bluuebunny/crossref_metadata_2025 huggingface dataset:
Intra-Atrial Y-Graft Fontan for Univentricular Heart With Discontinuous Pulmonary Arteries
Authors: Sharma Rajesh , Baruah Sudip Dutta , Marwah Ashutosh , Chauhan Chandra Prakash Singh
Published: November 2017

The Y-graft Fontan as described today suffers from the disadvantage of being hostage to restrictions imposed upon the design of the limbs of the Y by existent cardiac anatomy. We describe a patient with discontinuous pulmonary arteries following a prior Glenn shunt, who underwent Fontan completion using an intra-atrial Y-limb placement for recruitment of the discontinuous pulmonary artery. Intracardiac placement of the limb(s) of the Y-graft could potentially increase the applicability of this Fontan modification without being constrained by external cardiac anatomy.
Status and Challenges of Care in Africa for Adults With Congenital Heart Defects
Authors: Edwin Frank , Zühlke Liesl , Farouk Heba , Mocumbi Ana Olga , Entsua-Mensah Kow , Delsol-Gyan Desrie , Bode-Thomas Fidelia , Brooks Andre , Cupido Blanche , Tettey Mark , Aniteye Ernest , Tamatey Martin M. , Gyan Kofi B. , Tchoumi Jacques Cabral Tantchou , Elgamal Mohamed-Adel
Published: November 2017

The 54 countries in Africa have an estimated total annual congenital heart defect (CHD) birth prevalence of 300,486 cases. More than half (51.4%) of the continental birth prevalence occurs in only seven countries. Congenital heart disease remains primarily a pediatric health issue in Africa because of the deficient health-care systems: the adults with CHD made up just 10% of patients with CHD in Ghana, and 13.7% of patients with CHD presenting for surgery in Mozambique. With Africa’s population projected to double in the next 35 years, the already deficient health systems for CHD care will suffer unbearable strain unless determined and courageous action is undertaken by the African leaders.
Anomalous Aortic Origin of a Coronary Artery: Symptoms Do Not Correlate With Intramural Length or Ostial Diameter
Authors: Balasubramanya Shyamasundar , Mongé Michael C. , Eltayeb Osama M. , Sarwark Anne E. , Costello John M. , Rigsby Cynthia K. , Popescu Andrada R. , Backer Carl L.
Published: November 2017

Background:

Anomalous aortic origin of a coronary artery (AAOCA) is a known cause of sudden death. Our hypothesis was that longer intramural length and smaller ostial diameter correlate with preoperative symptoms. If true, this would assist in the decision for surgical indications. We also assessed the accuracy of preoperative imaging to predict intramural length.

Methods:

Retrospective analysis of patients who underwent AAOCA unroofing from 2006 to 2014. Patients had preoperative computed tomography angiography (CTA) or magnetic resonance imaging (MRI). Intramural length was measured. Intramural lengths and ostial diameters were also measured intraoperatively (operating room [OR]). Symptoms were noted. Intramural lengths and ostial diameters were compared between patients with and without preoperative symptoms. The accuracy of intramural length measured by CTA/MRI versus the length measured in the OR was assessed using a Bland-Altman analysis.

Results:

Sixty-six patients underwent surgical repair of AAOCA. Fifty-two (79%) patients were symptomatic and 14 (21%) were asymptomatic. Mean age was 12.4 ± 4.0 years. There was no mortality. There was strong agreement between intramural length measured by CTA/MRI and measured in the OR. There was no significant difference in AAOCA intramural length in the symptomatic (8.6 ± 3.5 mm) and asymptomatic (8.9 ± 2.8 mm, P = .77) patients, which were measured both by CTA/MRI and intraoperatively (symptomatic 7.3 ± 2.5 mm, asymptomatic 6.9 ± 2.8 mm; P = .62). There was also no significant difference in AAOCA ostial diameters between groups (symptomatic = 1.9 ± 0.5 mm, asymptomatic = 1.6 ± 0.5 mm; P = .09).

Conclusion:

Preoperative CTA/MRI was very accurate in predicting the length of surgical unroofing. There was no demonstrable correlation between preoperative symptoms and intramural AAOCA length or AAOCA ostial diameter.
Anomalous Origin of Pulmonary Artery From Aorta: Neonatal Autologous Aortopulmonary Reconstruction
Authors: Eason Alexander J. , Shafer Brent , Murdison Kenneth A. , Polimenakos Anastasios C.
Published: November 2017

Anomalous origin of a branch pulmonary artery (PA) from the ascending aorta is rather rare within the spectrum of congenital cardiovascular anomalies. In the scarce subset of patients with anomalous origin of right PA (RPA) from the ascending aorta originating from the lateral aspect of the distal ascending aorta, early neonatal repair by employing native aortic tissue for RPA reconstruction combined with translocation of the aorta posteriorly to the RPA can be an alternative option in the surgical armamentarium.
Surgical Options for Uhl’s Anomaly
Authors: Kalita Jyoti Prasad , Dutta Nilajan , Awasthy Neeraj , Chowdhuri Kuntal Roy , Girotra Sumir , Radhakrishnan Sitaraman , Srivastava Savitri , Iyer Parvathi Unninayar , Iyer Krishna Subramony
Published: November 2017

Background:

Uhl’s anomaly is an extremely rare congenital heart defect characterized by a near total absence of the myocardium of the parietal wall of the right ventricle. Few reports of surgical management exist in literature. We present three patients with this anomaly who were managed with different surgical strategies.

