Specific gravity and creatinine as corrections for variation in urine concentration in humans, gorillas, and woolly monkeys.

Hormones excreted in the urine are widely used to assess the physiological and psychological condition of unrestrained animals. In order to control for variation in the water concentration of urine samples, the hormone concentration is often indexed to the concentration of creatinine. Because there are several problems with using creatinine, we have investigated the efficacy of specific gravity as an alternative basis for adjusting the hormone concentration in humans, gorillas, and woolly monkeys. In an experimental manipulation of human urine hydration, ten volunteers drank a water load proportional to body weight, and provided complete urine collection and saliva samples for four consecutive 20 min intervals. From the urine, we measured cortisol (radioimmunoassay), creatinine (colorimetric assay), and specific gravity (refractometer). Only cortisol was assayed from saliva. During 80 min following water ingestion, cortisol, creatinine, and specific gravity declined as urine became diluted; however, total cortisol excretion remained constant. Only cortisol concentration indexed to specific gravity accurately reflected the consistent cortisol excretion. Specific gravity and creatinine-corrected cortisol values were highly correlated but were significantly different. Salivary cortisol provided evidence for the relative stability of serum cortisol. To determine the utility of these corrections in other primates, we compared specific gravity- and creatinine-corrected cortisol in urine samples from captive gorillas (N=16) and woolly monkeys (N=8). As with the human study, the two corrections were strongly correlated in each species, but the means were different. Specific gravity correction was superior in revealing the circadian variation in cortisol.

Management of complex abdominal wall defects using acellular porcine dermal collagen.

Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

Endoluminal full-thickness plication and radiofrequency treatments for GERD: an outcomes comparison.

HYPOTHESIS: Endoluminal therapies have emerged as adjuncts for the treatment of gastroesophageal reflux disease (GERD) in select patients. OBJECTIVE: To compare the effectiveness of endoscopic full-thickness plication and endoscopic radiofrequency treatments for patients with GERD. PATIENTS: A total of 126 patients who underwent either endoscopic full-thickness plication (FTP) of the gastric cardia or endoscopic radiofrequency (RF) treatment of the esophagogastric junction during a 4-year period were included (68 underwent RF and 58 underwent FTP). INTERVENTIONS: Follow-up data was obtained for 51% of patients (mean follow-up, 6 months). MAIN OUTCOME MEASURES: Comparison of medication use, symptom scores, and pH values at baseline and follow-up. RESULTS: In the RF group, patients with moderate to severe heartburn decreased from 55% to 22% (P < .01), and proton pump inhibitor (PPI) use decreased from 84% to 50% (P = .01). Decreases were also seen for dysphagia, voice symptoms, and cough. Percentage of time the pH was less than 4 was unchanged. In the FTP group, patients with moderate to severe heartburn decreased from 53% to 43% (P = .3), and PPI use decreased from 95% to 43% (P = .01). Percentage of time the pH was less than 4 decreased from 10.0% to 6.1% (P = .05). Decreases were also seen for regurgitation, voice symptoms, and dysphagia. There was no change in scores for chest pain or asthma in either group. CONCLUSIONS: For patients with GERD, RF and FTP both resulted in a decrease in both PPI use and in scores for voice symptoms and dysphagia. In addition, RF resulted in decreased heartburn and cough, while FTP resulted in the most dramatic reduction in regurgitation. Our experience indicates that both procedures are effective, providing symptomatic relief and reduction in PPI use. For patients whose chief complaint is regurgitation, FTP may be the preferred procedure.

Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS).

INTRODUCTION: Single incision laparoscopic surgery (SILS) is an area of active research within general surgery. DISCUSSION: A number of procedures, including cholecystectomy, appendectomy, urologic procedures, adrenalectomy, and bariatric procedures, are currently being performed with this methodology. There is, as yet, no standard published technique for single-port access to the peritoneal cavity for SILS. We describe, herein, an access technique utilizing existing instrumentation including a Gelport and wound retractor that is reliable and easy. This technique has been used successfully at our institution for a number of single incision laparoscopic procedures.

Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability.

OBJECTIVE: Reports of long-term outcomes for laparoscopic Heller myotomy (LHM) are scarce. In this work, outcomes of LHM for achalasia in patients who underwent surgery more than 10 years prior were investigated. METHODS: A cohort of patients treated with LHM and partial fundoplication for achalasia between 1993 and 1996 was followed for long-term outcomes, which were compared to baseline data at presentation. RESULTS: Thirty-two consecutive patients were identified, and follow-up information was obtained for 20 patients (62.5%). Mean follow-up was 11.2 years (range 10.3 to 12.3 years). Three patients (9.4%) were deceased (mean of 40 months postoperation). Of the 17 living patients, dysphagia was rated as severe in one (5.9%), mild to moderate in eight (47.1%), and absent in eight (47.1%). This was a significant improvement from preoperative scores in which dysphagia was rated as severe in 42.9%, mild to moderate in 57.1%, and absent in 0% (p < 0.05). In addition, 10-year dysphagia scores were unchanged from those at short-term follow-up (mean 27 months, p = 0.84). Other symptoms of heartburn, chest pain, voice symptoms, cough, and asthma were reported in fewer than 30% of patients at 10 years. Esophageal dilation following surgery was required in three patients, and two patients required repeat operations (esophagectomy in one patient, hiatal hernia in one patient). Satisfaction with the operation was reported by 16 patients (94.1%) at 10 years. CONCLUSIONS: Most patients who underwent LHM with partial fundoplication reported satisfaction 10 years after the operation. A small number of patients required additional intervention. Dysphagia scores at 10 years were not different from those collected at short-term follow-up. Our data suggest that the efficacy of LHM is sustained at 10-year follow-up.

Chest-rubbing in captive woolly monkeys (Lagothrix lagotricha).

The correlates of chest-rubbing were studied in a captive group of woolly monkeys (Lagothrix lagotricha) to assess possible functions of territorial marking, spacing among competing groups or competing males, reproductive communication, marking to identify familiar environments, selfanointing, and displacement activity. Chest-rubbing was observed only in sexually mature monkeys and was a predominantly male activity. Females increased chest-rubbing when the original adult male died. Chest-rubbing by the first adult male was more common during the two months that he was mating with two females and at times when keepers were likely to be at the exhibit. The results suggest a reproductive function for chest-rubbing in both males and females. There is also support for chest-rubbing as a spacing activity.