Complete fundoplication is not associated with increased dysphagia in patients with abnormal esophageal motility.

Abnormal esophageal motility is a relative contraindication to complete (360-degree) fundoplication because of a purported risk of postoperative dysphagia. Partial fundoplication, however, may be associated with increased postoperative esophageal acid exposure. Our aim was to determine if complete fundoplication is associated with increased postoperative dysphagia in patients with abnormal esophageal motor function.

Dissection: a positive experience.

First-year medical students were surveyed by questionnaire to assess levels of stress and physical symptoms resulting from their experience of the anatomy room. There was a 100% response rate from the 188 students. Most students (95%) found the prospect of their first visit to the anatomy room exciting.

A diffusion theory model of spatially resolved fluorescence from depth-dependent fluorophore concentrations.

A photon diffusion model has been developed to calculate the steady-state spatially resolved fluorescence from pencil beam excitation in layered tissue. The model allows the calculation of both the excitation reflectance and the fluorescence escape for an arbitrary continuous depth distribution of tissue optical properties and fluorophore concentration. The validity of this model was verified by comparison with Monte Carlo simulations and experimental measurements using phantoms with tissue-like optical properties.

Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: long-term results.

Purpose: To evaluate the long-term effectiveness of the percutaneous treatment of portal venous stenoses in children and adolescents with reduced-size hepatic transplants.

Materials And Methods: During the past 5 years, percutaneous transhepatic balloon venoplasty was attempted in 25 children and adolescents with anastomotic portal venous stenoses that occurred after reduced-size hepatic transplantation. All procedures were performed with direct puncture of the intrahepatic portal vein and with subsequent balloon dilation.

Anisotropy of light propagation in human skin.

Using spatially resolved, steady state diffuse reflectometry, a directional dependence was found in the propagation of visible and near infrared light through human skin in vivo. The skin's reduced scattering coefficient mu(s)' varies by up to a factor of two between different directions of propagation at the same position. This anisotropy is believed to be caused by the preferential orientation of collagen fibres in the dermis, as described by Langer's skin tension lines.

The development and validation of an algorithm for real-time computerised fetal heart rate monitoring in labour.

Objective: To develop and validate a computerised algorithm for the interpretation of the characteristics of fetal heart rate monitoring in labour.

Design: Prospective observational study.

Setting: Labour ward in a tertiary hospital.

Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication.

Toupet (270 degrees) fundoplication is commonly recommended for patients with gastroesophageal reflux (GER) and esophageal dysmotility. However, Toupet fundoplication may be less effective at protecting against reflux than Nissen (360 degrees) fundoplication. We therefore compared the effectiveness and durability of both types of fundoplication as a function of preoperative esophageal motility.

Endogastric surgery.

Endogastric surgery is a branch of minimally invasive surgery that combines flexible endoscopy and laparoscopy. By placing trocars directly into the stomach, quite a number of procedures may be performed. Leiomyomas and other benign gastric tumors are readily removed, and in Asia early gastric cancers are removed with these techniques.

Choice of insufflating gas influences on wound metastasis.

Background: Laparoscopic cancer surgery is limited by concerns about port-site metastasis. No study has definitively addressed the behavior and growth of tumor cells after the use of specific laparoscopic gases.

Methods: In athymic rats, 10,000 colon cancer cells were injected intraperitoneally.

Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts.

Objective: We evaluated the technical success and complications of percutaneous transhepatic biliary drainage in patients with nondilated intrahepatic bile ducts.

Materials And Methods: Between January 1, 1996, and August 31, 1998, 130 percutaneous transhepatic biliary drainage procedures were performed on patients with nondilated intrahepatic bile ducts. This group comprised primarily patients who had received liver transplants or who had sustained iatrogenic bile duct injuries.

Immunocytochemical characterization of catecholaminergic neurons in the rat striatum following dopamine-depleting lesions.

It is possible either permanently or transiently to deplete the rat striatum of dopamine. Following such depletions, striatal neurons immunoreactive for tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (AADC) or dopamine appear. The presence of dopamine-producing neurons in the striatum has relevance for the treatment of Parkinson's disease, but whether these catecholaminergic phenotypes all produce dopamine is unclear.

The significance of an 'insufficient' Pipelle sample in the investigation of post-menopausal bleeding.

Background: Out-patient endometrial sampling is a commonly performed procedure in the investigation of post-menopausal bleeding. We hypothesized that an 'insufficient' Pipelle sample reliably reflected the absence of serious endometrial pathology.

Methods And Results: A review of 141 consecutive cases reported as 'insufficient' for diagnostic purposes revealed 29 (20%) cases to have uterine pathology after secondary investigation.

