Assessing manual dexterity: Comparing the WorkAbility Rate of Manipulation Test with the Minnesota Manual Dexterity Test

Study Design

Cross-sectional study.

Liver biopsy findings in seventy-seven consecutive patients undergoing jejunoileal bypass for morbid obesity

To clarify the status of hepatic morphology existent at the time of jejunoileal bypass in morbidly obese patients (those more than 100 pounds overweight) and the subsequent changes in liver architecture after jejunoileal bypass, we are performing intraoperative and yearly postoperative liver biopsies in all of our patients managed in this manner. This is the first report of our liver studies and this paper is an analysis of the histologic aspects of the liver at the time of bypass in seventy-seven consecutive patients.This study clearly demonstrates that the majority of markedly obese patients undergoing jejunoileal bypass have fatty metamorphosis of the liver at the time of their operative procedure. Previous similar reports from the literature are reviewed, and theories for the origin of hepatic fatty infiltration in obesity per se and after jejunoileal bypass are discussed.     

Improvement of pancreas allograft survival after perfusion with concanavalin A.

Perfusion with Con A significantly improved the survival of canine pancreas allografts minimally immunosuppressed. Control dogs and those that received no Con A survived for only short periods of time. When the immunosuppression to the recipient animals was increased by adding methylprednisolone, the prolonging effect of Con A was even more significant.     

Reducing Minnesota Multiphasic Personality Inventory defensiveness: effect of specialized instructions on retest validity in a sample of preoperative bariatric patients

BACKGROUND: Because of the possibility of being denied or delayed surgery, bariatric patients might have a motivation to minimize any emotional difficulties in the preoperative psychological evaluation. This study examined changes in the psychometric test scores when extremely defensive patients were asked to repeat the testing. METHODS: Changes in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scale scores were studied in a subsample of patients referred to the author for a preoperative psychological evaluation. After producing defensive MMPI-2 test profiles, these bariatric patients (n = 31) were provided feedback on their defensiveness and asked to be more open and honest on the repeat testing. RESULTS: The vast majority (94%) of the patients produced valid profiles on the second test. On the second test, significant differences were found on 6 of the 13 MMPI-2 scales, as well as on separate measures of depression, anxiety, and anger. CONCLUSION: It appears to be important to include a psychometric measure that includes a validity scale in the evaluation process, because patients might be motivated to present in a defensive or overly virtuous light in fear that a negative evaluation from the psychologist would adversely affect a decision regarding their candidacy for surgery. It is recommended that patients who are defensive in their testing be asked to repeat the test battery.     

Renal transplantation in high risk patients older than sixty years

Nine patients between the ages of sixty and seventy-one years, with end-stage renal failure, received kidney grafts during a five year period. Five received related donor kidneys and four received cadaver donor kidneys. Six of these patients are still alive—four of the five (80 per cent) with related kidneys and two of the four (50 per cent) with cadaver kidneys. All six patients have normal kidney function an average of twenty-seven months after transplantation.We believe the elderly uremic patient should not be categorically excluded as kidney graft recipients on the basis of age alone. The prognosis of these patients treated by transplantation far exceeds that for uremic patients of the same age who are restricted to hemodialysis therapy.     

A simple snare for polypectomy through the fiberoptic colonoscope

A new snare for polypectomy through the fiberoptic colonoscope is described. It is safe, simple to manipulate, and economical. To insure longevity of the wire a detailed knowledge of the mechanism and technic is necessary.     

Renal transplantation for the nail patella syndrome

A patient with the nail patella syndrome (Fong's disease) with end stage renal failure received a renal transplant from his mother. There has been no recurrence of the disease in the year since transplantation. Such patients are apparently good candidates for transplantation, although careful selection of the donor from among the potentially affected family members should be conducted. In addition, the orthopedic and metabolic disabilities that characterize this disease may render these patients more susceptible to aseptic necrosis of the hips.     

The true incidence of synchronous cancer of the large bowel: A prospective study

The reported incidence of synchronous primary cancers and polyps associated with single cancers of the large bowel is varied. In a prospective study over a 5 year period, 166 patients with primary colorectal cancer had either total colonoscopy preoperatively or total colonoscopy within 6 months of surgical resection. One hundred seventy-eight cancers were detected. Synchronous cancers were found in eight patients (5 percent), and benign neoplastic polyps were demonstrated in 46 patients with single cancers (28 percent) and in 112 patients with synchronous primary cancers (38 percent). Of significance is that seven of eight (88 percent) synchronous cancers would not have been included in the standard resection for the index primary cancer. Similarly 31 of 46 neoplastic polyps (67 percent) were not in the same surgical segment as the primary cancer. Total large bowel evaluation, preferably using colonoscopy, is essential in all patients with cancer of the large bowel.     

