Pancreatic adenocarcinoma: why and when should it be resected?

Adenocarcinoma of the pancreas is a common and dreadful disease with an extremely poor prognosis. In practice, only a few patients are cured but surgical resection, although feasible in less than 20% of patients, offers maximum prolongation of life and provides good palliation of symptoms. This can now be performed safely, even in elderly patients, in specialist units. Better radiological imaging and laparoscopy allow selection of resectable tumours effectively. All patient with pancreatic cancer should now be assessed for surgical resection and potentially suitable patients should be referred to a specialist team at an early stage.     

Child abuse: why should I report it?

In Indiana, dental professionals are mandated by law to report suspected child abuse and neglect to Child Protective Services (CPS) or the law enforcement agency in their county. The penalty for non-reporting is fine and/or jail. This article will give dental professionals information on child abuse injuries that can be identified in the dental office, how to talk to the child and family members regarding suspicions, and how to report those suspicions to your local CPS or law enforcement agency. Dental professionals will receive reassurance and encouragement from this article to report suspected cases of child abuse to CPS or law enforcement. The report is not meant to be punitive, but is intended to get the family connected to services to assist them, the child, and any other children they have or may have in the future, to avoid further abuse, and to attempt to break the cycle of abuse. To report suspicions of child abuse in Indiana, dial: 1-800-800-5556.     

The cocktail party problem: What is it? How can it be solved? And why should animal behaviorists study it?

Animals often use acoustic signals to communicate in groups or social aggregations in which multiple individuals signal within a receiver's hearing range. Consequently, receivers face challenges related to acoustic interference and auditory masking that are not unlike the human cocktail party problem, which refers to the problem of perceiving speech in noisy social settings. Understanding the sensory solutions to the cocktail party problem has been a goal of research on human hearing and speech communication for several decades. Despite a general interest in acoustic signaling in groups, animal behaviorists have devoted comparatively less attention toward understanding how animals solve problems equivalent to the human cocktail party problem. After illustrating how humans and nonhuman animals experience and overcome similar perceptual challenges in cocktail-party-like social environments, this article reviews previous psychophysical and physiological studies of humans and nonhuman animals to describe how the cocktail party problem can be solved. This review also outlines several basic and applied benefits that could result from studies of the cocktail party problem in the context of animal acoustic communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If it can be studied or developed, should it be?

Discusses the proposition that humans are as much possessed by as they are possessed of a world view, undergirded by axioms that are never articulated and therefore never examined or challenged. The axiom regarding the unalloyed benefits that accrue to society by virtue of untrammeled scientific inquiry and technological advance is challenged, and examples of such challenges to axioms concerning the harnessing of atomic energy, space exploration, splicing and recombining genes, and inquiry into racial and ethnic differences in intelligence from within and without the scientific and technological communities are discussed. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Whether obesity should be treated.

Antidieting sentiment is strengthened in part by the assumption that all diets fail, which in turn is based on data from university-based treatment programs. A small percentage of overweight people attempt to lose weight in these programs, and they differ in important ways from overweight people in general. They are heavier, more likely to be binge eaters, and have higher levels of psychopathology, all negative prognostic factors for treatment. Generalizing from the treatment of this group to all programs is highly questionable. Hence, little is known about the effectiveness of approaches used by most people. There is a pressing need for research on this topic, and a need for treatments that address the specific needs of those who seek clinical treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heart and lung retransplantation: should it be done?

