bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of Cyclic Antidepressant-Induced Blood Dyscrasias
Authors: Hartshorn Edward A. , Levin Gary M. , DeVane C. Lindsay
Published: January 2017

OBJECTIVE:

To review the literature for cases of blood dyscrasias associated with cyclic antidepressants. Several types of blood dyscrasias are discussed.

DATA SOURCES:

All references were selected through the use of MEDLINE. Indexing terms were blood, abnormalities, dyscrasias, antidepressants, agranulocytosis, and eosinophilia. The only constraints were English language and human subjects.

STUDY SELECTION:

All cases were included except for letters to the editor of various journals when pertinent data such as doses and additional medications were omitted.

DATA SYNTHESIS:

The review provides a table listing the different blood dyscrasias and the drug the patient was receiving. The table also includes time of onset, time to recovery, and several symptoms for each patient.

CONCLUSIONS:

Common symptoms of various blood dyscrasias are discussed. The chemical structures of the antidepressants are related to phenothiazines, which are also implicated in causing blood dyscrasias. Recommendations for treatment of both the dyscrasia and depression are discussed.
Relationship Between Calf Muscle Size and Strength after Achilles Rupture Repair
Authors: Leppilahti J. , Lähde S. , Forsman K. , Kangas J. , Kauranen K. , Orava S.
Published: January 2017

The object was to study the relationships between calf muscle size and strength in 85 patients an average of 3.1 years after repair of achilles tendon rupture.

The isokinetic calf muscle strength results were excellent or good for 73 % of the patients, whereas calf muscle size was normal in only 30 %. The average plantar flexion peak torque per unit muscle cross-sectional area was higher on the injured side than on the uninjured side. The average calf muscle cross-sectional area deficit was 15±9% (p<0.001) of that on the unaffected side, while the average plantar flexion peak torque deficit was speed-dependent, being 9±18%, 10±18 and 2±13% of that on the unaffected side at 30, 90, and 2407sec (p<0.001). The correlation between cross-sectional area and peak torque varied in the range 0.52–0.61 at 30, 90 and 2407sec (p<0.001).
Metabolic Syndrome
Authors: Sherling Dawn Harris , Perumareddi Parvathi , Hennekens Charles H.
Published: January 2017

The United States is experiencing its greatest life expectancy ever. Nonetheless, the general health of the US population is far from at an all-time high. An important contributor to the pandemic of cardiovascular disease is that overweight and obesity are also the major determinants of metabolic syndrome, an all too common and all too serious clinical and public health challenge. Clinicians have traditionally evaluated each of the major risk factors contributing to metabolic syndrome on an individual basis. There is evidence, however, that the risk factors are more than additive. The overlap of these factors in each disease state, resulting in increased atherogenic risks, is worth examining as a broader entity rather than separately. While therapeutic lifestyle changes (TLCs) should be strongly recommended, clinicians should not let the perfect be the enemy of the possible. Evidence-based doses of statins, aspirin and angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers should be prescribed as adjuncts, not alternatives, to TLCs. In fact, there is cogent evidence that the benefits of these pharmacologic therapies may also be at least additive.
Using Writing Strategies in Math to Increase Metacognitive Skills for the Gifted Learner
Authors: Knox Heather
Published: January 2017

Metacognition is vital for a student’s academic success. Gifted learners are no exception. By enhancing metacognition, gifted learners can identify multiple strategies to use in a situation, evaluate those strategies, and determine the most effective given the scenario. Increased metacognitive ability can prove useful for gifted learners in the mathematics classroom by improving their problem-solving skills and conceptual understanding of mathematical content. Implemented effectively, writing is one way to increase a student’s metacognitive ability. Journal writing in the mathematics classroom can help students by clarifying their thought process while further developing content knowledge. Implementing writing can lead to increased understanding of the problem, identification of additional strategies that can be used to solve the problem, and reflective thinking during the problem-solving process. Reflective writing in mathematics can help students evaluate solution strategies and identify strengths and areas of improvement in their mathematical understanding.
Profit and Public Interest: A Publication History of John Hersey's “Hiroshima”
Authors: Forde Kathy Roberts
Published: January 2017

By exploring the production, publication, and circulation of John Hersey's “Hiroshima” in America in 1946, this study demonstrates how a landmark work of journalism traveled the breadth of the American media system, fueled more by an ethos of community building and citizenship than of commercial gain. In the case of the publication of “Hiroshima,” individuals and institutions in the American media system largely disregarded commercial imperatives to provide as many Americans as possible with vital information and a forum for debate about unsettling moral, political, and social realities of atomic warfare and the new atomic age.
“After the Humidity and Stillness of Yesterday . . .”
Authors: Gannon Susanne
Published: January 2017

This article turns to a handwritten travel journal from more than two decades ago to explore how the past might be animated in the present through provoking affective, material and imaginative encounters with the text, the subject, and the world. This experimental animation of space-time through writing draws upon the figure of the mirror in Foucault’s “heterotopias” as it sets in motion lines of force and displacement that enable openings toward emerging intercorporeal subjects in writing.
Prospective Study of Topical 5-Aminolevulinic Acid Photodynamic Therapy for the Treatment of Moderate to Severe Acne Vulgaris in Chinese Patients
Authors: Wang Hong-Wei , Lv Ting , Zhang Ling-Lin , Guo Ming-Xia , Stepp Herbert , Yang Kui , Huang Zheng , Wang Xiu-Li
Published: January 2017

Background:

Topical photodynamic therapy (PDT) mediated with 5-aminolevulinic acid (ALA) offers an alternative option for the treatment of acne vulgaris.

