Laparoscopic hernia repair in Leicester General Hospital: a prospective audit of 94 patients

Conventional hernia repair is effective in terms of cure but is associated with considerable postoperative pain and delay in return to normal activity. Laparoscopic repair has the potential to reduce pain and speed return to normal activity, but there have been few published reports of the outcome of this operation in the UK. We present a prospective audit of 94 patients who underwent laparoscopic repair. Of the 94 patients, 87 (92.6%) were male and 7 (7.4%) were female. Thirteen of the repairs were bilateral and 12 were recurrent. Two had to be converted to open repair. The mean operating time for unilateral repair was 56 min and for bilateral repair 98 min. Sixty-three patients (67%) were discharged within 24 h and 21 (22.4%) were discharged within 48 h. There were minor complications in 20 patients (21%), eight of whom (8.5%) developed a haematoma. The other minor complications included seromas (2), bruising at the site of the entry port (2), hyperaesthesia in the groin (2), port hernia (1), shoulder tip pain after surgery (3) and postoperative urinary retention (2). Nine (9.5%) patients claimed to have had no pain or discomfort at all; 35 (37.2%) were pain and discomfort free in 2 weeks. Thirty-two (34%) patients returned to normal activities in 2 weeks. With a median follow-up of 8 months 3 (3.2%) recurrences were noted. It is emphasised that this series represents a learning curve and that the operation is developmental. We are now restricting laparoscopic repair to recurrent and bilateral hernias where the technique offers particular advantages.     

Current Mode, Voltage Mode, or Free Mode? A Few Sage Suggestions

Many claims have been made about the benefits of a current-mode (CM) approach to IC design. The term is used to draw attention to some kind of special dependence on currents as signals, often without a clear orientation to the broader field, referring instead to recent CM papers. Its use suggests a significant and valuable distinction over “conventional” solutions, perhaps in the hope that this perspective, with an element of novelty at the cell level, will influence circuit design in the stringent context of IC production. This paper asks: What factors unambiguously define a current-mode circuit, and formally differentiate it from standard realizations of some function? Can one point to any compelling, and in the most favorable cases unique, advantages? Are these cells clearly of general value, capable of widespread utility? These issues are examined from the critical viewpoint that no circuits carry the entire functional burden by the exclusive use of either currents or voltages, and very few fully exploit the specific, but narrow, benefits of CM concepts. Real-world product development invariably demands the vigilant and full embrace of what might be called the Free Mode perspective, but merely as a mnemonic, not a classification.     

Computer configuration for Ontario Hydro's new energy managementsystem

In 1985, Ontario Hydro decided to build a system control center and install an energy management system (EMS). Because hardware was being installed, it provided an opportunity to review the standards of performance demanded of the EMS and technological advances that could be utilized. As a result of this review, more rigorous reliability requirements were defined and a computer configuration designed to satisfy these requirements. The authors discuss the resulting performance standards, examine alternative architectures, and describe the computer architecture finally chosen for the EMS     

Inhaled nitric oxide inhibits human platelet aggregation, P-selectin expression, and fibrinogen binding in vitro and in vivo