Patients and Methods:

Patient 1: This 43-month-old girl had maternal rubella syndrome with speech and hearing deficits and gross right heart failure. Diagnosis was made on echocardiography and magnetic resonance imaging. She underwent partial excision and plication of the right ventricular parietal wall and total cavopulmonary connection. Patient 2: This 19-month-old boy presented with progressive cyanosis and features of right heart failure. Diagnosis was confirmed on echocardiography. He underwent right ventricular exclusion by tricuspid valve closure and free wall plication followed by a bidirectional Glenn procedure. Patient 3: This 21-year-old male presented with right heart failure and cyanosis. Diagnosis was established with transesophageal echocardiography and magnetic resonance imaging. As the hemodynamics were not suitable for a Fontan conversion, a one and a half ventricle repair was done along with plication of the right ventricular free wall and tricuspid valve annuloplasty.

Results:

All three patients were extubated within 24 hours. Patients 2 and 3 were discharged relatively uneventfully, whereas patient 1 had a more prolonged stay due to transient hepatic failure. All were symptomatically and clinically improved on short-term follow-up.

Conclusion:

Uhl’s anomaly is an extremely rare condition with varied clinical presentation. Surgical exclusion of the right ventricle yields gratifying results; however, surgical technique has to be adapted to the individual patient.
Modified Aortic Uncrossing Procedure: A Novel Approach for Norwood Palliation of Complex Univentricular Congenital Heart Disease With a Circumflex Aorta
Authors: Bryant Roosevelt , Wallen William , Rizwan Raheel , Morales David L.
Published: November 2017

The circumflex aorta is a rare type of true vascular ring anomaly. It consists of a retroesophageal right aortic arch, a left-sided descending thoracic aorta, and a left-sided ligamentum arteriosum. The “aortic uncrossing procedure” described by Planché and Lacour-Gayet is the procedure of choice for managing this aortic anomaly in patients with a biventricular heart. The presence of a circumflex aorta in a patient with heterotaxy syndrome and univentricular congenital heart disease requiring Norwood palliation is highly unusual. We report such a case and describe our approach to its surgical management.
Outcomes of Patients Undergoing Primary Fontan Operation Beyond First Decade of Life
Authors: Talwar Sachin , Singh Sukhjeet , Sreenivas Vishnubhatla , Kapoor Kulwant Singh , Gupta Saurabh Kumar , Ramakrishnan Sivasubramanian , Kothari Shyam Sunder , Saxena Anita , Juneja Rajnish , Choudhary Shiv Kumar , Airan Balram
Published: November 2017

Objectives:

Studies on older patients undergoing primary Fontan operation (FO) are limited, with conflicting results. We review our experience with these patients beyond the first decade of life.

Patients and Methods:

Between January 2000 and December 2014, a total of 105 patients ≥10 years of age (mean 15.6 ± 4.9, range 10-31, median 15 years) underwent primary FO without a prior bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). Mean preoperative New York Heart Association (NYHA) class was 2.2 ± 0.57.

Results:

Operative procedure was extra-cardiac FO in 62 patients (8 were fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. Two patients underwent Fontan takedown. On univariate analysis, NYHA functional class III, mean pulmonary artery (PA) pressure ≥15 mm Hg, hematocrit ≥60%, preoperative ventricular dysfunction, and atrioventricular valve regurgitation (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 ± 6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 84.7% ± 3.7% at 5, 10, and 15 years.

Conclusion:

Carefully selected adolescents and young adults can safely undergo the primary FO. However, persistent pleural effusions, arrhythmias, thromboembolic events, and the need for reoperation mandate regular follow-up in such patients. Preoperative NYHA functional class III, mean PA pressure ≧ 15 mm Hg, hematocrit ≥ 60%, ventricular dysfunction, and AVVR were associated with early mortality, suggesting that primary FO should be avoided in such patients.
Asynchronous Pumping of a Pulsatile Ventricular Assist Device in a Pediatric Anastomosis Model
Authors: Good Bryan C. , Weiss William J. , Deutsch Steven , Manning Keefe B.
Published: November 2017

Background:

Both pulsatile and continuous flow ventricular assist devices are being developed for pediatric congenital heart defect patients. Pulsatile devices are often operated asynchronously with the heart in either an “automatic” or a fixed beat rate mode. However, most studies have only investigated synchronized ejection.

Methods:

A previously validated viscoelastic blood solver is used to investigate the parameters of pulsatility, power loss, and graft failure in a pediatric aortic anastomosis model.