Objective:

To study the effects of ALA dose, incubation time, and lesion type on protoporphyrin IX (PpIX) production and treatment outcomes.

Methods:

To examine the time course of PpIX production, 10% ALA was applied to inflammatory papules for 1 to 5 hours and followed by in situ fluorescence examination. To determine the effects of ALA dose and lesion type, 3, 5, and 10% ALA was applied to acne lesions in split-face fashion for 3 hours followed by whole-face light irradiation at 633 nm and 30 to 70 J/cm2. Treatment was repeated twice at 2-week intervals.

Results:

PpIX reached a stable level after 3 hours of incubation. Similar PpIX levels were seen in areas receiving 3, 5, and 10% ALA. Poisson regression analyses indicated that lesion counts decreased by 0.791 times for a one-unit increase in treatment times (95% CI 0.782–0.799, p< .0001) but only by 0.999 times for a one-unit increase in ALA dose (95% CI 0.998–1.000, p = .22).

Conclusion:

The combination of low-dose ALA and a red light is a safe and effective option for the treatment of moderate to severe acne.

Renseignements de base:

La thérapie photodynamique topique (TPD) suivant l'administration de l'acide 5-aminolévulinique (ALA) représente une autre possibilité pour le traitement de l'acné vulgaire.

Objectif:

Étudier les effets de la dose d'ALA, la durée d'incubation, le type de lésion sur la production de PpIX, et les résultats du traitement.

Méthodes:

Pour examiner l'évolution temporelle de la production de PpIX, de l'ALA 10 % a été appliqué sur des papules inflammatoires pendant 1 à 5 heures et a été suivi d'un examen in situ en fluorescence. Afin de déterminer les effets de la dose d'ALA et le type de lésion, de l'ALA 3, 5, et 10 % a été appliqué sur les lésions d'acné sur une moitié du visage pendant 3 heures, suivi d'une irradiation de lumière de tout le visage à 633 nm et 30 à 70 J/cm2. Le traitement a été répété deux fois à 2 semaines d'intervalle.

Résultats:

La PpIX a atteint un niveau stable après 3 heures d'incubation. Des taux de PpIX semblables ont été observés dans les parties ayant reçu de l'ALA 3, 5, et 10 %. Des analyses de régression de Poisson ont indiqué que le nombre de lésions a diminué de 0,791 fois pour une augmentation d'une unité de temps de traitement (IC 95 % 0,782 à 0,799, p <,0001), mais seulement par 0,999 fois pour un accroissement d'une unité de dose d'ALA (CI 95 % 0,998 à 1,000, p =, 22).

Conclusion:

La combinaison d'une faible dose d'ALA et de la lumière rouge est une option sûre et efficace pour traiter l'acné modérée à sévère.
Allergic Contact Dermatitis from Dimethyl Fumarate after Contact with a Chinese Sofa
Authors: Doumit Joseph , Gavigan Geneviève , Pratt Melanie
Published: January 2017

Background:

Dimethyl fumarate has been successfully used in the treatment of psoriasis in the past. Despite its clinical use, cutaneous contact with this molecule may cause contact dermatitis.

Objective:

We report a case in which skin exposure to a synthetic fabric sofa containing dimethyl fumarate made by a Chinese furniture manufacturer resulted in a severe, pruritic, papulovesicular, eczematous dermatitis to the sites of contact with the sofa.

Methods:

The patient was patch-tested with serial dilutions of dimethyl fumarate.

Results:

Patch testing results revealed strong positive reactions to dimethyl fumarate at different concentrations.

Conclusion:

Dimethyl fumarate is a potent contact sensitizer and is commonly found in sachets inside furniture and footwear boxes.

Contexte:

Le fumarate de diméthyle a été utilisé avec succès, dans le passé, dans le traitement du psoriasis. Malgré cet usage clinique, les contacts cutanés avec la molécule peuvent causer une dermatite de contact.

Objectif:

Nous faisons état ici d'un cas d'exposition de la peau à du fumarate de diméthyle présent dans le tissu synthétique d'un sofa fabriqué en Chine, qui a entraîné un eczéma grave, prurigineux, et papulovésiculaire aux sièges de contact avec le sofa.

Méthode:

Le patient a été soumis à des tests épicutanés, avec dilutions successives du fumarate de diméthyle.

