BMI-based body size guides for women and men: development and validation of a novel pictorial method to assess weight-related concepts.

OBJECTIVES: To develop and evaluate two BMI-based instruments to determine perceptions of weight status, particularly perceptions of overweight and obesity, using pictorial images of women and men. METHODS: Pictures of adults with known BMI values were used to construct gender-specific body size guides (BSGs) containing 10 bodies that ranged from underweight to class III obesity. Figures were standardized and a composite face was added to each. The BSGs were administered to 400 adults to assess the psychometric properties of the instruments and weight perceptions. RESULTS: High correlations between the BMIs of respondents and the BMIs of the current body selected by respondents provided strong support for the criterion-related validity of the BSGs, and the logical pattern of responses to items assessing perception of weight categories supported construct validity for the scales. Test-retest reliability, assessed by correlations for both current and ideal body, was also high, despite the lengthy 6-month testing interval. Respondents' perceptions of the bodies within specific weight categories indicated that a majority failed to recognize the overweight female as overweight and perceived the overweight male as normal weight. Obese bodies were generally unrecognized as such until the bodies reached the higher levels of obesity (that is, BMI values >39). Perception of weight was influenced by the respondents' weight status and gender. CONCLUSIONS: Psychometric analyses indicated the BSGs are valid and reliable instruments. These results, coupled with the face validity of the scales and the relationship between the bodies and BMI values, indicate the BSGs offer advantages over existing instruments for researchers of weight perception and body image. Administration of the scales to an adult sample confirmed that overweight and obesity are under-recognized. Increased efforts to improve public understanding of these terms are needed and the BSGs may provide useful tools for this purpose.

Evaluation of a required statewide interdisciplinary Rural Health Education Program: student attitudes, career intents and perceived quality.

INTRODUCTION: A shortage of healthcare providers in West Virginia led to creation of a statewide, community-based program with a required three-month rural experience for most state-sponsored health professions students. Project Description: Initiated using funding from the W. K. Kellogg Foundation and expanded using both state funds and Area Health Education Center support, the West Virginia Rural Health Education Partnerships (WVRHEP) program impacts institutions of higher learning, 50 counties, and 332 training sites, and all students in state-funded health professions schools. A longitudinal database has been constructed to study program effects on students' reported attitudes, service orientation, and career intents. METHODS: Baseline data are collected from medical students, and students in all disciplines provide feedback on rotations and information about career intents, social responsibility, and attitudes towards rural practice. RESULTS: Data indicate an association between perceived quality of the rural experience and increased interest in rural health, social responsibility and confidence in becoming part of the community. Medical students may tend to rate social responsibility higher after completion of the first rural rotation. Students who anticipate practice in smaller towns also tend to rate the quality of the rotation higher, to anticipate careers in primary care, and to acknowledge social responsibility. CONCLUSION: As WVRHEP program graduates who have completed these surveys enter practice, both personal and community-specific program characteristics may be identified which strengthen interest in rural practice. The predictive validity of intermediate outcomes of attitudes and career intents in forecasting the ultimate outcomes of recruitment and retention may be studied.

Nonadrenergic, noncholinergic responses of the human colon smooth muscle and the role of K+ channels in these responses.

The aim of the present study was to investigate the possible role of nitric oxide (NO) as a nonadrenergic, noncholinergic (NANC) mediator in human colon smooth muscle in vitro and to examine its possible interactions with K+ channels. In the presence of atropine (10(-6) M) and guanethidine (10(-5) M), electrical field stimulation (EFS, 1-10 Hz, 0.3 msec, 50 V) for 10 sec induced relaxations which were inhibited by tetrodotoxin (10(-6) M). In the presence of NG-nitro-L-arginine methyl ester (L-NAME, 10(-4) M), relaxations induced by EFS at 1, 2, 4, 8 and 10 Hz were reduced by 38.7 +/- 4.3, 31.5 +/- 3.8, 54.3 +/- 5.4, 59.8 +/- 4.5 and 68.6 +/- 5.3%, respectively. The relaxations inhibited by L-NAME were restored by the preincubation of L-arginine (L-ARG, 10(-3) M) at all frequencies tested. D-Arginine (D-ARG, 10(-3) M) had no effect. Tetraethylammonium (TEA, 10(-4) M) or glibenclamide (10(-6) M) significantly decreased the relaxations induced by EFS. Exogenously applied sodium nitroprusside caused concentration-dependent relaxation with maximum relaxation observed with 10(-3) M. TEA (10(-4) M) and glibenclamide (10(-6) M) significantly depressed the maximum response to sodium nitroprusside. In conclusion, our data indicate that NO is involved in NANC nerve-mediated relaxation in the human colon smooth muscle and the relaxant responses to endogenously released or exogenously applied NO are mediated, in part, by activation of calcium-dependent and ATP-sensitive K+ channels.

