Neonates with hypoplastic left heart syndrome have ultrasound evidence of abnormal superior mesenteric artery perfusion before and after modified Norwood procedure.

Objective: To a) describe superior mesenteric artery resistive index, as an estimate of perfusion, before and after modified Norwood; and b) assess incidence of diastolic flow reversal in the superior mesenteric artery before and after modified Norwood.

Design: Prospective observational trial.

Setting: Children's hospital pediatric intensive care unit.

Comorbidity: cannabis and complexity.

Cannabis is one of the most commonly used illicit drugs, and its effects have traditionally been seen as less harmful than outcomes associated with the highly prevalent use of alcohol and other illicit substances (e.g., cocaine and amphetamines), and injecting drugs.

Myocardial compliance was not altered after acute induction of atrial fibrillation in sheep.

Background: Although left ventricular (LV) contractility in atrial fibrillation (Af) is known to change in a beat-to-beat fashion, little is known about the changes in LV compliance in Af.

Material/methods: We experimentally induced tachycardic Af (average heart rate - 154 beats per minute) in 18 sheep. LV volume and pressure were simultaneously monitored using a conductance catheter.

Massage therapy improves the management of alcohol withdrawal syndrome.

Objectives: Massage therapy has promise as an adjunct to standard alcohol detoxification procedures but has not been investigated comprehensively.

Design: The study was a randomized controlled trial comparing massage therapy to a "rest" (control) condition in patients undergoing alcohol detoxification.

Settings/location: Hospital-based alcohol and drug detoxification clinic.

A comparison of the Yale-Brown Obsessive Compulsive Scale for "heavy drinking" with a single item craving measure: construct validity and clinical utility.

The measurement of alcohol "craving" began with single-item scales. Multifactorial scales developed with the intention to capture more fully the phenomenon of craving. This study examines the construct validity of a multifactorial scale, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd).

Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection.

Background: Multimodal postoperative care regimens accelerate recovery after abdominal surgery. The benefit of thoracic epidural (TE) analgesia over patient-controlled analgesia (PCA) remains unproven when used with a fast-track postoperative care plan.

Methods: Fifty-six patients undergoing major intestinal resection, and on a fast-track postoperative care plan, were randomized to preemptive TE or PCA.

Immunohistochemical detection and Western blot analysis of nitrated protein in stored human corneal epithelium.

While the production of nitric oxide by human corneas in storage has recently been demonstrated, protein nitration as a result of this production has not been demonstrated. In this study, nitrated protein accumulation in the epithelium of stored human corneas was assessed. One half of five donor corneas maintained in storage media for 3 days were prepared for immunohistochemical studies.

In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease.

Background & Aims: Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion.

Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy.

Background: Laparoscopic Heller myotomy (HM) has become an increasingly preferred modality to treat achalasia. However, the treatment course after a failed myotomy is controversial with fears that pneumatic dilation (PD) has high perforation risk.

Goal: To compare success and safety of graded PD with Rigiflex balloons in achalasia patients without a prior HM (untreated cases) and those with a failed HM.

Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.

Objective: Recent experience with surgery for enterocutaneous fistulae (ECF) at a specialist colorectal unit is reviewed to define factors relating to a successful surgical outcome.

Summary Background Data: ECF cause significant morbidity and mortality and need experienced surgical management. Previous publications have concentrated on mortality resulting from fistulae, while factors affecting recurrence have not previously been a focus of analysis.

Alcohol dependence: the impact of cognitive behaviour therapy with or without naltrexone on subjective health status.

Objectives: To examine the health-related quality of life of alcohol-dependent patients across a 12-week cognitive behaviour treatment (CBT) program and identify whether the patient selection of the anticraving medication naltrexone further enhanced these outcomes.

Method: One hundred and thirty-six consecutive alcohol-dependent subjects voluntarily participated and were offered naltrexone, of which 73 (54%) participants declined medication. A matched design was used.

Ex vivo histology-correlated optical coherence tomography in the detection of transmural inflammation in Crohn's disease.

Background And Aims: Distinguishing Crohn's disease (CD) from ulcerative colitis (UC) can be difficult. Transmural inflammation, a key feature of CD, cannot be assessed by conventional colonoscopy with biopsy. Optical coherence tomography (OCT) provides high-resolution, cross-sectional images of the gut wall and might become a new diagnostic tool.

The value of a p-valueless paper.

As is common in current biomedical research, about 85% of original contributions in The American Journal of Gastroenterology in 2004 have reported p-values. However, none are reported in this issue's article by Abraham et al. who, instead, rely exclusively on effect size estimates and associated confidence intervals to summarize their findings.

Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores.

Background & Aims: This study aims to quantify the risk of cardiac surgery in patients with cirrhosis.

Methods: Records of all adult patients with cirrhosis undergoing cardiac surgery using cardiopulmonary bypass at the Cleveland Clinic (Cleveland, OH) from January 1992 to June 2002 were analyzed for any relationship of Child-Pugh class and/or score and Model for End-Stage Liver Disease (MELD) score with outcome measures of hepatic decompensation and death during the first 3 months after surgery.

