Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation.

A 37-year-old woman presented with an incarcerated hernia at a previous umbilical laparoscopic port site. This was found to contain an ischaemic appendix, which was managed successfully with open appendicectomy and a mesh repair. Previous imaging from a year prior to these events demonstrated a degree of intestinal malrotation with the caecal pole lying just under the umbilicus. Finding the appendix within an incisional port site is very rare, for this to occur at the umbilicus is unique.

Elimination of neglected tropical diseases in the South-East Asia Region of the World Health Organization.

The neglected tropical diseases (NTDs), which affect the very poor, pose a major public health problem in the South-East Asia Region of the World Health Organization (WHO). Although more than a dozen NTDs affect the region, over the past five years four of them in particular - leprosy, lymphatic filariasis, visceral leishmaniasis (kala-azar) and yaws - have been targeted for elimination. These four were selected for a number of reasons. First, they affect the WHO South-East Asia Region disproportionately. For example, every year around 67% of all new leprosy cases and 60% of all new cases of visceral leishmaniasis worldwide occur in countries of the region, where as many as 850 million inhabitants are at risk of contracting lymphatic filariasis. In addition, several epidemiological, technological and historical factors that are unique to the region make each of these four diseases amenable to elimination. Safe and effective tools and interventions to achieve these targets are available and concerted efforts to scale them up, singly or in an integrated manner, are likely to lead to success. The World Health Assembly and the WHO Regional Committee, through a series of resolutions, have already expressed regional and global commitments for the elimination of these diseases as public health problems. Such action is expected to have a quick and dramatic impact on poverty reduction and to contribute to the achievement of the Millennium Development Goals. This paper reviews the policy rationale for disease control in the WHO South-East Asia Region, the progress made so far, the lessons learnt along the way, and the remaining challenges and opportunities.

AIDS prevention and care in Asia and the Pacific: what has Australia to offer?

PIP: Australia's response to the HIV epidemic has 4 major features. 1) Communities and individuals at risk have been encouraged to explore their risk factors and actions which they could take to increase their safety. Thus, treatment and care has been integrated with prevention in ways which allow people with AIDS to make contributions. 2) National, state, and local policies have concentrated on harm reduction and have deemphasized traditional moral concerns about sex behavior or IV drug use. Harm reduction policies reflect reality rather than what society views as ideal behavior. 3) A working consensus has been maintained between infected and affected groups and the community at large. 4) Finally, many political and strategic risks have been taken, mistakes have been made, and lessons learned from those mistakes. An inclusive, multisectoral, and multilevel program has been forged by debate and disagreements which were resolved rather than denied. Australia's approaches to HIV which could be transferred to other countries include the analysis of sexual and drug-using behavior in various communities; the provision of interpersonal, peer, and collective education along with condoms, needles, and syringes; and data provided by national and state laboratory and epidemiological networks. The sense of collaboration which has dominated the diverse groups seeking a national response to HIV in Australia is lacking on the international level where interagency brawling is the norm. With the incidence of newly-infected persons falling from 16/100,000 in 1987 to 8/100,000 in 1991, the lessons learned in Australia may well provide much needed answers in other countries.^ieng

Coarctation of the aorta in adults. Clinical presentation and results of surgery.

We studied the mode of presentation and results of surgery in 45 adults with coarctation of the aorta. Coarctation was unsuspected in 23 patients, 3 of whom presented with acute aortic dissection and 4 with severe aortic valve disease. Twenty seven were hypertensive before surgery. Three patients required emergency operation and all died. There was one death and one postoperative paraplegia amongst 39 patients who underwent elective operation. Of 21 preoperatively hypertensive patients studied at least 2 years after surgery blood pressure returned to normal levels in 10. Acute aortic dissection, aortic aneurysm formation and aortic valve disease complicate the surgical treatment of adult coarctation and hypertension may persist in as many as 50% of patients. Nevertheless surgery is preferable to the poor reported results of long term medical management.

Appearance changes associated with participation in a behavioral weight control program.

Relationships among objectively-measured weight changes, perceived changes in weight, and perceived changes in attractiveness of participants in a behavioral weight control program were examined. Participants in the program were weighed and photographed before and after treatment and at a six-month follow-up session. These photographs were then rated on the dimensions of perceived weight and perceived attractiveness by the same participants, who were kept blind to the times at which the photographs were taken. Correlational analyses indicated that there was little correspondence between objectively-measured weight change and perceived weight changes or between objectively-measured weight change and perceived change in attractiveness. Perceptions of weight change and perceptions of attractiveness change were, however, strongly related.

Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients.

To assess the clinical significance of coronary artery ectasia 4993 consecutive coronary arteriograms were reviewed to identify patients with this condition and to allow the assessment of their progress. Coronary ectasia was a relatively uncommon finding (overall incidence 1.4%). It was not related to the development of aortic aneurysms and did not affect the outcome, results of coronary artery surgery, or symptoms.

Effects of a short-term exercise program on caloric consumption.

The present study investigated the effects of a short-term exercise program on caloric intake. Thirty-three women were randomly assigned to either a high-intensity exercise group (80% maximum heart rate), low-intensity exercise group (55% maximum heart rate), or waiting list control group. Exercisers were required to ride ergometer bicycles three times per week for 7 weeks, expending 200 kilocalories of energy per exercise session. All participants recorded food intake during specified weeks before, during, and following the exercise program. Results showed no significant caloric intake differences among the three groups, but a trend toward reduction in food intake with increased exercise intensity was found. Interestingly, comparisons between caloric intake on exercise and nonexercise days revealed that both exercise groups consumed significantly less on exercise days. Additionally, the control group evidenced a larger caloric intake level than did the two exercise groups on exercise days. These results suggest that exercisers do not compensate for energy expenditure by increasing caloric intake and that choosing between low- and high-intensity exercise does not differentially alter caloric intake. Nevertheless, maximization of negative energy balance or weight loss may be best achieved by exercise programs of high frequency and intensity.

Visual versus computerised assessment of left ventricular function from cinéangiography.

Visual assessment of left ventricular function from cinéangiography was compared with computerised assessment in 48 randomly selected cinéangiograms. The parameters compared included end-diastolic volume, end-systolic volume, stroke volume, ejection fraction and left ventricular output. There was poor agreement between visual and calculated values for end-diastolic volume, stroke volume and left ventricular output, but good agreement for ejection fraction and moderately good agreement for end-systolic volumes. Absolute values are particularly difficult to assess.

The importance of magnification in left ventriculography.

A method of measuring the magnification of ventriculograms is described. The catheter in the ventricle is X-rayed on cine film together with a radio-opaque ruler attached to the table. A second cine run is exposed after shifting the table by an amount which can be determined from the ruler. The magnification is equal to the distance that the catheter moves on the projected angiogram divided by the actual distance moved. Studies to prove the accuracy and reproducibility of the method have been undertaken. In random series of 48 patients, the linear magnification factor varied between 1.04 and 1.46. The cubic magnification as used for calculating ventricular volume ranged from 1.12 to 3.11. The error by ignoring the magnification can therefore be 211% and by taking a mean value, up to 62%.

Coronary angiography Review of 1500 consecutive cases.

Fifteen hundred coronary angiograms have been performed by the staff of Harefield Hospital since 1970. Only 2 deaths have occurred in the last 1000 consecutive cases though there were 5 in the first 500 cases. This drop in the mortality is ascribed to careful attention to detail and better training of the operators. It is concluded that the Fudkin's method of coronary angiography in trained hands is a safe method of investigation but that because of the very serious potential dangers it is unjustifiable for new units to start unless there is a fully experienced investigator in charge.