Adult intussusception: 5-year experience in Sarawak.

Adult intussusception is rare. It represents only 5% of all intussusceptions and 1% of bowel obstruction. Clinical presentations are usually variable with a variety of acute, intermittent and chronic symptoms. It is associated with an underlying pathologic process in 90% of cases. A lack of Malaysia data prompted review of the Sarawak experience with this uncommon entity, focusing on the clinical features, diagnostic procedure and treatment. During the last 5 years, there were 14 cases of surgically proven adult intussusception. Mean age was 45.9 years. There were 9 enteric and 5 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Thirty-three percent of the enteric lesions were malignant and 67% were benign. Eighty percent of the colonic lesions were malignant and 20% were benign. Computed tomography scan has a good diagnostic accuracy of 83% and should be considered for all patients with nonspecific abdominal symptoms or suspected bowel obstruction. Treatment of choice for colonic intussusception in adults is en bloc resection without reduction whenever possible, whereas a more selective approach for enteric lesions.

The effect of influenza vaccination on the incidence of chronic obstructive pulmonary disease exacerbations in the immediate postvaccination period.

BACKGROUND: Influenza vaccination is an important strategy in the prevention of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Despite the proven benefits, there are patients who are reluctant to have this intervention for fear of triggering an exacerbation. There are very few studies looking at the effect of the vaccination on exacerbation rates of COPD in primary care. METHODS: Medical records were obtained from six primary care practices in the Derbyshire area (UK), and 293 pairs of patients were selected. All patients had a diagnosis of COPD based on post bronchodilator spirometry. Patients were matched according to age, sex, severity of COPD and comorbidities. The first group of patients received the influenza vaccination while the other group served as a control (either never received the vaccination or received it at a later date). The incidence of COPD exacerbations of both groups was recorded. RESULTS: There were 21 exacerbations in the control group compared to 11 in the vaccinated group. The difference in exacerbation rates between groups was not statistically significant (McNemar's p=0.11). In the 2 weeks after receiving the influenza vaccination, the risk of experiencing an exacerbation in this group of patients was 0.52 in the vaccinated group compared to the non-vaccinated group (OR 0.52, CI 0.29 to 1.14). CONCLUSION: Patients with COPD should be reassured that the influenza vaccination is safe and does not cause an increase in exacerbations. They should be encouraged to take up the vaccination annually before the onset of winter.

Pitching stabilization via caudal fin-wave propagation in a forward-sinking parrot cichlid (Cichlasoma citrinellum x Cichlasoma synspilum).

Caudal fin-wave propagation (CFP) is a commonly observed behavior in a fish but has been little investigated. Our objective is to understand the function of a CFP for a forward-sinking parrot cichlid that adopts a tilted-down swimming posture. We utilized stereoscopic digital particle-image velocimetry to measure the velocity fields in the wake of both the caudal fin and the pectoral fins and to evaluate the corresponding hydrodynamic forces. The tilted-down posture of this fish is inherently unstable because of the presence of the head-down pitching moment induced from the buoyant force of the body. The down-stroke of the pectoral fins results also in a head-down pitching moment that destabilizes the fish. Our results indicate that a CFP facilitates the pitching stabilization of a fish. In a forward-sinking parrot cichlid, a CFP produces periodic jets (CFP jets) that are oriented laterally and posterodorsally, which result in both thrust and negative lift that induce a head-up pitching moment. The CFP jets are initially trapped by the ventral part of the caudal fin, strengthened and reoriented by the dorsally propagating fin wave, and expelled near the dorsal part of the caudal fin.

Automating Veterans Administration libraries: II. Implementation at the Kansas City Medical Center Library.

In 1985, the Kansas City Veterans Administration Medical Center began implementation of the Decentralized Hospital Computer Program (DHCP). An integrated library system, a subset of that program, was started by the medical library for acquisitions and an outline catalog. To test the system, staff of the Neurology Service were trained to use the outline catalog and electronic mail to request interlibrary loans and literature searches. In implementing the project with the Neurology Service, the library is paving the way for many types of electronic access and interaction with the library.