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Continent urinary diversions have gained popularity during recent years in the treatment of patients who require cystectomy. The formation of urinary stones remains a possible late complication of urinary diversion. We report the successful use of a percutaneous approach to remove stones from an Indiana pouch after other methods failed.
We report a case of intermittent difficulty with catheterization of an Indiana continent urinary reservoir. Management was with the flexible ureteroscope. A possible explanation for this problem is proposed.
The right colon reservoir using a stapled plicated ileal efferent limb (Indiana continent urinary reservoir) has been demonstrated to be a reproducible durable form of continent diversion. The overall day and nocturnal continence rate of 94% compares favorably with all other forms of continent cutaneous diversion. Carefully following the technique of stapling and plicating the ileal efferent limb and ileocecal valve as described in this article nearly ensures adequate competence of the outlet valve. In the rare case in which incontinence occurs, it is almost always on the basis of high-pressure unit contractions of the reservoir. On occasion, patients who develop incontinence are observed to have high pressures within the reservoir despite complete detubularization of the right colon segment. When this problem is encountered it can be corrected successfully by adding an ileal patch augmentation to the previously detubularized reservoir. The issue of ureteral implantation in continent urinary diversions is as yet unsettled. Many authors have not used ureteral tenial tunnels and have reported a reflux rate of < 13%. Furthermore, these patients have not developed any long-term sequelae of their reflux. Although favorable results have been obtained without creating tunneled tenial reimplantation, we believe that continent cutaneous reservoirs are almost always colonized with bacteria, and an antireflux mechanism may offer protection against subsequent pyelonephritis. Closure of the reservoir traditionally has been conducted by hand at our institution; however, the development of smaller absorbable gastrointestinal anastomosis stapling devices offers the theoretic advantage of shortening the operative time. We anxiously await follow-up, including larger patient numbers and longer term follow-up of the absorbable staple technique. The use of continent cutaneous urinary diversion clearly has decreased as bladder replacement has become a more viable procedure over the past decade. Despite this, the urologic reconstructive surgeon must maintain the ability to perform continent cutaneous diversion in patients who are unwilling to accept the potential for nocturnal incontinence observed in all forms of bladder replacement as well as the patients who have ineffective sphincter mechanism or who need a urethrectomy due to their primary disease.
During the winter of 1993-94, male lesser scaup (Aythya affinis) were collected on the heavily polluted Indiana Harbor Canal (IHC), East Chicago, IN, USA, and examined for tissue contaminant levels. Lesser scaup collected on the IHC had higher concentrations of cadmium (Cd), mercury (Hg), selenium (Se), polychlorinated biphenyls (PCBs), selected organchlorine pesticides, polychlorinated dibenzodioxins, polychlorinated dibenzofurans, polycyclic aromatic hydrocarbons, and aliphatic hydrocarbons than reference birds. Of the scaup collected on the IHC, 44% had Cd concentrations in the liver considered above background for freshwater waterfowl (>3 microg/g dry wt.), 50% had Se concentrations in the liver above a level possibly harmful to the health of young and adult birds (>33 microg/g dry wt.), and 88% of the scaup carcasses exceeded the PCB human consumption guidelines for edible poultry in the USA (>3.0 microg/g lipid wt.). The ratio of pristane:n-heptadecane concentrations in 47% of lesser scaup collected on IHC was elevated above 1.0, which is indicative of chronic exposure to petroleum hydrocarbons.
The Indiana Job Satisfaction Scale (IJSS) is a brief job satisfaction questionnaire designed for use with individuals with a severe mental illness. This study seeks to validate the IJSS, as well as to examine the relationship between job satisfaction and job tenure in a group of 71 workers in supported employment. Job satisfaction measured during the first 3 months of a job was significantly associated with job tenure; however, this relationship weakened over time. Overall, the findings support the utility of job satisfaction as a tool in vocational rehabilitation, as well as the validity of the IJSS with this group.