Results:

Pulsatility was highest with synchronized flow and lowest at a 90° phase shift. Power loss decreased at 90° and 180° phase shifts but increased at a 270° phase shift. Similar regions of potential intimal hyperplasia and graft failure were seen in all cases but with phase-shifted ejection leading to higher wall shear stress on the anastomotic floor and oscillatory shear index on the anastomotic toe.

Conclusion:

The ranges of pulsatility and hemodynamics that can result clinically using asynchronous pulsatile devices were investigated in a pediatric anastomosis model. These results, along with the different postoperative benefits of pump modulation, can be used to design an optimal weaning protocol.
Experience Using Kaolin-Impregnated Sponge to Minimize Perioperative Bleeding in Norwood Operation
Authors: Shinkawa Takeshi , Holloway Jessica , Tang Xinyu , Gossett Jeffrey M. , Imamura Michiaki
Published: November 2017

Purpose:

A kaolin-impregnated hemostatic sponge (QuikClot) is reported to reduce intraoperative blood loss in trauma and noncardiac surgery. The purpose of this study was to assess if this sponge was effective for hemostasis during Norwood operation.

Description:

We conducted a retrospective review of patients undergoing Norwood operation in infancy between 2011 and 2016 at our institution.

Evaluation:

Of 31 identified Norwood operations, a kaolin-impregnated sponge was used intraoperatively in 15 (48%) patients. The preoperative profiles and cardiopulmonary bypass status were similar between the operations with or without kaolin-impregnated sponge. The comparison on each operative outcome between operations with or without kaolin-impregnated sponge showed that the intraoperative platelets, cryoprecipitate, and factor VII dosage were significantly less in the operations with kaolin-impregnated sponge (55 mL, 10 mL, 0 µg/kg vs 72 mL, 15 mL, 45 µg/kg; P = .03, .021, .019), as well as the incidence of perioperative bleeding complications (second cardiopulmonary bypass for hemostasis or postoperative mediastinal exploration, 0% vs 31%, P = .043). A logistic regression model showed that the nonuse of kaolin-impregnated sponge and longer aortic cross clamp time were associated with perioperative bleeding complication in univariable model ( P = .02 and .005).

Conclusions:

Use of kaolin-impregnated hemostatic sponge was associated with reduced blood product use and perioperative bleeding complications in Norwood operation at a single institution.
Feasibility of Biventricular Repair in Right Dominant Unbalanced Atrioventricular Septal Defect: A New Echocardiographic Metric to Refine Surgical Decision-Making
Authors: Lugones Ignacio , Biancolini María Fernanda , Biancolini Julio César , Dios Ana M. S. de , Lugones Germán
Published: November 2017

Background:

Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making.

Methods:

We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables.

Results:

A new metric called “indexed ventricular septal defect” is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons’ Society study to set the limits of the new index.

Conclusion:

Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.
Seeing Through the Lies: Surgical Innovation and the Need for Transparency
Authors: Elliott Martin
Published: November 2017

The Robert E Gross Lecture was delivered by Professor Martin Elliott of London, at Boston Children’s Hospital June 1st, 2016. Professor Elliott makes a plea for revision to the system of medical publication and academic reward, especially in the field of surgery.
The Joint Effects of Race, Ethnicity, Gender, and Age on the Incarceration and Sentence Length Decisions
Authors: Freiburger Tina L. , Sheeran Alyssa M.
Published: November 2017

The current study adds to the literature examining the effects of race, ethnicity, gender, and age on sentencing decisions. The results indicate that Black and male defendants were more likely to be incarcerated in jail as opposed to receiving a probation sentence than White and female defendants. When race, ethnicity, and gender interactions were considered, it appeared that the race effect was driven by Black males’ reduced likelihood to receive probation as opposed to jail. Black females were the least likely to be jailed. Age interactions revealed that being young disadvantaged Black males but advantaged other groups. The decision to incarcerate a defendant in jail versus prison was not significantly influenced by race, ethnicity, or gender. When sentence length was examined, Black males received significantly shorter jail sentences than all groups except Black females. When age was considered, Hispanic defendants 30–39 received longer jail sentences than almost every group.
Effects of a School-Based Social-Emotional and Character Development Program on Self-Esteem Levels and Processes: A Cluster-Randomized Controlled Trial
Authors: Silverthorn Naida , DuBois David L. , Lewis Kendra M. , Reed Amanda , Bavarian Niloofar , Day Joseph , Ji Peter , Acock Alan C. , Vuchinich Samuel , Flay Brian R.
Published: November 2017

This study evaluated effects of Positive Action (PA), a school-based social-emotional and character development program, on self-esteem levels and processes among minority, low-income, urban youth. A matched-pair, cluster-randomized controlled trial was conducted in 14 Chicago Public Schools with outcomes assessed longitudinally for a cohort of youth followed from Grades 3 to 8. A total of 1,170 students participated in the study (53% female, 48% African American, and 27% Hispanic). Students in PA schools had more favorable change and endpoint scores on indices of self-esteem in the domains of peer and school and use of both adaptive and (to a lesser extent) maladaptive processes for developing and maintaining self-esteem. These results align with areas of emphasis within the PA program and illustrate how important areas of impact on self-esteem-related outcomes may be overlooked without differentiated assessments of both self-esteem levels and processes.
Workplace Design Features, Job Satisfaction, and Organization Commitment
Authors: Bangwal Deepak , Tiwari Prakash , Chamola Pankaj
Published: November 2017

