Experience of laparoscopic incisional hernia repair in kidney and/or pancreas transplant recipients.

Despite the wide popularity of laparoscopic incisional hernia repair (LIHR) in the nontransplant population, there are very few reports of LIHR available in abdominal organ transplant patients and none exclusively on kidney and/or pancreas (KP) transplant patients. We retrospectively reviewed a consecutive series of LIHR in KP transplant recipients performed over a period of 4 years and compared the results with LIHR in non-transplant patients during the same period. A total of 36 transplant patients were compared with 62 nontransplant patients. There were five patients converted to the open procedure in the transplant and four in nontransplant patients (p-NS). There were three seromas and one patient had a bowel perforation in the transplant group versus eight seromas, one bowel perforation and one small bowel obstruction noted in the nontransplant group. One patient in each group had a mesh infection requiring explant. Patients were followed up for a mean period of 2.2 years in the transplant group and 3 years in the nontransplant group. Overall there were five recurrences in the transplant group and four in the nontransplant group (p = NS). These results suggest that that LIHR is a safe and effective alternative to open repair.

Describing weight status and fitness in a community sample of children attending after-school programming.

Although the body of research on public-health aspects of after-school programs is growing, little is known with regard to physical fitness levels of attending children. The purpose of this study was to describe the health-related fitness in a community sample (N.=826) of under-served children attending after-school programming. Health-related fitness was assessed via Fitnessgram(R) and body mass index. In this population, numerous children failed to meet national standards for the push-up (54%), curl-up (24%) and pacer (47%) tests. Many of those failing to meet national standards were unable to perform a single push-up (32%), or curl-up (12%), and over half (51%) of the children were overweight or obese. Significant differences by race/ethnicity, gender, and weight status emerged for some fitness measures. Based on these data, fitness aspects beyond weight status should be considered when designing PA programs for children, especially those in communities of underserved youth.

Length of docked tail and the incidence of rectal prolapse in lambs.

A multistate cooperative study was conducted to study the current issue of tail length in docked lambs and its relationship to incidence of rectal prolapse. A total of 1,227 lambs at six locations were randomly allocated to two or three tail dock treatments: 1) short--tail was removed as close to the body as possible, 2) medium--tail was removed at a location midway between the attachment of the tail to the body and the attachment of the caudal folds to the tail, and 3) long--tail was removed at the attachment of the caudal folds to the tail. Short-docked lambs had a greater (P < 0.05) incidence of rectal prolapse (7.8%) than lambs with a medium (4.0%) or a long (1.8%) dock. Female lambs had a higher (P < 0.05) incidence of rectal prolapse than male lambs. At two stations, lambs were finished either in a feedlot on a high-concentrate diet or on pasture with no grain supplementation. At one station, with a very low incidence of rectal prolapse, there was no difference in incidence between lambs finished in the feedlot or on pasture; however, at the station with a relatively high incidence of rectal prolapse, lambs in the feedlot had a higher (P < 0.05) incidence than lambs on pasture. The half-sib estimate of heritability for the incidence of rectal prolapse was low (0.14). The results of this study strongly implicate short dock length as a cause of rectal prolapse in lambs finished on high-concentrate diets. Furthermore, the results of this study and the only other study known conducted on this issue strongly suggest that docking lambs at the site of the attachment of the caudal folds to the tail will result in a negligible incidence of rectal prolapse.

Airway obstruction induced by angiotensin-converting enzymes inhibitors.

The air medical transport of patients with potential or actual airway problems is commonplace. Airway obstruction from angioedema, however, is seldom seen and can be life-threatening if not managed correctly. This case outlines airway compromise from angiotensin-converting enzyme inhibitors (ACEIs) and discusses its subsequent management.

Resident-directed communication patterns in community homes for persons with disabilities.

A descriptive assessment of environmental variables influencing patterns of staff communication with people living in three community-based residential facilities supporting persons with disabilities was presented. Each of the 16 participating staff persons was observed for 2 hours, and all resident-directed communication behaviors were coded according to staff person, activity context, and resident. Statistical analyses were performed examining frequencies of interaction across these variables. Frequencies of communication were found to differ across activities and residents (communicative partners), but not staff persons or homes. Directions for future research and clinical implications are given, including the development of a model of staff performance and the creation of self-reinforcing social communities in residential settings for persons with disabilities.

Using mand training to establish an echoic repertoire in young children with autism.

