neuropathic pain.

DISCUSSION

KTS occurs in 1 of 20 000 to 40 000 live births. The manifestations of KTS are protean and historically has been confused with other overgrowth syndromes such as Proteus syndrome and Parkes Weber syndrome. The absence of clinically significant arteriovenous shunting distinguishes KTS from Parkes Weber syndrome. (26)

The triad of capillary malformations (port wine stain), varicosities or venous malformations, and limb hypertrophy has been found to occur in 98%, 72%, and 67% of patients, respectively, in our series (5) of 252 patients. All 3 features were present in 63% of patients, and 37% had 2 of the 3 features, which illustrates that not all patients with KTS have all 3 features of the triad, and patients can receive a diagnosis of KTS with only 1 or 2 features. The cause of KTS is still unclear. Several theories have been proposed, including (1) Servelle's theory of a primary obstruction of the venous system resulting in venous hypertension and therefore development of abnormal venous pathways and tissue overgrowth; (2) failure of regression of the lateral limb bud vein; and (3) alteration of the tight balance between angiogenesis and vasculogenesis, which is controlled by numerous genes, among other theories. (27-30) KTS is a mixed malformation whereby soft tissue and bony malformation is associated with predominantly venous, lymphatic, and capillary vascular malformations, with involvement of usually 1 of the lower limbs.

Although pain is such a prevalent morbidity factor and affects up to 88% of patients with KTS, the causes of pain have not been well documented up until now. We have observed that there are 9 most common causes of pain in these patients: (1) chronic venous insufficiency, (2) cellulitis, (3) thrombophlebitis, (4) DVT, (5) calcification of vascular malformations, (6) growing pains, (7) intraosseous vascular malformation, (8) arthritis, and (9) neuropathic pain. Common complications that accompany KTS and also may contribute to pain include pregnancy-associated complications, coagulation abnormalities, and the psychological effects of the visible overgrowth.

Perhaps chronic venous insufficiency accentuates and predisposes to the other causes of pain. If that is the case, then controlling the venous insufficiency and improving venous drainage might reduce pain of a variety of causes. Although the true pathophysiology of venous insufficiency is not yet fully understood at this point, mechanisms that incorporate external compression, limb elevation, exercise, and even a pump to improve venous drainage may be beneficial.

Because it is such a rare condition and because of zits protean manifestations, most health care providers are uncomfortable treating patients with KTS. Hence, most patients become frustrated by their inability to find local health care providers who can help them deal with the many complications associated with KTS. For patients in whom pain significantly affects their quality of life, it is important to have local health care providers who can work with the patients on an ongoing basis to manage chronic pain. Because there are numerous causes of pain in KTS, the first step in management is to define the exact cause of the pain. One also must recognize that individual patients may have >1 source of pain, and treatment strategies must be designated to deal with all of the types of pain in an individual patient. A multidisciplinary team that has experience with KTS may best perform the initial evaluation of these patients. However, a local health care provider is best in providing ongoing care. We hope that this review will be useful to achieve this.

REFERENCES

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(8.) Gloviczki P, Hollier LH, Telander RL, Kaufman B, Bianco AJ, Stickler GB. Surgical implications of Klippel-Trenaunay syndrome. Ann Surg. 1983;197:353-362

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(10.) Cherry KJ, Gloviczki P, Stanson AW. Persistent sciatic vein: diagnosis and treatment of a rare condition. J Vasc Surg. 1996;23:490-497

(11.) Gloviczki P, Stanson AW, Stickler GB, et al. Klippel-Trenaunay syndrome: the risks and benefits of vascular interventions. Surgery. 1991;110:469-479

(12.) McGrory BJ, Amadio PC, Dobyns JH, Stickler GB, Unni KK. Anomalies of the fingers and toes associated with Klippel-Trenaunay syndrome. J Bone Joint Surg Am. 1991;73:1537-1546