Of late, there has been growing awareness among organizations as to the importance of green issues. This article seeks to examine how workplace design features of a green building contribute to the formation of employee organization commitment (OCM) through better job satisfaction (JST) within employees. Based on a comprehensive literature review, a theoretical model was proposed for investigation. Three putative paths linking workspace (WSP) to JST, departmental space (DSP) to JST, and JST to OCM were then tested relying on a survey data of 356 employees collected from three Leadership in Energy and Environmental Design (LEED)-certified companies, namely Indian Tobacco Company (ITC), Suzlon Energy Ltd, and Olympia Technology Park uses structural equation modeling (SEM) methodology as prescribed by Hair et al. Significant evidences were witnessed in support of all three purposed paths. The study drew data only from the green-certified organization. Future research should involve other green organization or larger sample of green building. The size and character of the sample were restricted by organizational constraints.
Ethnic Factor and Politics in the Asuogyaman District of Ghana
Authors: Aikins Kenneth Shelton , Ametefe Richard
Published: November 2017

The ethnic factor or ethnicity is noted to play a key role in protracted conflicts, which affect the social and political landscapes of modern Africa. We, therefore, examined the political behaviors in the Asuogyaman District in Ghana to unravel the complexities of cycles of conflict and resulting peace-building strategies. We collected data from 11 purposively sampled key informants and 220 randomly selected respondents using an interview guide and interview schedule, respectively. In sum, the ethnic factor has an indirect effect on political variables in the Asuogyaman District. For instance, the ethnic factor did not openly influence the choice of political party but rather, policy direction did. One major recommendation is that the government and the Asuogyaman District Assembly should put measures in place to ensure that all the ethnic groups are consulted and fairly treated as equal partners in developmental activities. This will result in peaceful coexistence and development.
The Essence That Is Belonging Together: Identity, Embodiment, and Skillful Coping During the 2015 Greek Referendum
Authors: Battin Justin Michael
Published: November 2017

In the forward of Heidegger’s Identity and Difference, Joan Stambaugh proposes that in his statement “identity is belonging together,” the emphasis ought to be placed on the word belonging. By emphasizing belonging rather than together, one is better able to jettison thinking that centers identity as a fundamental trait of Being, the traditional view of identity held by metaphysics. This article will explicate this idea by drawing from a series of unstructured interviews conducted with young people in Athens during the 2015 July 5th Greek Referendum. This article argues that with attention devoted to the practice of skillful coping, the essence of identity, rather than a reflective cognitive undertaking, correlates to what Heidegger refers to as the event of appropriation. When finding the self affected by the world, what becomes revealed is an intimate identification with the world and things within it as it unfolds. With mobile media technologies, we are privileged to witness a particular way of being affected by the world, one where material and immaterial locations (such as social media arenas) converge together and whose perceptual distinctions become inseparable. Subsequently, we can also witness how the act of skillful coping, the motivated relationship between the body and the object, stands as the principal site where engulfment and investment become unconcealed.
“There Is No Cultivable Land Here”: Food Security and the Politics of Coral Rag Cultivation in Jibondo Island, Tanzania
Authors: Moshy Victoria H.
Published: November 2017

Jibondo Island is widely known as the most disadvantaged area in Mafia Island, Tanzania, where there is virtually no cultivable soil. The Island is mainly covered by coral rag, which has tended to serve as a dominant factor for explaining the seemingly absence of crop production in the area. Evidence suggests that most people in Jibondo are often food insecure than people in other villages which have conducive soils for crop production. This article employs a range of qualitative methods to analyze the narratives of various actors about food production in Jibondo. It is argued that while actors have tended to blame coral rag for constraining crop production, they must recognize and respond to other social-ecological factors to understand why crop production is problematic in the area. It is further argued that it is necessary to consider how changes in livelihood activities, land use changes, rainfall variability, soil erosion, changes in the marketing of fish and octopus as well as changes in various cultural traditions have also emerged as key constraining factors, which have often been overlooked. Furthermore, the article points out that it is necessary to show how different actors have contributed to the making and strengthening of coral rag-based explanations as a dominant narrative that continues to persist. The article concludes by pointing to the measures that are crucial for enhancing resilience of both food production and food security in changing social-ecological conditions.
Hope Across Achievement: Examining Psychometric Properties of the Children’s Hope Scale Across the Range of Achievement
Authors: Dixson Dante D.
Published: November 2017