Résultats:

Les résultats des tests épicutanés ont révélé une forte réaction positive au fumarate de diméthyle, à différentes concentrations.

Conclusion:

Le fumarate de diméthyle est un puissant sensibilisant de contact, qu'on trouve souvent dans les sachets placés dans les meubles et dans les boîtes à chaussures.
Atypical Lupus Erythematosus Panniculitis Progressing to Antinuclear Antibody–Negative Systemic Lupus Erythematosus
Authors: Pandhi Deepika , Verma Prashant , Singal Archana , Sharma Sonal , Tondon Anupama
Published: January 2017

Background:

Lupus erythematosus panniculitis (LEp) is an uncommon but distinctive subset of lupus erythematosus (LE). It may develop in patients with discoid or systemic LE or may occur as an isolated phenomenon.

Case Report:

We describe a case of LEp affecting unusual sites: the parotid gland, eyelid, and scalp. Subsequently, the patient progressed to antinuclear antibody–negative systemic LE.

Contexte:

Le lupus érythémateux compliqué d'une panniculite (LEp) est une forme rare mais particulière de lupus érythémateux (LE). Il peut se manifester dans le contexte du LE discoïde ou du LE disséminé, ou encore n'être qu'un phénomène isolé.

Exposé de cas:

Il sera question ici d'un cas de LEp touchant des sièges inhabituels: la glande parotide, les paupières, et le cuir chevelu. L'état du patient a évolué, par la suite, vers un LE disséminé négatif à l'égard des anticorps antinucléaires.
Basaloid Squamous Cell Carcinoma of the Nasal Septum Presenting as a Primary Cutaneous Lesion
Authors: Hoy Nathan , Wong Joyce , Mahmood Muhammad , Brassard Alain
Published: January 2017

Background:

Basaloid squamous cell carcinoma is a rare aggressive variant of squamous cell carcinoma, with a predilection for the head and neck region. There are only two case reports in the literature documenting a nasal cavity squamous cell carcinoma presenting as a primary cutaneous lesion.

Objective:

We report a rare case of nasal cavity basaloid squamous cell carcinoma presenting initially as a nasal bridge mass. Two initial biopsies revealed features consistent with basal cell carcinoma and basosquamous cell carcinoma, respectively.

Result:

Final surgical pathology showed extensive invasive squamous cell carcinoma with basaloid differentiation arising from the nasal septal mucosa with extension to the overlying skin. The clinicopathologic features were interpreted as basaloid squamous cell carcinoma.

Conclusion:

We discuss the difficulties in pathologic diagnosis of this condition given its varied phenotypical expression. As well, this case emphasizes the necessity for diagnostic vigilance when assessing a primary cutaneous lesion as it may be a rare presentation of an underlying malignancy extending to the skin.

Contexte:

Le carcinome squameux basaloïde est une variante rare et très maligne du carcinome squameux, qui touche le plus souvent la tête et le cou. La documentation médicale ne compte que deux exposés de cas sur le carcinome squameux de la cavité nasale se présentant sous forme de lésion cutanée primitive.

Objectif:

Nous faisons état ici d'un rare cas de carcinome squameux basaloïde de la cavité nasale, se présentant au départ comme une masse dans la voûte des fosses nasales. Deux biopsies ont été pratiquées au départ, et les résultats se sont montrés compatibles avec les caractéristiques du carcinome basocellulaire et du carcinome basospinocellulaire, respectivement.

Résultat:

L'examen histopathologique définitif de la pièce opératoire a révélé la présence d'un carcinome squameux invasif, étendu, accompagnée d'une différenciation basaloïde prenant naissance dans la muqueuse de la cloison nasale et se prolongeant jusqu'à la peau sus-jacente. Les manifestations clinicopathologiques laissaient croire à un carcinome squameux basaloïde.

Conclusion:

Il sera question ici des difficultés que pose le diagnostic histopathologique de cette affection compte tenu de son expression phénotypique variée. De plus, le cas met en évidence la nécessité de faire preuve de vigilance dans l'établissement du diagnostic lorsqu'on évalue des lésions cutanées primitives étant donné que celles-ci peuvent être une manifestation rare d'une tumeur maligne sous-jacente, qui s'étend jusqu'à la peau.
The Influence of Health Needs Assessment on Health Care Decision-Making in London Health Authorities
Authors: Hensher Martin , Fulop Naomi
Published: January 2017

Objectives:

Health needs assessment gained prominence under the model of health care purchasing developed to support the 1991 reforms of the UK National Health Service (NHS). The objectives of this paper are to determine how needs assessment has been used in the NHS, to assess the influence it has had on decision-making, and to relate the observed uses of needs assessment to competing theoretical models of health care policy-making.

Methods:

A survey of needs assessment activity in 14 London health authorities identified 217 needs assessments conducted between 1993 and 1996. Semi-structured interviews were conducted with public health and commissioning staff in each authority.

