Gentle teaching and applied behavior analysis: a critical review.

In recent years, there has been a growing controversy surrounding gentle teaching. This paper explores the nature of this controversy with particular reference to the relationship between gentle teaching and applied behavior analysis. Advantages and disadvantages of this approach are discussed, and it is suggested that gentle teaching and applied behavior analysis need not be regarded as mutually exclusive approaches to working with persons with mental retardation.

Extrahepatic biliary obstruction versus intrahepatic disorder. Differentiation with hepatobiliary scintigraphy and ultrasonography.

In 43 patients with various hepatobiliary disorders, we compared retrospectively the sensitivity and specificity of hepatobiliary scintigraphy and ultrasonography in diagnosing extrahepatic biliary obstruction. Hepatic uptake of radioactivity from the circulation was assessed by early scintiscan at 2 min, and the clearance ratio was combined with transit time in the interpretation of hepatobiliary scintiscans. The transit time was defined as the time taken by detectable radioactivity to appear in the extrahepatic biliary tree or small intestine, whichever occurred sooner. The sensitivity and specificity were 92% and 97%, respectively. However, the specificity dropped to 74% when biliary-bowel transit time, i.e., time taken for detectable radioactivity to appear in small intestine only, was used instead of transit time in the interpretation of the scintiscans. The sensitivity and specificity of ultrasonography were 55% and 94%, respectively. We conclude that hepatobiliary scintiscan is more sensitive than ultrasonography and is reliable for diagnosing extrahepatic biliary obstruction when it is done and interpreted by the method described here.

The association of Streptococcus bovis fecal carriage and colon neoplasia: possible relationship with polyps and their premalignant potential.

We designed a study to evaluate the fecal carrier rate of Streptococcus bovis in patients with endoscopically proven colonic polyps. Benign polyps (n = 63), i.e., hyperplastic, inflammatory, and juvenile, had a similar fecal carrier rate as the normal control colons. Colons with polyps that are at increased risk for malignant degeneration (n = 62), i.e., tubulovillous and villous adenomas, and colons with carcinoma (n = 18), had a statistically significant increase (p less than 0.05) in the fecal carrier rate for S. bovis over the benign colon group. Overall, the incidence of S. bovis carriage in all colons with polyps was intermediary between normal colons and colons with carcinoma although the numbers did not achieve statistical significance.

Paraganglioma of the duodenum: a case report.

Paraganglioma of the duodenum is a tumor which typically occurs in the ampullary region and which has been regarded as benign. This patient, as well as most of the 25 similar cases previously described, presented with upper gastrointestinal bleeding. Diagnosis may be elusive, particularly when a Billroth II anastomosis has been done previously. Careful identification of the ampulla is mandatory to ensure safe excision of the tumor. The possibility of multicentricity in these tumors heightens the necessity of distinguishing them from ampullary carcinoma at operation.

Ataxia-telangiectasia and hepatocellular carcinoma.

Ataxia-telangiectasia (AT) is a multi-system disease involving the cerebellum, cutaneous blood vessels and the immune system including both cellular and humoral components. It also involves hematological, endocrine and peripheral nervous systems. This disease is often associated with abnormal liver function tests, such as, raised alkaline phosphatase and various nonspecific histological changes in the liver. High incidence of various malignancies involving lymphoreticular, gastrointestinal and mesenchymal organs have reported in ataxia-telangiectasia. Elevated levels of alpha fetoprotein have been noted commonly in this disorder. In spite of the hepatic histological and biochemical changes associated with elevated alpha fetoprotein, to our knowledge, development of hepatocellular carcinoma has not been reported in patients with ataxia-telangiectasia. A case of a young white female with AT who developed hepatocellular carcinoma along with significantly elevated levels of alpha fetoprotein is presented.

Primary Crohn's disease of the appendix: report of 14 cases and review of the literature.

Fourteen patients with primary Crohn's disease of the appendix have been seen in a 12 year period. These patients represent 12.8% of the total number undergoing surgical resection because of Crohn's disease. Twenty-three cases of appendiceal Crohn's disease have been previously reported in the literature. A correct preoperative diagnosis is rarely made; the usual diagnosis is that of acute appendicitis or appendiceal abscess. The removed appendix in twelve of our 14 cases had marked thickening of the wall with transmural fibrosis and often with granulomatous inflammation. The enlarged appendix had an external appearance similar to that of ileal Crohn's disease, and we consider a correct surgical diagnosis might be possible with better awareness of its existence. The diagnosis might be suspected earlier when the clinical course of apparent appendicitis is protracted or atypical. Contrary to the previous estimation of high recurrence rate, this series and the cumulative evidence in the literature show a relatively low rate at 14%. The feared fistula formation following the removal of the appendix has not been seen in either our series or the literature. These patients, however, merit long-term follow-up.

Postgastrectomy bezoars.

Sixteen cases of postgastrectomy bezoars were diagnosed and treated in the period of five years. Various mechanisms of their information, symptomatology and therapy are discussed. We believe postgastrectomy bezoars are relatively frequent but often missed entities. Considering the relative frequency of this entity and ease of therapy, this condition should not be missed if one is aware of its existence.