Conversion of choledochojejunostomy stents to jejunal feeding tubes for postoperative enteral alimentation

The problem of protein calorie malnutrition following major gastrointestinal surgery can be treated with central venous or enteric alimentation, with the latter being preferred. The authors describe a simple technique for the conversion of biliary stents placed after pancreaticoduodenal surgery into jejunal feeding tubes when the stenting function is no longer needed. Three illustrative cases are presented. In each case, the procedure took less than 30 min and had no associated morbidity. This technique allows early conversion from central venous to enteric alimentation without the need to create a second surgical enterostomy.     

KENNETH FITZPATRICK RUSSELL: THE FIRST READER TO THE GORDON CRAIG LIBRARY

A review of the life and achievements of Kenneth Fitzpatrick Russell, whose death in his 76th year robbed us of a civilized gentleman who was at the zenith of his creative output, would be a daunting task, if only because of the breadth of his hobbies and interests: art and medical literature; reading; sinology and seal carving; numismatics, medical philately; bookbinding, collecting bookplates; carpentry; metal work, including pewter casting and silversmithing; model ship building and cooking. Yet these various interests were simply a backdrop to his public career at the University of Melbourne and the Royal Australasian College of Surgeons, where he laid the foundations of an international reputation as scholar and collector.     

VEGETARIAN DIET COMPONENTS,PROTEIN AND BLOOD PRESSURE: WHICH NUTRIENTS ARE IMPORTANT?

1. Evidence that vegetarian dietary patterns lower blood pressure (BP) comes from both population studies and randomized controlled trials in normotensive and hypertensive subjects. 2. The effect has been shown most clearly in those who keep to a strict lacto-ovo vegetarian diet characterized by a relatively low intake of saturated fat, a high polyunsaturated/saturated fat ratio, and a high intake of fruit, vegetables and other fibre containing products. Randomized controlled dietary trials suggest the effects are independent of dietary sodium, additive to that of calorie restriction, and not due to the absence of meat protein per se. Indeed, recent population studies suggest an inverse relationship between dietary protein and BP. 4. Dietary fats, fibre, potassium, magnesium and calcium do not independently seem to account for the effects. A possible role for complex carbohydrate in conjunction with the other dietary factors has yet to be fully explored.     

High-dose gadoteridol in MR imaging of intracranial neoplasms.

Twelve patients with a high suspicion of brain metastases by previous clinical or radiologic examinations were studied in a phase III investigation with magnetic resonance (MR) imaging at 1.5 T after a bolus intravenous injection of 0.1 mmol/kg gadoteridol followed at 30 minutes by a second bolus injection of 0.2 mmol/kg gadoteridol. All lesions were best demonstrated (showed greatest enhancement) at the 0.3-mmol/kg (cumulative) dose, with image analysis confirming signal intensity enhancement in the majority of cases after the second gadoteridol injection. More lesions were detected with the 0.3-mmol/kg dose than with the 0.1-mmol/kg dose, and more lesions were detected with the 0.1-mmol/kg dose than on precontrast images. In this limited clinical trial, high-dose gadoteridol injection (0.3-mmol/kg cumulative dose) provided improved lesion detection on MR images specifically in intracranial metastatic disease.     

Differences in leisure-time physical activity levels between blacks and whites in population-based samples: The Minnesota heart survey

Energy expenditure in leisure-time physical activity (LTPA) was measured using the Minnesota LTPA Questionnaire in 35- to 74-year-old black and white residents of Minneapolis-St. Paul, Minnesota. Estimates of the geometric mean LTPA energy expenditure were 129 and 204 kcal per day for black and white men (p<.05) and 91 and 123 kcal per day for black and white women (p<.05). The percentage of individuals expending 2000 kcal or more per week in LTPA was significantly lower in black men than white men (25 vs. 35%; p=.01) but was not different in black versus white women (18 vs. 17%). Although black men and women reported greater occupational physical activity than their white counterparts, LTPA and job activity were unrelated in all race and sex groups. In both races, LTPA energy expenditure declined with age. LTPA increased with level of formal education, and the largest LTPA difference between blacks and whites was observed in those who had a high-school diploma or less. Blacks had lower participation rates than whites in most of the individually assessed physical activities. Additional research is needed on the determinants and promoters of LTPA in population subgroups.The research was funded by National Heart, Lung, and Blood Institute Research Grant R01 HL 23727 and National Research Award T32 HL 07328-10.     