Results:

The survey indicated that needs assessment directly supported decision-making and action in two-thirds of the studies identified, but up to 20% of needs assessments had no impact on service provision. Four key functions of health needs assessment were observed: identifying a problem; planning detailed changes to services; providing post hoc justification for earlier decisions; and using participation in needs assessment to build ‘ownership’ of subsequent decisions.

Conclusions:

The survey suggests that needs assessment is, in practice, consistent with a ‘mixed scanning’ model of decision-making. Needs assessment is used to help select issues for detailed investigation and to direct analytical and decision-making resources. However, certain key areas are not amenable to technical analysis and solution, and are resolved through bargaining.
A Review of Scottish Telemedicine
Authors: Maclean J R , Brebner J A , Norman J N
Published: January 2017

Telemedicine services have been provided from Scotland for many years. Initial activities centred on the provision of health care to workers on the oil installations in the North Sea, to mixed-gas divers supporting the oil industry, and to scientific staff in British Antarctic Territory. Other Scottish research work has contributed to space medicine. The remote location of much of the Scottish population is currently the reason for much telemedicine research. This paper reviews the past quarter of a century of telemedicine in Scotland and identifies the principles that have led to success in some challenging locations. The same principles can be expected to apply when telemedicine services are provided more generally.
A Comparison of Communication Modes in Adult Psychiatry
Authors: Ball C J , McLaren P M , Summerfield A B , Lipsedge M S , Watson J P
Published: January 2017

The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.
A Telemedicine System for High-Quality Transmission of Paper Electrocardiographic Reports
Authors: Ong K , Chia P , Ng W L , Choo M
Published: January 2017

To overcome problems associated with the faxing of ECGs, we developed a telemedicine system providing fast transmission of ECGs between physicians and cardiologists at different locations. It digitized ECGs at a resolution of 300 dots/inch (118 dots/cm), processed them, and transmitted them over a standard telephone line in under one minute. The system also paged the cardiologist in order to direct him or her to the location where the ECG would be waiting for interpretation. The system enabled physicians at remote locations to consult using voice, images and simultaneous cursor pointers. A transmitting site was set up at the Medical Centre of the Ministry of Defence and a receiving site at the National University Hospital, about 5 km away. During a six-month trial, 200 ECG reports were transmitted from one site to the other. They were rated excellent in quality by the cardiologists, being virtually indistinguishable from the originals. Our telemedicine system transmits high-quality ECGs rapidly and at low cost.
Eat what you hear: Gustasonic discourses and the material culture of commercial sound recording
Authors: VanCour Shawn , Barnett Kyle
Published: January 2017

This article analyzes discursive linkages between acts of listening and eating within a combined multisensory regime that the authors label the gustasonic. Including both marketing discourses mobilized by the commercial music industry and representations of record consumption in popular media texts, gustasonic discourses have shaped forms and experiences of recorded sound culture from the gramophone era to the present. The authors examine three prominent modalities of gustasonic discourse: (1) discourses that position records as edible objects for physical ingestion; (2) discourses that preserve linkages between listening and eating but incorporate musical recordings into the packaging of other foodstuffs; and (3) discourses of gustasonic distinction that position the listener as someone with discriminating taste. While the gustasonic on one hand serves as an aid to consumerism, it can also cultivate a countervailing collecting impulse that resists music’s commodity status and inscribes sound recording within alternative systems of culture value.
Improving ASL fingerspelling comprehension in L2 learners with explicit phonetic instruction
Authors: Geer Leah C , Keane Jonathan
Published: January 2017

Students acquiring American Sign Language (ASL) as a second language (L2) struggle with fingerspelling comprehension more than skilled signers. These L2 learners might be attempting to perceive and comprehend fingerspelling in a way that is different from native signers, which could negatively impact their ability to comprehend fingerspelling. This could be related to improper weighting of cues that skilled signers use to identify fingerspelled utterances. Improper cue-weighting in spoken language learners has been ameliorated through explicit phonetic instruction, but this method of teaching has yet to be applied to learners of a language in a new modality (M2 learners). The present study assesses this prospect. Eighteen university students in their third-semester of ASL were divided into two groups; one received explicit phonetic training, and the other received implicit training on fingerspelling. Data from a fingerspelling comprehension test, with two experimental conditions and a control, were submitted to a mixed effects logistic regression. This revealed a significant improvement from the pre-test to post-test by students who received the explicit training. Results indicate that even short exposure to explicit phonetic instruction significantly improves participants’ ability to understand fingerspelling, suggesting that ASL curricula should include this type of instruction to improve students’ fingerspelling comprehension abilities.
Surgical Aspects of Cardiac Resynchronisation Therapy
Authors: Shaw S. M. , Williams S. G. , Fox D. J.
Published: January 2017

Despite significant advances in the pharmacological treatment of heart failure, rates of mortality and morbidity from the condition remain a concern. The introduction of cardiac resynchronisation therapy (CRT) has been a welcome addition to the treatment strategy of patients who display ventricular dyssynchrony. Several control studies have shown significant benefits from this intervention in particular improved mortality and reduction in symptom burden. In this short review, we focus on several concepts of CRT and discuss the implications of surgical implantation of the left ventricular (LV) lead as compared to the standard transvenous approach.
Clinicopathological Characteristics and Non-Adhesive Organ Culture of Insulinomas
Authors: Hoem D. , Jensen D. , Steine S. , Thorsen T. E. , Viste A. , Molven A.
Published: January 2017

Background and Aims:

Insulinoma is a very rare type of islet cell tumour, but nevertheless the most common endocrine tumour of the pancreas. We aimed at reviewing our clinical experience with this tumour type and to assess whether organ culture could be obtained from surgically resected insulinoma material.

