Abdominal incisional hernia occurring after an esophagectomy reconstructed with a gastric tube through an antesternal route: report of a case

A Japanese man, who had undergone a subtotal esophagectomy reconstructed with a gastric tube through an antesternal route for esophageal carcinoma 16 years previously, was admitted to our hospital because of an abdominal incisional hernia. The abdominal incisional hernia was in his upper abdomen and was difficult to push back into the intraabdominal cavity by hand. The hernia was successfully repaired by operation. We thus conclude that an abdominal incisional hernia is a rare but important late-phase complication occurring after an esophagectomy reconstructed with either an antesternal or retrosternal route, and an operation should be the treatment of choice.     

The effect of intraarticular anesthesia and elastic bandage on elbow proprioception

Twenty uninjured male volunteers were studied to characterize normal elbow proprioception and to investigate the effect of applying an elastic bandage to the extremity and injection of an intraarticular anesthetic. A modified Biodex dynamometer was used to study position sense and detection of motion. In part 1 of the study position sense was tested by flexing the elbow to a predetermined angle, returning to the starting position, and then asking the subject to identify that angle. In part 2 detection of motion was tested by asking the subject to disengage the apparatus by pressing a stop button when movement was detected. The testing conditions in part 1 and part 2 were repeated after the elbow was wrapped with an elastic bandage and again after an intraarticular injection of 3 cc 1% lidocaine with the bandage removed. Ten additional subjects underwent testing of both elbows to examine the effect of arm dominance. Mean position sense was within 3.3 degrees+/-1.3 degrees of the actual angle in trials without an elastic bandage or an anesthetic. A significant improvement in position sense was observed (2.2 degrees+/-1.2 degrees) after an elastic bandage was applied (P < .004). No significant difference was seen in position sense after lidocaine was injected. The mean threshold for detection of motion in trials without an elastic bandage or an anesthetic was 4.21 degrees+/-1.56 degrees. No significant differences were seen in detection of motion observed with the elastic bandage or intraarticular anesthetic. No significant differences were seen between dominant and nondominant extremities for both position sense and detection of motion. The application of an elastic bandage improved position sense, suggesting that tactile cues from cutaneous or other extraarticular receptors may play a role in elbow proprioception. Intraarticular anesthesia, however, had little effect, suggesting that intracapsular receptors play a lesser role in elbow proprioception. The determination of proprioceptive qualities for the normal elbow can aid in the understanding of elbow function and provide a basis for defining its role in elbow dysfunction.     

Extended-spectrum beta-lactamases in clinical isolates of Klebsiella pneumoniae from Zagreb, Croatia

Forty clinical isolates of Klebsiella pneumoniae, from various clinical specimens, with reduced susceptibility to ceftazidime, were tested for extended-spectrum beta-lactamase (ESBL) production. ESBL production was demonstrated by an 8-fold reduction in the minimum inhibitory concentration (MIC) of ceftazidime combined with clavulanate (2 mg/L) compared to ceftazidime alone in all strains. The aim of this investigation was the biochemical and molecular characterization of the ESBL produced by K. pneumoniae strains and their Escherichia coli transconjugants. Transfer of ceftazidime resistance was demonstrated in 23 of 40 strains. Thirteen strains produced an ESBL with the isoelectric point of 8.2 which was encoded by a self-transferable multiresistance plasmid of 150 kb. The substrate profile was similar to that of the SHV-5 isolated initially in Chile. Seven of these 12 strains had an additional TEM beta-lactamase. Six isolates and their transconjugants produced a plasmid-encoded ESBL with an isoelectric point close to 5.4. The remaining 21 strains produced an ESBL with an isoelectric point of 7.6 (thus probably SHV-2) which was encoded on a plasmid transferable to E. coli in 4 strains only. Four of those strains possessed an additional plasmid encoded TEM beta-lactamase with an isoelectric point close to 5.4. The transconjugants harbored a multiresistance plasmid of 150 kb. Thus SHV-2 and SHV-5 enzymes appear to have been the most common ESBLs in K. pneumoniae from Zagreb during 1994-1995.     

