Morphology of pulmonary atresia with intact ventricular septum in patients dying after operation

In 1976, we adopted staged surgical management of pulmonary atresia with intact ventricular septum: stage 1 = establishment of a systemic to pulmonary artery shunt; stage 2 = open reconstruction of the right ventricular outflow tract and pulmonary valve; and stage 3 = closure of the shunt and interatrial communication. The morphological features of nine specimens obtained from 10 patients who died were reviewed. Special attention was given to features that might have influenced the poor surgical outcome in these patients. Survival after stage 1 depends on adequate systemic to pulmonary artery blood flow, initially as a combination of ductus arteriosus and shunt flow, with subsequent modification if the ductus closes. After stage 2, survival is influenced by left ventricular function and mitral valve function. The success of final correction (stage 3) depends largely on the morphology of both ventricles and their atrioventricular valves. It appears that the behavior of the ductus arteriosus and the size of the shunt are of vital importance for the survival of the infant. In 3 of the specimens, no right ventricular outflow tract was present, and in 2 others, short chordal attachments of the mitral valve were observed. Staged surgical correction appears to be a satisfactory approach if these considerations are taken into account.     

Greater variety of fruit served in a four-course snack increases fruit consumption

Greater variety of energy-dense foods increases intake in meals composed of several courses. Little research has examined the effect of variety in low-energy-dense foods (i.e., fruits and vegetables). This study examined the effect of fruit variety on fruit intake during a four-course snack. Twenty unrestrained eaters (50% female, 100% White and Non-Hispanic, aged 26.5±8.1years, with a body mass index [BMI] of 22.9±3.0kg/m) completed two, counter-balanced sessions, VARIETY and NON-VARIETY. In VARIETY, participants received four highly-liked fruits over 4, 7-min courses, while in NON-VARIETY participants received their most highly-liked fruit (fruit 1) for each of the four courses, to consume ad libitum. Intake, grams and energy, in each course was measured. Changes in pleasantness for each of the four fruits, with measures taken prior to course 1 and at the completion of course 4, were calculated. Greater intake (grams and energy) occurred in course 4 in VARIETY as compared to NON-VARIETY. Changes in pleasantness for fruit 1 were significantly different between the sessions, with NON-VARIETY decreasing more so than VARIETY. These results indicate that greater fruit variety increased fruit consumption in the last course, which may be due to differential changes in fruit pleasantness.     

Coping Strategies of African American Head and Neck Cancer Survivors

A cross-sectional study was conducted with 50 African American head and neck cancer survivors. Common coping strategies were identified and examined in relation with quality of life and relationship well-being. Coping through support from God, seeking emotional support from family and friends, and helping others were the most commonly used strategies. Having emotional support, being strong and self-reliant, and engaging in distracting activities with family and friends had strongest associations with quality of life. Coping through emotional support, help from God, assistance from one's church family to maintain religious practices, helping others, and engaging in distracting activities with others was more strongly associated with relationship well-being. Future intervention studies should consider these strategies and their possible impact on the physical, psychological, and relationship well-being of this population.     

Outcome for arterio-venous fistula at the elbow for haemodialysis

Background: Few studies have examined the outcome of arterio‐venous fistulas (AVF) at the elbow for haemodialysis.
Methods: All AVFs at the elbow created between 1994 and 1998 were identified retrospectively from case notes and the computerised database. Patients were followed until fistula failure, death, or for a minimum of 6 months until June 1999. Life table analysis and Kaplan–Meier actuarial curves with the log rank test were used to assess the influence of age, sex, diabetes, hypertension, heart disease, cerebrovascular disease, use of erythropoietin, aspirin or warfarin, previous insertion of subclavian vein catheter and the levels of haemoglobin and serum albumin on long‐term AVF survival.
Results: A total of 137 AVFs (primary procedure in 84 and as a secondary procedure in 53 cases) at the elbow were performed in 130 patients; 7 patients had AVFs attempted at both elbows. The mean age was 56.57 yr with a mean follow‐up of 48.54 months. Twenty‐two patients died with a functioning AVF, while 7 patients also with a functioning AVF received a renal transplant. Overall 74% of AVF were patent at the end of 1 yr, while 22.5% failed or did not mature immediately after the procedure. Two patients had their AVFs tied off due to steal syndrome. Of the various factors known to affect long‐term survival of AVF in patients receiving haemodialysis, only plasma albumin> 35 g/L was associated with poorer long‐term patency in our study.
Conclusion: Our report supports the view that AVF at the elbow may obviate the disadvantages of AVF at the wrist in elderly patients, females and in diabetics. In this group of patients it may be preferable to create a primary AVF at the elbow rather than the wrist. Patients who have a failed attempt at creating an AVF at the wrist should undergo AVF at the elbow before the placement of a synthetic graft. This strategy will result in saving time and avoid multiple operations. There may also be a reduction in the use of synthetic grafts resulting in cost savings and avoiding the complications associated with synthetic grafts.     

