Laparoscopic anterior gastroplasty. A preliminary report of a new technique

BACKGROUND: The treatment of the morbidly obese patient is difficult because compliance with dietary regimens is poor. As a result, most weight reduction programs fail very quickly. Surgical treatment, on the other hand, provides a reliable method for sustained weight reduction. The most frequently performed procedure has been the vertical banded gastroplasty. Adaptation of the standard open procedure to laparoscopic techniques has been technically difficult and imprecise. We have developed, in the laboratory, an anterior wall banded gastroplasty that can be performed precisely and reproducibly using laparoscopic techniques. METHODS: Five Yorkshire pigs were used in attempt to laparoscopically perform the standard vertical banded gastroplasty. The procedure was difficult and was associated with a risk of staple line leak and with bleeding along the lesser curvature of the stomach. Furthermore, a reproducible pouch of proper dimension could not be created reliably. Fifteen animals were then used to develop a new technique using a small gastric pouch based on the anterior gastric wall. RESULTS: A reproducible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube. A standard polyproylene band of 5.2 cm in length was utilized at the gastric pouch outlet. CONCLUSIONS: This operation can be reproduced accurately and has not demonstrated any leaks on postmortem examination.     

Efficacy of an outpatient treatment program for insomnia: A preliminary report.

Evaluated 20 patients who suffered from chronic insomnia and who completed all phases of a 1-yr treatment program. The treatment, which consisted of 5 weekly, 1-hr group sessions and a follow-up 1 mo later, provided education about sleep, instruction in relaxation techniques, stimulus control instructions, and training in sleep hygiene. Self-monitoring data collected by the Ss showed general improvement across a variety of sleep parameters. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dacryocystantrostomy. A preliminary report

A new operative technique is described in which the lacrimal sac is drained into the maxillary sinus. The advantages of the procedure, especially of avoiding a facial incision, are emphasized. Five patients suffering from long-standing epiphora underwent surgery. Two patients had chronic dacryocystitis. Two other patients presented with a mucocele of the lacrimal sac. In the fifth patient, there was obstruction in the nasolacrimal duct. Short term follow-up results suggest its usefulness as a first line of surgical treatment in cases of epiphora due to obstruction in the lacrimal sac or the naso-lacrimal duct.     

Treatment of mallet finger fractures by the extension-block K-wire technique

OBJECTIVES: This report describes successful anaesthesia and electroconvulsive therapy (ECT) in a patient with an unruptured basilar artery aneurysm. ECT is associated with a hyperdynamic state characterised by arterial hypertension, tachycardia, and considerably increased cerebral blood flow rate and velocity. These responses pose an increased risk for subarachnoid haemorrhage when an intracranial aneurysm coexists. METHODS: A 54 year old woman presented for ECT. She had a 20 year history of major depression which was unresponsive to three different antidepressant drugs. There was also an unruptured 5 mm saccular aneurysm at the basilar tip, which had been documented by cerebral angiography, but its size had remained unchanged for the previous four years. After she declined surgical intervention, she gave informed consent for ECT. During a series of seven ECT sessions middle cerebral artery flow velocity was recorded by a pulsed transcranial Doppler ultrasonography system. She was pretreated with 50 mg oral atenolol daily, continuing up to the day of the last ECT and immediately before each treatment, sodium nitroprusside was infused at a rate of 30 microg/min, to reduce systolic arterial pressure to 90-95 mm Hg. RESULTS: Systolic flow velocity during the awake state ranged from 62-75 cm/s, remaining initially unchanged with sodium nitroprusside infusion. After induction of anaesthesia (0.5 mg/kg methohexitone and 0.9 mg/kg succinylcholine), flow velocities decreased to 39-54 cm/s, reaching maximal values of 90 cm/s (only 20% above baseline) after ECT. These flow velocities recorded post-ECT were considerably below the more than twofold increase recorded when no attenuating drugs were used. Systolic arterial blood pressure reached maximal values of 110-140 mm Hg and heart rate did not exceed 66 bpm. Rapid awakening followed each treatment, no focal or global neurological signs were apparent, and the patient was discharged in remission. CONCLUSION: In a patient with major depression and a coexisting intracerebral saccular aneurysm who was treated with ECT, the combination of beta blockade with atenolol and intravenous infusion of sodium nitroprusside prevented tachycardia and hypertension, and greatly attenuated the expected increase in flow velocity in the middle cerebral artery.     

