Serial renal transplant surgery: technical reflections concerning third transplants

Iodine distribution was studied in isolated porcine eyes after iontophoresis using 131I-labelled solutions and chemical methods. After a 15-min treatment with a therapeutically used iodine brine, the iodine content in the ocular tissues showed the following rank order: cornea > retina > vitreous body > anterior chamber fluid > lens. Replacement of the brine by 0.15 M NaI increased the uptake values in a different way, but the same rank order was maintained. The increase was highest in the cornea (5.6-fold) and only about 2-fold in the lens, nevertheless approaching now the level of 10(-4) M, a concentration which was regarded as being optimal for the antioxidant effect of I-. Among the other eye components, the relatively high iodine enrichment of the retina was remarkable. The data are discussed with respect to a possible protective, antioxidative and OH-scavenging efficacy of I- and to previous results in the literature concerning iodine uptake in ocular tissues.     

Gastrointestinal surgery for obesity

Surgery is becoming an increasingly common method for treatment of morbid obesity in the United States. This text includes the presentation of a typical morbidly obese man with a number of obesity related comorbidities who was treated with a modification of Roux-en-Y gastric bypass. Subsequently, the gastrointestinal operations currently in use as treatment for morbid obesity are discussed. Preoperative and postoperative care for this patient population is discussed briefly. The results of the various procedures are also discussed in terms of both complications and improvement of medical comorbidities.     

Lipid composition of bile in morbid obesity before and after jejunoileal bypass surgery

Bile cholesterol, phospholipids, total bile acids, individual bile acids, and fatty acid compositions of bile neutral lipids and phospholipids were analyzed before, at one month and at six months following jejunoileal bypass surgery in a series of morbidly obese patients. Preoperative mole percentages of cholesterol and lithogenic indices were high, indicating that biles were supersaturated with cholesterol and outside the micellar solubility zone when plotted on triangular coordinates. At the one month post-operative period percentages of cholesterol and lithogenic indices were significantly increased as compared to the pre-operative state. At six months post-operatively these values had decreased to approximately the pre-operative levels. No changes were observed in percentages of lithocholic acid, but deoxycholic acid decreased to markedly low levels at one month and remained low at the six month post-operative interval. Relative proportions of cholic acid increased, and the ratio of cholic to chenodeoxycholic acid was significantly increased at both post-operative intervals. No significant changes were noted in bile neutral lipid or phospholipid fatty acid composition, indicating that no depletion of essential fatty acids had occurred.     

Organizational wellness programs: A meta-analysis.

Organizational wellness programs are on or off-site services sponsored by organizations which attempt to promote good health or to identify and correct potential health related problems (Wolfe, Parker, & Napier, 1994). The authors conducted a meta-analysis on studies that examined the effects of participation in an organizational wellness program (fitness or comprehensive) on absenteeism and job satisfaction. The results revealed that participation in an organizational wellness program was associated with decreased absenteeism and increased job satisfaction. The type of wellness program (fitness only or comprehensive) and the methodological rigor of the primary studies were examined as moderators; however, no moderating effects were found. These results provide some empirical support for the effectiveness of organizational wellness programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tuberculosis after jejunoileal bypass for obesity

One hundred patients who underwent jejunoileal bypass for obesity were followed for a mean period of 2 1/2 years. Four patients developed a clinical illness that resembled a systemic form of tuberculosis during the first postoperative year. This incidence exceeds that found in the general population by sixtyfold. Any patient with jejunoileal bypass who develops an illness with accelerated weight loss, enlarged lymph nodes, and unexplained fever with chills should be suspected of having tuberculosis. Aggressive diagnostic measures are required. Treatment with isoniazid and ethambutol at usual doses can be successful, but blood levels should be measured to confirm adequacy until additional information becomes available.     

Phenomenology and nursing: reflections

The project is about phenomenology and its elements. It points out the essential ideas of existential phenomenology interpreted by Maurice Merleau-Ponty's ideas and tries to connect this philosophy to nursing world.     

Intestinal bypass surgery for morbid obesity. Long-term results

Since 1962, jejunoileal bypass has been performed on 59 male and 171 female subjects, aged 18 to 55 years; these patients were followed clinically. Postoperative weight loss at two years averaged 37% in men and 35% in women. Hypokalemia (23%), hypocalcemia (22%), hypoalbuminemia (9%), metabolic acidosis (14%), elevated liver enzyme values (41%), and hyperbilirubinemia (6%), were the most commonly encountered blood chemical alterations. Complications were arthritis syndrome (men, 8%; women, 19%). urinary calculi (men, 24%; women, 10%), cholelithiasis (men, 10%; women, 9%), liver impairment (men, 2%; women, 6%), and major emotional upset (men, 8%; women, 9%). Forty-nine percent of the men and 51% of the women required rehospitalization for management of complications, surgery for hernia, anorectal disorders, nutritional support, and metabolic study. There were 19 bypass-related deaths (8%), including 10 due to liver failure.     

