Unique variant of partial anomalous pulmonary venous connection with intact atrial septum

Summary Partial anomalous pulmonary venous connections (PAPVCs) are rare in association with an intact atrial septum. However, the diagnosis should be considered in patients with otherwise unexplained findings of left-to-right shunt and right heart enlargement. An unusual variant is presented, which we considered unsuitable for operative repair, based on findings at catheterization. Developmental, hemodynamic, and surgical considerations are discussed.     

A case-control study of trapezius muscle activity in office and manual workers with shoulder and neck pain and symptom-free controls

A case-control study with matched pairs was initiated to investigate the relationship between shoulder-neck complaints and activity in the upper trapezius muscle. The matching was done so that the physical demands from work (external exposure) were equal for both the case and the control. Each pair was also matched for gender, age, working hours, and employment time. Male (n = 18) and female workers (n = 78) employed in both manual and office work were included. Muscle activation levels and pause patterns during work and muscle activity during tests of attention, coordination, and rest were recorded by surface electromyography. The results showed consistent associations between pain and signs of increased activation of the upper trapezius for the cases in the manual group. No such associations were observed in the office group. The results are consistent with the hypothesis that muscle activation patterns may in some instances, but not in all, explain why some workers develop pain while others do not in work situations where the physical demands are similar.     

Necrotizing fasciitis and evisceration complicating an inferiorly based epigastric TRAM flap

Summary The rectus abdommis myocutaneous flap, based on the deep inferior epigastric vessels, is an excellent flap for reconstructing large wounds of the groin and perineum. However, wound infection in the donor site is a potential complication, even with thorough preparation of the recipient site. We present one such case in a diabetic patient who developed a necrotizing fasciitis and evisceration following transfer of an inferiorly based myocutaneous flap.     

Analog language teaching versus natural language teaching: Generalization and retention of language learning for adults with autism and mental retardation

Examined the effects of two instructional methods on language generalization and longterm retention in 23 adults with autism and severe to profound mental retardation. Analog language teaching employed discrete trials in a controlled setting concentrating on discrimination and identification of materials. Natural language teaching emphasized instruction through interactions that occurred incidentally to training students in the use of materials to perform functional tasks. Assessments were conducted under conditions favoring analog teaching to assure against partiality toward natural language teaching. Under such disadvantageous conditions, the methods of natural language teaching would be supported by results showing either no difference or an advantage in their favor. Both techniques increased initial and long-term generalization though the results suggest no relative superiority for either method under these assessment conditions. A significant interaction was found between prior functioning level and sequence of instruction. Because natural language teaching has many strengths, few drawbacks, and produces equal generalization and retention under disadvantageous conditions, it is strongly supported as preferable for people with autism and mental retardation.The authors acknowledge the important assistance provided by the following people: the staff and management of the Behavior Development and Learning Center at CSH/DC directed by Israel Perel, Lisa Kramer, Steve Hafferkamp, James Lowdermilk, and, finally, and especially, to the participants themselves.