Transvaginal ultrasound for the detection of urethral diverticula at urodynamic assessment

At the time of urodynamic assessment, 91 patients were examined by transvaginal echography. Two urethral diverticula were detected, one of which was only detected by ultrasound. Transvaginal echography clearly showed the size and anatomical relationship of the diverticulum to the bladder. We conclude that the procedure is a useful adjunct to routine testing for the detection of urethral diverticula.     

Raising a colostomy — results of a prospective surgical audit

A prospective surgical audit of all colostomies fashioned over a 1-year period in one hospital was conducted. Of one hundred and ten colostomies there were 56 loop and 52 end stomas. Following the formation of the colostomy a proforma was completed and the surgeon interviewed to document the precise surgical technique employed. Whilst in hospital the patients were regularly reviewed and the colostomies assessed by a surgeon and stomatherapist using a scoring system. Follow up was continued until closure of the colostomy or for a minimum period of 1 year. Only 53 (48%) of patients saw a stomatherapist preoperatively. This rate was higher in elective (86%) than in urgent cases (15%). The surgial technique used did not appear to influence the outcome of any given colostomy. However, failure to cruciate the posterior rectus sheath may predispose to stomal stenosis and the use of a subcutaneous polyethylene rod to support a loop colostomy often led to infection. Tension of the colostomy led to complications in 29 cases (26%), this was often the precipitating event to other complications and led to the only colostomy-related death. Registrars with experience of fewer than 5 colostomies received their training largely from other registrars rather than consultants. This prospective surgical audit has disclosed that fashioning a colostomy carries significant stoma related morbidity, most of which is potentially avoidable. Appropriate audit can contribute to the maintenance and improvement of surgical standards.     

Synaptic linkage in the vestibulo-ocular reflex pathway of rabbit

Summary Microelectrodes were inserted into IIIrd cranial nucleus of anaesthetized rabbit. IIIrd nucleus was identified by observing the field potentials evoked antidromically by stimulation of IIIrd cranial nerve. After stimulation of VIIIth nerve extracellular field potentials, spike potentials in secondary vestibular fibers, and postsynaptic potentials in IIIrd nucleus neurones were recorded. VIIIth nerve impulses either excite or inhibit IIIrd nucleus neurones postsynaptically with disynaptic latencies around 1.7 msec. By local stimulation of the medulla, it was found that the secondary vestibular impulses inhibiting IIIrd nucleus neurones are mediated by the superior nucleus. The excitatory impulses are relayed by the rostral half of the medial nucleus as well as a certain structure(s) relevant to the brachium conjunctivum. Preliminary pharmacological investigations on the inhibition of IIIrd nucleus neurones are reported.     

Mental health training for county welfare social work personnel: An exercise in education and community organization

The background, need for and implementation of a training program for a group of county welfare caseworkers representing ten counties in southwestern Minnesota is outlined. The program, which evolved from a cooperative effort by two community mental health centers, is described in terms of its philosophy, content and results. Implications for extended training of welfare and other social service personnel are denied.     

A correlational study of the Community Adaptation Schedule and the Minnesota Multiphasic Personality Inventory

The Community Adaptation Schedule (CAS) and Minnesota Multiphasic Personality Inventory (MMPI) were administered to 45 prisoners at a Federal prison and 40 nonprisoners at a vocational-technical school in order to explore the relationships between the CAS scales and 93 clinical and experimental MMPI scales. The CAS scores correlated with MMPI scales in a pattern consistent with the construct of community adaptation as assessed by the CAS. Implications of the study for further development of the CAS were discussed.This study was part of a Master's Thesis submitted to the Department of Psychology and was supported by a grant from the Council on Training and Research of the Florida Division of Mental Health. References for MMPI scales not listed in Dahlstrom and Welsh (1960) may be obtained from Dr. Cook.     

Volvulus of the small intestine in adults

The presentation and subsequent management of 53 patients with volvulus of the small bowel are reviewed. Important features of the presentation are the acute onset of the abdominal pain and its severity which is often inconsistent with the findings on clinical examination. The diagnosis was made preoperatively from plain abdominal x-rays in only 1 patient, although several radiological features are described. In 16 patients there were no obvious predisposing factors, although in the remaining 37 patients the volvulus occurred as a consequence of a predisposing anatomical abnormality. The mortality rate associated with volvulus in the presence of gangrenous small bowel is 47%. In the management of a patient presenting with small bowel obstruction, the possibility of volvulus must be considered in order to reduce this high mortality.

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Resumen Se revisaron la presentación clínica y el manejo de 53 pacientes con vólvulos del intestino delgado. Características importantes de la presentación son el comienzo agudo del dolor abdominal y su grado de severidad, el cual con frecuencia no guarda relación con los hallazgos en el examen clínico. El diagnóstico preoperatorio se hizo mediante la radiografía abdominal en sólo un paciente, a pesar de que varias características radiológicas han sido descritas. En 16 pacientes no se encontraron factores predisponentes obvios, aunque en los otros 37 pacientes el vólvulos se presentó como consecuencia de una anormalidad anatómica predisponente. La mortalidad asociada con el vólvulos en presencia de gangrena del intestino delgado es de 47%. En el manejo del paciente que se présenta con obstruccion del intestino delgado, debe considerarse la posibilidad de vólvulos si se pretende disminuir tan elevada mortalidad.

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Résumé L'aspect clinique et le traitement de 53 cas de volvulus de l'intestin grêle font l'objet de l'article. La clinique est dominée par le début soudain et l'intensité de la douleur qui contrastent avec la discrétion des données de l'examen clinique. Le diagnostic préopératoire dans cette série n'a été porté avec exactitude que dans un seul cas grâce à la radiographie simple de l'abdomen ce qui est surprenant en raison de la richesse de la symptomatologie radiologique de l'affection. Chez 16 malades, aucun facteur prédisposant n'a été trouvé mais chez 37 autres patients le volvulus a représenté la conséquence d'une anomalie anatomique favorisante. La mortalité s'est élevée à 47% quand l'intestin était sphacélé. Chez tout malade qui présente une occlusion aiguë du grêle le diagnostic de volvulus doit être envisagé pour intervenir sans délai et réduire ainsi le taux encore élevé de la mortalité.