Results of 100 consecutive polypectomies with the fiberoptic colonoscope. A new mode of treatment

With the recognition of colonoscopy and snare polypectomy as one of the most significant advances in colon and rectal surgery, this new modality of therapy was employed enthusiastically. One hundred consecutive polyps in seventy-eight patients were removed through the fiberoptic colonoscope. The ages of the patients ranged from four to eighty years. There were three postoperative bleeding episodes, none requiring blood transfusions. There was one delayed perforation of the sigmoid colon from fulguration of a small polyp. All the procedures were performed in the outpatient clinic except the one in a four year old boy who had removal of a polyp in the operating room. This procedure is strongly advocated for the removal of benign colonic polyps, but only by those with appropriate experience.     

Plasma activities of lysosomal enzymes after hepatic dearterialization in man.

Six patients with liver metastases from carcinoid or colon carcinoma underwent hepatic derterialization. This operation, known to cause both tumor necrosis and liver cell damage, caused considerable increases of several lysosomal acid hydrolases in the circulation. Thus, beta-glucosidase showed a small temporary increase during the operation, followed by a slower but higher reaction reaching a maximum 12 to 36 hours postoperatively. Similar reactions were noted for beta-glucuronidase, acid phosphatase, beta-galactosidase, arylsuphatase A, and N-acetyl-beta-glucosaminidase while no reactions were found for cathepsin D. Very high enzyme levels occurred in a patient dying from bleeding complications in the postoperative period.     

Kidney transplants from distant relatives.

From January 1, 1968 to June 1976 twenty patients received first kidney transplants from distant relatives including half-siblings, uncles, aunts, cousins, nephews, or grandparents. All recipients have been followed for at least one year and several for as long as nine years. Only one patient has been lost to follow-up six years post transplantation. The absolute one year patient survival is 85 per cent and the five year actuarial survival is 78.5 per cent including all causes of death, even death on dialysis years after kidney loss. The absolute one year functional survival is 75 per cent and the five year actuarial kidney survival is 51 per cent. Only three patients had diabetes in this series; one died after rejection and two survive and are well with kidneys at twenty-four months. There was no relationship of type of relative or number of shared HLA antigens with function and survival in this small series.The results are essentially equal to the results of transplants to siblings differing at one HLA haplotype, and well matched (2 to 4 HLA shared antigens) cadaver transplants except for a late high incidence of chronic rejection in recipients of distantly related transplants. If no closer blood-related volunteer is available, a more distant relative can be used with greater success than a poorly matched cadaver. On the other hand, if a large number of cadaver kidneys are available, a well matched cadaver kidney is worth waiting for and is equally successful as kidneys from distant relatives.     

A critical study of lister's work on antiseptic surgery

The work of Pasteur on alcoholic and lactic acid fermentation demonstrated that minute organisms (germs) caused these fermentative changes. Lister applied these basic findings in the introduction of his antiseptic system. Its principles were based on the destruction of germs by antiseptics (carbolic acid) to prevent their entering the wound or spreading after surgery. Lister's work on antisepsis was therefore based on the germ theory of disease. The believers of the germ theory defended Lister's theories whereas the nonbelievers of the germ theory created an atmosphere of resistance to Listerism. The work of Koch in 1878 on the etiology of traumatic infective diseases contributed greatly to the acceptance of Lister's antiseptic principles. By the mid 1880s there was a rapid increase in the use of antiseptic technics, soon followed by the introduction of aseptic methods and rapid progress in surgery.     

Double renal transplants from pediatric donors to adult recipients

Ten pairs of kidneys from pediatric cadaver donors have been transplanted in patients with renal failure. Preservation by perfusion and transplantation are carried out by way of the distal aorta after the proximal aorta and vena cava are closed. Seven of the ten pairs of kidneys have normal function sixteen to twenty-four months later. Since pediatric donors appear to be unusually frequent, this technic permits transplantation of pediatric kidneys into adults and provides adequate renal mass for normal function.     

Tuberculous joint disease in transplant patients.

Three patients with tuberculosis, all manifesting monarticular joint involvement, among 845 renal allograft recipients at the University of Minnesota are reported on. Clinical symptoms, methods of diagnosis, and optimal antibiotic regimes are discussed. The physician must suspect tuberculous joint disease when confronted with monarticular swelling and pain in the transplant recipient.     

Renal transplantation with blood supply by axillofemoral bypass graft

An axillofemoral bypass was used to preserve a functioning renal allograft after excision of a mycotic abdominal aortic aneurysm in a diabetic patient. In the presence of continued immunosuppression the aortic wall infection progressed and the patient expired after rupture of the proximal aortic closure.     

美容咨询者与受术者个性差异分析

目的：探讨美容咨询者与受术者的个性特征.方法：运用明尼苏达多相人格调查表（Minnesota Multiphasic Personality，MMPI）对西京医院整形外科美容门诊2005年3月～2005年4月就诊的61例女性咨询者进行心理测试，对其1 0个临床相进行分析，并与1999年杭州市整形医院12月份1 03例女性美容手术受术者MMPI1 0个临床相进行比较.结果：女性美容咨询者与受术者在个性方面表现不同，咨询人群在疑病相（HS）、抑郁相（D）、癔症相（叶）、病态人格相（PD）、偏执相（PA）、神经衰弱相（PT）、精神分裂相（SC）和社会内向相（SI）方面显著低于受术人群.结论：女性美容咨询者与女性美容手术受术者在个性方面存在差异。