(13.) Sorom A, Driscoll DJ, Stanson AW. Klippel-Trenaunay syndrome: a rare cause of severe headache. Int Angiol. 2002;11:7-8

(14.) Travers JP, Brookes CE, Evans J, et al. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content. Eur J Vasc Endovasc Surg. 1996;11:230-237

(15.) Rose SS, Ahmed A. Some thought on the etiology of varicose veins. J Cardiovasc Surg. 1986;27:534-543

(16.) Araki CT, Back TL, Padberg FT, et al. The significance of calf pump function in venous ulceration. J Vasc Surg. 1994;20:872-877

(17.) Labropoulos N, Ginannoukas AD, Nicolaides AN, et al. The role of venous reflux and calf muscle pump function in nonthrombotic chronic venous insufficiency. Correlation with severity of signs and symptoms. Arch Surg. 1996;131:403-406

(18.) Nicolaides AN, Zukowski AJ. The value of dynamic venous pressure measurements. World J Surg. 1986;10:919-924

(19.) Quartey-Papafio CM. Lesson of the week: importance of distinguishing between cellulitis and varicose eczema of the leg. BMJ. 1999;318: 1672-1673

(20.) Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg. 2003;25:1-5

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(26.) Biesecker LG, Happle R, Mulliken JB, et al. Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet. 1999;84:389-395

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Adriana Lee, MD *; David Driscoll, MD * ([double dagger]); Peter Gloviczki, MD ([section]); Ricky Clay, MD ([parallel]); William Shaughnessy, MD ([paragraph]); and Anthony Stans, MD ([paragraph])

From the Departments of * Pediatric and Adolescent Medicine, ([paragraph]) Orthopedic Surgery, ([double dagger]) Divisions of Pediatric Cardiology, ([section]) Vascular and ([parallel]) Plastic Surgery, Mayo Clinic School of Medicine, Gonda Vascular Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Accepted for publication Aug 11, 2004.

doi:10.1542/peds.2004-0446

No conflict of interest declared.

Reprint requests to (D.D.) Division of Pediatric Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905

2005-12-09T17:45:00.000-05:00

Las Vegas -- A visible scar, earlobe distortion, and bald areas in the temple and postauricular regions are some of the more common untoward sequelae of rhytidectomy that can be corrected with secondary surgery but may be avoided through careful planning and execution of the primary procedure, says Tolbert S. Wilkinson, M.D., who spoke at Facial Cosmetic Surgery 2004.

"Incorrect placement of incisions and failure to adequately shape the internal structures of the face can leave rhytidectomy patients with unwanted stigmata of that surgery. The end result should be a natural and refreshed appearance without telltale signs," says Dr. Wilkinson, a plastic surgeon with a private practice based in San Antonio.

Common complaints of patients displeased with the outcome of their rhytidectomy are that they are unable to wear their hair pulled up because of a visible scar or that they look bizarre when the wind blows because hairless areas around the ear are revealed. Over time, patients who have had a poorly performed facelift might also be dissatisfied by earlobe distortion as the earlobe stretches progressively down toward the chin.

Incision placement

Noting that he has never met a post-rhytidectomy patient with a visible scar who is pleased with the outcome of surgery, Dr. Wilkinson reminds his colleagues that a major principle in planning the procedure is to keep the incisions well inside the hairlines.

As an addendum, Dr. Wilkinson notes that he will occasionally breach that rule if he is performing a reverse forehead lift and aiming to create eyebrow central elevation in a patient with a very high forehead and recessed hairline. To establish a more normal hairline in that situation, the incision must be placed anteriorly, and then techniques are used when mobilizing the scalp from back to front to salvage the existing hair follicles.

Erasing errors

Correcting problems relating to visible scars and unnatural hairlines can be accomplished using a double-opposing rotation in which the surgeon rotates tissues in seemingly incompatible directions. In that technique, skin from the cheek region is rotated upward while the temple hairline is rotated downward to restore the hairline so that it covers the top part of the ear.