Healthy lifestyles through an Adaptive Living Program: a pilot study

This study examined the effects of an Adaptive Living Program (ALP) on quality of life and life satisfaction of 19 low‐income adults living in a city‐subsidized apartment complex in Michigan. The ALP included 12 modules and three community outings over a 12‐week period, two times a week, with each session lasting 1.5 hours. Occupational therapy students conducted the groups under faculty supervision. The RAND SF‐36 and a non‐standardized tool were used to collect data. Results obtained from the participants' RAND SF‐36 pre‐test and post‐test scores demonstrated no significant difference in the physical, social and emotional health variables. Qualitative information gathered in a 60‐minute semi‐structured focus group held on the final day of the programme indicated that participants reported that they had increased their quality of life and life satisfaction through developing better social skills, increased knowledge of nutrition and improved interpersonal skills. Methodological limitations included a small sample, limited ethnic population, occasional absences during the group sessions, abbreviated length of programme and application of a non‐standardized assessment. Recommendations include a larger sample size of diverse ethnic population with varying ages, an established cut‐off date for new evaluations, a lengthened programme, a standardized qualitative questionnaire and alternative quantitative assessment. Copyright © 2008 John Wiley & Sons, Ltd.     

Alanine enhances jejunal sodium absorption in the presence of glucose: studies in piglet viral diarrhea

We measured the response of jejunal sodium (Na) absorption to neutral amino acid (L-alanine) and to dipeptides (L-alanyl-L-alanine, glycylsarcosine) in normal piglets and in piglets with acute viral diarrhea after experimental infection with transmissible gastroenteritis (TGE) virus. In the TGE jejunum villi were blunted, crypts were deepened, and the epithelium was composed of relatively undifferentiated cells with reduced disaccharidase, decreased sodium-potassium-stimulated ATPase, and elevated thymidine kinase activities. The response of Na absorption to a maximal concentration of L-alanine (20 mM) or D-glucose (30 mM) was significantly blunted in TGE jejunum in Ussing chambers. However, the addition of L-alanine together with D-glucose caused a significantly greater increment of Na absorption than either L-alanine or D-glucose alone in control and TGE tissue. The effect of Na absorption of the dipeptide L-alanyl-L-alanine (10 mM), which was rapidly hydrolyzed by control and TGE mucosa, was similar to that of L-alanine (20 mM), while glycylsarcosine, a poorly hydrolyzed dipeptide, did not change net Na absorption in the jejunum. Our data support the concept of separate carrier systems for neutral amino acid and hexose in the crypt-type intestinal epithelium characterizing viral enteritis. We speculate that a sodium-cotransporting amino acid, if added to oral glucose-electrolyte solutions, could benefit oral rehydration therapy in acute viral diarrhea; neither of the dipeptides tested here can be expected to enhance absorption to any greater extent than its constituent amino acids.     

Experiential sampling in the study of multiple personality disorder

The authors describe the application of experiential sampling, a new time-sampling method, to the assessment of rapid state changes in a woman with multiple personality disorder. She was signaled at random intervals during study periods and asked to provide information on alternate personality switches, amnesia, and mood state. The alternates displayed some characteristics that were as different as those occurring between separate individuals studied previously with this method. There were notable discrepancies between the self-report study data and information reported during therapy hours. The authors conclude that the phenomenology of multiple personality disorder is frequently more complex than is suspected early in the course of treatment.     

Using reagent-supported thromboelastometry (ROTEM((R))) to monitor haemostatic changes in congenital heart surgery employing deep hypothermic circulatory arrest

Objective: Cardiac surgery employing cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) can induce coagulation disturbances and bleeding complications that may be especially severe in infants. A better understanding of the coagulopathy and a quick method for its evaluation would be helpful in the management of patients exposed to CPB and DHCA. This study aimed to monitor coagulation defects in congenital heart surgery using rotational thromboelastometry (ROTEM((R))), standard coagulation tests and platelet flow cytometry. Methods: The study comprised 10 infants undergoing surgery for congenital heart disease on CPB and DHCA. Blood was sampled at skin incision, after heparinisation during CPB (directly pre- and directly post-DHCA) and after protamine administration post-CPB. ROTEM((R)) using different reagents including a heparinase-containing assay to evaluate coagulation during heparinisation, APTT and INR, and flow cytometry to evaluate platelet activation were performed. Results: During CPB, the ROTEM((R)) indicated CPB-induced clotting factor depletion and platelet dysfunction that persisted after CPB and heparin neutralisation. ROTEM((R)) results were available within 15min and therefore much faster than standard tests. ROTEM((R))-guided specific blood product treatment resulted in satisfactory coagulatory function. The highest degree of platelet activation was found directly after DHCA. Conclusions: A major benefit of ROTEM((R)) is the quick detection of a developing coagulopathy already during CPB. ROTEM((R)) guides quick and specific blood product treatment after CPB, which may decrease bleeding complications in cardiac surgery. The finding of maximal platelet activation directly after DHCA suggests that not only CPB but also hypothermia activates platelets in vivo, thereby contributing to platelet dysfunction.