Material and Methods:

All patients with insulinomas (6 men and 10 women) referred to Haukeland University Hospital between 1986 and 2006 were included in the study. Median age of onset was 53 years (range 21–74). Biochemical diagnosis was established during a 72 h fast test. Imaging and localization of the tumours were performed with intra-operative ultrasonography, endoscopic ultrasonography, CT-scan and/or transcutaneous ultrasonography. For six patients, organ cultures were set up from tumour tissue fragments.

Results:

The annual incidence of insulinoma was 0.8 per million. The patients generally presented with non-specific, episodic symptoms, which often were mistaken for cardiovascular, neurological or diabetic disease and in some cases delayed the diagnosis with several years. Two patients had diabetes prior to the diagnosis of insulinoma. Patient weight gain was probably due to increased food intake, compensating for the hypoglycemia. Intra-operative ultrasonography detected all tumours correctly, whereas 73% were detected by endoscopic ultrasonography and 38% by CT scan. Five insulinomas were located in the head, eight in the body and three in the tail of the pancreas. All were removed by open-access surgery, eleven cases by resection and five by enucleation. One tumour was malignant with liver metastases and two patients had tumours defined as borderline. Insulinoma tissue fragments developed into spheroids during the first week of culturing and insulin secretion into the media was demonstrated.

Conclusions:

Insulinomas are rare and diagnostically challenging tumours. Intra-operative ultrasonography was superior to other imaging modalities to locate the lesion. In organ culture, insulinomas readily form spheroids which may be used to yield insight into beta-cell biology.
Seroma Formation and Method of Mesh Fixation in Laparoscopic Ventral Hernia Repair — Highlights of a Case SERIES
Authors: Sodergren M. H. , Swift I.
Published: January 2017

Introduction:

Laparoscopic ventral hernia repair (LVHR) is gaining popularity amongst minimally invasive surgeons, promising shorter lengths of hospital stay and decreased morbidity compared to conventional open repair. We aim to report our experience of LVHR performed at a single institution and analyse morbidity to improve outcome.

Methods:

A retrospective analysis using a prospectively collected database and patient records was performed on all patients that underwent LVHR. Patient demographics, morbidity and mortality were recorded. Patients with recurrences underwent further analysis.

Results:

There were a total of 55 laparoscopic ventral hernia operations performed on 50 patients. 24 (48%) were male, and the median BMI was 31 (range 20–41). The median operating time was 50 mins (range 30–120), the median length of stay (LOS) was one day (range 1–14) and the median follow-up period was 14 months (range 3–31). Operative complications occurred in two (3.6%) patients. Minor morbidity occurred in 12 (21.8%) patients. Eight (14.5%) patients developed seromas within the residual hernia sac post-operatively. There were six recurrences following LVHR in five patients. At re-operation, all recurrences appeared to be due to mesh detachment.

Conclusion:

LVHR is safe and the results are comparable to published series. We are encouraged by a shorter LOS and operative time compared to most published data. Post-operative seroma formation is common. If there is a suspicion of recurrence, these should all be imaged appropriately to avoid unnecessary operative intervention. A higher BMI is an independent risk factor for recurrence in LVHR. Consideration should be given to using transfascial sutures or other fixation methods to improve recurrence rates in this difficult patient group.
Obesity May Impair the Early Outcome of Total Knee Arthroplasty a Prospective Study of 100 Patients
Authors: Järvenpää J. , Kettunen J. , Kröger H. , Miettinen H.
Published: January 2017

Background and Aims:

Obesity has been linked to the development of osteoarthritis of the knee and increases the probability to fall into total knee arthroplasty. In this study we compared short-term outcome of total knee arthroplasty (TKA) in non-obese and obese patients.

Material and Methods:

A total of 100 patients underwent TKA between October 2006 and March 2007. They were divided into two groups based on the body mass index: 52 of the patients were obese (BMI ≥ 30 kg/m2) and 48 non-obese (BMI < 30 kg/m2). The short-term outcome was studied using clinical, functional and radiological analysis. The mean of the follow-up period was 3 months.

Results:

There were five complications (2 wound infections, phlebitis, nerve injury and massive edema) in obese patients group compared with no complications in non-obese (p = 0.028). The obese patients had also worse postoperative range of motion (110o̱ vs.118o̱, p = 0.001) than non-obese and the number of technical errors was 17 in obese and 5 in non-obese group, respectively (p = 0.007).