Percutaneous endoscopic gastrostomy to treat upside-down stomach before stent insertion in a patient with distal esophageal carcinoma

A 89-yr-old woman presenting with dysphagia due to an obstructing adenocarcinoma of the distal esophagus was additionally diagnosed to have an upside-down stomach creating a sharp angulation at the esophagogastric junction. Gastric anatomy had to be restored before palliative stent insertion. As the patient was judged unfit for surgery, the stomach was repositioned endoscopically and fixed to the abdominal wall by percutaneous endoscopic gastrostomy. In the same sitting, a metal stent was placed. Effective palliation of dysphagia was achieved until the patient died of an unrelated cause 5 months later.     

Local injection of cisplatin for vaginal stump recurrence of gynecological malignant tumor

Chlorophyll a was adsorbed to a synthetic smectite intercalated by poly(vinylpyrrolidone) (PVP) to form the chlorophyll-PVP-smectite conjugate (Chl-PVP-SME) having an absorption maximum at 677 nm. The conjugate was found to be stable toward light illumination in comparison with chlorophyll-smectite, chlorophyll-PVP, and free chlorophyll a. Chl-PVP-SME had a photoinduced activity for catalyzing the reduction of methyl viologen. Furthermore, the evolution of hydrogen gas was observed when an aqueous suspension containing Chl-PVP-SME, methyl viologen (an electron carrier), 2-mercaptoethanol (an electron donor), and hydrogenase was illuminated by visible light.     

Lymph flow disorders following arterial surgery of the leg

In a series of 342 arterial reconstructions of the iliacolic to popliteal arteries 24 patients with lymph vessel damage were observed. The diagnosis of lymphedema was established in 18 patients by clinical findings and in 2 of them the diagnosis was confirmed by lymphography with followup of 1 year. Three patients developed an internal lymphogenic cyst, 3 showed an external lymph fistula, and 1 patient developed an infection of a dacron bifurcation graft. The infection occurred when an additional occlusion of the left femoral artery was bypassed with an autologous saphenous vein graft and a lymph cyst in the groin, which was excised several times, became infected. The patient was treated successfully by excising the graft and performing an axillofemoral bypass. Although cases of surgical damage to lymph vessels following arterial reconstructions are rare in the literature, it is assumed that this complication occurs more often than reported, because of lack of lymphographic information.     

A new approach in restorative treatment of external root resorption. A case report

This case report describes the treatment of an external root resorption with extensive loss of tooth structure and bone at the labial surface of an upper left central incisor. The area of bone loss and root resorption was surgically exposed and an impression was taken using curing silicone. An individual ceramic insert was fabricated, allowing endodontic retreatment through an artificial root canal. The insert was incorporated using a dentin bonding system and a dual curing luting composite. Following endodontic retreatment and internal bleaching, a ceramic veneer was bonded to the tooth to obtain good esthetics and to improve stability. Twenty months after surgical treatment no further root resorption could be detected radiographically. A shallow residual pocket but no bleeding on probing was found.     

Personal adjustment as a determinant of aggressive behavior toward the mentally ill.

36 undergraduates acted as teachers whose job was to enable a person whom they believed to be an exmental patient to learn an arbitrarily correct series of button presses. Ss could only communicate with the learner by shocking him when he was incorrect and could vary both the intensity and duration of the shock. It was found, using mean shock duration as an index of punitiveness, that the more emotionally unstable (and thus similar to the learner) an S believed himself to be, the less punitive he was toward the learner. The surprising utility of the shock duration measure as an index of aggression against a stigmatized person is discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of incidental hints when problems are suspended before, during, or after an impasse.

Two studies examine how the time at which problem solving is suspended relative to an impasse affects the impact of incidental hints. An impasse is a point in problem solving at which a problem solver is not making progress and does not know how to proceed. In both studies, work on remote associates problems was suspended before an impasse was reached, at the time an impasse was reached, or after a period of continued work during an impasse. After problem solving was suspended on a set of problems, participants completed a lexical decision task before resuming work on the set of unsolved problems. For half of the problems suspended during each impasse state, solution words were presented as incidental hints in the lexical decision task. The proportion of initially unsolved problems that were solved after the intervening lexical decision task was greater when problem solving was suspended at the point an impasse was reached than when problem solving was suspended before an impasse or after a period of continued work during an impasse. These results suggest that suspending problem solving at the point of impasse may increase susceptibility to incidentally presented hints. The point of impasse may be an opportune time for hints because the problem has been explored but there has not been a large increase in fixation on failed solution attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rheumatoid arthritis improved by treatment with levamisole and L-histidine