In this study, the psychometric properties of Children’s Hope Scale (CHS) scores were examined in three different adolescent samples: an academically gifted sample ( n = 321), a general education sample ( n = 318), and an academically at-risk sample ( n = 266). In addition, score invariance across the range of achievement and gender was also examined. Results indicated that CHS scores had high internal consistency and were structurally sound across all three samples. In addition, CHS scores also showed scalar invariance across gender and measurement invariance across achievement levels. These findings suggest that CHS scores can be used and interpreted across the full range of achievement groups and that comparisons between genders can be made on the basis of CHS scores.
An Exploration on HIV/AIDS Funding in South Africa
Authors: Duarte Anida A. , Hancock John W.
Published: November 2017

The human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS) epidemic, is a global concern in which billions of dollars have been poured into various countries for the prevention and management of this life threatening disease. African countries contain the highest populations of individuals carrying HIV, and the majority of global funding is poured into the Sub-Saharan region. The purpose of this report is to explore and examine the source and utilization of these funds from bilateral and unilateral countries and entities. The goal is to identify the origin of these funds that are estimated between US$7 and US$8 billion annually, and determine if the allocation of monies is reaching its potential recipients. Recommendations will be provided for any potential breaks in the logistical chain to ensure those in need are receiving these funds.
Experiences of Engaging With Mental Health Services in 16- to 18-Year-Olds: An Interpretative Phenomenological Analysis
Authors: Jones Siobhan , Hassett Alex , Sclare Irene
Published: November 2017

Despite older adolescence being a risk period for the development of mental health concerns, mental health service engagement is low among 16- to 18-year-olds. As therapeutic attendance is linked to clinical outcome, it is important to understand engagement in this population. There is a paucity of research looking specifically at the older adolescent engagement phenomenon. Previous qualitative research into adolescent experiences has provided rich and detailed results. Interpretative phenomenological analysis was chosen as the methodological approach. Ten 16- to 18-year-olds were recruited from two London-based child and adolescent mental health services. Each young person was interviewed to understand his or her personal experience of engaging in mental health services, and associated engagement barriers and facilitators. Interviews were transcribed and underwent analysis. Analysis revealed ten subthemes subsumed within four superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self and in the clinic room. Themes are discussed in detail. Conclusions are drawn in relation to previous theory and research. When considering 16- to 18-year understandings of the engagement phenomena, key elements include clinician and service developmental appropriateness, negotiation of developmental tasks in relation to engagement, experience of the physical building environment, and awareness of service policy. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed.
Gender Differences in the Effect of Family Structure on Educational Outcomes Among Nigerian Youth
Authors: Odimegwu Clifford , Somefun Oluwaseyi Dolapo , Akinyemi Joshua
Published: November 2017

Due to globalization, sub-Saharan Africa (SSA) is experiencing some changes in her traditional family patterns. A large body of research has examined the relationship between family structure and youth developmental outcomes and few studies have reported the gender differentials in the effect of changing family structure on these outcomes. In an increasingly knowledge-based globalized world, educational achievement is critical for the development of youth. This exploratory study examines the gender differences in the effect of family structure on educational outcomes of youth in Nigeria. We used the 2010 Nigeria General Household Survey which is available through Integrated Public Use Microdata Series (IPUMS)–International, consisting of 14,178 males and 13,858 females. Family structure was a significant predictor of youth educational outcomes, and there were significant gender differentials. There was a negative relationship between living with neither parent and ever enrolling among males and females, but the effect was much stronger for females. Interventions should focus on improving existing resources and place youth who are living with neither parents and are unmarried in stable and friendly environments through mentorship programs and community caregiver support. Programs should also engage community leaders continuously about the consequences of early marriages among female youth.
A Visual Analysis on How the Physical Environment Conditions Relatives’ Involvement in Nursing Homes
Authors: Holmgren Jessica
Published: November 2017

This study seeks to describe how the composition of the physical care environment conditions relatives’ involvement in nursing home institutions. It is well known that the physical care environment in institutions has a significant impact on the well-being of residents and the work satisfaction of nursing staff. Less explored is how physical care environmental factors are related to the involvement of relatives in nursing homes. A visual analysis of 52 photographs from three nursing homes in Sweden shows how the physical environment acts to condition the involvement of relatives through the use of design, information displays, and cultural symbols. Although various aspects of the physical environment promoted participation of relatives, that engagement was based on certain limited concepts of involvement. This suggests that other conceptual frameworks of involvement in nursing homes are possible, and that these might encourage other aspects of involvement from the relatives of nursing home residents.
Back to the Rough Ground of Rights: Pathways for a Historicisation of ‘Civil Liberties’ in India
Authors: Upadhyay Amit , Hegde Sasheej
Published: November 2017

