Abdominal wall reconstruction for a large caesarean scar endometrioma.

Endometrioma formation is an uncommon complication of caesarean sections. Frequently the diagnosis is delayed, due to a failure to include it in the differential diagnosis for an abdominal wall mass. The case of a thirty-six year-old female, presenting with the classical triad of a mass and cyclical pain arising in a caesarean section scar, is reported. Wide excision was performed via a transverse lower abdominal ellipse, similar to that used for abdominoplasty. The involved rectus muscle was excised and the abdominal wall was reconstructed using polypropylene mesh. An abdominoplasty-like approach affords clear margins for large caesarean section scar endometriomas thus reducing the recurrence risk. Abdominal wall reconstruction may be required for extensive lesions.

Gravitational retrograde venous perfusion--a technique for limb extremity salvage when microvascular arterial repair is not possible.

Occasionally in plastic surgery immediate microvascular arterial repair is not possible. This occurs when distal vessels in the extremities are extensively damaged or thrombosed. If there is some intact venous anatomy it may be possible to maintain adequate perfusion for viability using a gravitational retrograde venous perfusion technique, until collateral arterial supply develops. We have used this technique successfully in three cases--blast injury to the hand, extensive digital thromboembolism and a devascularised sole of foot. This technique involves elevating and lowering the limb at 30 min intervals for 5-7 days. Elevation results in venous drainage and pallor of the limb and dependency results in venous congestion confirming retrograde venous flow. In the authors' experience ischaemic necrosis was inevitable in these cases without the use of this new technique. We have attempted to explain this phenomenon by way of retrograde venous perfusion in association with high venous pressure and high oxygen tension.

Management of massive lower limb plexiform neurofibromatosis--when to intervene?

Massive plexiform neurofibromatosis is an uncommon manifestation of Type 1 neurofibromatosis. These tumours result in functional disability and severe disfigurement. Due to the variable natural history od these lesions, the optimal management is not well defined and surgery is often delayed until significant disfigurement has occurred. The aim of this report is to discuss the optimum timing of surgical intervention and to highlight the difficulties in dealing with an advanced lesion.

Neonicotinoid insecticides alter diapause behavior and survival of overwintering white grubs (Coleoptera: Scarabaeidae).

The chloronicotinyl, imidacloprid, and the thianicotinyl, thiamethoxam, are effective insecticides against white grubs when applied as preventative treatments during or immediately after egg laying. Their efficacy sharply declines when the grubs reach late-instar stage. As both imidacloprid and thiamethoxam act on post-synaptic nicotinic acetylcholine receptors and modify insect behavior, we hypothesized that the two compounds will interfere with overwintering behavior of scarabs, thus reducing their ecological fitness and exposing them to increased winter mortality. We tested this hypothesis by applying the two compounds curatively against late second-instar and early third-instar Popillia japonica and Cyclocephala borealis grubs in turfgrass. Imidacloprid provided control of P japonica equivalent to the most widely used curative organophosphate, trichlorfon, by 14 days after treatment, but thiamethoxam had no affect. In contrast, both imidacloprid and thiamethoxam caused significant reductions in C borealis populations. Both insecticides altered the overwintering behavior of P japonica by significantly reducing the normal downward movement of grubs in October. Halofenozide, an ecdysone agonist, also caused rapid mortality of the late second-instar C borealis equivalent to trichlorfon, but had no affect on P japonica. In another experiment on a site naturally infested with entomopathogenic nematodes, the exclusive treatment of third-instar P japonica with imidacloprid resulted in no significant mortality in the autumn (up to 15 days after treatment), but caused a significant reduction in the survival of overwintered grubs. There was an increase in the numbers of grubs infected with nematodes in the imidacloprid and trichlorfon treatments compared with control, but these differences were significant only for trichlorfon. These results indicate that imidacloprid can effectively control late second-instars of both P japonca and C borealis and can significantly reduce survival of overwintered third-instar P japonica by altering their normal overwintering behavior.

Relationship between achievement goal orientations and the perceived purposes of playing rugby union for professional and amateur players.

The recent professionalization of rugby union makes it an excellent achievement context in which to examine the relationship between achievement goal orientations and the perceived purposes of sport as a function of competitive standard. During the 1996-97 season, 73 professional and 106 amateur rugby players in England completed a series of questionnaires assessing their achievement goal orientations, beliefs about the purposes of rugby and demographic information. The results of a canonical correlation analysis revealed a conceptually coherent relationship between achievement goal orientations and purposes of rugby. Specifically, a high ego/moderate task orientation was positively related to fitness, aggression and financial remuneration as significant purposes of rugby. Professional players scored higher on those purposes of rugby related to aggression, financial remuneration and fitness, but lower on sportspersonship than amateur players. Professional players also reported higher task and ego goal orientations than amateur players. The findings are discussed in terms of the differences in lifestyle and motivation of professional and amateur rugby union players.