Results: Forty-four patients underwent coronary artery bypass grafting (16 patients), valve surgery (16 patients), a combination of the 2 procedures (10 patients), or pericardiectomy (2 patients).

Afferent limb ulcers predict Crohn's disease in patients with ileal pouch-anal anastomosis.

Background & Aims: Some patients who undergo ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC) or indeterminate colitis are subsequently diagnosed with Crohn's disease (CD). Making the diagnosis of CD in patients with IPAA can be difficult, but it is important for prognostic and therapeutic purposes. The aim of this study was to identify diagnostic features of CD in patients with IPAA.

Complexities of managing achalasia at a tertiary referral center: use of pneumatic dilatation, Heller myotomy, and botulinum toxin injection.

Purpose: The purpose of this study is to describe the results and complexity of treatment for achalasia patients presenting to a single esophagologist at a tertiary referral center and to make treatment recommendations based on this experience.

Methods: Retrospective chart review of achalasia patients treated between 1994 and 2002. Symptoms, manometric and timed barium esophagram results, and treatments/outcome at CCF determined.

The role of drinking restraint in alcohol dependence: validation of the temptation and restraint inventory in an alcohol dependent sample.

Objective: The Temptation and Restraint Inventory (TRI) is commonly used to measure drinking restraint in relation to problem drinking behavior. However, as yet the TRI has not been validated in a clinical group with alcohol dependence.

Method: Male (n = 111) and female (n = 57) inpatients with DSM-IV diagnosed alcohol dependence completed the TRI and measures of problem drinking severity, including the Alcohol Dependence Scale and the quantity, frequency and week total of alcohol consumed.

Fecal lactoferrin for diagnosis of symptomatic patients with ileal pouch-anal anastomosis.

Background & Aims: Increased stool frequency, urgency, and abdominal pain in patients with ileal pouch-anal anastomosis (IPAA) may be due to inflammatory conditions, including pouchitis, cuffitis, or Crohn's disease or noninflammatory conditions such as irritable pouch syndrome. Distinction among these entities requires pouch endoscopy and biopsy. Noninvasive means of diagnosis are preferable.

Predictors of outcome of pneumatic dilation in achalasia.

Background & Aims: Graded pneumatic dilation (PD) is a widely accepted treatment for achalasia. We investigated the potential predictors of outcome in a large group of patients with achalasia and tested the hypothesis that graded PD may not be appropriate for all patients.

Methods: Patients undergoing PD from 1992 to 2002 were evaluated retrospectively.

Type of fistula determines response to infliximab in patients with fistulous Crohn's disease.

Objectives: Infliximab has been shown to be efficacious for treating perianal fistulae in patients with Crohn's disease. There is limited information regarding response to infliximab in patients with other types of fistulae.

Methods: Sixty consecutive patients with fistulous Crohn's disease and at least three months of follow-up after three infliximab infusions were evaluated.

Inhibition of nitric oxide synthesis in corneas in storage media.

The nitrate/nitrite content in storage media was determined after nitric oxide synthase inhibition by adding 400 microl of 100 mm N(G)-monomethyl-l-arginine (LMMA) to four chambers of Optisol GS corneal storage media, each containing one viable human cornea. The companion corneas in storage media without LMMA served as controls. Four hundred microlitre aliquots obtained at baseline (day 0) and at one-day intervals for 20 more days for both groups were analyzed for nitrate and nitrite (breakdown products of nitric oxide) concentration levels using a spectrophotometric method based on the Greiss reaction.

Chromosomal gains and genomic loss of p53 and p16 genes in Barrett's esophagus detected by fluorescence in situ hybridization of cytology specimens.

Endoscopic brush cytology is a promising surveillance technique for Barrett's esophagus. Ancillary markers are sought to increase the sensitivity of cytology and allow identification of patients at increased risk for disease progression. To determine if there are specific genetic changes in Barrett's esophagus with associated high-grade dysplasia/intramucosal adenocarcinoma compared to those without dysplasia, we performed fluorescence in situ hybridization (FISH) on cytologic specimens using probes to chromosomes and genomic regions previously described as altered in this disease.

Air-charged and microtransducer urodynamic catheters in the evaluation of urethral function.

This study aimed to compare measurements of urethral pressure profile and Valsalva leak point pressure (VLPP) obtained with air-charged and microtransducer catheters. Forty-five women with urogynecologic dysfunction underwent multichannel urodynamic evaluation including maximum urethral closure pressure (MUCP), functional urethral length (FUL), and VLPP with air-charged balloon catheters as well as microtransducer catheters. Lin's concordance coefficient was used to examine the agreement of MUCP, VLPP, and FUL measurements with the two catheters.

Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes.

Objective: To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients.

Design: Prospective cohort study.

Setting: Eighteen-bed MICU in 964-bed tertiary care center.