Psychological Outcomes of Intimate Partner Violence Experienced by Jordanian Working Women

This study aimed at investigating psychological health problems experienced by working women as a result of their experiences of intimate partner violence (IPV). One hundred one working women participated in the study. Results indicated that nearly half of the participants reported partner violence. Compared with nonabused women, abused women showed significantly higher levels of depressive symptoms (t (78) = ?3.4, p = .001) and stress (t (93) = ?4.8, p < .0001), while self-esteem did not differ significantly between the two groups. Acknowledgment of this problem and early recognition of the victims may result in improving the health of working women in Jordan.     

Distal esophageal ballooning following Heller myotomy

Eccentric ballooning of the distal esophagus was observed radiographically in 11 of 23 patients (48%) who underwent Heller myotomy for achalasia. While, to the authors' knowledge, ballooning at the site of myotomy incision has not been described previously in the radiologic literature, it should be recognized as a normal and frequent postoperative finding. Radiologists should be aware of this finding so that it is not mistaken for postoperative abnormalities following esophagomyotomy or an epiphrenic diverticulum.     

Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time

Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.     

Lung and heart-lung transplantation in patients with end-stage cystic fibrosis: the Stanford experience

BACKGROUND: Bilateral lung (BLTx) and heart-lung transplantation have gained wide acceptance as treatment of end-stage lung disease from cystic fibrosis. We reviewed our 13-year experience with thoracic transplantation for cystic fibrosis with an operative approach that favors use of cardiopulmonary bypass for BLTx. METHODS: Sixty-four patients with cystic fibrosis underwent heart-lung transplantation (n = 22, 34.4%) or BLTx (n = 42, 65.6%) between 1988 and 2000. Mean age and weight at transplantation were 29 +/- 8 years and 51 +/- 11 kg, respectively. Mean follow-up for survivors was 4.4 +/- 3.6 years. Immunosuppression regimen included cyclosporine, tapered corticosteroids, azathioprine, and induction therapy with OKT3 (murine monoclonal antibodies) or rabbit antithymocyte globulin. Cardiopulmonary bypass was used in all but 5 patients (7.8%). However, in 8 (19%) of the 42 patients having BLTx, only the grafting of the second lung was performed with cardiopulmonary bypass. RESULTS: The operative mortality rate was 1.6%. The actuarial survival rates at 1 year, 3 years, 5 years and 10 years were 93.2%, 77.7%, 61.8%, and 48.1%, respectively, with no significant difference between BLTx and heart-lung transplantation. The major hospital complications were pneumonia (n = 11, 17.2%) and bleeding (n = 8, 12.5%). Clinically significant reperfusion injury was observed in 6 patients, 3 of whom required reintubation. Freedom from acute lung rejection beyond 1 year was 47.7%. One patient underwent late retransplantation, and 4 required bronchial stenting. Obliterative bronchiolitis accounted for eight (50.0%) of 16 late deaths. CONCLUSIONS: Though postoperative bleeding and pneumonia are still of concern, satisfactory early and intermediate-term results can be expected in patients undergoing BLTx or heart-lung transplantation for cystic fibrosis. Cardiopulmonary bypass can be used for BLTx with no adverse impact on intermediate and long-term outcomes.     

Investigating the use of preoperative nasogastric tubes and postoperative outcomes for infants with pyloric stenosis: a retrospective cohort study

Purpose

Literature is lacking regarding the role of nasogastric tubes in patients with pyloric stenosis. There is also no consensus among surgeons. Some believe that pyloric stenosis is a form of gastric outlet obstruction, and the stomach should be drained until the obstruction is relieved. Others claim that infants can handle their secretions, and draining the stomach may further exacerbate the alkalosis. This chart review examines the use of preoperative nasogastric tubes in a single pediatric institution and its effect on vomiting rates and length of stay.

Methods

After research ethics board approval, a retrospective review was performed on 109 patients admitted between January 1, 2007, and December 31, 2008, with pyloric stenosis who underwent pyloromyotomy. Data were collected on presence of a preoperative nasogastric tube, preoperative electrolyte levels, ultrasound characteristics, episodes of postoperative vomiting, and length of stay.

