PURPOSE: Gastric outlet obstruction is a debilitating complication of upper gastrointestinal malignancy. We present our experience with insertion of self-expanding metal stents (SEMS). METHODS: Twenty-eight patients were referred, stenting being attempted in 23. Two patients had esophageal Wallstents inserted through a gastrostomy; 21 had an endoscopic approach with enteral Wallstents. RESULTS: One stent insertion failed, ten patients (45%) returned to a normal diet, ten patients (45%) managed semi-solid food and two patients (9%) had no significant improvement. No immediate complications were seen. One patient subsequently developed pancreatitis. Reintervention (4 stents, 1 jejunostomy, 1 gastrojejunostomy) was required in six of 22 patients (27%) for inadequate stent expansion (1), second stricture (2), stent migration (1), and tumor ingrowth (2). The mean survival was 95.4 days (SD 78.8 days, range 3-230 days). The mean follow-up time was 98.9 days (SD 86.7 days, range 3-309 days). CONCLUSIONS: SEMS are effective in palliating malignant gastric outlet obstruction. A combined endoscopic/fluoroscopic approach allows the most complete assessment of the stricture and removes the need for gastrostomy insertion. Careful assessment of the gastrointestinal tract distal to the lesion is important.

Adult↗

PubMedDate not supplied

Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur.

The authors present a preliminary report of a new microsurgical mandibular reconstruction procedure using a segment of the internal condyle of the femur as a free vascularised bone graft. It is possible to harvest a compound flap including a bony segment measuring 8 X 1.5 X 1.5 cm and a cutaneous saphenous flap with its nutrient pedicle arising from the descending genicular artery and vein. This surgical procedure provides a good cortico-cancellous bony segment and a separate skin flap. Dissection of the flap is sometimes difficult due to the inconsistency of its vascular anatomy; the donor site is left with minimal morbidity but, because of weakening of the femur, our patients are instructed not to return to full weight-bearing before the sixth postoperative week. We consider segmental reconstruction of the mandibular body to be one of the best indications for the flap.

Adult↗

PubMedDate not supplied

Evaluating carotid artery disease. The concordance between pulsed Doppler/spectrum analysis and angiography.

The results of ultrasonic pulsed Doppler duplex scanning with spectral analysis and computer pattern recognition are compared with the results of contrast arteriography in patients screened for extracranial carotid artery disease. The intraangiographer variability (one radiologist reading the same films twice) and the interangiographer variability (two radiologists reading the same film independently) were also studied. To calculate degrees of agreement corrected for chance, the Kappa statistic was computed for all the evaluation methods employed. At the present time, the concordance between spectral analysis and cerebral contrast angiography reaches a Kappa value of 0.682 +/- 0.064. This level of agreement compares favorably with the interangiographer agreement level (K = 0.568 +/- 0.058) and the intraangiographer agreement (K = 0.711 +/- 0.054). The computer pattern recognition program predicted the degree of stenosis by angiography with an agreement of K = 0.721 +/- 0.059. This concordance compares favorably to that observed when the radiologists are compared with themselves and is greater than that reached by two different radiologists. The continuous improvement in precision and accuracy of duplex scanning offers the promise of its usefulness in clinical and epidemiological studies.

Blood Flow Velocity↗

PubMedDate not supplied

Emergency air transport of pregnant patients: the national experience.

There is considerable debate as to the appropriate role of helicopter transfer of sick patients. The debate over helicopter transfer of high-risk obstetric patients is even more intense. There is clear evidence that high-risk neonates are more likely to survive when they are delivered in a perinatal center compared with local delivery followed by transfer. On the other hand, there is concern that in-flight delivery entails "extreme risks, both to mother and child." In spite of this debate, there has been little research into the frequency of delivery during transport to a hospital or into the mortality associated with such a delivery. A study involving a single center suggests that the incidence of in-flight delivery is very low. We contacted all American Society of Hospital-Based Emergency Air Medical Services (ASHBEAMS) member air ambulance programs to determine the national statistics for in-flight delivery and associated perinatal mortality. We found no instances of in-flight delivery in 357 helicopter transports; 315 of these women were in active labor at the time of transport and 72 were in the accelerated phase of labor. There is evidence that these flights were screened for safety. Airplane flights generally took more time than helicopter flights (P less than .05), and there was one in-flight delivery during 88 airplane transfers. Also presented are additional data that suggest in utero transport of high-risk fetuses to a perinatal center by helicopter is cost effective.

Adolescent↗

PubMedDate not supplied

Prenatal exposure to ethanol decreases the sensitivity of the adult rat hippocampus to N-methyl-D-aspartate.

Morphological, neurochemical, and electrophysiological studies suggest that the hippocampal formation is one of the brain regions most sensitive to the teratological consequences of prenatal exposure to ethanol. We now report that prenatal ethanol exposure results in a reduction in the sensitivity of the hippocampi of adult offspring to N-methyl-D-aspartate (NMDA). Moreover, it appears that reduced sensitivity to NMDA results from abnormal magnesium regulation of the NMDA receptor-channel complex. These deficits in hippocampal function may underlie some of the behavioral and learning deficits which are characteristic of the offspring of mothers that consume even moderate amounts of ethanol during pregnancy.

Action Potentials↗

PubMedDate not supplied

Acoustic correlates of dysphonia: type and severity.

The purpose of this study was to explore the acoustic discrimination and graded severity of three clinical voice types. Listeners classified 102 samples of dysphonic vowels /a/ and /i/ on the basis of voice types: breathy, hoarse, and strained. The vowels were analyzed acoustically with two measures of perturbation and 2 measures of spectral noise. Discriminant analysis showed that apriori, acoustic classifications of voice type were made with 92% accuracy using four acoustic parameters: (a) cepstral peak prominence (CPP), (b) jitter standard deviation (SD-J), (c) fundamental frequency (F0), and (d) standard deviation of signal-to-noise ratio (SD-SNR). Findings suggest that voice type is associated with the interaction of spectral noise, fundamental frequency, and signal irregularity, and that dysphonic severity is associated with similar parameters, regardless of voice type.

Adolescent↗