Development and validation of a literacy assessment tool for persons with diabetes.

PURPOSE: This research was conducted to develop a valid, reliable, quick, and nonstigmatizing tool for assessing literacy in the healthcare setting. METHODS: The Literacy Assessment for Diabetes (LAD) instrument was developed as a word recognition test composed of 3 graded word lists in ascending difficulty. This literacy test, which was specific to diabetes, measured a patient's ability to pronounce terms that they would encounter during clinic visits and in reading menu and self-care instructions. The majority of the terms were on a 4th-grade reading level, with the remaining words ranging from the 6th-through 16th-grade levels. To assess reliability and validity, the LAD was compared with the Wide Range Achievement Test (WRAT3) and the Rapid Estimate of Adult Literacy in Medicine (REALM) by administering all 3 tests to 203 participants in a test-retest study design. RESULTS: All 3 tests (LAD, REALM, and WRAT3) reliably detected true intrasubject variation in word recognition from test to retest. In addition, LAD measured word recognition ability similar to the REALM and WRAT3. CONCLUSIONS: The LAD is a reliable and valid instrument for measuring literacy in adults with diabetes. It can be administered in 3 minutes or less, and the raw score is scaled to a reading grade level.

Design strategies for longitudinal spirometry studies: study duration and measurement frequency.

Measuring the longitudinal change in FEV(1) is useful for assessing the adverse effects of respiratory exposures and pulmonary diseases. Investigators seek to estimate the "true" mean FEV(1) slope (mu(beta)) of an infinite population. The difference between the estimated mean FEV(1) slope (mu(beta)) and the true mean slope, resulting from biological variation and measurement errors, can be minimized by increasing the number of subjects (N), years of follow-up (D), or the frequency of measurements (P). We defined maximum error e(max) such that P[|mu(beta) - mu(beta)| < or = e(max)] = 0.95, and thus e(max) is one-half the width of the 95% confidence interval for mu(beta). We computed the values of e(max) on the basis of actual data obtained from 160 coal miners and working nonminers who had completed 11 spirometry measurements, using recommended equipment and procedures, at 6-mo intervals over 5 yr. Individual 5-yr FEV(1) slopes (Delta FEV(1)) were calculated by linear regression. For a range of values of N, D, and P, tables are provided for e(max), the magnitude of detectable differences in Delta FEV(1) between two groups, and the recommended number of subjects needed in each of two groups to reliably detect the anticipated differences in Delta FEV(1). The tables provide unique guidance for investigators in selecting among various study design options.

Monitoring the metabolic response to major surgery in neonates.

BACKGROUND: Visceral proteins and acute phase reactants have commonly been used as indicators of nutritional status, and metabolic response of surgical trauma. AIM: This study was undertaken to determine how some plasma proteins, alone or together reflect metabolic response in neonates recovering from major surgery. METHODS: Serum albumin, pre-albumin (PA), C-reactive protein (CRP), and alpha1-acid glycoprotein (AGP) levels were measured, and the prognostic inflammatory and nutritional index (PINI) was calculated for preoperative day 1 (-1) and postoperative (PO) days 1 (+1) and 7 (+7). RESULTS: PA, CRP, AGP and PINI were significantly different on day +1 from day -1. While AGP and PINI were still significantly higher than that of day -1, PA and CRP returned to the preoperative levels on day +7. CONCLUSION: PA, CRP and AGP measurements are superior to PINI for assessing postoperative metabolic changes in term neonates following uncomplicated major surgery on early and late phase. But this comparison must be performed in the management of more complex cases to determine which one is better to indicate morbidity and mortality.

A study of the future practice location intent of family medicine residents in West Virginia.