STUDY OBJECTIVES: To evaluate unattended full polysomnography (PSG) recorded in the home by the DigiTrace Home Sleep System (DHSS) and to assess the ability to acquire, store and analyze polysomnographic data using the DHSS compared to standard paper PSG. DESIGN: Part 1 used a prospective, cross-over design. Part 2 consisted of a prospective concurrent collection of polysomnographic data. SETTING: Sleep Disorders Center in a university medical center. PARTICIPANTS: All adult patients who required standard clinical PSG as part of their clinical evaluation, regardless of suspected diagnosis, except patients requiring video recording for abnormal behaviors. MEASUREMENTS AND RESULTS: The DHSS is a digital recording system with miniature preamplifiers and the capacity to record 18 channels of polysomnographic data, including 4 channels of EEG (C3-A2, C4-A1, C3-O1 and C4-O2), right and left EOG, two channels of chin EMG, ECG naso-oral airflow, respiratory effort (piezo crystal thoracic and abdominal belts and bilateral interacostal EMG), snore microphone, bilateral anterior tibialis EMG, and body-position sensor. In part 1,77 DHSS home recordings were evaluated. No recordings were lost due to equipment failure and each parameter was scorable in greater than 95% of all epochs. Most of the subjective assessments by questionnaire following each study revealed no difference between the two testing situations. However, patients reported more sleep time and a better overall test experience in the lab. Assessments of sleep quality and morning alertness compared to usual were rated higher in the lab. After completing both studies, more patients preferred the lab study (p < .01), mostly because of minor inconveniences and apprehension regarding acquisition of data during the home study. There was no difference in the assessment of which test most accurately represented their sleep. In Part 2, the DHSS recorded concurrently with paper PSG in the laboratory in 16 patients. The results show no significant differences for any parameter and strong positive correlations for all parameters. CONCLUSION: Using the DHSS, unattended full PSG can be performed in the home with reliable and high quality recordings. Full PSG can be extended to a larger patient population, because it is no longer limited by the number of beds, and there is a reduction in cost due to elimination of overnight staff and facility cost.     

Bronchial ruptures are rare and should be surgically treated

Bronchial rupture in blunt trauma is caused by sudden compression of the chest with dislocation of the lungs. The less pliant bronchi may thus rupture. Bronchial rupture is rare in patients admitted alive. Bronchial rupture has been diagnosed in two of the last 275 severe chest traumas admitted to Ullev?l hospital since 1993 (0.7%). A 19-year-old male had total atelectasis of the lung 19 days after the trauma. A four-year-old boy experienced total collapse of the lung and became critically ill the fourth day after initial normalisation of the chest X-ray. Both patients were successfully operated on, with reconstruction of the left main bronchus in both cases, after 29 and seven days, respectively. In the child an upper lobectomy was necessary. These patients illustrate that with expectative treatment in bronchial rupture, serious complications may be experienced.     

To medicate or not to medicate: Let us be honest about why we should.

Responds to the articles of P. H. DeLeon et al (see record 1991-25292-001) and S. J. Kingsbury (see record 1992-25066-001) on prescribing privileges for psychologists. It is argued that such privileges would help psychologists provide the best, most efficient, and least complicated care for the patients, unencumbered by a 3rd party. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which patients with antiphospholipid antibody should be treated and how?

The tests for antiphospholipid antibody are relatively crude but usable. Asymptomatic persons with incidentally discovered antiphospholipid antibody do not need treatment. Those with symptoms are best treated with anticoagulation, but data specifically supporting aspirin, heparin, or warfarin or combinations thereof remain to be generated. High-dose corticosteroid therapy has at best equivocal efficacy and much toxicity and should be used only for lupus activity and not for phenomena of the antiphospholipid antibody syndrome. The roles of low-dose corticosteroid therapy, immunosuppressive agents, and other treatments are unknown.     

Tissue harmonic imaging: why does it work?

The recent utilization of harmonic frequencies in the imaging of both tissue and contrast agents has dramatically improved echocardiographic image quality. In contrast harmonics, the harmonic frequency energy is generated on reflection from the microbubble contrast agent. In tissue harmonics, the harmonic frequency energy is generated gradually as the ultrasonic wave propagates through the tissue. Critical to the utility of tissue-generated harmonic frequencies is their origin beyond the chest wall and their nonlinear relation to the fundamental frequency energy strength. These two characteristics of tissue-generated harmonics ensure that the echoes most likely to produce artifact are least likely to produce harmonic waves. Armed with an understanding of how these images are produced and with data emerging as to their clinical utility, we anticipate that harmonic imaging will become the standard for assessing regional and global left ventricular function in technically difficult studies.