This research describes a method that initially establishes a mand repertoire as the first component in producing echoic and tact repertoires in young children with limited verbal repertoires. The subjects were 3 nonverbal children with autism, aged 2.5 to 3.5 years. The results indicated that establishing a mand repertoire as the starting point for echoic training produced the acquisition of an initial echoic repertoire in all 3 children within the first 10 sessions. Two of the children also began tacting during the same period. A mand repertoire was acquired by all subjects by the sixth session. Negative vocal behavior was rapidly reduced without the use of aversive contingencies by shaping inapproapriate vocalizations into acceptable vocal mands. Our discussion analyzes those contingencies that contribute to the effectiveness of the manding procedure and compares this procedure with the conventional vocal imitation model. We also discuss variables that may contribute to the long-term success of language training programs and describe strategies for preventing language delay in typical infants and children.

Dietary fish oil inhibits cholesterol monohydrate crystal nucleation and gallstone formation in the prairie dog.

BACKGROUND: Epidemiologic studies suggest that populations consuming a diet rich in fish oil have lower rates of both atherosclerotic heart disease and gallstones. The mechanisms underlying this inhibitory effect on cholesterol gallstone formation remain unclear. We therefore studied the effect of dietary fish oil on bile composition and cholesterol precipitation in an animal model of gallstone disease. METHODS: Adult male prairie dogs were fed a standard control diet (n = 12) or a lithogenic 1.2% cholesterol diet (n = 16). One half of the animals in each group had their diet supplemented with concentrated fish oil. RESULTS: After 14 days animals receiving the cholesterol diet all developed biliary cholesterol monohydrate crystals and gallstones. When fish oil was added to this high cholesterol diet, solid cholesterol crystal precipitation and gallstone formation were completely inhibited. This inhibition of gallstone formation was accompanied by a significant decrease in biliary calcium and total protein concentration. Microscopic cholesterol liquid crystals were evident in the bile of all of the animals fed the cholesterol plus fish oil diet. Dietary fish oil also significantly prolonged cholesterol monohydrate crystal observation time in animals receiving the lithogenic diet. CONCLUSIONS: These data suggest that dietary fish oil exerts a potent antilithogenic effect on cholesterol gallstone disease and may induce a stable liquid crystalline phase retarding nucleation.

The hemodynamics of simple and sequential iliofemoral grafts in dogs three months after insertion.

Hindlimb pressures and flows were measured 3 months after insertion of simple and sequential iliofemoral grafts in the hindlimbs of dogs to determine which type of graft provides the highest blood flow under resting and vasodilated conditions. Under resting conditions, the sequential graft had 94 percent greater distal blood flow than the simple graft. The pressure gradients across the grafts were comparable. When the hindlimb was dilated by intra-arterial injection of adenosine, both distal and proximal blood flows increased in both graft types. The sequential graft, however, provided higher proximal flows than the simple graft although the pressure gradients were increased by the same magnitude across both graft types. Therefore, our data indicated that 3 months after insertion, sequential iliofemoral grafts provide improved vascular flows compared with simple grafts under resting and dilated conditions.

Caffeine prevents cholesterol gallstone formation.

Methylxanthines are known to inhibit in vitro gallbladder absorption. Increased gallbladder absorption has been observed during formation of cholesterol gallstones. Therefore we tested the hypothesis that caffeine would inhibit in vivo gallbladder absorption and thus prevent formation of cholesterol gallstones. Sixteen adult male prairie dogs received a control nonlithogenic diet, and 16 were fed a diet containing 1.2% cholesterol. Half of the animals in each group received caffeine in their drinking water. Gallbladder and hepatic bile were examined microscopically and analyzed for biliary lipids and electrolytes. The gallbladder/hepatic bile ratios of bile acids and sodium were calculated as indices of gallbladder absorption. All eight animals receiving the 1.2% cholesterol diet formed cholesterol gallstones, whereas none of the eight animals fed the cholesterol diet plus caffeine formed gallstones. The cholesterol saturation index was similar, however, in both groups. In animals fed a control diet, the administration of caffeine significantly increased hepatic bile flow and decreased the gallbladder/hepatic bile ratio for both bile acids (5.4 +/- 0.9 vs 3.6 +/- 0.3; p less than 0.05) and sodium (1.26 +/- 0.03 vs 1.12 +/- 0.03; p less than 0.01). In animals fed the high-cholesterol diet, caffeine significantly decreased the ratios for both bile acids (9.0 +/- 1.6 vs 5.3 +/- 0.6; p less than 0.05) and sodium (1.37 +/- 0.06 vs 1.21 +/- 0.01; p less than 0.05), lowered gallbladder bile protein levels, normalized gallbladder stasis, and lowered serum cholesterol levels. In summary, caffeine prevented formation of cholesterol gallstones in this experimental model. The effect of caffeine may be the result of alterations in multiple biliary parameters including the inhibition of gallbladder absorption.