BACKGROUND: Recent data suggest that inhaled NO can inhibit platelet aggregation. This study investigates whether inhaled NO affects the expression level and avidity of platelet membrane receptors that mediate platelet adhesion and aggregation. METHODS AND RESULTS: In 30 healthy volunteers, platelet-rich plasma was incubated with an air/5% CO2 mixture containing 0, 100, 450, and 884 ppm inhaled NO. ADP- and collagen-induced platelet aggregation, the membrane expression of P-selectin, and the binding of fibrinogen to the platelet glycoprotein (GP) IIb/IIIa receptor were determined before (t0) and during the 240 minutes of incubation. In addition, eight patients suffering from severe adult respiratory distress syndrome (ARDS) were investigated before and 120 minutes after the beginning of administration of 10 ppm inhaled NO. In vitro, NO led to a dose-dependent inhibition of both ADP-induced (3+/-3% at 884 ppm versus 70+/-6% at 0 ppm after 240 minutes; P<.001) and collagen-induced (13+/-5% versus 62+/-5%; P<.01) platelet aggregation. Furthermore, P-selectin expression (36+/-7% of t0 value; P<.01) and fibrinogen binding (33+/-11%; P<.01) were inhibited. In patients with ARDS, after two who did not respond to NO inhalation with an improvement in oxygenation had been excluded, an increase in plasma cGMP, prolongation of in vitro bleeding time, and inhibition of platelet aggregation and P-selectin expression were observed, and fibrinogen binding was also inhibited (19+/-7% versus 30+/-8%; P<.05). CONCLUSIONS: NO-dependent inhibition of platelet aggregation may be caused by a decrease in fibrinogen binding to the platelet GP IIb/IIIa receptor.     

Use of the behavior problem checklist with psychotic adolescents.

Compared teacher ratings on the Behavior Problem Checklist of 56 adolescents who (a) were clinically diagnosed as schizophrenic (psychotic) and (b) had an adjustment reaction of adolescence (nonpsychotic). The schizophrenics tended to be rated as more deviant on both the flag items and Inadequacy–Immaturity dimensions of the checklist, whereas the adjustment reaction group was rated higher on the Conduct Problem and Socialized Delinquency dimensions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Application of Pattern Recognition Techniques to the Contingent Negative Variation for the Differentiation of Subject Categories

Pattern recognition techniques and the statistics of directional data have been applied to a repetitive waveform to differentiate between subject categories. Normal subjects and Huntington's Chorea patients were distinguished by comparing the patterns in the summarized results of statistical tests applied to the Fourier harmonics of their contingent negative variation (CNV) responses, by the consecutive phase angle variations of the first harmonic of their CNV's, and by their different averaged CNV's. A logic algorithm which may provide the basis of computerized diagnosis, or even prediction of the condition, is described.     

Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer: ten-year outcome

PURPOSE: To evaluate the 10-year outcome of patients with invasive (T2-3N0M0, staged according to the tumor, node, metastasis system) bladder cancer who responded completely to a combination of methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) chemotherapy followed by bladder-sparing surgery. PATIENTS AND METHODS: Of 111 surgical candidates who received neoadjuvant MVAC, 60 (54%) achieved a complete clinical response (T0) on transurethral resection (TUR) of the primary tumor site. Of these, 28 requested follow-up with TUR alone, 15 had a partial cystectomy, and 17 elected a radical cystectomy. The patients were followed up for a median of 10 years (range, 8 to 13 years). RESULTS: Of 43 patients who had bladder-sparing surgery, 32 (74%) are alive, which includes 25 (58%) with an intact functioning bladder. Twenty-four patients (56%) developed bladder tumor recurrences from 5 to 96 months, which were invasive in 13 (30%) and superficial in 11 (26%). Thirteen patients required a salvage cystectomy, of whom 6 died, which includes 4 (9%) from a new invasive neoplasm. Of the 17 patients who had radical cystectomy, 11 (65%) are alive. CONCLUSION: The majority of patients with invasive bladder tumors who achieve T0 status after neoadjuvant MVAC chemotherapy preserve their bladders for up to 10 years with bladder-sparing surgery. The bladder remains at risk for new invasive tumors. Cystectomy salvages the majority, but not all, of relapsing patients.     

Graves' ophthalmopathy

Ophthalmopathy develops in about 30% of patients who have Graves' disease. The pathogenesis, like that of the hyperthyroidism, is probably autoimmune in nature. The eye manifestations are diverse and include lid lag, soft tissue swelling, proptosis, corneal damage, diplopia, and optic neuropathy. The natural history is benign in 90% of patients, with gradual improvement over time. Therapeutic options include corticosteroid therapy, radiation, and surgical treatment. The last is usually the therapy of choice for severe or disfiguring ophthalmopathy.