Conclusions:

We suggest that obesity may impair the early outcome of total knee arthroplasty and obese patients should be informed about the increased risk of complications related to TKA.
Feasibility of Minilaparotomy versus Laparoscopic Cholecystectomy for Day Surgery: A Prospective Randomised Study
Authors: Harju J. , Kokki H. , Pääkkönen M. , Karjalainen K. , Eskelinen M.
Published: January 2017

Background and Aims:

Minilaparotomy (MC) and laparoscopic cholecystectomy (LC) are commonly applied surgical techniques in the management of symptomatic gallstone disease. Both techniques are used in day surgery patients, but to our knowledge MC and LC have not been compared in randomised trials as day surgery procedures.

Material and Methods:

In this randomised parallel group clinical trial we compared the success rate of day surgery of MC with that of LC in 60 consecutive patients with non-complicated symptomatic gallstones presented for elective surgery at the Kuusankoski District Hospital (n = 38) and the Kuopio University Hospital (n = 22). Twenty nine patients underwent MC and 31 LC. The patients' outcome was recorded up to four weeks after the operation.

Results:

The success rate as a day surgery for MC was 66% (19/29) and that for LC 55% (17/31) with no difference between the two groups. Chronic cholecystitis, postoperative nausea and vomiting were significant variables associated with failure in day surgery. There was no difference between the two groups in operation time, perioperative bleeding, conversion to conventional open cholecystectomy (one with MC and three with LC), length of hospital stay or sick leave. Three patients developed superficial infection (two with MC and one with LC). One patient with conversion in the LC-group developed a common bile duct stricture and was readmitted at the 10th postoperative day.

Discussion:

Both MC and LC are feasible surgical techniques for day surgery. However, appropriate prevention and prompt management of established postoperative nausea and vomiting and careful patient selection are important aspects for success of short-stay approach. If there is a sign of chronic cholecystitis preoperatively, it might be considered as a contraindication for day surgery.
Impact of Early Angiographic Evaluation on the Frequency of Emergency Reoperations after Coronary Bypass Surgery
Authors: Karhunen J. , Raivio P. , Maasilta P. , Sihvo E. , Suojaranta-Ylinen R. , Vento A. , Salminen U. S.
Published: January 2017

Background and Aims:

Early graft failure following coronary bypass surgery results in elevated morbidity and mortality. This study focused on the impact of angiographic graft evaluation.

Material and Methods:

Of 5251 coronary artery bypass grafting (CABG) patients, 36 with postoperative persistent ischaemia underwent early angiography (23) or emergency resternotomy (13) 2000–2007 (Angiography era). Of the 23 patients, who underwent angiography, five were subsequently reoperated. Of 8807 CABG patients, 76 underwent postoperative emergency resternotomy 1988–1999 (Pre-angiography era) and served as controls.

Results:

The Angiography era patients were older (64.0 years vs. 58.2 years, P = 0.002) and the proportion of female patients (22% vs. 43%, P = 0.029) was smaller. The rate of emergency reoperations decreased (0.86% vs 0.34%, P < 0.001) during the Angiography era and graft repairs ( P = 0.013) or additional grafts ( P = 0.006) were less frequent, although occluded anastomoses were observed more often ( P = 0.043). In 5 Angiography era patients graft complications were corrected with percutaneous coronary intervention. ICU stay (5.72 ± 0.98 days vs. 5.53 ± 0.68 days) and hospital stay (12.2 ± 1.54 days vs. 13.1 ± 1.63 days) did not differ between the groups, but the rate of myocardial infarction (63.8% vs. 92.1%, P < 0.001) and in-hospital death (22.2% vs. 46.1%, P = 0.015) decreased.

Conclusion:

After the introduction of early postoperative angiographic evaluation of CABG patients the rate of emergency reoperations and related morbidity and mortality decreased.
Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options
Authors: Gockel I. , Sgourakis G. , Drescher D. G. , Lang H.
Published: January 2017

Minimally invasive Heller myotomy has evolved the “gold standard” procedure for achalasia in the spectrum of current treatment options. The laparoscopic technique has proved superior to the thoracoscopic approach due to improved visualization of the esophagogastric junction. Operative controversies most recently include the length of the myotomy, especially of its fundic part, with respect to the balance between postoperative persistent dysphagia and development of gastroesophageal reflux, as well as the type of the added antireflux procedure. Perioperative mortality should approach 0%, and favorable long-term results can be achieved in > 90%.
Surgical Outcomes and Prognostic Factors for Ampulla of Vater Cancer
Authors: Choi S. B. , Kim W. B. , Song T. J. , Suh S. O. , Kim Y. C. , Choi S. Y.
Published: January 2017

Background and Aims:

The prognosis for patients with ampulla of Vater cancer is better than other periampullary cancers. The aim of the present study is to determine the clinicopathologic factors predictive of survival and recurrence in patients with ampulla of Vater cancer.