Experimental comparisons are reported between computer-based and human judgments of speech quality for the same sets of utterances. Speech stimuli were recorded from two normal talkers, who intentionally varied the quality of their speech, and from a hearing-impaired child who was receiving speech therapy on the Indiana Speech Training Aid (ISTRA). The tape recordings were submitted for evaluation to a naive jury, an expert jury, and the ISTRA System, a microcomputer equipped with a speaker-dependent speech recognition board that generated scores representing how well utterance matched a stored template. Correlational analyses of these data indicated that humans were slightly better at judging speech quality than was the computer, but that the computer was much more reliable. These results demonstrate that computer-based speech evaluation may be a reasonable substitute for human judgments for certain types of speech drill.
The authors report their experience in the treatment of recurrent stricture of the appendiceal stump in continent diversion (Indiana pouch) after cystectomy by means of the Memotherm ureteral stent. The patient presented was treated successfully with this device after failure of repeat cold-knife incisions of the stricture. At 9-months' follow-up from positioning, the stent is in place, covered by mucosa. Self-catheterization of the pouch is easily performed five or six times a day with a 12F catheter.
The eggs of Mansonia uniformis, Ma. indiana, Ma. annulifera, and Ma. annulata are described with the aid of scanning electron micrographs. Comparisons of egg structure among the four species showed that the eggs differed discernibly with respect to the outer chorionic tubercles on the anterior tube, the spines surrounding the raised central micropyle within the anterior cup, and the outer chorionic tubercles in the posterior region. Attempts to produce a key for identification of these eggs under scanning electron microscopy are discussed.
A total of 145 ectoparasites was found on five pups of the Indiana bat, Myotis sodalis, from a roost in Warren County, in southwestern Ohio. Most were Macronyssus crosbyi, the common mite of this host, but three males, two nymphs and a nonengorged female of Paraspinturnix globosa were found. Males and nymphs of this species have not previously been reported. In addition, two female adults of Paraspinturnix globosa were found in the anus of one adult female. The male, female deutonymph and nongravid engorged female of P. globosa are described for the first time.
Gerstmann-Sträussler-Scheinker (GSS) disease is a cerebral prion protein (PrP) amyloidosis associated with mutations in the PrP gene (PRNP). A GSS disease variant with mutation at codon 198 (F198S) has been studied in a large Indiana kindred. Biochemical investigations showed that the amyloid protein consists of 11 and 7 kDa fragments of PrP. Immunohistochemical studies showed that in addition to amyloid, these patients accumulate PrP deposits which are neither fluorescent nor birefringent when stained with thioflavin S and Congo red. In the present paper, we analyzed proteinase-K (PK)-resistant PrP in 7 patients with GSS F198S disease. Immunoblots of PK-treated brain extracts show prominent bands of ca. 27-29, 18-19, and 8 kDa. Immunohistochemistry and thioflavin-S-fluorescence show that the amyloid deposits are conspicuous in the cerebellum but sparse in the caudate nucleus. However, immunoblot analysis reveals PK-resistant PrP bands of similar intensity in both regions. Treatment with PK and PNGase F generates a pattern similar to that of PK alone. Our findings suggest that brain extracts from GSS F198S disease contain 3 prominent nonglycosylated PK-resistant PrP fragments forming a pattern not previously described in other prion diseases, which may in part explain the pathology of this GSS disease variant.