Recruitment of graduating family medicine residents into practice in rural West Virginia has been hampered by many factors. A cross-sectional survey was done to obtain the opinions of family medicine residents in West Virginia in 1996 in order to characterize their perceptions regarding certain aspects of their rural training and the relative importance of various factors influencing their future practice location intent. There was a positive association between cumulative resident experience and intent to practice in West Virginia and in rural areas. Perceived preparation for rural practice varied with educational area. There was significant variation in the relative importance of recruiting factors for likelihood of practice in West Virginia and in rural areas. Some recruiting factors tended to be positive or negative discriminators for intent to practice in West Virginia and in rural areas. Enhanced recruitment may be aided by an active community involvement which addresses the identified relevant factors.

Comparison of bracket debonding force between two conventional resin adhesives and a resin-reinforced glass ionomer cement: an in vitro and in vivo study.

The purpose of this study was to compare the debonding force of orthodontic brackets bonded with two conventional resin adhesives (Resilience L3 and Light Bond) and a resin-reinforced glass ionomer cement (Fuji Ortho LC). For the in vitro part of the study, 80 extracted premolars were randomly divided into four groups. In groups A and B, brackets were bonded to unetched enamel using Fuji Ortho LC cement in wet and dry conditions, respectively. In groups C and D, brackets were bonded to etched enamel using Resilience L3 and Light Bond, respectively. Debonding force was determined using a servohydraulic testing machine at a crosshead speed of 1 mm/min. Data was analyzed using the ANOVA and Tukey-Kramer multiple comparison test at p<0.05. A significant difference was found in debonding force between unetched Fuji Ortho LC and the two conventional resins. There was no significant difference between the two conventional resins or between unetched resin-reinforced glass ionomer in the wet and dry conditions. For the in vivo part of the study, 30 patients were randomly assigned to one of the three bonding material groups. Bracket survival rates and distributions were obtained by following these patients for 1.2 years. Data was analyzed using the Kaplan-Meier product-limit estimates of survivorship function. Bond failure interface was determined using a modified adhesive remnant index (ARI). These results showed no significant difference between survival rates and distributions among the three bonding materials with respect to the type of malocclusion, type of orthodontic treatment, or location of bracket. There were significant differences between survival distributions of males and females in the unetched Fuji Ortho LC group and among type of teeth in the conventional resin groups. The predominant mode of bracket failure for the unetched Fuji Ortho LC cement was at the enamel-adhesive interface, and for conventional resins, the enamel-adhesive interface and the bracket-adhesive interface. These results suggest that resin-reinforced glass ionomer cement can withstand occlusal and orthodontic forces despite having a bond strength lower than that of conventional resin adhesives.

Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists.

In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p = 0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p = 0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs. 72/94), with a better specificity, 55% vs. 76% (p = 0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p = 0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent.

Functional innervation of the isolated bowel segment.

PURPOSE: The aim of this study is to investigate whether there might be an eventual change in the enteric nerve responses to electrical field stimulation (EFS) of the isolated bowel segment (IBS) created by omentoenteropexy. METHODS: In the experimental group, an IBS was created in 10 rats using the omentum as the host organ by dividing of its mesentery 4 weeks later. In the control group, a jejunal loop of identical site and length to the IBS was studied in another 10 rats as normal jejunal segment. Longitudinal muscle strips were prepared from the IBSs (n 20) and the normal jejunal segments (n = 20). The effects of atropine, tetrodotoxin, L-arginine, and L-nitroarginine methyl ester (L-NAME) on the responses to transmural EFS were examined in both the IBS and normal jejunal segment using the isometric tension recording technique. RESULTS: Transmural EFS of the IBS strips produced contractile responses. Atropine and tetrodotoxin abolished the EFS-induced contractions of the IBS. Moreover, EFS-induced contractions were increased by the application of L-NAME, and were decreased by the application of L-arginine in the IBS. Mean percent change of IBS's contraction was not found statistically different from mean percent change of normal jejunal segment's contraction on the effects of L-NAME and L-arginine. CONCLUSION: These results suggest that the IBS, created by omentoenteropexy, produced enteric nerve responses to EFS as seen as in normal jejunal segment.

Reactive oxygen radical levels in caustic esophageal burns.