Material and Methods:

From 1991 to 2008, we identified and reviewed 78 patients with ampulla of Vater cancer retrospectively. Clinicopathologic factors possibly influencing survival and recurrence were statistically analyzed.

Results:

Pancreaticoduodenectomy was performed in 68 patients and 2 patients underwent transduodenal ampullectomy. Hospital mortality was 2.6%. The 5-year survival rates following resection were 59.9%. Univariate analysis for overall survival revealed that total bilirubin greater than 5mg/dl, ulcerative tumors, differentiation, and pancreatic invasion were significant prognostic factors. Recurrence occurred in 31 patients. Univariate analysis for disease-free survival revealed that total bilirubin greater than 5mg/dl, preoperative biliary drainage, tumor differentiation, and stage were statistically significant. Multivariate analysis revealed that tumor differentiation was an independent prognostic factor for recurrence. The presence of lymph node metastasis did not affect overall survival significantly in this study. However, two or more metastatic lymph nodes significantly affect disease-free survival.

Conclusions:

Pancreaticoduodenectomy is a safe surgical procedure with acceptable long-term survival for ampulla of Vater cancer. Pancreaticoduodenectomy with lymph node dissection might control lymph node spread and enhance survival outcome.
Secondary Healing versus Midline Closure and Modified Bascom Natal Cleft Lift for Pilonidal Sinus Disease
Authors: Dudink R. , Veldkamp J. , Nienhuijs S. , Heemskerk J.
Published: January 2017

Background and Aims:

Pilonidal sinus disease is a common disease in young employed male adults. Ongoing discomfort usually indicates an operative intervention. The main drawback is however the complication of wound healing. Numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique.

Material and Methods:

A retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between May 2005 and December 2006. Used techniques were: ‘modified Bascom procedure’, ‘excision and primary closure’ and ‘excision with secondary wound healing’. Patients' characteristics, operative parameters and data on outcome were included. The primary endpoint was wound healing.

Results:

Twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. There were no demographical differences between the groups of patients. The modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). The duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01).

Conclusions:

Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.
Management of Cement Vertebroplasty in the Treatment of Vertebral Hemangioma
Authors: Boschi V. , Pogorelić Z. , Gulan G. , Perko Z. , Grandić L. , Radonić V.
Published: January 2017

Background:

The vertebral hemangiomas are benign vascular lesions occurring in spine. Although uncommon, symptomatic vertebral hemangiomas can be painful and can limit daily activities. A number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Treatment with cement vertebroplasty showed very good results. This study aims to illustrate the validity of the treatment with cement vertebroplasty in patients with painful vertebral hemangiomas.

Patients and Methods:

From January 2000 to January 2007, 24 patients were treated by percutaneous vertebroplasty because of hemangioma: 16 thoracic, 8 lumbar. There were 11 males and 13 females. The average age at the time of surgery was 48 years. All the patients complained of a pain syndrome resistant to continuing medication. All patients underwent X-ray examination, CT-scan and MR of the involved level preoperatively. A unipedicular approach under fluoroscopic guidance has been performed in all patients. All procedures have been carried out under the local anesthesia. The mean follow-up was 5.8 years.

Results:

In all the patients a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular cement leakage has been observed in 3 patients, without any clinical radicular syndrome onset due to the epidural diffusion. Clinical and radiological follow-up showed stability of the treatment and absence of pain in all patients.

Conclusion:

Percutaneous treatment with vertebroplasty for symptomatic vertebral hemangiomas is a valuable, less-invasive, and a quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of the vertebral body's fracture.
Role of sexual partner and social networking in fracture penis aetiology
Authors: Majhi Paresh C , Patro Chandra S , Singh Gyan P , Hota Datteswar
Published: January 2017

Introduction

Fractured penis is a well-recognised urological emergency resulting from blunt trauma to the erect penis. The incidence and severity of penile fracture mostly relies on the method of sexual practice adopted by the couple which again depends on their psychosocial behaviour. The aim of this study was to analyse the different circumstances that accompany this injury in relation to severity, such as associated urethral injury, and to address the contribution of the patients’ partners in possible aetiologies and prevalences.

Methods

A prospective observational study over two years of all patients presenting to our institution with a fractured penis. All patients who were subjected to detailed history and clinical examination, which included educational status, profession and access to internet. The patients’ partners were asked the same questions as well as a sexual behaviour questionnaire to grade their level of sexual appetite.

Results

Thirteen patients were included; all patients were married with an average age of 37. The coital positions associated with this injury were female on top position (four cases), T position (three cases), knee–elbow coital position (two), male superior coital position (two) and lateral coital position (one); one couple were unable to explain the exact position. Overall, 11/13 (85%) female partners showed moderate to high sexual appetite and only two (15.5%) showed low appetite. Out of the 26 patients and partners, only nine (34.6%) had a profession related to computers, but 16 (61.5%) of them had access to the internet.

