Robotic Sigmoidectomy of a Rare Instance of Sigmoid Colon Duplication in an Elderly Patient: A Case Report.

Duplication of the alimentary tract is a rare malformation that can occur in any portion of the gastrointestinal tract. Rarely diagnosed in adulthood, it is usually an incidental finding due to non-specific gastrointestinal symptoms. Approximately 80% of cases are diagnosed in infants less than two years old.

Sample selection in the face of design constraints: Use of clustering to define sample strata for qualitative research.

Objective: To sample 40 physician organizations stratified on the basis of longitudinal cost of care measures for qualitative interviews in order to describe the range of care delivery structures and processes that are being deployed to influence the total costs of caring for patients.

Data Sources: Three years of physician organization-level total cost of care data (n = 156 in California) from the Integrated Healthcare Association's value-based pay-for-performance program.

Study Design: We fit total cost of care data using mixture and K-means clustering algorithms to segment the population of physician organizations into sampling strata based on 3-year cost trajectories (ie, cost curves).

Double Application of TA-90 B Four-Row AutoSuture(c) Stapling Instrument: A Safe, Effective Method of Staple-line Production Indicated by Follow-up GI Series.

BACKGROUND: Controversy continues, concerning the best method of isolating upper and lower gastric pouches in Roux-Y gastric bypass. This paper reports a technique used from August 1991 through May 1996, in which there was a double application of the TA-90 B Four-Row AutoSuture Stapling Instrument to form the proximal gastric pouch. Because of a significant staple-line failure rate historically, many are separating the pouches.

Delayed hemorrhage following endoscopic retrograde sphincterotomy for choledocholithiasis.

To define the clinical significance of delayed postsphincterotomy hemorrhage, we reviewed 476 consecutive ERCP procedures performed over a three-year period. Of 250 patients who underwent endoscopic sphincterotomy (ES), five (2%) developed postprocedure hemorrhage, two of whom had immediate, self-limited bleeding that resolved after endoscopic injection of epinephrine and did not require transfusion. The other three had delayed hemorrhage characterized by: onset 20-48 hr after the procedure, melena without hematemesis as the index clinical manifestation of bleeding, and atraumatic balloon extraction of common duct stones.

Roux-Y Gastric Bypass: an effective anti-reflux procedure.

Gastric limiting procedures have made an improvement in the lives of those patients in whom they have been successful. Not only have there been marked improvements in diabetes, hypertension, and arthritis, but there have been a number a number of other 'spin-offs', not the least of which is control of reflux esophagitis by totally eliminating the secretion of the parietal cell mass of the stomach from rising into the esophagus. We compared a group of 100 obese patients with reflux esophagitis who underwent Roux-Y gastric bypass (RYGBP) to a normalisized group of 23 patients on whom we had done Nissen fundoplications in the past.

Computerized tomographic findings in two cases of congenital fibrosis syndrome.

Two patients with congenital ptosis and extraocular muscle fibrosis are described. The first patient showed marked atrophy of the left inferior rectus muscle. The second patient showed bilateral changes in all extraocular muscles.

Cerebellar infarct: late complication of the Fontan procedure?

Cardiac disease is present in approximately 30% of children with stroke. Other case reports have documented stroke in patients who have previously undergone the Fontan procedure for correction of tricuspid atresia. Most of these strokes have occurred in the immediate postoperative period.

Balloon dilatation of post-surgical ano-rectal strictures in two infants.

Balloon dilatation of ano-rectal strictures offers an alternative to surgical repair of such lesions. This procedure has been described in higher colonic strictures secondary to necrotizing enterocolitis in infants but not in post-surgical ano-rectal strictures. Two cases of successful balloon dilatation are reported.

Computed tomography of renal sarcoidosis.

Radiographic evidence of renal involvement by sarcoidosis is usually demonstrated as nephrocalcinosis or nephrolithiasis. We present a case of renal sarcoidosis manifested as noncalcified masses on contrast enhanced CT.

Spiral saphenous vein graft for replacement of internal jugular vein: a series of case reports.

Bilateral radical neck dissection with internal jugular vein extirpation, be it simultaneous or staged, results in severe cephalic venous hypertension. Symptoms remit with time, however, acutely contribute to the morbidity of the procedure. Internal jugular vein replacement using autogenous saphenous vein that is fashioned into a spiral conduit has been used in three patients undergoing bilateral or second side radical neck dissection.

Aerial adulticiding for the suppression of Culex tarsalis in Kern County, California, using low-volume propoxur: 1. Selection and evaluation of the application system.

Propoxur applied aerially at 4.7 liters/ha was an effective adulticide against organophosphate resistant Culex tarsalis. Applications by fixed-wing and helicopter underslung spray systems equipped with hydraulic nozzles provided good coverage of test areas as indicated by the mortality patterns of sentinel mosquitoes.

Histamine-evoked nasal secretion in the dog.

Nasal secretory activity was measured in seven dogs in response to topical stimulation by histamine and methacholine. The methacholine response was blocked by atropine but not by chlorpheniramine. The histamine response was blocked by chlorpheniramine but not by atropine.

Lymphoma of the nose and paranasal sinuses.

The records of 37 patients with lymphoma of the nose and paranasal sinuses in an 18-year period were studied. The symptoms were divided into three categories: (1) local symptoms: obstruction, bleeding, and rhinorrhea; (2) symptoms of invasion of adjacent structures: facial pain and ear fullness; and (3) systemic symptoms: fever, weight loss, and nocturnal sweating. The presence of an intranasal mass was the most common physical finding.

Crohn's disease of the epiglottis, aryepiglottic folds, anus, and rectum.

A 23-year-old white women complained of sore throat and difficulty in breathing. Examination of her larynx revealed chronic inflammatory changes of the epiglottis and aryepiglottic folds, and a biopsy demonstrated chronic granulomatous reaction. Six months later she developed chronic diarrhea, rectal pain, and typical anorectal findings of Crohn's disease.