PURPOSE: This study was designed to determine the tissue levels of reactive oxygen radicals in caustic esophageal burns in a rat model. METHODS: Forty rats were divided into four groups of 10 animals each. The control rats were uninjured in group A, and the others were injured rats in groups B, C, and D. Through a median laparatomy incision, a 1.5-cm abdominal esophageal segment was isolated and tied with 2-0 chromic sutures in all groups as described by Gehanno. One milliliter of 10% sodium hydroxide solution in groups B, C, and D and 0.9% saline solution in group A were instilled through the isolated segment via a no. 24 cannula for 3 minutes, then the esophagus was rinsed for 1 minute with distilled water. The studied 1.5 cm of the abdominal esophagus was removed from each animal 24 hours after caustic injury in group B, 48 hours after in group C, and 72 hours after in group D. In group A, studied uninjured segments were removed for biochemical investigation. Tissue malondialdehyde (MDA) and glutathione (GSH) levels were determined for each group. RESULTS: The mean MDA levels in esophageal tissue were significantly higher in groups B, C, and D than in group A (P < .05). Moreover, the mean GSH levels in the same esophageal tissues were significantly lower in groups C and D than in groups A and B (P < .05). CONCLUSION: The reactive oxygen radicals may be play an important role in early phase of caustic esophageal burns by increasing the tissue damage.

Proposed cephalometric diagnosis for osteogenic obstructive sleep apnea (OSA): the mandibular/pharyngeal ratio.

The purpose of this laboratory study is to devise a simple, diagnostic test to assess possible osteological deficiency as a probable cause of OSA. Modern day skulls of fifty males and forty eight females of Tuscan origin and an additional seventy-five skulls, from India, with their cephalograms were used for this study. Mandibular length and antero-posterior dimension of the nasopharynx--pharyngeal tubercle (PhT) to posterior nasal spine (PNS)--were measured on the Tuscan skulls. The nasopharynx was similarly measured on the Indian skulls and readings multiplied by 1.14, the magnification factor of the cephalometric apparatus used. The PhT-PNS distance was then plotted on the cephalogram of Indian skulls with point PhT at the basiocciput. The possible presence of an osteogenic etiology of OSA can be determined by comparison of the mandibular/pharyngeal ratio obtained from the skull cephalograms to that of the individual patient.

Treatment of intestinal reperfusion injury using antioxidative agents.

BACKGROUND/PURPOSE: A number of antioxidants are present in human tissues, which comprise the secondary defence system against the oxygen-free radicals and oxidative stress. Therefore, this study was undertaken in an animal model to investigate the effects of antioxidants such as vitamin E, vitamin C, methyl prednisolone, and mannitol, on the treatment of intestinal reperfusion injury when given during ischemia. METHODS: The study was performed on six groups of animals, each composed of six rabbits: Group I, mesenteric ischemia group; group R, ischemia-reperfusion group; group E, ischemia-reperfusion plus Vitamin E treatment; group C, ischemia-reperfusion plus vitamin C treatment; group CS, ischemia-reperfusion plus corticosteroid treatment; and Group M, ischemia-reperfusion plus mannitol treatment. Malondialdehyde (MDA) and glutathione (GSH) levels of the intestinal mucosa were assayed to reflect the free radical formation. RESULTS: Mucosal injury scores in the M and C groups were significantly lower than the R group (P< .01 and P< .01, respectively), and in the E and CS groups, mucosal injury scores were not significantly different from R group. MDA levels in the M and C groups were significantly lower than the R group (P < .01 and P < .01, respectively). GSH levels in the E, C, and M groups, were significantly higher than R group (P < .01, P < .05, and P < .01, respectively). CONCLUSION: The results of this study showed that antioxidant drugs, such as vitamin C and mannitol, may play a role in attenuating reperfusion injury of the gut demonstrated by depression of tissue MDA levels and by elevation of tissue GSH levels.

Cephalometric and occlusal changes following maxillary expansion and protraction.