A case of classical rheumatoid arthritis of 12 years' duration, was treated during an exacerbation with levamisole and remission was induced. The findings support the postulate that depressed cell-mediated immunity to an unknown antigen is the primary immunity defect in rheumatoid arthritis, and that the defence mechanism stimulant levamisole is an effective treatment, at least in some cases. The lack of toxicity of the drug is noted, but in this case the blood aspirin level rose while the patient was taking levamisole with an unaltered dose of aspirin. There was some depression of the neutrophil count after five months which responded to a reduced dosage.     

Recombinant natural killer enhancing factor augments natural killer cytotoxicity

An 18-year-old schizophrenic female was recently treated after overdosing on trihexyphenidyl, thioridazine and an unknown antidepressant. On presentation to a local hospital, she was cyanotic with dilatated pupils and in acute respiratory failure. She was intubated prior to transfer. While in our Emergency Department, she exhibited occasional premature ventricular contractions which later became intermittent torsade de pointes. As this was an anticholinergic overdose we infused sodium bicarbonate in an attempt to increase protein binding, hoping to decrease the concentration of toxic metabolites. We also tried to suppress the dysrhythmia by infusing magnesium. The potassium level was borderline low so a supplemental infusion was initiated. Defibrillation was attempted. To try to shorten the action potential duration by activating the K+ channel, an isuprel infusion was also attempted. All methods failed. The patient fluctuated between an irregular sinus rhythm with prolonged QT interval and pulseless torsade de pointes for almost 24 hours. At all times, she responded appropriately to pain. Finally we attempted blockade of the calcium channel using verapamil with dramatic results. Each single bolus (0.1 mg/kg) successfully converted the patient back to sinus rhythm for some 15-20 minutes before the torsade recurred. After the initiation of a continuous verapamil infusion (0.005 mg/kg/hr), the patient remained in stable sinus rhythm. Verapamil proved highly effective in this patient with an anticholinergic overdose induced dysrhythmia.     

Unilateral tongue atrophy due to an enlarged emissary vein in the hypoglossal canal

A 16-year-old girl presented to our clinic with right-sided tongue atrophy and fasciculations of 1-year duration. Enlargement of the outer opening of the hypoglossal canal was reveal by conventional and computed tomography of the skull. Magnetic resonance imaging disclosed an enlarged venous system extending from the jugular vein to the internal jugular vein on the right, with low signal density suggestive of a flow void. A right-sided occipital craniotomy was performed. When the hypoglossal canal was opened, an enlarged emissary vein compressing the hypoglossal nerve was identified. This is the first reported case of unilateral tongue atrophy and an enlarged hypoglossal canal due to an enlarged emissary vein.     

Culpable causation.

"Culpable causation" refers to the influence of the perceived blameworthiness of an action on judgments of its causal impact on a harmful outcome. Four studies were conducted to show that when multiple forces contribute to an unfortunate outcome, people select the most blameworthy act as the prepotent causal factor. In Study 1, an actor was cited more frequently as the primary cause of an accident when his reason for speeding was to hide a vial of cocaine than when it was to hide his parents' anniversary gift. In Study 2, of the 4 acts that produced an unfortunate outcome, the most blameworthy act was cited as the factor with the greatest causal impact. Study 3 found that greater causal influence was perceived throughout a causal chain when the act that engaged the chain was positive rather than negative. Finally, Study 4 found that both traditional causal factors (i.e., necessity and sufficiency) and culpable factors influenced perceived causation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perspective taking and self-awareness: Drawing an E on your forehead.

