Current management of anorectal anomalies

A significant amount of new information has been obtained concerning the early management of anorectal malformations. The surgical approach also has changed and improved the functional prognosis of children with these defects. Recommendations are made based on a series of 632 cases. A simplified approach to avoid the most common errors in the management of these defects is emphasized. Yet, there are still many children born with severe anatomic deficiencies who cannot expect normal bowel function; however, for this group, a bowel management program is available to help improve their quality of life.     

A new transrectal pull-through operation for high anorectal anomalies

Twenty-five cases of high anorectal anomalies were treated by a modified transrectal pull-through operation. All patients underwent diverting colostomy before definitive surgery, through which a balloon was passed into the blind rectal pouch. EMG studies were done at the site of the external sphincter in response to gradual inflation of the balloon. There was typical behavior both before and after surgery, except in two cases with sacral anomalies. These findings indicate the importance of a sensitive mucosa in the rectal pouch and of a functioning external sphincter. A modification of the pull-through technique in which a window of intact mucosa is left in situ to preserve sensation was employed in five cases and is expected to provide improved continence.     

Psychosocial adjustment of children treated for anorectal anomalies

The psychosocial adjustment of 160 children with anorectal malformations was assessed at 6 to 17 years of age in relation to levels of continence (Kelly score). Five measures of emotional and behavioural adjustment were used to assess a number of domains of child/adolescent functioning and to include measures from multiple perspectives. The psychiatric assessment of the child identified a disorder in 29% of the group overall. Based on parental assessments, behavioural maladjustment was shown in 27% of the children, and on the basis of a self-report questionnaire 24% of the children were depressed. Behavioural adjustment as rated by teachers was similar to the norms. The level of continence achieved (total Kelly score) did not appear to influence psychological adjustment, with the exception of the incontinent young girls (6 to 11 years) who were shown to be less well adjusted than the continent young girls. Differences between children showing positive versus negative adjustment were dependent on the perspective of the respondent and were also related to the child's age and gender, age of achieving continence, frequency of accidents, and parental factors.     

The role of magnetic resonance imaging in the preoperative assessment of anorectal anomalies

Venous ulcers are common in clinical practice. They are due to end stage skin and subcutaneous damage from sustained venous hypertension. The common cause may be post thrombotic syndrome or primary superficial venous insufficiency. This case illustrates the need to think of inherited thrombophilia as a primary cause.     

Meehl's contribution to clinical versus statistical prediction.

Paul E. Meehl's work on the clinical versus statistical prediction controversy is reviewed. His contributions included the following: putting the controversy center stage in applied psychology; clarifying concepts underpinning the debate (especially his crucial distinction between ways of gathering data and ways of combining them) as well as establishing that the controversy was real and not concocted, analyzing clinical inference from both theoretical and probabilistic points of view, and reviewing studies that compared the accuracy of these 2 methods of data combination. Meehl's (1954/1996) conclusion that statistical prediction consistently outperforms clinical judgment has stood up extremely well for half a century. His conceptual analyses have not been significantly improved since he published them in the 1950s and 1960s. His work in this area contains several citation classics, which are part of the working knowledge of all competent applied psychologists today. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevention of adhesions in surgery. A clinical review and experimental contribution

Induction of apoptosis in human monocytic THP.1 cells by etoposide or N-tosyl-L-phenylalanyl chloromethyl ketone resulted in release of mitochondrial cytochrome c, formation of ultracondensed mitochondria, development of outer mitochondrial membrane discontinuities and a reduction in mitochondrial membrane potential (delta psi m), as well as externalisation of phosphatidylserine, caspase-3 and -7 activation, proteolysis of poly(ADP-ribose) polymerase and lamin B1. The caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp (OMe) fluoromethyl ketone inhibited all these ultrastructural and biochemical characteristics of apoptosis except for the release of cytochrome c. Release of mitochondrial cytochrome c was a late event in non-apoptotic cell death occurring after commitment to cell death and without caspase activation. Thus apoptosis is characterised by release of mitochondrial cytochrome c prior to formation of ultracondensed mitochondria and a reduction in delta psi m and by a mechanism independent of rupture of the outer mitochondrial membrane.     