A prospective clinical trial was conducted to determine the cephalometric and occlusal changes following maxillary expansion and protraction. Twenty Southern Chinese patients (eight males and 12 females with a mean age of 8.4 +/- 1.8 years) with skeletal Class III malocclusions were treated consecutively with maxillary expansion and a protraction facemask. Growth adaptation of these patients was followed for 2 years after removal of the appliances and compared with a control group of subjects with no treatment. Lateral cephalometric radiographs were used to quantify the skeletal and dental changes before treatment (T1), immediately after treatment (T2) and 2 years after removal of appliances (T3). With 8 months of treatment (T2-T1), overjet was overcorrected from a -2.0 to 3.5 mm. The maxilla moved forwards by an average of 2.1 mm and the molar relationship was improved to a Class I dental arch relationship. The palatal and occlusal planes were tilted upward 1.0 and 2.0 degrees, respectively. Two years following removal of the appliances (T3-T2), a positive overjet was maintained in 18 out of 20 patients. The maxilla continued to move forwards in the treated subjects similar to the controls. The mandible outgrew the maxilia. In most instances, dental compensation with proclination of the maxillary incisors was observed. The palatal plane returned to pre-treatment value. The occlusal plane continued to tilt upward due to eruption of the molars and proclination of the incisors. Analysis of dental casts showed a significant increase in maxillary intercanine (2.2 mm) and intermolar widths (2.3 mm) with 7 days of rapid palatal expansion followed by maxillary protraction. The percentage relapse in maxillary intermolar widths was 30-45 per cent after 1 year, in most cases with minimal retention. In the mandibular arch, the concurrent increase in intermolar width (2.3 mm) was primarily due to buccal uprighting of the posterior molars when the maxilla was protracted into a Class I skeletal relationship and was stable after 1 year. The results of this study indicate stability of orthopaedic treatment of Class III malocclusions directed at the maxilla. Despite some relapse, a net improvement in maxillomandibular relationship and a positive overjet was maintained in 18 out of 20 patients at the end of the follow-up period.

Malaria in West Virginia: forty cases seen at West Virginia University Hospital.

In the U.S., malaria predominately occurs in travelers and immigrants. We report a series of 40 cases at West Virginia University Hospital, and 24 of whom were students who had visited areas of East Africa, West Africa and Asia usually in either December, January, August or September. Most patients (79%) reported a previous episode of malaria, and P. falciparum was identified in 60%. Fever, chills and rigors were the most common symptoms. Correct use of malaria prophylaxis was recorded in five patients, and only two of these were students. Successful outcomes were recorded in all but one patient. Our series suggests that international students would benefit from the proper use of chemoprophylaxis, thus decreasing the number of cases of malaria seen in university settings.

Helicobacter pylori and hypergastrinemia in children with recurrent abdominal pain.

Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups. The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group, aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50 children in the control group, 32 were seropositive (64%) for Hp IgG (P > 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels in 62 Hp-seropositive children (60.4 ng/l) were not different from those in 30 Hp-seronegative children (57.3 ng/l) and those in 42 children with RAP (58.2 ng/l) were also not significantly different from those in 50 healthy children (62.9 ng/l). Thus, no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population.

Serum D-lactate levels as a predictor of intestinal ischemia-reperfusion injury.

Currently, no serum marker has proved helpful in diagnosing intestinal ischemia and reperfusion (I/R) injury. An experimental study was conducted to determine the value of serum D-lactate in detecting intestinal I/R injury. Thirty New Zealand White rabbits were divided into three groups of 10 animals each: sham-operation controls (S); I/R; and I/R plus mannitol treatment (M). Serum samples were obtained before operation (T0), at the end of the ischemic period (T1), after the first 30 min of reperfusion (T2), and at the end of the reperfusion period (T3). In Group S, mean D-lactate levels for T0, T1, and T2 were 0 microgram/dl, while T3 was 5. 8 +/- 4.7 micrograms/dl. Before the operation (T0), serum mean D-lactate levels were 0 microgram/dl in all groups (S, I/R, M). Levels increased after 1 h of ischemia (T1) in groups I/R (83.5 +/- 25.6 micrograms/dl) and M (89.8 +/- 19.9 micrograms/dl), but not in group S (0 microgram/dl). The mean T2 level in group I/R (231.6 +/- 78.6 micrograms/dl) was statistically higher than in group M (140.1 +/- 53.5 micrograms/dl) (P = 0.007). At the end of the reperfusion period, the mean T3 level in group I/R (698.4 +/- 360.4 micrograms/dl) was significantly higher than in group M (158.7 +/- 61.4 micrograms/dl) (P = 0.000). In group I/R, mean D-lactate levels changed significantly at each time point (T1 vs T2, P = 0.001; T2 vs T3, P = 0.004). However, in group M the increase from T1 to T2 was significant (P = 0.012), but that from T2 to T3 was not (P = 0.293). As a result, the mean T3 level was significantly higher than the T2 level in group I/R (P = 0.004), but not in group M. This study confirmed a significance rise in D-lactate levels in animals with I/R injury compared to sham-operated and I/R injury plus M treatment. We suggest that serum D-lactate levels could be a useful marker of intestinal I/R injury before laparatomy.