Conclusions

High aggressive sexual behaviour may be a factor for vigorous sexual activity and increase the chance of penile injury. The exact role of social networking though not well established may precipitate more injury through the learning of different coital positions; ‘female on top position’ may be related to a higher incidence of fractured penis.
“I’m a Red River local”: Rock climbing mobilities and community hospitalities
Authors: Rickly Jillian M
Published: January 2017

With individuals continually on the move, mobility fosters constellations of places at which individuals collectively moor and perform community. By focusing on one climbing destination—the Red River Gorge—this article works across scales to highlight the spatial politics of mobilizing hospitality. In so doing, it summarizes the ways hosting/guesting thresholds dissolve with the growth of particular rock climbing–associated infrastructures and moves to examine the ways climbers’ performances of community result in the (semi-)privatization of public space and attempts at localization. Furthermore, this article highlights the ways mobility is employed to maintain a political voice from afar, as well as to forge “local” identities with The Red as place with distinct subcultural (in)hospitality practices. Hospitality practices affirm power relations, and they communicate who is at “home” and who has the power in a particular space to extend hospitality. The decision to extend hospitality is not simply the difference between an ethical encounter and a conditional one; it takes place in the very performance of identity. Thus, integrating a mobilities perspective into hospitality studies further illuminates the spatial politics that are at play in an ethics of hospitality.
Long-term and meaningful community leadership and engagement in natural resources and environmental governance through university access programs
Authors: Zurba Melanie
Published: January 2017

Indigenous and local people are increasingly asked to participate in natural resources and environmental governance with limited training and knowledge of environmental, economic, and social policies. This article presents the case for the development of university access programming with a specialization in environmental, economic, and social policy towards building long-term capacity of communities for participating in governance. It does so by looking at examples of existing access programs, identifying potential focus areas, and considering the institutional support networks that would be required for such a program to succeed. Access programs are increasingly becoming part of the university landscape, typically filling gaps where community people require skills and qualifications. Access programs also present unique opportunities for interdisciplinarity, decolonization, and community-focused approaches to education.
Relationship between Coping and Depression in Heart Transplant Candidates and Their Spouses
Authors: Burker Eileen J. , Evon Donna M. , Ascari Jill C. , Loiselle Marci M. , Finkel Jerry B. , Mill Michael R.
Published: January 2017

Context

Survival rates for heart transplantation are encouraging, but the pretransplant period can be extremely stressful for patients and their spouses. Although a relationship between patients' depression levels and the coping strategies employed by their spouses has been demonstrated, this association has not been examined in heart transplant candidates and their spouses. Depression in this group of patients is important because heart transplant patients with preoperative depression have been found to have a higher mortality rate after transplantation.

Objective

To determine if a relationship exists between spousal coping strategies and heart transplant candidates' depression.

Methods

A descriptive, exploratory pilot study.

Participants

Twenty-two individuals with end-stage heart disease who were undergoing an inpatient evaluation for heart transplantation, plus their spouses.

Design

Heart transplant candidates were assessed via the Structured Interview Guide for the Hamilton Depression Scale. Spouses completed the COPE Inventory and the Center for Epidemiological Studies Depression Scale.

Results

Spousal behavioral disengagement was positively associated with heart transplant candidates' depression.

Conclusions

Heart transplant candidate depression may follow spousal disengagement, or, conversely, a spouse may disengage in response to the patient becoming depressed. Identification during the pretransplant evaluation of those spouses who cope using behavioral disengagement might be a first step in the process of assessment and intervention. Clinical interventions may need to focus on the spouse as well as on the transplant candidate.
Alternative Therapy Use in Liver Transplant Recipients
Authors: Tickerhoof Lisa , Wagener Marilyn M. , Cacciarelli Thomas V. , Singh Nina
Published: January 2017

Background

The extent of use of alternative therapies and the psychosocial variables predictive of their use have not been well defined in liver transplant recipients.

Objective

To determine types of alternative therapies used by liver transplant recipients and to assess psychosocial, behavioral, and quality of life variables associated with the use of alternative therapies in these patients.

Methods

Assessment of types of alternative therapies used, demographic characteristics, satisfaction with social support, coping styles, sense of personal control (mastery), quality of life, and health beliefs in 32 liver transplant recipients.

Results

Overall, 34.4% of the liver transplant recipients used a form of alternative therapy. Herbal products were used by 45% of the alternative therapy users and included milk thistle (silymarin), eclipta, and green beet leaf—all considered “hepatic tonics.” Alternative therapy users tended to have greater problem-focused coping skills than nonusers ( P = .08). Nineteen percent of the patients incurred annual out-of-pocket expense of at least $100 for alternative therapies. Patients incurring out-of-pocket expenses reported better overall health ( P = .02), were more likely to be employed ( P = .025), and had higher mastery scores ( P = .01).

Conclusions

Use of alternative therapies is common after liver transplantation. Herbal products used by liver transplant recipients are disease specific; that is, they claim to promote liver health.