This article is directed at historicising the language and practice of ‘civil liberties’ in India, and it does so by addressing the specific contingencies that have marked its early twentieth-century trajectory that continue to resonate in our historical present. Of course, the immediate point of departure for the article is a methodological fixation with what has been termed as a ‘political approach’ to rights, whose limits set the terms for a more historically resonant and contextually determined approach to an appraisal of normative languages like rights and civil liberties in highly charged political contexts. In thus illustrating the argument that the political approach to rights has translated into a constriction of the space of our normative languages, the effort here is also to set in perspective the pathways for a historicisation of ‘civil liberties’ in India—one sensitive to its subterranean regulatory folds that served to constitute the inner and outer limits of protest across socio-political collectivities active in the historical fields of action germane to the twentieth century India. These regulatory folds have persisted and sustain themselves well beyond the contours of the Constituent Assembly (CA) that went on to make for a republican India (although this latter point is only being hinted at within the broad ground traversed by this article).
Assessment of Speech the Day after Primary Palate Repair in 10 Patients Aged 11 to 36 Years
Authors: Hayden David S , Lalonde Donald H , Hanson Marvin
Published: November 2017

Ten previously unoperated cleft palate patients with ages ranging from 11 to 36 years underwent primary palate repair. Speech assessment was performed within 24 h before surgery, and then again within 24 h after surgery. Further follow-up was not possible. An overall improvement in speech was found the day after surgery in these adult primary palate repair patients.
Dupuytren's Disease in Saudi Arabia
Authors: Al-Qattan Mm
Published: November 2017

In a prospective study, 600 consecutive adult Saudi patients were examined for clinical evidence of Dupuytren's disease. Dupuytren's disease was found in two of the 600 patients (0.003%). Both patients were native Saudi. Predisposing factors and clinical findings were reported for both cases. It was concluded that Dupuytren's disease is extremely rare among Saudi Arabians.
Management of a Lower Lip Avulsion Injury Due to a Human Bite
Authors: Malpass Kristian G , Zuker Ronald M , Cohen Meir
Published: November 2017

The present case report illustrates the management of an avulsion involving two-thirds of the lower lip. An unsuccessful attempt at microsurgical replantation led to a trial of composite tissue engraftment. Ultimately, the tissue sloughed, and after minimal debridement, the defect was treated by direct approximation of mucosa, muscle and skin. The treatment decisions made in caring for this injury show the challenge of microsurgical tissue replantation, the unpredictability of the composite graft and the benefit of having enough tissue to consider direct tissue approximation. Clearly, lips are worth every attempt at preservation, given their functional, cosmetic and psychological importance.
Metastatic Basal Cell Carcinoma – A Dramatic Case
Authors: French Gavin David , Jewer David D
Published: November 2017

Metastatic basal cell carcinoma (MBCC) is extremely rare, with an incidence of 0.0028% to 0.1%. Typical lesions are large, ulcerated, neglected, refractory to treatment and occur more commonly in middle-aged men. Metastases are usually single and to local lymph nodes. Multiple metastases to distant sites are much less common. Certain criteria must be met to diagnose MBCC. A case of MBCC meeting the criteria for diagnosis is reported. The present case is unusual in that the patient is a young woman and the tumour metastasized diffusely throughout the skeleton.
Surgical Management of Injuries Sustained from Grizzly Bear Maulings Treated in Vancouver, British Columbia
Authors: Mahabir Raman C , Olesen Peter R , Cannon Wendy G , Barré Nicole M , Snelling Charles Ft , Williamson J Scott , Courtemanche Douglas J
Published: November 2017

Background

Between January 1, 1992 and May 31, 1999, four patients underwent operation at Vancouver Hospital and Health Sciences Centre for injuries sustained in grizzly bear maulings.

Purpose

To document and discuss surgical diagnosis and treatment of grizzly bear attack victims.

Methods

Data were collected retrospectively from clinical charts.

Results

Injuries were characterized by scalp and tissue avulsions, puncture wounds, lacerations and fractures. On average, patients underwent eight operations. The mean hospital stay was 43 days. Despite irrigation, debridement and antibiotic therapy, patients developed wound colonizations or infections with multiple Gram-positive and -negative organisms. All four patients developed post-traumatic stress disorder necessitating psychiatric counselling and pharmacological treatment.

Conclusions

Grizzly bear maulings result in multiple injuries requiring careful management and complex reconstruction. Bacterial infections and post-traumatic stress disorder were common complications in this group of patients.
The Sad Story of a Family with Xeroderma Pigmentosum
Authors: Cohen Jack
Published: November 2017

A family of xeroderma pigmentosum patients, three of whom died of internal malignancies and the fourth of a possible radiation-induced melanoma, is described.
An Unusual Use of Simpson Forceps
Authors: Cohen Jack
Published: November 2017

An unusual use of Simpson forceps is presented. A woman in her 40s who had undergone subglandular augmentation mammoplasty with a pair of 120 cc silicone prostheses 20 years earlier presented to the medical office. For several months, she had been experiencing tenderness and pain in her breasts. After examination, an operation to replace the prostheses was performed under general anesthesia. Upon opening the right breast, it was found that the capsule around the prosthesis had completely calcified, and, could not be incised with a scalpel. By using Simpson forceps, the capsule was retracted inferiorly, and the dissection was completed without nicking or lacerating the breast skin.
Fibroma of Tendon Sheath of the Hand: Clinical and Pathological Study
Authors: Thoma Achilleas , Rao Jaggi , Salama Samih
Published: November 2017