Radioisotope choroid plexography. A preliminary report

Radioisotope plexography seems as easy and innocuous as routine brain scanning. An introductory method is given which could be improved. The choroid plexuses of the four ventricles were well visualized in 15 patients. Consideration is given to the possible labeling process. Besides its morphological value, the test could give interesting clues in the dynamic study of hydrocephalus.     

Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report

A cluster of four cases of haemolytic uraemic syndrome in children occurred in Northern Bohemia, Czech Republic, between 15 June and 7 July, 1995. All the cases had significantly elevated titres of anti-O157 lipopolysaccharide (LPS) antibodies as detected by the indirect haemagglutination assay. All but one of them had drunk unpasteurized goat's milk from the same farm within the week before the disease. Evidence of E. coli O157 infection was subsequently found in 5 of 15 regular drinkers of the farm's raw goat's milk; four of them were asymptomatic, 1 had mild diarrhoea at the end of June. Verocytotoxin 2-producing E. coli O157:H7 strains of phage type 2 and of identical pulsed-field gel electrophoresis patterns were isolated from 1 of 2 farm goats and from 1 of the asymptomatic goat's milk drinkers. The frequency of anti-O157 LPS antibodies found among regular drinkers of the farm's raw goat's milk (33%; 5 of 15) was significantly higher than that found in control population (0%; none of 45) (P = 0.0005; Fisher's exact test). Our findings indicate that goats may be a reservoir of E. coli O157:H7 and a source of the infection for humans; raw goat's milk may serve as a vehicle of the pathogen transmission.     

A new finger joint prosthesis

A new finger joint prosthesis is being developed for the proximal and distal interphalangeal positions. Currently available "joint spacer" prostheses provide relief from pain and cosmetic improvement, but relatively poor long-term function. The new prosthesis employs a mechanical hinge at the joint. It is fabricated from titanium alloy (6A14V). The hinge mechanism avoids direct metal to metal contact by using high density polyethylene bearings. In vitro tests of the hinge mechanism have passed 75 million cycles of continuous flexure without failure (n = 12). The hinge also incorporates a mechanical limit stop to prevent hyperextension. The hinge mechanism is enclosed in a sealed elastomeric jacket that isolates the hinge from connective tissue ingrowth. The jacket, equivalent to an artificial synovial membrane, has an integrally textured exterior surface designed to promote tissue attachment to the implant to stabilize tissue capsule formation around the joint. To test the in vivo efficacy of the new design, a series of 12 devices were implanted in the knee joint position of adult rabbits. A jacketed prosthesis was implanted on one side, whereas 2 weeks later an unjacketed control was implanted contralaterally. The animals then were maintained for an 8 week period. At sacrifice, the implants were removed, and the response of the surrounding tissues was studied histologically. At the time of implantation, the range of motion of the joints was approximately 100-105 degrees. There was a progressive loss in range of motion observed in both groups. The fibrous tissue capsule around the jacketed implants, however, was significantly reduced in thickness compared with the controls (mean thickness, 1.5 mm vs. 4.5 mm).(ABSTRACT TRUNCATED AT 250 WORDS)     

Colonic anastomosis-a new approach: preliminary report

A case of fetal death from abruptio placentae is reported in which the placenta was the seat of multiple chorangiomata. This association is believed not to have been fortuitous and a possible mechanism is suggested by which chorangioma may contribute to the pathogenesis of placental abruption. The incidence, morphological variation and clinical manifestations of placental chorangiomata are briefly discussed.     

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.     

Our method of treatment of dislocated fractures of the heel bone (preliminary report)

The authors present first experience with their method of treatment of displaced fractures of calcaneus. The method is based on the combination of direct and indirect reposition of fragments and exact fixation with K-wires. Axial and AP X-ray and 2 plane CT scan are indispensible conditions for operation planning. The procedure can be divided into 4 phases: traction, elevation, compression, transfixation. Up till now 65 patients have been treated with this method. 20 patients with 24 fractures were evaluated according to the Creighton-Nebraska Health Foundation score in the interval 24 months after the operation. The average value of the score was 96.6 points, 16 patients were evaluated as excellent, in 2 patients the result was good.     