Next, skin is rotated beneath the lobule in order to make sure the ear hangs in its normal position with the lobule free. Working directly behind the ear, hair-bearing scalp skin is rotated forward in an opposite direction with neck skin to move available hair closer to the back of the ear and to conceal any posterior scar.

To enhance facial contours when performing primary rhytidectomy or in patients who present for revision, Dr. Wilkinson also advocates the use of external ultrasound and autologous fat grafts. The external ultrasound procedure is performed with a "superwet" anesthetic technique and can be very helpful for reducing fat in the jowl and submental regions and for flattening nasolabial lines.

"The ultrasound energy acts to dislodge fibrous attachments and allows the fat cells to be dispersed or absorbed while it simultaneously targets tissues of the deep dermis to induce contracture. Even patients who have not had any more invasive facial surgery can appear as if they have had a facelift because the external ultrasound causes skin tightening and dissipation of fat deposits contributing to jowl lines and folds in the mid-cheek and nasolabial regions;' he says.

Fat grafting is also used as a safe and more permanent filler to address defects in the sub-commissure region, across the wrinkled upper lip, and to reduce the appearance of glabellar frown lines. In addressing the glabellar region, Dr. Wilkinson first introduces a blunt dissector through a stab wound in the scalp and uses it horizontally to elevate the flown rhytids from their deep dermal attachments. When that step is completed, the instrument is withdrawn, reinserted vertically, and used to shred the corrugator and other muscles just above the nose.

The space created in the subdermal and intramuscular region by those manipulations provides an excellent receptacle for autologous fat injections. In addition, the shredding technique weakens the muscles so that the glabellar lines are less likely to recur and also helps to smooth out some of the bulkiness that may be present in the region between the eyebrows.

2005-12-08T01:37:00.000-05:00

Byline: Jeremy Laurance Health Editor

THE NUMBER of men who had cosmetic surgery rose by two thirds last year, according to industry research which suggests demand for plastic surgery among men is outstripping growth in women. But nine out of 10 procedures are still performed on women, according to the British Association for Aesthetic Plastic Surgery, which represents the country's top cosmetic surgeons. Its members performed 16,397 procedures last year, 1,348 of them for male clients.

An estimated 75,000 cosmetic surgery procedures are carried out each year, many by surgeons who lack specialist qualifications in plastic surgery.

However, the Government has announced that it will this week launch a crackdown on rogue cosmetic surgery clinics to protect patients from high- pressure sales techniques and botched operations.

Two reports from the Chief Medical Officer, Sir Liam Donaldson, and the Healthcare Commission, the independent health service watchdog, will herald a new drive to clean up the booming private business.

2005-11-26T01:12:00.000-05:00

Most men want bigger penises

FICTION: Around 75 per cent of UK men say they are happy with the size of their manhood - while the other quarter are reading those dodgy ads for pills, potions and plastic surgery. Just for the record, the average length of a flaccid penis is 3.4 inches and erect is 6.4 inches.

2005-11-23T12:06:00.000-05:00

Physicians at Harmony Ambulatory Surgery Center in Fort Collins, Colo., opted for efficiency when they first opened their doors in 2000. They bypassed traditional dictation and transcription options for the clinical documentation that follows gastroenterology procedures, and instead selected ProVation MD with its GI module. Right out of the gate, they chose IT, time savings, cost savings and a one-and-done approach to documenting the surgical experience.

Harmony's Administrator Rebecca Craig, R.N., says, "Our physicians had vision. They knew that all aspects of clinical documentation are moving in an electronic direction. Even though we didn't have an EMR in 2000, the physicians still wanted a procedural documentation system that could download to one." Turns out, it was the right decision.

Harmony Ambulatory Surgery Center is affiliated with Poudre Valley Hospital and is a 27,000 square foot, multispecialty ambulatory surgery center (ASC) offering general, orthopedic, plastic, GYN, urology, ENT and ophthalmology surgery, and GI and pain management services, with the availability of six overnight beds for those who need more care than a same-day discharge affords. Accredited by JCAHO, the center includes four operating rooms, two gastroenterology endoscopy rooms and a pain management room, plus separate admission and recovery areas. The original five GI physicians have increased their numbers to eight GI physicians, and the ASC handles more than 700 cases per month.