Self-awareness theory assumes that individuals direct their attention outward or back on themselves as a function of characteristics of the situation. Taking this theory literally, it was hypothesized that Ss taking a self-focused perspective would draw a capital letter E on their forehead such that the E would be oriented for the external perspective of an observer. Ss' whose attention was directed outward would draw an E that would appear backward to another person. As hypothesized, in 3 experiments with 175 female undergraduates, Ss in high self-focus conditions significantly more often than low self-focus Ss drew an E on their forehead oriented toward the perspective of an outside observer, even though they believed they could not be observed by anyone else. Self-focus was induced using a video camera placed either to the side of the S (Exp I) or behind the S (Exp II), where it could not record how the E was drawn. In Exp III, an audiotape recorder was used to induce self-focused attention. The results demonstrate that an external, reflexive visual perspective could be induced by an auditory self-focusing manipulation. Furthermore, in Exp III, when situationally induced self-focus was low, Ss who were high in public self-consciousness (as measured by the Self-Consciousness Scale) were more likely to draw the E from an external perspective than were Ss low in public self-consciousness. Degree of private self-consciousness was unrelated to perspective taking. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internal pancreatic fistula: surgical treatment

The authors present 13 cases of internal pancreatic fistula, of which 11 were secondary to a chronic pancreatitis and two were caused by an abdominal trauma. Beside the clinical picture, the diagnosis was anticipated by the high amylase levels present in the fluid obtained by paracentesis or thoracocentesis. The diagnosis was confirmed by the radiological analysis of the pancreatic duct system, when an endoscopic retrograde pancreatography was performed in seven patients, one pancreatography was carried out during surgery in five cases, and one patient underwent an injection of hydrosoluble contrast in the pleural cavity. The treatment was a latero-lateral pancreaticojejunoanastomosis in five cases, associated with a corpora-caudal pancreatectomy in four patients; a cephalic duodenopancreatectomy was performed in one case. Two patients underwent a cystoenteroanastomosis, while the option chosen in the last four cases was an external drainage. One patient refused to undergo surgical treatment. Operation mortality was null. The conclusion was that an adequate surgical treatment results in the occlusion of the internal pancreatic fistula and, furthermore, allows for the definitive resolution of underlying pancreatic affection.     

Orbital squamous cell carcinoma following retinal detachment surgery

Double-stranded DNA was effectively complexed with alginic acid and immobilized on a surface of polystyrene microtiter plate. Dose-dependent binding of anti-DNA autoantibodies was finely observed to the solid phase DNA-alginate complex in enzyme-linked immunosorbent assay (ELISA). In contrast, non-specific binding of antibodies to alginate was scarcely detected rather than to poly-L-lysine. These results shown an availability of the solid phase DNA-alginate complex as an antigen in ELISA for detection of anti-DNA antibodies.     

The effects of frequency of feedback on a simple coaction task.

Used a learned drive approach to predict the effects of feedback on a coaction task; 60 female undergraduates were Ss. It was hypothesized that the magnitude of social facilitation would be greater the more often Ss were given feedback of their own or the other coactor's performance. The frequency of feedback was manipulated by varying the number of responses required to produce a tone. Coactors received a tone after every 4 (FR4) or 7 (FR7) responses and performed in the presence of another person who was either on an FR4 or an FR7 schedule. To furnish a comparison to the coaction conditions, some Ss were tested individually on an FR4 and others on an FR7 schedule. Within the coaction conditions, the most responding occurred when both Ss received an FR4 schedule, and the fewest responses when both coactors were on an FR7 schedule. An intermediate number of responses was produced when one coactor was on an FR4 and the other on an FR7 schedule. Also, Ss working in coaction conditions responded more than those performing alone. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Renal artery aneurysm presenting as a chest mass

An enlarging mass in the right chest in a 25-year-old woman was found at operation to be a false aneurysm of the renal artery. Preoperative diagnosis was not made despite an extensive workup including arteriography. Successful resection was carried out via a posterolateral thoracotomy. Although vascular reconstruction was not feasible. The danger of rupture of such an aneurysm from an incisional biopsy is emphasized.     

Pulmonary artery reconstruction for tuberculosis

A 35-year-old woman underwent reconstruction of her right pulmonary artery for treatment of acquired right pulmonary artery stenosis. The stenosis was secondary to tuberculosis causing both an extrinsic and an intrinsic obstructive component. After her reconstruction, the patient made an uneventful recovery, and perfusion to the right lung was subsequently restored.