Y to V instead of Z to N

A multiple Y to V plasty is easier to perform than a multiple Z-plasty, it permits further elongation and does not tend to provoke flap necrosis.     

Treatment of complete rectal prolapse: To narrow,to wrap,to suspend,to fix,to encircle,to plicate or to resect?

Selection of the best surgical procedure for the treatment of complete rectal prolapse is difficult amid the many different techniques for which excellent results are reported. A critical review is given. It is concluded that any surgical procedure with rectal mobilization and fixation as a standard maneuver will lead to a recurrence rate of 2% to 4%. Advocacy of additional maneuvers to make the procedure easier is acceptable if it does not lead to a higher complication rate. But to obtain a better result its benefit has to be proven, either by a large prospective double-blind study, or by tests from the colorectal laboratory. New surgical techniques for rectal prolapse should therefore be based, not only on a low recurrence and complication rate, but also on tests that evaluate the effect of the procedure on fecal continence.

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Resumen Seleccionar el mejor procedimiento quirúrgico para el tratamiento del prolapso rectal completo es difícil, frente a las numerosas y diversas técnicas, cada una de las cuales reclama excelentes resultados. Se presenta una revisión crítica y se plantea la conclusión de que cualquier procedimiento quirúrgico que implique la movilización y fijación como maniobra estándar, da lugar a una tasa de recurrencia de 2–4%. Es aceptable preconizar maniobras adicionales para una más fácil realización del procedimiento mientras no resulten en incremento de la tasa de complicaciones. Para reclamar un mejor resultado, es necesario comprobar el beneficio mediante un estudio prospectivo y doble ciego mayor o por medio de pruebas funcionales en la laboratorio colorrectal. Las nuevas técnicas quirúrgicas para el tratamiento del prolapso rectal deben fundamentarse no sólo en bajas tasas de recurrencia y de complicaciones, sino también en pruebas funcionales que valoren objetivamente el efecto del procedimiento sobre la continencia fecal.

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Résumé Choisir le meilleur procédé chirurgical pour traiter le prolapsus total du rectum est d'autant plus difficile qu'il existe de nombreuses méthodes thérapeutiques, toutes vantées dans la litérature pour être la meilleure. Une revue critique des ces procédés est faite. On conclue que toute méthode comportant une mobilisation et une fixation du rectum est suivie de récidive dans 2 à 4% des cas. Recommander des gestes supplémentaires pour faciliter la technique n'est acceptable que si le taux des complications n'augmente pas. Pour prouver que les résultats sont meilleurs, cependant, il faudrait soit réaliser une grande étude prosective à double insu, soit faire des comparaisons par des tests de laboratoire de physiologie colorectale. Des techniques nouvelles de chirurgie du prolapsus rectal devraient être basées non pas sur le taux de récidive ou de complication, mais aussi sur le résultats des tests qui démontrent son efficacité sur la continence fécale.

     

A case of shock due to hypersensitivity to dextran

An examination is made of the relevant literature in the light of a case of shock due to serious hypersensitivity to high molecular weight (70,000) dextran. It is shown that similar cases occur with a certain frequency when dextran is used in situations other than surgery and frank shock. The reaction explodes in response to the first drops of the first administration. The ready availability of resuscitation equipment is a fundamental requisite for the satisfactory outcome of treatment.     

Relation of precurarization to suxamethonium to provide ease of intubation and to prevent post-suxamethonium muscle pains.

Tubocurarine 0.05 and 0.07 mg.kg-1, gallamine 0.1 and 0.2 mg.kg-1 and pancuronium 0.01 and 0.02 mg.kg-1 given three minutes before suxamethonium 1.0, 1.5 and 2 mg.kg-1 in groups of 10 patients each (total 210 patients) to compare ease of tracheal intubation and incidence of post-suxamethonium muscle pain. These were compared with a control group of suxamethonium 1.0, 1.5 and 2 mg.kg-1 given alone after thiopentone 5 mg.kg-1. On analysis, tubocurarine 0.07 mg.kg-1 and suxamethonium 2 mg.kg-1 was the ideal combination with the best intubation conditions and the lowest incidence of post-suxamethonium muscle pains. The second best combination was gallamine 0.2 mg.kg-1 and suxamethonium 2 mg.kg-1. Pancuronium 0.01 mg.kg-1 and 0.02 mg.kg-1 in combination with suxamethonium 2 mg.kg-1 were satisfactory, although less efficient than the combination with either tubocurarine or gallamine.     

Relationship of family schema to family adaptation to brain injury

The relationship between family schema and family adaptation to brain injury was investigated. Participants were 87 primary caregivers of persons with brain injuries in Wisconsin who are part of a comprehensive, longitudinal study of family adaptation to having a member with a brain injury. Stepwise multiple regression of variables measuring family schema on family adaptation indicated that manageability and meaningfulness were predictive of family adaptation. Thus the hypothesis that family adaptation can be predicted from variables measuring family schema was supported. Family intervention and research implications are discussed.     

Addition of sertraline to other therapies to reduce dialysis-associated hypotension

Sertraline has shown promise in the treatment of dialysis-associated hypotension (DAH) in a limited number of end-stage renal disease patients. We undertook a study to evaluate the effect of adding sertraline to other therapies for patients with documented DAH. We also measured the effect of sertraline on intradialytic haemodynamics. We used the ultrasound dilution technique (HD01 monitor) to measure cardiac output (CO), central blood volume (CBV) and peripheral vascular resistance (PVR) in these patients. The study was performed in two phases. Phase 1 was a control, while the second phase consisted of treatment with sertraline (50 mg/day). Cardiac output and central blood volume were measured 30 min following the initiation of dialysis and 30 min prior to the termination of dialysis. Blood pressure (BP) was monitored during haemodynamic measurements and throughout dialysis. Eighteen patients with documented DAH completed the study. Cardiac output, CBV and PVR were no different in the sertraline phase as compared with the control phase. The declines in systolic BP, diastolic BP and mean arterial pressures from pre-haemodialysis (HD) to lowest intradialytic and pre-HD to post-HD were not significantly different for the sertraline phase versus the control phase. In conclusion, it appears that sertraline has no additive effect on intradialytic haemodynamics to improve blood pressure in patients with DAH who are under therapy (with sodium modelling, cool dialysate and midodrine).     

How to use one's voice to take care of others

Voice is something which can greatly help healthcare providers because it is a genuine relational tool. Knowing one's voice means finding one's ability to receive, listen, be heard and approach others. Thus, working on one's voice helps to attain self-knowledge which naturally leads to knowledge of others and better quality care for them.