Originally hired as the organization's clinical director, Craig says the software works so well that Harmony added ProVation's pain management module in 2003. In fact, the ASC hasn't yet identified an EMR product that physicians like well enough to purchase and has suggested to ProVation that the vendor consider developing an EMR product as well.

Software at Work

Immediately after completing a procedure, Harmony physicians sit at a workstation and complete their clinical documentation via ProVation MD. In large part, documentation is completed by a series of pull-down screens and menus in which doctors make choices and click, although the system does permit physicians to key in free text as an additional component of their post-operative documentation. As they pull down, point, click and select, the software suggests appropriate ICD-9 and CPT codes for the coding and billing tasks to follow. The physician can accept the suggested codes or change them, if he wishes. The entire package was designed to offer physicians a robust menu of automated options for post-procedure orders, patient instructions, letters to patients with physician impressions and recommendations, recall functions and pathology results tracking, while still allowing and encouraging individual input from physicians who want to generate it.

The physician can also verbally dictate into the system, see his words as text on the monitor and self-edit the text for greater clarity. Craig says most physicians maximize their use of the system's menu-based suggestion and selection features, although several physicians are comfortable keying in free text, and at least one or two regularly use the voice recognition and self-edit features.

When the physician is satisfied with his report, he signs it electronically. The physicians' signatures have been scanned into the system, and each physician has his own password that only he knows, so that only he can sign his own reports. Once a report is signed, the physician pushes another button to print, and the information is not only printed but also pushed forward to multiple next-step users.

One copy of the report automatically goes to the physician's office, whether he is located on-campus or off-campus. Another copy is sent to the coder/biller of Harmony Ambulatory Surgery Center. Another copy is sent directly to the nurses' station. The nurse has the operative report, along with any subsequent orders, discharge instructions and aftercare recommendations for patients heading home, which expedites the discharge process.

Craig says that for physicians who primarily use the system's pull-down menu and selection options, a typical operative report might take five minutes. For physicians who want to key in free text or use the dictation and text-editing functions, the time requirement might expand to seven to 10 minutes. She adds that the nature of pain management treatment also might require documentation time beyond the typical five minutes.

One and Done

"Our physicians don't enjoy having to come back to functions again and again to complete them," says Craig. "After the procedure is done, they want to complete their documentation, and this system allows them to do that. We have no extraneous phone calls, no moving of files or pulling of charts, and we have no three- or four-day turnaround times between the procedure's completion and a physician's signature on the op report. The physicians appreciate us helping them to be more efficient with their time which, in turn, allows them to spend more time with their patients or to see additional patients."

She says the software also helps the organization comply with JCAHO requirements in a way that doesn't add work to anyone's plate. JCAHO requires physicians to have available a brief summary following a surgical procedure. For physicians who use typical dictation and transcription services that may result in a two- to four-day turnaround, this requirement compels the physician to generate a short, handwritten summary of what took place immediately following each procedure. But with ProVation MD, the physician can generate a complete operative report in the same amount of time it would take to generate a handwritten summary, meet JCAHO requirements and still complete the case and move onto the next with no re-dos.

Once the physician electronically signs his report and the coder receives her copy, she can begin to verify codes for billing. The organization has but one coder/biller. "She's kept pretty busy," says Craig, and yet she admits that Harmony's coder increasingly functions as a verifier and auditor of the system, because the accuracy of the codes suggested by the software is so high. In fact, Craig estimates a time savings of 15 coder minutes per case because of the application's efficiency, a significant factor when coding more than 700 procedures per month.

