Stapled versus hand-sewn pediatric intestinal anastomoses: A retrospective cohort study

Background

Whereas the adult literature has demonstrated the acceptable safety profile of stapled anastomoses when compared to the hand-sewn alternative, the choice of intestinal anastomosis using sutures or staples remains inadequately investigated in children. The purpose of this study is to compare the anastomotic outcomes of both techniques in children under 5 years of age.

Affinities and densities of high-affinity [3H]muscimol (GABA-A) binding sites and of central benzodiazepine receptors are unchanged in autopsied brain tissue from cirrhotic patients with hepatic encephalopathy

The integrity of GABA-A receptors and of central benzodiazepine receptors was evaluated in membrane preparations from prefrontal cortex and caudate nuclei obtained at autopsy from nine cirrhotic patients who died in hepatic coma and an equal number of age-matched control subjects. Histopathological studies revealed Alzheimer Type II astrocytosis in all cases in the cirrhotic group; controls were free from neurological, psychiatric or hepatic diseases. Binding to GABA-A receptors was studied using [3H]muscimol as radioligand. The integrity of central benzodiazepine receptors was evaluated using [3H]flunitrazepam and [3H]Ro15-1788. Data from saturation binding assays was analyzed by Scatchard plot. No modifications of either affinities (Kd) or densities (Bmax) of [3H]muscimol of central benzodiazepine binding sites were observed. These findings do not support recent suggestions that alterations of either high-affinity GABA or benzodiazepine receptors play a significant role in the pathogenesis of hepatic encephalopathy.     

Neuronal cell death in hepatic encephalopathy

It is generally assumed that neuronal cell death is minimal in liver failure and is insufficient to account for the neuropsychiatric symptoms characteristic of hepatic encephalopathy. However, contrary to this assumption, neuronal cell damage and death are well documented in liver failure patients, taking the form of several distinct clinical entities namely acquired (non-Wilsonian) hepatocerebral degeneration, cirrhosis-related Parkinsonism, post-shunt myelopathy and cerebellar degeneration. In addition, there is evidence to suggest that liver failure contributes to the severity of neuronal loss in Wernicke’s encephalopathy. The long-standing nature of the thalamic and cerebellar lesions, over 80% of which are missed by routine clinical evaluation, together with the probability that they are nutritional in origin, underscores the need for careful nutritional management (adequate dietary protein, Vitamin B₁) in liver failure patients. Mechanisms identified with the potential to cause neuronal cell death in liver failure include NMDA receptor-mediated excitotoxicity, lactic acidosis, oxidative/nitrosative stress and the presence of pro-inflammatory cytokines. The extent of neuronal damage in liver failure may be attenuated by compensatory mechanisms that include down-regulation of NMDA receptors, hypothermia and the presence of neuroprotective steroids such as allopregnanolone. These findings suggest that some of the purported “sequelae” of liver transplantation (gait ataxia, memory loss, confusion) could reflect preexisting neuropathology.     

Mental health problems and marital disruption: is it the combination of husbands and wives’ mental health problems that predicts later divorce?

BACKGROUND: Divorce has been established as an adverse social consequence of mental illness. There is, however, little research that has considered how the mental health of both spouses may interact to predict relationship disruption. The aim of the current study was to use data from a large population-based survey to examine whether the combination of spouses' mental health problems predicts subsequent marital dissolution. METHODS: Prospective analysis of data from a longitudinal national household survey. 3,230 couples were tracked over 36 months, with logistic regression models used to determine whether the mental health problems of both spouses at wave 1 (determined by the SF36 mental health subscale) predicted subsequent relationship dissolution. RESULTS: Couples in which either men or women reported mental health problems had higher rates of marital disruption than couples in which neither spouse experienced mental health problems. For couples in which both spouses reported mental health problems, rates of marital disruption reflected the additive combination of each spouse's separate risk. Importantly, these couples showed no evidence of a multiplicative effect of mental illness on rates of subsequent divorce or separation. CONCLUSIONS: The results do not support the notion that a combination of mental health problems in both spouses uniquely predicts marital dissolution. Rather, there is an additive effect of individual mental health problems on the risk of dissolution.     

Entering work: employment outcomes of people with developmental disabilities

This paper provides a current snapshot of employment outcomes for individuals with developmental disabilities who had recently entered integrated employment (individual and group supported jobs) with the support of a community rehabilitation provider. Individual outcomes are based on an analysis of the National Survey of Community Rehabilitation Providers conducted between 2004 and 2005 by the Institute for Community Inclusion at the University of Massachusetts in Boston. Survey results show that the majority of respondents with developmental disabilities worked part-time in individual jobs, predominantly in the entry-level service industry; earned above federal minimum wage; and received paid time off. Differences in employment outcomes by type of integrated employment model are discussed. The paper concludes with a discussion of the implications of the findings.