"Internal dialogue" in a "normal" population: the implications for health promotion

The most common model of the human personality implicit in mosthealth promotion campaigns is based predominantly on sociallearning theory. We would suggest that a complementary approachthat uses a humanistic psychological model aimed at the integrationof the disparate parts of the self in conjunction with sociallearning theory may be more effective in achieving the long-termgoals of health promotion. In a survey of a "normal" population, 80% of 330 respondentsreported that they experienced "self-agreements", and 44% explicitlydescribed a process of "internal dialogue", in relation to issuessuch as smoking, weight-loss, drinking, personal relationships,working and studying. The dialogue appeared to take place betweendifferent "parts" of the self with different or opposite orientations—forexample a rational part with an emotional part, or a goal-orientatedpart with a hedonistic part. "Internal dialogue" appeared tobe a process that helped to resolve contradictions between externaldemands and internal needs. It also served to reduce internalconflicts in cases where certain aspects of a person's lifeproceeded as though it were out of contact with another, orwhere individuals lived in a "one-sided" manner and ignoredpart of themselves. In this study, it is suggested that in somecases these tensions were expressed in smoking or over-eating.Thus the attempts of health promotion campaigns at changingthese behaviours that are based on reasoned argument or socialmodels are inadequate. The potential use of the "internal dialogue"process that sought to align various facets of the self witha variety of health-related behaviours and the general enhancementof mental health, is discussed.     

Heated lymphocytes express HLA-DR antigens despite their inability to stimulate in MLC

We have utilized serological techniques and mixed lymphocyte culture (MLC) reactions to examine HLA-DR and HLA-D expression by heated (45 degrees C for 1 h) lymphocytes in order to study the functional relationship of these antigens. Heated lymphocytes do not stimulate proliferation of allogeneic lymphocytes in MLC, yet they express HLA-DR antigens. The fraction of peripheral blood lymphocytes (PBL) expressing DR is not altered by heating, nor is the staining intensity altered as detected by fluorescence microscopy. Alloantisera to "B cell alloantigens" recognize HLA-DR determinants on heated cells without any detectable change in either specificity or quantitative cytotoxic effects. Flow cytometry with monoclonal antibody demonstrates only minimal decrease in HLA-DR expression after heating. Thus stimulation in MLC requires more of the stimulating cell than the mere expression of HLA-DR.     

ANATOMICAL ALIGNMENT FOR THE CORRECTION OF BURIED PENIS

Purpose

We report a straightforward surgical technique for the correction and anatomical alignment of the skin in patients with various degrees of buried penis.

Materials and Methods

A combined series of 74 patients 7 months to 10 years old who were treated for buried penis at 2 institutions during a 7-year period. Patients presented with various symptoms, including balanitis, urinary tract infection, painful voiding, ballooning of the foreskin and urinary retention. In 29 patients (38%) trapped penis was due to previous circumcision. In our estimation the major anatomical defect in buried penis is an insufficient attachment of the dartos fascia and penile skin to Buck's fascia. Our technique involves making a circumferential incision of the inner preputial skin layer proximal to the corona, unfurling it from the shaft skin and leaving a coronal collar of approximately 1 cm. The annular band that usually constricts the corpora on retraction of the penile skin is incised, and the remaining proximal penile skin and dartos fascia are dissected off Buck's fascia proximally to the base of the penis. The penile dermis is sutured to the lateral aspect of the tunica albuginea at the penopubic junction and mid shaft of the penis. This technique restores normal anatomical relationships with excellent cosmetic results and negligible complications.

Results

At a median 5-year followup cosmesis was excellent in all case. Two patients with micropenis who required revision responded to endocrine therapy.

Conclusions

Excellent cosmetic results were obtained in all cases using this surgical technique.     

Anesthetic considerations for the pediatric oncology patient – part 2: systems‐based approach to anesthesia

One of the prices paid for chemo‐ and radiotherapy of cancer in children is damage to the vulnerable and developing healthy tissues of the body. Such damage can exist clinically or subclinically and can become apparent during active antineoplastic treatment or during remission decades later. Furthermore, effects of the tumor itself can significantly impact the physiologic state of the child. The anesthesiologist who cares for children with cancer or for survivors of childhood cancer should understand what effects cancer and its therapy can have on various organ systems. In part two of this three‐part review, we review the anesthetic issues associated with childhood cancer. Specifically, this review presents a systems‐based approach to the impact from both tumor and its treatment in children, followed by a discussion of the relevant anesthetic considerations.