Interpretation of the BBT chart: using the "Gap" technique compared to the Coverline technique

OBJECTIVE: The aim of the study was to compare the accuracy of the Gap and Coverline techniques of interpreting the basal body temperature chart. METHODS: We compared the proportion of menstrual cycles for which the Gap and Coverline techniques accurately identified the post-ovulatory final fertile phase (FFP) and the initial infertile phase (IIP) and the median number of days each overestimated the fertile period, using urinary LH testing as the gold standard. RESULTS: The Gap and Coverline techniques identified the FFP within +/-1 day of that identified by LH testing in 13/33 (39%) and 10/33 (30%) cycles (chi2=0.6; p=.44), respectively, and the IIP within +1 day of that of LH testing in 13/33 (55%) and 4/33 (12%) cycles, respectively (chi2=13.4; p<.001). The Gap and Coverline techniques overestimated the fertile period by 1 and 4 days, respectively (p=.0002). CONCLUSION: Based on this small study, the Gap technique appears to be more accurate than the Coverline technique in identifying the post-ovulatory IIP.     

Integrating service learning into a curriculum to reduce health risks at alternative high schools

Service learning has been identified as a promising approach to reduce sexual risk behavior, among other outcomes. This study used qualitative data analysis to offer suggestions for optimally integrating service learning into a program to reduce sexual risks among alternative school students. Data were collected from student participants in the All4You! Project using classroom materials, focus groups, and individual interviews. Project educators and project staff also provided data through summary forms and field notes. Qualitative data analysis revealed 5 strategies for creating positive service experiences for alternative school students: (1) find appropriate service-learning sites, (2) create staff support, (3) maintain appropriate student participation and behavior; (4) enhance student reflection on service-learning experiences, and (5) address students' self-images.     

Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption

Introduction

Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a ‘tamponade effect’ of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation?

Materials and methods

We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90 mmHg after receiving 2 L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2 h), underwent therapeutic angiography within 24 h in order to control bleeding.

Results

Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%).

Conclusions

Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients.

     

"Right-Angled" Stapled Latero-lateral Duodenojejunal Anastomosis in the Duodenal Switch

A simplified technique to perform the duodeno-enteral anastomosis in the duodenal switch is presented. A linear stapled duodeno-jejunal side-to-side anastomosis is performed. The technique is easy and rapid to perform, avoids passing an anvil through the mouth of the patient and is safe for the patient, with satisfactory short-term results.     

The diagnosis of prosthetic joint infection: current techniques and emerging technologies

It is important to diagnose prosthetic joint infection accurately because the medical and surgical treatment of prosthetic joint infection differs from that of other causes of prosthetic joint failure. Recognition of the presence or absence of infection at or before the time of surgery is important in directing the appropriate surgical approach. Recovery and susceptibility testing of the infecting organism are essential to the selection of appropriate anti-infective therapy.     

Pitfall in renal cyst surgery: serous cystadenoma of pancreas mimicking renal cyst

Pancreatic lesions, particularly cysts, can simulate various diseases. We report a case of a 43-year-old woman with a large, symptomatic, retroperitoneal cyst misdiagnosed as a "renal cyst." During the retroperitoneoscopic marsupialization, the correct diagnosis of a pancreatic cyst was made, leading to an open pancreas tail resection. Histologic evaluation revealed serous cystadenoma. Especially in large retroperitoneal cysts on the left side, the correct diagnosis of a pancreatic cyst can be difficult.     

Chyloretroperitoneum with secondary chylothorax after retroperitoneoscopic donor nephrectomy

A 59-year-old woman complained of increasing pain in the left abdomen and of diarrheal symptoms after left-sided retroperitoneoscopic living donor nephrectomy. Computed tomography revealed chyloretroperitoneum. The fluid was drained percutaneously, followed by recurrent drain replacement surgery. Her diet was changed to short-chain and medium-chain fatty acids without success. After onset of dyspnea due to chylothorax, the donor underwent thoracic drainage, fully parenteral therapy, and finally somatostatin application therapy. The postoperative management of severe chylous fistula is difficult. Therefore, we recommend an early start of maximal conservative therapy. Surgical options depend on pain occurrence or mechanical problems.     

Reduction of childhood malaria by social marketing of insecticide-treated nets: a case-control study of effectiveness in Malawi

Use of an insecticide-treated net (ITN) is now the central focus for the Roll Back Malaria campaign, and disease-endemic countries have embarked on large-scale ITN distribution programs. We assessed the impact of an ITN social marketing program on clinical malaria in children less than five years of age. A case-control study was undertaken at Ndirande Health Center in the peri-urban area of the city of Blantyre, Malawi. Cases were defined by an axillary temperature > or = 37.5 degrees C or a history of fever within the last 48 hours and a positive blood smear for Plasmodium falciparum. The individual effectiveness of ITN use was 40% (95% confidence interval [CI] = 10-60%) when cases were compared with clinic controls and 50% (95% CI = 0-60%) in comparison with community controls. With ITN coverage of 42%, the community effectiveness of this program was estimated to range from 17% to 21%. This represents 1,480 malaria cases averted by the intervention in a population of 15,000 children. Our results show that the benefits of ITN social marketing programs in reducing malaria are enormous. Targeting the poor could increase those benefits.