Orbital venous anomalies. A long-standing dilemma

Chronic pancreas transplant rejection with enteric exocrine drainage can lead to significant long-term complications. We report a case of a 47-year-old male insulin-dependent diabetic who survived the complications of peripancreatic abscess, enterocutaneous fistula, and arterioenteric fistula related to pancreas transplantation. To avoid these long-term complications, we now recommend elective removal of nonfunctioning, enterically drained pancreas allografts.     

Dysraphic myelodysplasias associated with urogenital and anorectal anomalies: prevalence and types seen with MR imaging

OBJECTIVE: The purpose of this study was to determine by MR imaging the prevalence and types of dysraphic abnormalities of the spinal cord (i.e., myelodysplasias) associated with urogenital and anorectal malformations of childhood. MATERIALS AND METHODS: Since 1987, 92 patients with imperforate anus complex, cloacal malformation, and cloacal exstrophy have had MR imaging as a screening examination for occult dysraphic myelodysplasia. The prevalence and types of myelodysplasia were determined for each group. RESULTS: The prevalence of dysraphic myelodysplasia in each group of children was 17% (1/6) for low imperforate anus (ectopic anus), 34% (11/32) for high imperforate anus (with fistulization), 46% (19/41) for cloacal malformation, and 100% (13/13) for cloacal exstrophy. The most common abnormalities in each group were tethered cord with intradural or filar lipoma in imperforate anus; low-placed or dysplastic conus medullaris and tethered cord with lipoma or myelolipoma in cloacal malformation; and lipomyelocele, lipomyelomeningocele, or lipomyelocystocele in cloacal exstrophy. CONCLUSION: Our results show that the prevalence of myelodysplasia as seen on MR imaging is high in patients with urogenital and anorectal anomalies.     

Correlational anomalies.

Considers that differences in research findings regarding the relationship between any 2 variables are commonplace. Controversies regarding the validity of divergent findings may be irrelevant in some circumstances because of correlational anomalies. These situations are illustrated, using sets of hypothetical data to demonstrate how several apparently conflicting findings can all be valid. It is suggested that realization of types and causes of correlational anomalies should lead to caution in generalizing from parts to a whole or from the whole to its parts. One might attempt to integrate relationships from this perspective before concluding that divergent findings are a consequence of inadequate research methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contribution of cognitive decision models to clinical assessment: Decomposing performance on the Bechara gambling task.

The Bechara simulated gambling task is a popular method of examining decision-making deficits exhibited by people with brain damage, psychopathology, antisocial personality, or drug abuse problems. However, performance on this task is confounded by complex interdependencies between cognitive, motivational, and response processes, making it difficult to sort out and identify the specific processes responsible for the observed behavioral deficits. The authors compare 3 competing cognitive decision models of the Bechara task in terms of their ability to explain the performance deficits observed in Huntington's disease patients as compared with healthy populations and people with Parkinson's disease. The parameters of the best fitting model are used to decompose the observed performance deficit of the Huntington patients into cognitive, motivational, and response sources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unusual clinical presentation of infection due to Flavimonas oryzihabitans

Six cases of Flavimonas oryzihabitans infection are presented, four of which were community-acquired pneumonia and two of which were nosocomially acquired bacteremia. All four cases of pneumonia occurred in immunosuppressed hosts, three of whom were HIV-positive individuals and one of whom was a young man affected by chronic myeloid leukemia. Flavimonas oryzihabitans is recognized with increasing frequency as a cause of opportunistic infection, but the present cases of community-acquired pneumonia due to this organism are believed to be the first four reported in the English literature. The findings emphasize that Flavimonas oryzihabitans should be included in the list of pathogens that cause community-acquired infections in the immunocompromised host.     