Endoscopically controlled sinus floor augmentation. A preliminary report

Sinus augmentation has been advocated to be a surgical technique with predictable results in peri-implant surgery. Endoscopic surgery of the maxillary sinus so far has been used as diagnostic procedure. In this paper, the use of endoscopy is described as a low invasive adjunctive technique in sinus floor augmentation. After preparation of the mucoperiosteum, bone grafts can be placed under endoscopic control between sinus floor and mucoperiosteum. A laterobasal approach via a small osteotomy and a transalveolar approach are possible for mucosal elevation and graft placement. First clinical results are reported. Endoscopic sinus lift may contribute to a reduction of perioperative morbidity, reduction of oroantral fistulae and control of graft position. The less invasive technique may allow to extend the indication for sinus augmentation.     

A new method for investigating prototype learning.

Past researchers studied prototype learning by asking subjects to categorize exemplars constructed from different prototypes. This procedure is less than ideal because learning must be inferred from the percentage of correct categorizations pooled across many trials or subjects or both. An alternative procedure is proposed in which subjects are asked to reproduce their estimate of the prototype on each trial, thereby providing trial-by-trial information about changes in the estimated prototype. This procedure provides straightforward tests of three basic properties implied by several prototype learning models: additivity across exemplars, noninterference among features, and time invariance of serial position effects. An experiment is reported and the results provide reasonably good support for the properties of additivity and noninterference, but clear violations of time invariance were observed. The implications of the results for distributed-memory models and multiple-trace models of prototype learning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new scheduling method for time-limited counseling.

The conventional method of scheduling counseling sessions in an equal-interval manner (e.g., weekly sessions) is not optimal, as it rests on an incorrect assumption that the client's need for help and retention of the therapeutic effects of counseling are linear functions of time. A new method is described in which sessions are scheduled in a nonlinear manner, because both the need for counseling and the retention of therapeutic effects are often nonlinear functions of time. An example of such a schedule, derived from work in addiction treatment, is presented. This particular method is called the relapse-sensitive schedule. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ultrasonic pelvimetry. A method for preliminary estimation of the pelvic outlet

Vaginal sound, with transmitter crystals of 2 MHz, is used when measuring the interspinous diameter. The echo from pelvic wall, the effect on the measured spinal diameter by altering the position of the ultrasonic transmitter, and the influence of air or faeces between the ultrasound transmitter and the pelvic wall, have been analysed in a series of model trials on a dummy submerged in water. Thereafter clinical trials were performed on 102 women, pregnant in their 9th month. The results obtained when measuring the interspinous diameter on the ultrasonic tomogram were compared with the results obtained when measuring the same distance on a frontal x-ray picture taken using the orthographic technique according to Borell-Frenstr?m. The method is suitable for selecting those cases with suspect constriction of the pelvic outlet for an x-ray examination by the Borell-Fernstr?m technique.     

Effects of ten hours of implosive therapy in the treatment of outpatients: A preliminary report.

The present report, investigating the effectiveness of implosive therapy (IT) with outpatients, mainly was designed as an exploratory study to determine the feasibility and value of more effective evaluations of this new behavioral therapy. 40 patients were divided into 1 experimental and 3 control groups. Only the IT group showed a consistent trend to shift away from psychopathology as measured by the MMPI. Some evidence is presented that the changes in this group are not due to the number of therapy sessions, to the skills and personal qualities of the therapists independent of the treatment technique, to the termination of treatment, or to effects resulting from the commitment to and expectation of professional treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of cryosurgery in the treatment of low and medium grade chondrosarcoma. A preliminary report

Eighteen chondrosarcoma (Grade I and Grade II) have been treated with cryosurgery. One patient subsequently developed a metastasis; three later had to have an en bloc resection (in two of these there was no tumor in the specimen) and three underwent amputation (one of these had tumor in the specimen). In general, cryosurgery for low grade chondrosarcoma is encouraging as long as the limb is protected postoperatively from fracture -- using various orthopedic appliances to allow bone regeneration (i.e. ischial weight bearing brace). Other complications such as nerve paralysis have been transient. One air embolis death occurred (in another disease) where the exit of nitrogen gas was blocked. This is preventable by allowing free exit of gas from the bone. Approximately 500 cases of primary bone have been treated with cryosurgery as of this date; long term follow-up results will be reported later.