Presented are seven cases of the rare tumour known as fibroma of tendon sheath of the hand. Diagnosis was uncertain before surgery. When the lesions were removed, they resembled schwannomas. Immunohistochemistry helped distinguish these tumours from giant cell tumours of the flexor sheath and schwannomas. The authors recommend that fibroma of the tendon sheath be included in the differential diagnosis of soft tissue neoplasms of the hand.
Halogen Lamp Burn to the Penis
Authors: Peters Walter
Published: November 2017

A 46-year-old man presented with a unique partial thickness burn to the tip of his penis that resulted from contact with a 150-watt halogen reading lamp. The mechanism and prevention of halogen lamp burns are discussed, and the hazardous nature of halogen lamps is presented.
The Previously Grafted Forearm as a Source of Thin Free Flaps for Release of Neck Burn Contractures
Authors: Hallock Geoffrey G
Published: November 2017

Often, a better means to minimize recurrence after burn contracture release is by interposition of a thin, vascularized block of tissue. Such a flap should not disturb the normal contour to allow unrestricted function. If a local flap is unavailable, the forearm can be an excellent donor site for a thin free flap that also has the advantage of a long vascular pedicle. Unfortunately, in most major burn injuries, the upper extremities typically are involved and have been previously skin grafted. Nevertheless, the radial forearm free flap can be a possible option that should not be overlooked, as is demonstrated for neck resurfacing after burn contracture release. Another advantage of the radial forearm free flap is that the requisite regrafting of the forearm causes no new morbidity from an esthetic standpoint, which otherwise has been the major detriment of this donor site.
Helpful Surgical Technique in Massive Abdominal Panniculectomy
Authors: Goldberg Cory , Fish Joel
Published: November 2017

A morbidly obese 51-year-old woman who was 155 cm tall and weighed 170 kg, and had functional limitation and angina due to her weight and massive pannus, underwent abdominal panniculectomy. The abdominal pannus was pierced with two, 4 mm, nonthreaded Steinmann pins (Synthes, USA) from which the pannus was elevated and suspended with rope. This elevation allowed for traction and simultaneous exposure of both the superior and inferior aspects of the pannus, assisting in surgical resection. The pannus removed weighed 25 kg. Postoperatively, the patient developed cellulitis on the inferior flap that resolved with antibiotics, and the wound healed in two weeks.
Long Term Complications of Orbital Floor Fracture Repair
Authors: Boulos Patrick R , Harris Patrick G , Cordoba Carlos , Ciaburro Hugo , Frenette Gilles
Published: November 2017

Purpose

To search for complications of orbital floor fracture repair that occur late postoperatively, to reveal their natural course and to attempt to associate the complications with variables that are possibly involved in their genesis.

Methods

A retrospective comparative case series of all orbital floor fracture repair cases (158 eyes) from 1983 to 1998 was done. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction (eg, sinus) was required. Variables studied included age, sex, trauma to surgery time lag, surgeon, fracture type, length of surgery, antibiotics, prosthesis material, hospital stay and follow-up. These variables were tested for association with the following complications: altered vision, diplopia, dysesthesia, ectropion, pain, infection, enophthalmos and extrusion. Occurrence and resolution data were collected.

Results

One of four complications (often more than one per eye) resolved without surgery. Reintervention resolved one of three complications. Of all patients, 39.2% remain with long term unresolved complications. Altered vision is more probable with older patients and with longer surgeries. Diplopia was least likely to occur with orbitozygomatic or panfacial fractures and more probable with bone grafts. Ectropion and epiphora increased with a fracture's severity. Pain was mostly attributable to bone grafts. Enophthalmos was mainly due to large or comminuted fractures. Infection and extrusion were rare. Sex, surgeon and trauma to surgery time lag had no bearing on the incidence of complications.

Conclusions

Delaying surgery did not seem to influence complications. Lessening ocular manipulation during longer surgeries may reduce vision changes. The only truly modifiable variable was the material used for orbital floor repair. Alloplastic prostheses should be used, but if large or comminuted fractures are involved, bone grafting is an interesting first choice.
Cost minimization while ensuring safety of reduction mammaplasty
Authors: Kerrigan Carolyn L , Schwarz Gaston , Charbonneau Roland
Published: November 2017

A prospective randomized study was designed to address the safety of performing reduction mammaplasty without drains. In the same cohort, the postoperative pain requirements, length of stay and complications were recorded in an effort to document the efficacy of performing this surgery in an outpatient setting. All women presenting for reduction mammaplasty at the Royal Victoria Hospital during a one-year period were asked to participate in the study. A total of 75 patients enrolled, and complete data were available at the 28-day follow-up for all women. The overall hematoma rate was 0% with drains and 2.7% without drains. The observed infection rate was 8% with drains and 5% without drains. There is no statistically significant or clinically meaningful difference in complication rates between breasts treated with drains and those treated without drains. In addition, 90% of women can be managed with oral analgesics within 23 h of surgery. Combined, this information suggests a potential cost savings of 57% based on prestudy observations. Careful analysis of the process of care will continue to enable the care of patients to be more efficient without compromising quality or safety.
Free flap monitoring using an implantable Doppler probe
Authors: French Rodney J , O'brien James P , Sparkes Gerald L , Lalonde Donald H
Published: November 2017

