Nonoperative management of benign postoperative biliary strictures

Selected benign biliary strictures can be treated safely and successfully by percutaneous balloon dilatation. Primary biliary strictures appear to be less responsive to balloon dilatation alone and require stenting with large catheters (16-20 F) for several months to permit scarring around the catheter. A long period of healing around such a large-bore stent is crucial to the success of such treatment. The most important physiologic indicators for successful dilatation are a long period of stricture challenge with a catheter placed proximal to the dilated segment to allow bile to drain internally across the previously strictured segment, and a near anatomic result as demonstrated by cholangiogram.     

Reducing the cost of using contrast media: a look at discarded volumes

A study of the volume of radiopaque contrast media (ROM) discarded during angiographic procedures was conducted at one tertiary care teaching hospital to evaluate the potential cost savings from reducing that volume. Volumes of ROM used and discarded during 31 cerebral angiographic procedures and 16 percutaneous transluminal coronary angioplasties (PTCAs) were analyzed. An average of 98 mL of ROM was discarded during cerebral angiography and 175 mL during PTCA. When low-osmolality contrast media (LOM) were used, the cost of discarded ROM was 15.8% of the technical charge for cerebral angiography and 21.5% for PTCA. If LOM were used, a savings of $11,000 per year could be achieved if 80-mL, rather than 100-mL, bottles were used for cerebral angiography and $35,000 per year if a single 300-mL bottle with inverted-Y tubing were used, rather than two 200-mL bottles currently employed for PTCA. Substantial savings could be realized by modifying technical procedures and by increasing the range of bottle sizes in which ROM are marketed.     

Percutaneous transhepatic biliary drainage for bile leaks and fistulas

Percutaneous transhepatic cholangiography and biliary drainage were performed in 12 patients with major injuries to the bile ducts manifested by biliary leaks and fistulas. Eleven of the 12 patients had had inadvertent biliary trauma during surgery. In six patients, the biliary leaks sealed with percutaneous drainage. In other patients requiring definitive surgical procedures on the biliary tract, initial percutaneous drainage allowed these procedures to be delayed until the patients' clinical condition improved. Percutaneous biliary drainage is an important adjunct to the management of patients with traumatic extravasation of bile into the peritoneal cavity or biliary-cutaneous fistula.     

Effect of extracellular fluid volume expansion on the interparabronchial septum of the avian lung

Scanning electron microscopy was used to examine the interparabronchial septa of chickens as a potential site of lymphatic drainage in the avian lung. Anaesthetized chickens were subjected to extracellular fluid volume expansion to produce pulmonary oedema as a result of increased capillary fluid flux into the interstitial spaces of the lung. In normal (control) chickens, the adjacent parabronchi were separated by a minimal septal space. In the "volume-loaded" birds, however, the interparabronchial septal spaces were measurably thickened and engorged as a result of hydrostatic pulmonary oedema. These results, which were consistent with reports of the effect of hydrostatic pulmonary oedema in mammals, suggest that the interparabronchial septum is a potential route of lymphatic drainage in the avian lung.     

Comparison of recurrent varicocele anatomy following surgery and percutaneous balloon occlusion

Venography of 44 recurrent varicoceles in 37 patients demonstrated different anatomical patterns of recurrence in surgical patients (26) compared to those treated by percutaneous balloon occlusion (18). The 3 types of patterns identified included parallel, renal vein and transcrotal collateral pathways. Virtually all surgical recurrences were owing to mid retroperitoneal (27 per cent) or low (inguinal) parallel collaterals (58 per cent). The majority of post-balloon occlusion recurrences were due to either high retroperitoneal parallel (44 per cent) or renal vein collaterals (28 per cent). Surgical recurrences were treated easily with percutaneous balloon occlusion. However, 39 per cent of the patients with recurrences following balloon embolization were not anatomical candidates for repeat percutaneous occlusion. We conclude that venous collaterals are identified easily by renal venography, and knowledge of these collaterals is helpful in planning further surgical or radiological treatment.     

Atlantic Sturgeon Use of the Penobscot River and Marine Movements within and beyond the Gulf of Maine

Atlantic Sturgeon Acipenser oxyrinchus oxyrinchus were recently listed as threatened in the Gulf of Maine and endangered in the rest of their U.S. range. Continued research priorities include long-term population monitoring, identifying the species’ spawning and nursery grounds, and determining its use of estuaries and marine coastal waters. Although recent and ongoing research is filling in knowledge gaps, the Atlantic Sturgeon’s life history and its severely depleted populations make this a challenging species to fully characterize. Our goal was to compile data collected over 7 years from fish captured in the Penobscot River estuary, Maine, to inform management decision making. Atlantic Sturgeon were captured (n = 199), recaptured (n = 16), and passively telemetered (n = 32 that were analyzed here) from 2006 to 2013. Captured individuals were predominantly subadults, and data from telemetry indicated repeated use of a 5-km reach of the mesohaline portion of the estuary. Subadults predictably emigrated from the river each fall (mean date ± SD, August 31 ± 43.5 d) and immigrated back each spring to early summer (May 15 ± 27.8 d), with most individuals (>95% [31 of 32]) returning one or more years after tagging. Marine detections of these subadults were common (81.25% [26 of 32]) and spanned the geographic extent of both the threatened and endangered U.S. distinct population segments and into international waters, e.g., from the Hudson River, New York, to Minas Basin, Nova Scotia. However, they were more typically detected by receivers in the Gulf of Maine; 77% (20 of 26) were only detected in the Gulf of Maine when not in the river. These data indicate that, based on the temporal and spatial predictability of habitat use, the estuary of the Penobscot River is important for subadult Atlantic Sturgeon of the Gulf of Maine. The wider movement patterns emphasize the need for conservation and management across regions and international boundaries.

Received June 23, 2016; accepted January 4, 2017     

Sexual victimization and hazardous drinking among heterosexual and sexual minority women

Aims

Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because the rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women.

Method

Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking.

Results

Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian.

Conclusions

This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women's heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization.