Anal endosonography in patients with anorectal symptoms after haemorrhoidectomy

Although allergic persons can react to foods containing trace quantities of unlabeled or unintended food allergens, there are few data available on the quantities of these allergens required to evoke allergic symptoms. We report a milk-allergic 3-year-old boy who experienced throat itching, facial angioedema, and vomiting within 20 min of ingesting 4 to 6 oz (ca. 113.4 to 170.1 g) of lemon sorbet. Subsequent analysis of two sorbet samples provided by the parents and a third sample purchased locally by the investigators revealed trace quantities of milk allergens, whey protein (8.8 micrograms/ml), or lactose (200 ppm). The quantity of whey protein ingested was estimated to be 120 to 180 micrograms (equivalent to 23 to 24 microliters of milk). All three sorbet samples had been manufactured in the same plant within a 4-month period; the equipment used to produce and package the sorbet was also used to produce and package ice cream. No milk allergen or whey protein was detected in 38 other marketplace sorbet samples submitted by the manufacturer for testing. We concluded that trace quantities of whey proteins (< 200 micrograms) can elicit systemic reactions in exquisitely milk-allergic individuals. Such individuals should avoid eating frozen desserts prepared using equipment also used for producing or packaging ice cream, unless manufacturers can demonstrate unequivocally that their cleaning practices are sufficient to prevent milk contamination. Adequate tests are not currently available to food manufacturers but are under development.     

Diagnosis of depth of invasion of gallbladder carcinoma with endosonography

We reported on the usefulness of endosonography (EUS) in the diagnosis of the depth of invasion of gallbladder carcinoma. We performed EUS on 69 patients with gallbladder carcinoma: the degree of tumor extension in 17 was m (tumor invading the mucosa), in 5 pm (tumor invading the muscular layer), in 21 ss (tumor invading the subserosa), 14 in se (tumor invading the serosa), and 12 si (tumor extending to adjacent organs). The detection rate of tumors with EUS was 91.3% (63 of 69). All 6 (100%) patients with pedunculated lesions (Ip type) were correctly diagnosed with EUS. Eighteen of 21 patients (85.7%) with broad-based elevated tumors (Is type), and 5 of 7 (71.4%) with flat-elevated lesions (IIa type) were also diagnosed correctly. EUS is a useful modality for the diagnosis of gallbladder carcinoma. In particular, EUS diagnosis of the depth of invasion is reliable in Ip-type lesions. It is recommended that patients with Ip-type lesions undergo laparoscopic cholecystectomy, but in patients with Is-or IIa-type lesions conventional cholecystectomy with lymph node resection should be performed.     

Hydrosonography as an alternative or supplement to endosonography in stomach carcinoma

This study examined the effect of mothers' exposure to the 1957 A2/Singapore influenza virus in the first, second, and third trimesters of pregnancy on the electrodermal activity of their 15-year-old offspring. The epidemic occurred during cold months of the year. The results show that maternal viral (and cold) exposure during all trimesters of pregnancy produced a lower frequency of nonspecific electrodermal responses and diminished responsivity to 75-db and 90-db tones as compared with the offspring of mothers who were not exposed. However, there was a critical effect of second trimester exposure as indicated by an increase in frequency of nonresponses to orienting tones. The findings are compared with those from an earlier study from Mauritius involving 3-year-old children in which the effects of exposure to the 1968 A2/Hong Kong virus were examined and in which the effect of could exposure could be examined separately because viral exposure occurred during the hot months.     

The anatomical basis of anal endosonography. A study in postmortem specimens

PURPOSE: Anal endosonography is an imaging modality new to the diagnostic workup of incontinence. Interpretations even of normal endosonomorphologic findings now vary considerably. The conjoined longitudinal muscle (LM), a widely ignored structure, has until recently not been fully recognized by anal endosonography. The aim of this study, therefore, was to accurately determine the normal anatomy of the anal canal and correlate it with the findings obtained by anal endosonography. METHODS: Eight postmortem specimens of the anal canal were examined by endosonography. The findings were correlated with macroscopical dissection and gross sectional histology of the same specimens. RESULTS: The external echogenic ring is composed of two anatomical structures: the LM and the external anal sphincter (EAS). However, during anal endosonography the LM cannot always be differentiated from the EAS. Histologically, the relation of the diameters of the LM and the EAS ranged from 0.45:1 to 1.25:1. The narrow hyperechogenic ring between the inner hypoechoic layer and the external hyperechoic ring is an artificial finding that cannot be related to a distinct anatomical structure and most likely represents a sonographic interface. CONCLUSIONS: This study exactly outlines the relation of diameters of the conjoined longitudinal muscle and external anal sphincter for the first time. Until now, the LM has been underestimated in its dimensions. The role of such a thick muscular structure should be included in the conception of anal continence in the future. Especially in view of the fact that anal endosonography is increasingly used in the diagnostic workup of incontinence and fistula in ano, it is essential to understand the anatomical basis of endosonography. This study accurately delineates the sonomorphology of the anal muscles. When viewed in light findings reported here, endosonographic findings in diseases of the anal canal are nor based on a correct idea of the correlation between endosonomorphology and anal anatomy.     

Guided tissue regeneration update

The ultimate goal of periodontal therapy is to restore periodontal tissues lost through disease or trauma. The most predictable way to accomplish this goal is by guided tissue regeneration (GTR). The principle of GTR is to give preference to certain cells to repopulate the wound area to form a new attachment apparatus. Clinically this is accomplished by placing a barrier over the defect thereby excluding gingival tissues from the wound during early healing. The first generation of GTR barriers were non-resorbable which implies that they have to be removed in a second surgical procedure. Resorbable barriers have recently been introduced, changing GTR into a single-step procedure. Periodontal defects that will predictably benefit from GTR therapy are intrabony, furcation class II and gingival recession defects. This paper reviews the scientific evidence of what can be achieved by GTR procedures for various periodontal defects as well as factors of importance to increase the predictability of a successful treatment outcome.     

Guided memory in eyewitness identification.

72 witnesses (college students) of staged vandalism either subsequently viewed no lineup (NL) or viewed lineups in which the vandal was present (VP) or absent (VA). Ss were asked 5 mo later to view 5 simultaneously displayed lineup photographs. Half the Ss in each lineup condition group were asked whether the vandal's photograph was present and, if so, to identify it; the other half of the Ss were asked to do the same after an interview guiding recollection of the incident, the vandal, and the S's reactions. Recognition accuracy was greater for Ss who underwent guided memory interviews (60% vs 40%). The VP Ss were more often accurate and more confident than were NL or VA Ss. Thus, the guided memory procedure enhanced the accuracy of identification after a moderate delay without biasing the witnesses' recollections about the offender. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guided tissue regeneration. Nonabsorbable barriers

Nonabsorbable barriers are considered the material by which all other barriers are judged. They have a well-established record of safety and efficacy. They are not a panacea, however. Practitioners must take special care when selecting both patients and surgical sites for GTR. Extensive experience, superior surgical ability, and meticulous attention to detail are also required if one is to achieve predictably favorable results.     

Guided tissue regeneration. Absorbable barriers

Over the past 15 years, techniques aimed at regeneration of lost periodontal tissue have become widely used and accepted in clinical practice. Among these techniques are those which use the principles of guided tissue regeneration (GTR), wherein barriers (i.e., membranes) are used to control cell and tissue repopulation of the periodontal wound. A variety of non-absorbable and absorbable barriers have been developed and used for this purpose, with a trend in recent years toward increased use of absorbable GTR materials. This article describes the evolution of absorbable barrier materials and overview materials available for clinical use today. In addition, advantages and disadvantages of these materials are discussed, as well as possible new developments in barrier-based GTR therapy.     

Guided tissue regeneration in the esthetic zone

Common cosmetic failures in guided tissue regeneration (GTR) procedures performed in the esthetic zone include an unacceptable postoperative recession of the gingival flap and loss of the papillae. This article describes the dynamics of flap healing that contribute to esthetic failures. Specific technique modifications of GTR procedures that enhance the predictability of successful functional and esthetic outcomes are described.     

Graphical User Interface for Guided Acoustic Waves

This paper presents GUIGUW v0.1, a graphical user interface (GUI) for the computation of stress-guided wave dispersive features. The software exploits semianalytical finite-element (SAFE) formulations for the calculation of wave-propagation characteristics. The interface allows for the selection of geometrical, mechanical, and frequency-related parameters for the computation. Isotropic and anisotropic materials with linear elastic and linear viscoelastic rheological behaviors can be considered, and any waveguide cross section can be modeled. For each existing wave, the dispersive results can be represented in terms of wave number, wavelength, phase velocity, group velocity (for undamped waveguides), energy velocity, and attenuation (for damped waveguides). By simply working with the GUI, original results for guided stress waves can be obtained.     