Although clinical observation is the gold standard, the ideal free flap monitoring device has not been identified. The purpose of the present study was to review the first 14 months of experience using an implantable 20-MHz ultrasonic Doppler probe to monitor the microvascular anastamoses of free tissue transfers. Twenty-five flaps in 23 patients, with an average age of 51 years (age range 18 to 81 years), were performed. Probes were secured downstream of the venous anastamosis using a silicone-poly fluorotetraethylene sleeve. Doppler sounds were transduced before the flap was inset. Monitoring by nursing staff included conventional techniques (temperature, colour, capillary refill) and continuous Doppler flow monitoring. Dynamic diagnostic testing for anastomotic patency was facilitated by applying manual pressure on the flap to increase venous flow (the audible ‘whoosh’ sign) and valsalva manoeuvre to impede venous return momentarily (the ‘heave’ sign). Intraoperative vessel kinking, hematoma formation occluding venous outflow, and venous thrombosis were detected in four cases before concluding the procedure and corrected. Rapid, immediate cessation of audible flow was detected postoperatively in three of 25 flaps. Re-exploration (re-exploration rate 12%) led to salvage of all three flaps (salvage rate 100%). It was concluded from this study that flap re-exploration was prevented in four cases (16%) because of intraoperative use of the implantable Doppler probe. Earlier detection of flap compromise perioperatively is thought to have contributed to the 100% salvage rate and to the 100% flap survival rate in the first 25 cases in which the implantable Doppler probe was used.
Measuring quality of life in women undergoing surgery for breast hypertrophy
Authors: Kerrigan Carolyn L , Schwarz Gaston , Charbonneau Roland
Published: November 2017

The purpose of the present study was to describe the outcomes associated with reduction mammaplasty in terms of physical parameters and health-related quality of life. A prospective cohort study was designed and included women undergoing bilateral breast reduction surgery at the Royal Victoria Hospital, Montreal, Quebec, who consented to participate. Women were evaluated preoperatively for symptoms, physical parameters, quality of life (Short Form [SF]-36 and Multidimensional Body Self Relations Questionnaire [MBSRQ]) and general demographic characteristics that were identified as potential confounders. Postoperatively, women were re-evaluated at six months for symptoms, physical parameters and quality of life.

A total of 74 women were entered in the study. Their average age was 32.3 years, and the mean mass of resected volume per breast was 630 g. There was a statistically significant improvement in symptoms six months after surgery (P<0.05). There was also a statistically significant improvement in the physical component summary scale of the SF-36 and several additional subscales: bodily pain, physical functioning, role-physical, and vitality. The MBSRQ subscale of appearance evaluation was significantly increased (2.69 compared with 3.12, P=0.000), whereas the appearance orientation subscale was unchanged. The amount of tissue removed did not appear to correlate with the change in physical symptoms or health-related quality of life resulting from the surgery.

This study showed significant improvement in physical and psychological aspects of health-related quality of life in women undergoing reduction mammaplasty.
Metastatic synovial sarcoma of the sternum: A case report and review of the literature
Authors: Balakrishnan Chenicheri , Bradt Lisa M , Sylora Roxanne L
Published: November 2017

Synovial sarcomas and metastasis of sarcomas to the sternum are a rare occurrence. Due to the rarity of occurrence, a case of synovial sarcoma metastasizing to the sternum with reconstruction is reported.
Changes in sleep architecture after burn injury: ‘Waking up’ to this unaddressed aspect of postburn rehabilitation in the developing world
Authors: Masoodi Zulqarnain , Ahmad Imran , Khurram Fahud , Haq Ansaul
Published: November 2017

Background

Changes in sleep architecture are common phenomena observed in post-traumatic patients; such altered sleeping patterns have negative implications on various phases of rehabilitation. Sleep is an essential process, without which one cannot function effectively and, hence, any aberrations in the quality of sleep in such patients need to be critically analyzed.

Objective

To probe the quality of sleep in postburn patients at one year compared with a group of adequately matched controls.

Methods

Quality of sleep in postburn patients at one year was measured using the Pittsburg Sleep Quality Index questionnaire and compared with a group of adequately matched controls. Data were tabulated and subjected to statistical analysis using Pearson's χ2 test.

Results

The relationship between the postburn state and sleep disturbances was found to be statistically significant. Other relevant parameters are also highlighted and discussed.

Discussion

Sleep is one of aspect of functioning that may be least taken into account by professionals during the phase of postburn rehabilitation because more obvious threats receive preferred treatment. Unless these problems are dealt with in the postburn period, rehabilitation can never be complete.

Conclusion

Postburn patients experience significant changes in sleep architecture, which need to be taken into account to enable complete rehabilitation of the patient.