Savings Beyond Time

The old adage "time is money" is an old adage for a simple reason: It's true. In a surgery center, every activity and supply has its price. Transcription services, often costing 12 cents to 18 cents per line, can add $1,000 a month to the budget of an ASC like Harmony Ambulatory Surgery Center. Right off the bat, Craig figures that the software saves her organization $12,000 a year minimum in transcription costs alone for the pain management service line.

She says that because the GI physicians started their practice at Harmony with ProVation MD in place, the organization didn't track for return on investment. But implementation of the pain management module in 2003 allowed Harmony to track for ROI and "it was extremely fast, seven and a half months." The center's coder/biller gets her copy of each operative report the same day, which means Harmony gets most bills out the door within 24 hours of a procedure, or 48 hours at the latest, rather than the typical three or four days required with outside transcription services. A bottom line impact of this efficiency is that procedures documented with the ProVation software typically spend less than 30 days in accounts receivable.

Craig says Harmony Ambulatory Surgery Center will be a ProVation beta tester for their new general surgery module and expects to go live with that component at the end of September. "Our general surgeons perform a high volume of laparoscopic procedures, so we are looking forward to realizing the same efficiency in that area that we have seen in the GI and pain management specialties."

In the hard-to-quantify arena, Craig is quick to say that it's not software alone, or even the bottom-line impact of the software, that make the partnership a favorable one. "ProVation has offered us excellent support. A lot of vendors are quick to make promises, but only a few regularly deliver on those promises. We have a partner that does."

The ProVation MD product is a specialty-specific one that currently offers modules dedicated to gastroenterology, orthopedics, cardiology, urology and pain management. But forewarned is forearmed. The development folks at ProVation Medical should probably expect a little additional nudging about that EMR needed by Harmony Ambulatory Surgery Center. After all, another old adage dictates: When you find something you like, stay with it.

2005-11-21T07:12:00.000-05:00

ATLANTA, July 26 /PRNewswire/ -- National Health Information is pleased to announce the launch of Plastic Surgery Practice Advisor, the first and only newsletter devoted solely to the unique practice management issues of plastic surgeons.

The incredible opportunities available for board-certified plastic surgeons today are unlike those in any other specialty, and challenges and legal threats are just as unique. The public appetite for aesthetic procedures is off the charts -- but the dramatic growth in the field is a double-edged sword, bringing not only a huge upside, but also a host of difficult legal and practice management challenges.

Each month, Plastic Surgery Practice Advisor provides detailed coverage of specific concerns and challenges with actionable advice and specialty-specific guidance. This dynamic new publication is so valuable, in fact, that it has been endorsed by the American Society of Plastic Surgeons.(R)

"Plastic surgeons are busier than ever today. Given the myriad clinical advancements and the skyrocketing number of patients seeking aesthetic procedures, these practitioners are helping more patients than ever before," says Lynn Yoffee, associate publisher of Plastic Surgery Practice Advisor. "But there's a business and legal side to every practice and considering our intensely litigious society, it just makes sense for these physicians to build an armamentarium of tools that will protect against liability, boost revenues and ensure long-term practice stability and growth. We think Plastic Surgery Practice Advisor fills that niche's need and, in fact, so does the American Society of Plastic Surgeons as demonstrated by their unique endorsement of this valuable resource."

The August issue of Plastic Surgery Practice Advisor includes the following features:

 
   - Avoid malpractice claims with a careful screening process 
   - Trust your gut when interviewing patients 
   - Watch for these red flags during patient screening 
   - How to get the most out of your before & after pictures 
   - Does your website really bring in patients? Don't be so sure 
   - Stop and take a critical look at your marketing campaign

A free, three-month trial subscription is available. Twelve monthly issues of Plastic Surgery Practice Advisor are offered for $367. ASPS members pay $267. (Candidates for membership and plastic surgery residents pay only $217.) To place an order by credit card, call toll-free (800) 597-6300 or order online at http://www.nhionline.net/.

CONTACT: Lynn Yoffee, Associate Publisher, National Health Information, +1-404-607-9500, or lyoffee@nhionline.net

Web site: http://www.nhionline.net/