Hairy cells and monocytoid B lymphocytes: are they related?

The normal tissue counterpart of hairy cell leukemia is unknown. Because of the morphologic similarities of hairy cells to reactive and lymphomatous monocytoid cells, we compared the phenotypic characteristics of seven spleens involved by hairy cell leukemia with four reactive lymph nodes containing benign monocytoid B cells and three lymph nodes diagnosed as monocytoid B cell lymphoma. The hairy cells had a phenotype of surface Ig+, B1/Leu-14+, Leu-M5+, PCA-1+, Tac+, B2-, BA-1-, BA-2-, J5-, T10-, T11-, Leu-1-, Leu-2a-, Leu-3a-. The immunophenotype of both the reactive and neoplastic monocytoid B lymphocytes was virtually identical to the hairy cells. The major difference was that monocytoid B cells failed to react with anti-Tac and that PCA-1 expression was inconsistent. Despite these variances, the immunophenotypic similarities are remarkable, particularly the common expression of B1/Leu-14 and Leu-M5 (S-HCL3), and suggest a possible lineage relationship between hairy and monocytoid B cells.     

Use of gasoline exposure data and assessment. A summary report of work group III.

The overall consensus of the Work Group was that the workshop provided an excellent opportunity for discussion of the scientific issues pertaining to non-occupational exposures to gasoline as it related to public health officials, legal and regulatory agencies, and industrial (workplace) concerns. It was enlightening to discuss the implications of new and existing data and methods for determining the public's exposure to gasoline. The workshop resulted in a list of data needs and a vision of the future research that will be required to aid future users of exposure data.     

Limitations of laser treatment for malignant dysphagia.

Of 86 patients with inoperable malignant dysphagia, 68 (79 per cent) underwent successful palliation by endoscopic laser therapy, of whom 24 remained well palliated until the time of death. In 18 patients laser treatment was unsuccessful and nine of these underwent intubation, eight successfully. After successful laser therapy, dysphagia recurred in 44 patients a mean of 7.8 weeks later. Of these, 31 received palliation until death by dilatation with or without laser therapy, and 13 required intubation. The overall laser-related complication rate was 12 per cent with a mortality rate of 4 per cent. The intubation-related mortality rate was 9 per cent.     

Tonsil cryptolysis usingCO2 Swiftlase

Treatment for inflammation of the tonsils has taken a variety of therapeutic forms over the years, ranging from the application of iodine and massage in the preantibiotic era to the tonsillectomy, which prevails today. The architecture of the cryptic tonsil, its clinical implications, and the rationale for a conservative, yet effective treatment modality focusing on the tonsillar crypts are addressed in this article. Also described are the procedures and results of a retrospective clinical study in which conventional tonsillectomy was compared with CO₂ SwiftLase cryptolysis. Although our observations are not based on a prospective, controlled study, the information disseminated here may be useful to otolaryngologists who routinely perform tonsillectomy in their practice, using conventional surgical dissection methods or the CO₂ laser. According to our experience with a population of 120 patients, cryptolysis offers some clear advantages, particularly when performed with the SwiftLase apparatus. The procedure can be performed safely in an ambulatory surgery or office setting under local anesthesia. The cooperative patient avoids the cost and risks of general anesthesia. Limited tissue destruction significantly reduces operative and postoperative complications, discomfort, and recovery time. To conclude, CO₂ SwiftLase cryptolysis is a safe and cost-effective method of treating tonsil pathology without unnecessary sacrifice of the organ, and undue risks and expenses to the patient.^11,12