Results

One hundred six patients were used in the final analysis. A nasogastric tube was placed in 77 patients (73%). Patients with a preoperative nasogastric tube had significantly higher episodes of postoperative vomiting (P = .015; 95% confidence interval [CI] 0.29-2.63) and length of stay (P = .017; 95% CI, 2.49-25.01). Bicarbonate levels were also significantly higher in patients with a nasogastric tube. There was no difference in the duration of symptoms, ultrasound characteristics, or type of operation between the 2 cohorts.

Conclusion

The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial.     

Portal vascular anomalies in Down syndrome: spectrum of clinical presentation and management approach

Purpose

The occurrence of portal vascular anomalies in Down syndrome has been sporadically reported in the literature. These rare disorders have a wide spectrum of anatomical and clinical presentations. The aim of this communication was to describe the clinical course, imaging features, and management approaches in patients with this association.

Methods

We conducted a comprehensive search of the databases of the Vascular Anomalies Center and the Department of Radiology at Children's Hospital Boston for patients with Down syndrome and portal vascular anomalies. Medical records and imaging studies of varying modalities were reviewed.

Results

Three children with Down syndrome and portal anomalies (portosystemic shunt, simple arterioportal shunt, complex arterioportal shunt) were managed at our institution. The portosystemic shunt was clinically insignificant and resolved without any intervention. The simple arterioportal shunt was successfully treated with embolization. The complex arterioportal shunt was associated with major congenital cardiac defects and the child ultimately expired despite a decrease in the arterioportal shunting after embolization.

Conclusions

Three is a wide spectrum of clinical and anatomical features of portal vascular shunts in Down syndrome. The management approach should be tailored based on the severity of symptoms. Percutaneous embolization can offer a safe, effective, and minimally invasive alternative to the surgical approach in selective cases.     

An Antireflux Anastomosis Following Esophagectomy: A Randomized Controlled Trial

Background  

Reflux of duodeno-gastric fluid is a significant problem after esophagectomy with gastric conduit reconstruction. Symptoms may be severe and impact considerably upon the quality of life. Previous studies have suggested that a fundoplication type anastomosis may limit post-esophagectomy reflux.     

Involvement of nitric oxide pathway in the acute anticonvulsant effect of melatonin in mice

Melatonin, the major hormone produced by the pineal gland, is shown to have anticonvulsant effects. Nitric oxide (NO) is a known mediator in seizure susceptibility modulation. In the present study, the involvement of NO pathway in the anticonvulsant effect of melatonin in pentylenetetrazole (PTZ)-induced clonic seizures was investigated in mice. Acute intraperitoneal administration of melatonin (40 and 80 mg/kg) significantly increased the clonic seizure threshold induced by intravenous administration of PTZ. This effect was observed as soon as 1 min after injection and lasted for 30 min with a peak effect at 3 min after melatonin administration. Combination of per se non-effective doses of melatonin (10 and 20 mg/kg) and nitric oxide synthase (NOS) substrate L-arginine (30, 60 mg/kg) showed a significant anticonvulsant activity. This effect was reversed by NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME, 30 mg/kg), implying an NO-dependent mechanism for melatonin effect. Pretreatment with L-NAME (30 mg/kg) and N(G)-nitro-L-arginine (L-NNA, 10 mg/kg) inhibited the anticonvulsant property of melatonin (40 and 80 mg/kg) and melatonin 40 mg/kg, respectively. Specific inducible NOS (iNOS) inhibitor aminoguanidine (100 and 300 mg/kg) did not affect the anticonvulsant effect of melatonin, excluding the role of iNOS in this phenomenon, while pretreatment of with 7-NI (50 mg/kg), a preferential neuronal NOS inhibitor, reversed this effect. The present data show an anticonvulsant effect for melatonin in i.v. PTZ seizure paradigm, which may be mediated via NO/L-arginine pathway by constitutively expressed NOS.