Complications of controlled tissue expansion in the pediatric burn patient.

All patients at the Burn Institute reconstructed with tissue expanders between June of 1984 and June of 1987 were included in this review. There were 122 expanders used in 77 patients. Complications were defined as "absolute" (23 of 122 expanders, 20 percent) if they resulted in loss of expanders or additional surgery or none of preoperative plan was satisfied or "relative" (14 of 122 expanders, 11 percent) if they included spotty alopecia or alopecia greater than 50 percent or the operative plan only partially satisfied, reflecting poor judgment. The most common absolute complication was prosthetic exposure secondary to wound dehiscence occurring in the scalp area. Complications relative to specific anatomic areas were neck and face, 2 of 20 (10 percent); lower extremity, 1 of 4 (25 percent); trunk, 0 of 6 (0 percent); and scalp, 20 of 92 (22 percent). We feel that this high complication rate in the use of tissue expanders may be unique to the pediatric burn patient. Knowledge of indications for use and potential complications is essential to add this entity to the armamentarium of the burn reconstructive surgeon.

Chylous ascites after abdominal aortic surgery.

Chylous ascites is an unusual postoperative complication that can lead to significant mechanical, nutritional, and immunologic consequences. We present the report of a patient with chylous ascites after abdominal aortic aneurysm repair. Paracentesis is essential for diagnosis and is often useful in the initial management of the patient with mechanical respiratory distress. Nonoperative management is appropriate, but careful attention must be given to the patient's nutritional status. Elemental diet supplementation or total parenteral nutrition may be necessary to minimize lymph flow. The sequestration of lymphocytes into the ascitic fluid may result in a profound decrease in absolute lymphocyte count. With appropriate nutritional support the prognosis of postoperative chylous ascites is excellent and reoperation rarely necessary.

The axillary mass in occult breast carcinoma. Case reports and overview.

The presentation of mammary carcinoma as an axillary mass is quite rare (0.5%). "Occult" breast cancer will be defined as nonpalpable breast carcinoma presenting as an axillary mass. This article presents two such patients and reviews the available literature. The patients are of similar age and have breast lesions at similar sites as "nonoccult" breast carcinoma. However, the prognosis is somewhat better than that of "nonoccult" breast cancer perhaps due to early histopathology and small primary size. This subject is reviewed in terms of case reports, clinical findings, radiographic findings, pathologic findings, management, treatment, prognosis, and a flowchart for surgical work-up.

A critical review of amputation in vascular patients.

A study was made of 53 patients who underwent amputation for peripheral vascular disease over a 5-year period at West Virginia University Medical Center. The follow-up period ranged from 1 to 6 years. Data concerning operative deaths, risk factors, use of prosthetic devices, and ultimate self-sufficient living were obtained. The functional outcome for this group of patients was encouraging with modern prosthetic fitting and social rehabilitation. Approximately 75% of the patients were returned to a useful life with a prosthetic limb or in a wheelchair. Amputation is a less desirable alternative than successful revascularization, but with the prostheses available today, amputation does not foreshadow a dismal existence.

Shadworth Hodgson and William James's formulation of space perception: phenomenology and perceptual realism.

This paper has two related goals. First, it seeks to show that the theory of perception found in William James's Principles of Psychology is thoroughly consistent if it is approached through the framework of perceptual realism versus constructionism rather than the nativism versus empiricism debate. As such, this paper offers an alternative to Nicholas Pastore's claim that there are two contradictory theories of perception in the Principles. James's commitment of perceptual realism is articulated within the contexts of his (1) critique of constructionist perception theories, (2) notion of the spatial quale, and (3) formulation of the role of knowledge in adult perception. The second goal of this paper deals with the historical development of James's perceptual realism. Here it is argued that Shadworth Hodgson's method of reflection-an anticipation of Husserl's phenomenological reduction-served as the basis of James's commitment of perceptual realism.

Color as a variable in making an erotic film more arousing.

Eight adult male subjects participated in a counterbalanced, repeated-measures design to determine the relative efficacy of color and black-and-white visual sexual stimuli in eliciting sexual arousing, as objectively measured by a mercury-in-rubber strain gauge transducer. There were no consistent or significant differences in either the intensity of the pattern of penile responding during color and black-and-white presentations of the same film.