Past, present, and future of obesity surgery

The ribulose bisphosphate carboxylase/oxygenase rbcL and rbcS genes of a carbon monoxide-oxidizing bacterium, Hydrogenophaga pseudoflava DSM 1084, were cloned and sequenced. The cloned rbcL and rbcS genes had open reading frames of 1422 and 351 nucleotides encoding RbcL and RbcS with calculated molecular masses of 52,689 and 13,541, respectively. The known active site residues in other RbcL proteins were conserved in the H. pseudoflava proteins. The H. pseudoflava RbcS protein lacked the 12-residue internal sequence found in the plant enzymes. The 2 genes were separated by a 134 bp intergenic region and cotranscribed as a 2.0 kb rbcLS mRNA. Novel two perfect 9 bp direct repeats overlapping with two dyad symmetries were found in the rbcLS promoter region.     

In pursuit of wellness: The self-care imperative.

The practice of psychology can be demanding, challenging, and emotionally taxing. Failure to adequately attend to one's own psychological wellness and self-care can place the psychologist at risk for impaired professional functioning. An ongoing focus on self-care is essential for the prevention of burnout and for maintaining one's own psychological wellness. Salient aspects of self-care are discussed, including the ethical imperative of addressing self-care throughout one's career. Three invited expert commentaries provide additional insights and recommendations on positive actions, preventive strategies, and steps to be taken by individual psychologists, by those training the next generation of psychologists, and by professional associations. Realities of the current state of psychology and a clear call for action are highlighted, with the overarching goal being the ethical and effective treatment of clients and the successful management of the challenges and stresses faced by practicing psychologists. Baker, Elman, and Schoener provide commentaries on the initial article by Barnett. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Final height and craniofacial development after surgical resection of craniopharyngioma

There is a subgroup of patients with coronary artery disease who are refractory to the therapeutical methods so far applied. We report on 128 patients who fulfill this definition and have therefore undergone pure transmyocardial laser revascularisation (TMLR) or transmyocardial laser revascularisation in combination with coronary bypass surgery at our institution. The patients can be characterized by a long history of coronary artery disease with multiple revascularizing procedures, e.g. bypass surgery or percutaneous transluminal coronary angioplasty (PTCA), pronounced symptoms of coronary artery disease and chronic heart failure in the presence of markedly reduced left ventricular ejection fractions and intense antiischemic medical therapy. The patients were 62.2 +/- 9.8 (SD) years of age, in 89.9% of them at least one bypass operation and in 44.5% up to more than three percutaneous transluminal coronary angioplasties (PTCAs) had been performed prior to TMLR. There was a history of myocardial infarction in 90.7% of patients and 89.8% were in the Canadian Cardiovascular Society (CCS) classes III or IV and 94.5% of them were in the NYHA classes III or IV. The left ventricular ejection fraction was 49.5 +/- 16.4% and all of the patients were under intense antiischemic medical treatment which included nitrates or molsidomine in 96.9%, beta blockers in 53.1%, angiotensin converting enzyme inhibitors (ACE inhibitors) in 44.5%, digitalis in 22.7% and diuretics in 52.3% of patients. The preoperative data on myocardial viability, inducible ischemia and coronary morphology provided important clinical information for the decision, which revascularizing method would be the most appropriate for each vessel or myocardial region. This had to be weighed against the patient's operative risk, which is predominantly determined by the left ventricular ejection fraction, the arteriosclerotic involvement of the remaining vascular system and concomitant diseases, particularly of pulmonary origin.     

Starvation injury after gastric reduction for obesity

Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. Vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-Korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.     

Neuropathic beriberi as a complication of surgery of morbid obesity

We describe a women of 22 years of age who had had a vertical gastroplasty (as treatment for morbid obesity). She was admitted to hospital with a 4 week history of nausea and vomiting of food. Treatment with intravenous dextrose, without vitamin supplements was started. One week later she complained of diplopia, paresthesia and weakness of the limbs. All investigations proved to be normal. A deficiency state was suspected, probably Wernicke's encephalopathy, although no alterations were seen in her mental state. We started treatment with high doses of parenteral thiamine, other vitamins and a suitable diet. The treatment was followed by complete recovery. Few neurological complications have been described in association with vertical gastroplasty. The commonest are polyneuropathies. The probable deficiency origin of these is considered. We emphasise the importance of vitamin supplements following the surgical treatment of morbid obesity to avoid the development of deficiency states. Wernicke's encephalopathy is due to thiamine deficiency. It may be associated with any type of malnutrition, not only with chronic alcoholism. The full clinical triad which is diagnostic of this condition is only present in one third of the cases. When the condition is suspected on clinical grounds treatment should be started early to avoid the occurrence of irreversible secuelae.