Special issue on self-determination theory: A Canadian contribution.

A number of theories have been proposed to account for the role of motivation in human functioning. Amongst these theories, self-determination theory (e.g., Deci & Ryan, 1985) has been especially influential. Canadian researchers have played a key role in the development of this important theory. The collection of articles in this special issue concern self-determination theory. Following an introductory article by Deci and Ryan, a total of nine articles appear. These articles review research in a variety of contexts on various important themes, such as work, education, relationships, parenting, health, environmental issues, and psychotherapy. Finally, a concluding article provides some reflection on these articles and proposes directions for future research. As such, this special issue celebrates the role that Canadian researchers have played, and continue to play, in testing and refining this major motivation theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Operation compatibility: A neglected contribution to dual-task costs.

Traditionally, dual-task interference has been attributed to the consequences of task load exceeding capacity limitations. However, the current study demonstrates that in addition to task load, the mutual compatibility of the concurrent processes modulates whether 2 tasks can be performed in parallel. In 2 psychological refractory period experiments, task load and process compatibility were independently varied. In Experiment 1, participants performed 2 mental rotation tasks. Task load (rotation angle) and between-task compatibility in rotation direction were varied. Results suggest more considerable parallel execution of compatible than of incompatible operations, arguing for the need to attribute dual-task interference not only to structural but also to functional capacity limitations. Experiment 2 tested whether functional capacity limitations to dual-task performance can be caused only by demanding processes or whether they are also induced by relatively automatic processes. Results indicate that an irrelevant circular movement of Stimulus 2 interfered more with mental rotation of Stimulus 1 if the rotation directions were opposite than if they were equal. In conclusion, compatibility of concurrent processes constitutes an indispensable element in explaining dual-task performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delusions in the aged. A contribution to anthropological understanding

During the last 25 years, substantial progress has been made in the detection and treatment of bone tumors in adolescents and young adults. Due to more effective chemotherapy treatments, patients are now surviving these illnesses and living quality lives. In the past, the only surgical option for treatment of these tumors was amputation. Today, however, limb-sparing procedures such as allograft implantation, together with effective chemotherapy treatments, provide patients with another treatment option. The allograft procedure includes removing the tumor and affected bone and replacing it with bone procured from deceased donors. During the following 2 years, the body does the work of incorporating the allograft and replacing it, at least in part, with new host bone. After a long rehabilitation process, the patient will have a functioning limb. Nursing care of the adolescent undergoing allograft procedure encompasses meeting important physical and psychosocial needs. Adolescents are often still dealing with the emotional and physical stress of having cancer and chemotherapy or chemotherapy side effects at the time of surgery. They are concerned not only with their immediate recovery but also with their long-term prognosis. All treatment modalities, including allograft surgery, impinges on the normal developmental tasks of adolescents. The nursing challenge is to help the adolescent balance the limits of their illness and recovery with normal developmental needs.     

Partialing out intelligence: A methodological and substantive contribution.

Criticizes the use of the partial correlation methodology to control trait variance. It is argued that the only methodology that can be used with fallible measures to control trait variance is factor analysis. In spite of its history of misuse and abuse, the factor methodology can be used objectively and effectively for this purpose. A study by D. J. Satterly (1976) on the relation between cognitive style and intelligence is used as an example of the misuse of factor analysis. However, it is pointed out that when an appropriate factor model is used for Satterly's data, somewhat different interpretations are required. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening of congenital anomalies in the mid-trimester of pregnancy. Prospective epidemiologic study. Developmental anomalies

Authors report about the data of 60,000 pregnant women from three district counties of Eastern-Hungary between 1988 and 1990, on whom both ultrasound and alfa-fetoprotein screenings were performed. They demonstrate the value of this screening for the detection of fetal malformations and for the birth prevalence rate as well. This effective screening-protocol is proposed for a nation-wide application.