A WEB based approach in biomedical engineering design education.

As part of the accreditation process for university engineering programs, students are required to complete a minimum number of design credits in their course of study, typically at the senior level. Many call this the capstone course. Engineering design is a course or series of courses that bring together concepts and principles that students learn in their field of study--it involves the integration and extension of material learned in their major toward a specific project. Most often, the student is exposed to system-wide analysis, critique and evaluation for the first time. Design is an iterative, decision making process in which the student optimally applies previously learned material to meet a stated objective. At the University of Connecticut, students work in teams of 3-4 members and work on externally sponsored projects. To facilitate working with sponsors, a WEB based approach is used for reporting the progress on projects. Students are responsible for creating their own WEB sites that support both html and pdf formats. Students provide the following deliverables: weekly progress reports, project statement, specifications, project proposal, interim report, and final report. A senior design homepage also provides links to data books and other resources for use by students. We are also planning distance learning experiences between two campuses so students can work on projects that involve the use of video conferencing.

Pancreatic pseudocyst complicating treatment of acute lymphoblastic leukemia.

In the management of children with acute lymphoblastic leukemia, L-asparaginase has become established as an effective drug in the usual multi-agent therapy; and the significance of pancreatitis as a complication of this drug is well recognized. Less well appreciated, however, is the progression of such pancreatitis in some patients to pseudocyst formation and the possible necessity for surgical management. Two adolescent girls who developed pancreatic pseudocysts while being treated with L-asparaginase are described in this report. Both were being treated for acute lymphoblastic leukemia for periods of 18 and 4 months, respectively, prior to the onset of pancreatitis. Both were in remission of their leukemic disease when typical clinical and laboratory manifestations of acute pancreatitis developed. In one girl, a pancreatic pseudocyst became apparent 2 weeks following the diagnosis of acute pancreatitis and in the other girl, this complication developed over a period of 8 weeks. The usual nonsurgical management of pancreatitis over protracted periods of time was ineffective in the treatment of the pseudocysts. Surgical drainage (internal in one and external in the other) was successful in both in eradicating the pseudocyst, and in neither did further evidence of pancreatic disease subsequently occur. In both resumption of chemotherapy, omitting L-asparaginase, was well tolerated. One has been in remission of leukemia and in good health for a 3-year period of follow-up observation, while the other subsequently had a relapse of leukemia and died 18 months following the onset of pancreatitis.

[Treatment of inguinal hernia using Shouldice's technic]. / Cure de hernie inguinale selon la technique de Shouldice.

The very high frequency of recurrence of inguinal hernia after surgical repair during the 30s led Earl Shouldice to devote his efforts to the study of this affection. In 1945 he opened an institution for the purpose of treatment of hernia, and since then a total of 130,000 operations have been performed. Progressive advances in the techniques used have enabled the relapse rate to be reduced to less than 1%, and the procedure used at the present time is described.

Antibiotic management of complicated appendicitis.

A prospective, randomized, double-blind clinical trial was undertaken comparing gentamicin, ampicillin, and clindamycin (GAC) to gentamicin, ampicillin, and placebo (GAP) in children with complicated appendicitis. Of the 64 patients enrolled in this study, 33 were assigned to the GAC group and 31 received GAP. A single GAC patient (3%) was considered a therapeutic failure in comparison to seven children (23%) in the GAP group (P less than 0.05). Duration of fever was significantly prolonged in the GAP patients (4.7 +/- .8 days versus 2.9 +/- .5 days) when compared to the clindamycin treated children (P less than 0.05). Duration of leukocytosis was 3.2 +/- .4 days for GAC patients and 4.9 +/- .9 days for those on the GAP protocol (P = 0.08). On the basis of this experience the routine use of gentamicin, ampicillin, and clindamycin is recommended for all children with complicated appendicitis.

Blue Rubber Bleb Nevi as a cause of intussusception.

The Blue Rubber Bleb Nevus syndrome is a rare disease characterized by a distinctive type of hemangioma which involves the skin and the gastrointestinal tract. In the latter location, these lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may act as a leading point for an intussusception. The diagnosis of intussusception in children older than 3 or 4 yr is frequently difficult and delayed. In a child with typical skin lesions of the Blue Rubber Bleb Nevus syndrome, an acute illness with manifestations of intestinal obstruction should indicate the possibility of an associated intussusception.

Extra-anatomical vascular bypass and external skeletal fixation in limb replantation.

The scientific background for limb replantation began 75 yr ago with the work of Hopfner and of Carrel and Guthrie. Thirty-five years ago, Hall indicated that the techniques were available, but it was not until 17 yr ago that Malt and McKhann performed the first successful replantation of a limb in man. Since then, the techniques have become more sophisticated and guidelines have been formulated. Many successful replantations have been reported. We present two children with partial amputation of a lower limb. Both had severe soft tissue and bone damage sufficient to contraindicate replantation by conventional criteria. Wound sepsis resulted in failure of replantation of the first child's limb replanted by conventional methods. The second child's limb was salvaged. Extra-anatomical vascular bypass graft separated the critical vascular anastomoses from the open contaminated wound. External skeletal fixation allowed aggressive open wound treatment. In selected cases, these two techniques would appear to increase the chances for successful limb replantation.