Laparoscopic cholecystectomy: evaluation of intraoperative complications with respect to 2 different kinds of anesthesia

Two anaesthetic managements for elective laparoscopic cholecystectomy were compared in 64 patients in order to investigate some perioperative complications: 1) bowel distension during surgery. 2) recovery from anaesthesia. 3) post-surgery incidence of emesis and pain. In addition, the quality of postoperative peristalsis as well as the time of dimissal were recorded. Group I (n = 30) was treated with NLA in N2O-O2 and Group II (n = 34) received propofol plus fentanyl in air-O2. Bowel distension, evaluated by surgeon at 15 min intervals throughout the operation was similar in both the groups as well as postoperative peristalsis recuperation. During the first 12 hours after laparoscopy no differences were found at any times of observation in the incidence or severity of emesis and pain between the two different anaesthesia patients. In subjects which were given propofol the psychomotor recovery was more rapid than after NLA, particularly during the first 6 hours after surgery. The patients were discharged between 36-48 hours following the operation independently from anaesthetic management. It is concluded that both the anaesthetic techniques provide similar intra/postoperative conditions, except the early recovery that is more rapid for the propofol patients. The overall frequency of emesis and pain was rather high in both the groups, suggesting a routine medication with analgesics and antiemetics.     

Family health and mental health six years after economic stress and unemployment

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.     

The Economic Impact of Sports Stadium Construction: The Case of the Construction Industry in St. Louis,MO

This article examines the St. Louis construction industry’s employment with special attention given to the periods during which the Kiel Center and the Trans World Dome were being built. We analyze whether the construction of a major sports stadium increases construction industry employment. An econometric model is developed to explain the times series trend of construction industry employment in the St. Louis SMSA. The statistical evidence suggests that the levels of employment in the construction industry were neither higher nor lower during the construction of these stadia. It is argued that construction on these projects merely substituted for other construction projects in this SMSA.     

Medical residents' colorectal cancer screening may be dependent on ambulatory care education

Colorectal cancer results in significant morbidity and mortality in the United States. Screening is a critical component of cancer prevention. However, research has suggested that physicians may inconsistently adhere to surveillance guidelines. Since residency training can significantly impact upon future practice patterns, assessment of postgraduate colorectal cancer education is important. This retrospective chart review of patients > or = 50 years of age compared screening performed by resident physicians' in different internal medicine residency programs at The George Washington University Medical Center. Resident physicians who received multiple lectures in colorectal cancer surveillance or were required to document performance of screening on a medical record preventive care summary form performed significantly more rectal examinations (P < 0.0004), fecal occult blood testing (P < 0.00001), and flexible sigmoidoscopies (P < 0.00001) when compared to other resident physicians. Postgraduate education should employ multiple education techniques and reinforcement procedures to increase physician compliance with cancer screening.     

Toward a developmental-contextual model of the effects of parental spanking on children's aggression

OBJECTIVE: To challenge the application of an unqualified social learning model to the study of spanking, positing instead a developmental-contextual model in which the effects of spanking depend on the meaning children ascribe to spanking. DESIGN: Population-based survey data from 1112 children aged 4 to 11 years in the National Survey of Families and Households. Controlled for several family and child factors including children's baseline aggression. MAIN OUTCOME MEASURES: Schoolyard fights and antisocial scores on the Behavior Problems Index at the 5-year follow-up. RESULTS: Structural equation modeling yielded main effects (P < or = .05, change in chi 2) of children's age and race; spanking predicted fewer fights for children aged 4 to 7 years and for children who are black and more fights for children aged 8 to 11 years and for children who are white. Regression analyses within subgroups yielded no evidence that spanking fostered aggression in children younger than 6 years and supported claims of increased aggression for only 1 subgroup: 8- to 11-year-old white boys in single-mother families (P < or = .05, F test). CONCLUSIONS: For most children, claims that spanking teaches aggression seem unfounded. Other preventive effects and harmful effects of spanking may occur depending on the child and the family context. Further efforts to identify moderators of the effects of spanking on children's adjustment are necessary.     

Characterization of the enzymatic and nonenzymatic reaction of 13-oxooctadecadienoic acid with glutathione

The enzymatic oxygenation of linoleic acid leads to the production of 13-hydroxyoctadecadienoic acid (13-HODE). Subsequent dehydrogenation of 13-HODE by the NAD(+)-dependent 13-HODE dehydrogenase results in the formation of the 2,4-dienone 13-oxooctadecadienoic acid (13-OXO). These oxidized derivatives of linoleic acid have been shown to be involved in several cellular regulatory processes. In the present study, we have examined the enzymatic and nonenzymatic reaction of 13-OXO with glutathione (GSH) and N-acetylcysteine (N-AcCySH). Nonenzymatic reaction rates were determined spectrophotometrically and exhibited a pH optimum of 9.0 which is consistent with attack of a thiolate anion. Product formation was evaluated by reverse-phase HPLC which showed formation of one major product upon reaction with either GSH or N-AcCySH. The HPLC-purified products were examined by FAB MS as well as one- and two-dimensional NMR. The products, with either GSH or N-AcCySH, were found to consist of an equal mixture of two diastereomers arising from addition of a thiolate to the 9 position of 13-OXO. Using GSH as the thiol, the reaction was also shown to be catalyzed by rat glutathione transferase 8-8. In the case of the enzymatic reaction there is stereoselective product formation. Furthermore, submicromolar concentrations of the 13-OXO-GSH conjugate were shown to significantly inhibit glutathione transferase activity in HT-29 homogenates. These investigations provide insight into the potential metabolic disposition of linoleate oxygenation products.