Guided bone regeneration in the treatment of periimplantitis

Immunological abnormalities frequently observed in patients with primary biliary cirrhosis are considered to be related to the pathogenesis of this disease. We performed a prospective trial to evaluate whether immune mechanisms play a role in the effectiveness of ursodeoxycholic acid (UDCA) therapy. Fifteen female patients with primary biliary cirrhosis were followed for 1 year and were then treated with UDCA (600 mg/day) for another year. Laboratory tests, including peripheral blood lymphocyte subsets assessed by dual colour fluorescence analysis using monoclonal antibodies against respective T cell markers, were evaluated at the beginning of the study, at the start of therapy and at the end of therapy. In primary biliary cirrhosis, the proportion of cytotoxic T cells, suppressor inducer T cells and alpha beta-receptor bearing T cells were significantly lower than in healthy controls. No significant changes were observed in the proportions during the year before the therapy. These reductions, however, recovered to normal ranges after 1 year of UDCA therapy. These changes were associated with an improvement in the serum levels of aspartate aminotransferase, alkaline phosphatase, gamma-globulin and IgM. The close correlation between the improvement in the imbalance of lymphocyte subsets after the therapy and the clinical status suggests that an immunological process may play a role in the effectiveness of therapy in primary biliary cirrhosis.     

Quantitative Structural Health Monitoring by Ultrasonic Guided Waves

This paper presents a global-local (GL) method to simulate the interaction of ultrasonic guided waves with structural defects in isotropic and multilayered composite platelike structures. The GL method uses a full finite-element (FE) discretization of the defected region to properly represent wave diffraction phenomena and a suitable set of wave functions to simulate regions away from the joint. Displacement and stress continuity conditions are imposed at the boundary between the global and the local regions. The radiated wave field can be then calculated by using standard techniques (least-squares method). The novelty of the proposed approach over previous GL techniques is the use of semianalytical FE (SAFE) modeling for the “global” simulation. The SAFE method, which only requires the discretization of the waveguide’s cross section, allows handling complex structures (multilayered composites, arbitrary cross sections, etc.) in a computationally efficient manner. Applications of the GL method to damage quantification will be shown for the cases of notches in aluminum plates and delaminationlike defects in aircraft composite panels.     

Guided imagery and memory: Implications for psychotherapists.

Imagery techniques involve the mental generation of perceptual experiences in the absence of external perceptual stimulation. Such techniques are used for many purposes in psychotherapy but have recently come under attack as a risky practice that may result in memory distortion or the creation of false memories. This article reviews research linking imagery with changes in memory, both to sensitize clinicians to possible inappropriate applications of guided imagery techniques and to discourage researchers from understating the potential utility of guided imagery. The implications of this research for the psychotherapeutic use of imagery are discussed, and strategies for using imagery while reducing the potential for memory distortion are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guided tissue regeneration without a stage 2 surgical procedure

In the two cases described, the problems of insufficient bone and insufficient soft tissue in the edentulous ridge were addressed concurrently. Freeze-dried demineralized bone was used to fill the osseous defect. Freeze-dried fascia lata was used to prevent epithelial migration into the defect, act as a barrier, and eliminate a second surgery for membrane removal. This regeneration procedure can provide increased alveolar bone for better implant placement and esthetics.     

Guided bone regeneration in long bone. An experimental study

To assess the satisfaction with the department and hospital services provided by a medium-size community hospital during a 2 month period (April-May 1995), 118 randomly chosen patients were asked to complete a questionnaire designed to reflect their opinions during hospitalization. The principal points of the survey concerned the general perception regarding the services in the department and the hospital, the admission and discharge procedures, the quality of food and sanitary conditions, an evaluation of the physicians' and nurses' skill and attitude, as well as their compliance to patients' needs. Overall satisfaction with the medical care was very high, the physicians' attitude and nurses' compliance being the two most important determinants. The role of this type of questionnaire as an instrument for improving health services is emphasized.     

自动导引车系统关键技术的研究

提出了一种改进型电磁导引技术方案.该方案使自动寻引系统的核心部分——路径规划算法及程序得以实现.分析及实验结果证明,该项技术是可行的,并且具有极高的经济性.