Problem-based learning in ophthalmology: a pilot program for curricular renewal.

Objectives: To gain experience with problem-based learning as a demonstration project in a medical school's curriculum renewal effort and determine if using a single facilitator to circulate among the small groups would yield positive results.

Design: We developed 16 cases around 4 ophthalmic problems that were used in 3-hour small-group sessions during the Introduction to Clinical Medicine semester of the second-year curriculum. A single faculty member facilitated the small groups of 4 students each that were created by self-division at each of 5 sessions.

Laparoscopic fundoplication for dysphagia and peptic esophageal stricture.

Peptic esophageal stricture with dysphagia is a late manifestation of severe gastroesophageal reflux disease (GERD). Although laparoscopic fundoplication is an effective antireflux operation, its efficacy for persons with peptic esophageal stricture and dysphagia has not been well defined. The aim of this study was to evaluate outcomes after fundoplication in this subgroup of GERD patients.

Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus.

Background: Columnar-lined esophagus with intestinal metaplasia (IM), also called Barrett's esophagus, is a manifestation of severe gastroesophageal reflux (GER) and may predict poor symptom relief and high failure rate after fundoplication. We compared symptom scores and reoperation rates in GER patients with and without Barrett's esophagus.

Methods: Between July 1992 and July 1997, 646 patients underwent fundoplication (626 laparoscopic).

Intrapartum umbilical artery Doppler velocimetry as a predictor of adverse perinatal outcome: a systematic review.

Objective: To evaluate the diagnostic prediction of intrapartum umbilical artery Doppler velocimetry for adverse perinatal outcomes using systematic quantitative overview of the available literature.

Design: Online searching of MEDLINE database (January 1966-September 1997), scanning of bibliography of known primary and review articles, review of recent journal issues and that from personal files. Study selection, assessment of study quality and data extraction were all performed in duplicate under masked conditions.

Treatment of venous outflow stenoses in thigh grafts with Wallstents.

Objective: We studied the effectiveness of Wallstent deployment to treat elastic femoral and iliac vein stenoses in patients with lower extremity hemodialysis grafts.

Materials And Methods: Between August 31, 1992, and October 13, 1997, 44 metallic stents were deployed in 20 patients to treat stenoses exhibiting immediate, significant elastic recoil after angioplasty. Twenty-four stents were placed in the femoral and saphenous veins, and the remaining 20 stents were placed in the iliac veins.

Temporal characteristics of speech produced by inexperienced signers during simultaneous communication.

This study investigated temporal characteristics of speech produced during simultaneous communication (SC) by inexperienced signers. Recordings of stimulus words embedded in sentences produced with speech-only versus SC were made by 12 students during the first and last weeks of an introductory sign language course. Results indicated significant temporal differences between speech-only and SC conditions during both the first week and the last week of the class.

Fundoplications resist reflux independent of in vivo anatomic relationships.

Background: Antireflux operations restore lower esophageal sphincter (LES) function and hiatal anatomy; however, the relative contributions are unclear.

Methods: We measured the competency of fundoplications, exclusive of in vivo variables, in gastroesophageal explants from 8 cadavers. Using a multichannel manometer, esophageal, LES, and intragastric pressures were recorded during transpyloric distension.

Tomorrow's doctors: today's mistakes?

Tomorrow's Doctors, published by the General Medical Council of the UK in December 1993, has prompted far-reaching changes to medical education in Britain. We draw attention to some inconsistencies in the document and to those aspects of it that we maintain are undesirable. We question the emphasis in Tomorrow's Doctors on change in view of the unchanging nature of the structure and function of the human body.

Sharp recanalization of central venous occlusions.

Purpose: To describe a sharp puncture technique for recanalization of chronic central venous occlusions that could not be traversed by a guide wire.

Materials And Methods: Five patients presented with six longstanding central venous occlusions that could not be traversed with a guide wire after thrombolysis. The occlusions occurred following radiation for lung carcinoma (n = 2) and indwelling venous catheters (n = 4).

The lack of augmentation by aspirin of inhibition of platelet reactivity by ticlopidine.

A decreased threshold for platelet activation apparently contributes to the risk of cardiovascular events, such as acute myocardial infarction. To evaluate the impact of specific agents, we characterized platelet reactivity in 9 healthy subjects before and after 5 days of ingestion of 4 commonly prescribed regimens, 81 mg of aspirin daily, 325 mg of aspirin daily, ticlopidine 250 mg twice daily, and ticlopidine plus 325 mg of aspirin daily. Platelet reactivity was assessed with (1) aggregometry induced by 4 microM adenosine diphosphate (ADP) and collagen (0.