Acute-phase changes in children recovering from minor surgery.

The metabolic response to surgical stress is a nonspecific increase in hepatic synthesis of some specialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which specific proteins were the better clinical indices in monitoring the metabolic response to surgical stress in children recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively (-1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Prealbumin (PA), C-reactive protein (CRP), and a1-acid glycoprotein (AGP) values, and to calculate the prognostic inflammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA +1 was significantly lower than PA -1 and PA +5 (P < 0.001). Median CRP +1 and mean AGP +1 values were significantly higher than median CRP -1 and mean AGP -1 (P < 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still significantly higher than preoperative values (P < 0.01 and P < 0.0001). Moreover, the median PINI +1 was also greater than PINI -1 and PINI +5 (P < 0.0001), but the median PINI+5 was significantly higher than PINI -1 (P < 0.01). Median percent changes of PINI values were significantly higher than those of the other parameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic response, we suggest that the PINI is more valuable for reflecting the response to surgical stress in patients recovering from minor surgery.

Isolated bowel segment created by omentoenteropexy: histologic findings.

An isolated bowel segment (IBS) is a viable loop of bowel that is completely free of its mesenteric attachments. In this study, omentoenteropexy (OEP) was performed in 5-cm-long IBS of rats in order to provide neovascularization. Thirty-two rats were divided into four groups. After OEP, mesenteric division of the IBSs was performed at successive 1 week intervals in each group (3-6 weeks). The bowel-wall structures were histologically examined 2 days after division of the mesentery. Ischemic changes were observed in the group in which the interval was shorter than 4 weeks. In the IBSs that were supplied by the pediculated omental flap for 4 or more weeks no ischemic changes were noted in the mucosa, muscle layers, or intramural ganglia. We conclude that an IBS that preserves normal bowel structures can safely be created in the rat when its mesentery is divided 4 weeks after OEP. Physiological studies of motility and absorption can be performed and longitudinal tubularization may enable such an IBS to be used in short-bowel syndrome.

Calcium, magnesium, and phosphorus: emergency department testing yield.

OBJECTIVES: To investigate how often the ED ordering of stat serum calcium (Ca+2), magnesium (Mg+2), and phosphorus (PO4(-3)) levels affected clinical treatment; to define the diagnoses of patients for whom Ca+2, Mg+2, and PO4(-3) measurements did affect clinical therapy; and to suggest guidelines for more appropriate ordering of these laboratory tests. METHODS: A retrospective chart review was performed in an academic teaching hospital. All adult ED patients who had Ca+2, Mg+2, or PO4(-3) laboratory testing during the 9-month study period were included and evaluated for potential clinical impact of an abnormal Ca+2, Mg+2, or PO4(-3) laboratory test. RESULTS: 1.477 patients had Ca+2, Mg+2, or PO4(-3) measured while in the ED during the study period. Of these, 260 patients (17.6%) had a total of 312 abnormal Ca+2, Mg+2, or PO4(-3) values as defined by results exceeding +/- 15% of normal reference values. Of these, only 5 patients (0.3%) received treatment for abnormal values in the ED, while 75 patients (5.1%) were treated once admitted to the hospital. In this study, the only diagnostic groups to whom significant treatment was administered were diabetic patients (Ca+2 and PO4(-3); alcoholic patients (Mg+2); and renal failure patients (Ca+2, Mg+2, and PO4(-3). CONCLUSION: These results suggest that stat Ca+2, Mg+2, and PO4(-3) levels seldom affect clinical treatment in the ED. The frequency of ordering these tests may be reduced by obtaining Ca+2, Mg+2, or PO4(-3) measurements only for patients known to be at risk for such abnormalities, based on their existing or suspected diagnoses. The authors suggest obtaining these tests, when indicated, on a "non-stat" basis, with the subsequent laboratory results becoming available in-hospital, where treatment is more likely to occur.