As the partial pressure of CO2 (pCO2) in the atmosphere rises, photorespiratory loss of carbon in C3 photosynthesis will diminish and the net efficiency of light-limited photosynthetic carbon uptake should rise. We tested this expectation for Indiana strawberry (Duchesnea indica) growing on a Maryland forest floor. Open-top chambers were used to elevate the pCO2 of a forest floor habitat to 67 Pa and were paired with control chambers providing an ambient pCO2 of 38 Pa. After 3.5 years, D. indica leaves grown and measured in the elevated pCO2 showed a significantly greater maximum quantum efficiency of net photosynthesis (by 22%) and a lower light compensation point (by 42%) than leaves grown and measured in the control chambers. The quantum efficiency to minimize photorespiration, measured in 1% O2, was the same for controls and plants grown at elevated pCO2. This showed that the maximum efficiency of light-energy transduction into assimilated carbon was not altered by acclimation and that the increase in light-limited photosynthesis at elevated pCO2 was simply a function of the decrease in photorespiration. Acclimation did decrease the ribulose-1,5-bisphosphate carboxylase/oxygenase and light-harvesting chlorophyll protein content of the leaf by more than 30%. These changes were associated with a decreased capacity for light-saturated, but not light-limited, photosynthesis. Even so, leaves of D. indica grown and measured at elevated pCO2 showed greater light-saturated photosynthetic rates than leaves grown and measured at the current atmospheric pCO2. In situ measurements under natural forest floor lighting showed large increases in leaf photosynthesis at elevated pCO2, relative to controls, in both summer and fall. The increase in efficiency of light-limited photosynthesis with elevated pCO2 allowed positive net photosynthetic carbon uptake on days and at locations on the forest floor that light fluxes were insufficient for positive net photosynthesis in the current atmospheric pCO2.
A 10-year-old spayed female mixed-breed dog was presented to the Purdue University Veterinary Teaching Hospital (PUVTH) with complaints of persistent anemia with occasional exacerbations, anorexia, and lethargy. The dog had been presented to the referring veterinarian 2 months prior with multiple bite wounds received during a fight with 3 Pit Bull Terriers. The dog was discharged after the wounds were cleaned and surgically closed. Upon admission to the PUVTH, blood was collected for a complete blood count and biochemical analysis. Microscopic examination of peripheral blood smears revealed intraerythrocytic protozoal parasites consistent with Babesia gibsoni. Molecular analysis confirmed that the organism was B. gibsoni and that its 18S ribosomal RNA sequence was identical to that of other B. gibsoni isolates from Oklahoma, North Carolina, and Okinawa, Japan. Hematologic changes included moderately severe, regenerative, macrocytic, normochromic anemia, with poikilocytosis, polychromasia, anisocytosis, and a marked increase in nucleated RBCs. Biochemical changes included increased serum alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase activities. The dog was treated with imidocarb, but despite initial clinical improvement, the dog died 2 weeks after the first dose. A necropsy was not performed. The infection in this dog is the first reported case of B. gibsoni infection in Indiana. Because of the widespread geographical distribution of the organism, veterinarians and veterinary clinical pathologists throughout the United States should carefully examine Romanowsky-stained blood smears from patients with acute hemolytic anemia for small intraerythrocytic babesial parasites.
The relationship between primary and bacterial production in two dimictic Indiana lakes with different primary productivities was examined during the summer stratification period in 1982. Primary production rates were calculated from rates of HCO(3) incorporation by natural samples, and bacterial production was calculated from rates of [H-methyl]thymidine incorporation by natural samples. Both vertical and seasonal distributions of bacterial production in the more productive lake (Little Crooked Lake) were strongly influenced by primary production. A lag of about 2 weeks between a burst in primary production and the subsequent response in bacterial production was observed. The vertical distribution of bacterial production in the water column of the less productive lake (Crooked Lake) was determined by the vertical distribution of primary production, but no clear relationship between seasonal maxima of primary and bacterial production in this lake was observed. High rates of bacterial production in Crooked Lake during May indicate the importance of allochthonous carbon washed in by spring rains. Bacterial production accounted for 30.6 and 31.8% of total (primary plus bacterial) production in Crooked Lake and Little Crooked Lake, respectively, from April through October. High rates of bacterial production during late September and October were observed in both lakes. Calculation of the fraction of bacterial production supported by phytoplankton excretion implies an important role for other mechanisms of supplying carbon, such as phytoplankton autolysis. Several factors affecting the calculation of bacterial production from the thymidine incorporation rates in these lakes were examined.
Herpetofaunal Salmonella enterica serovars have not been fully examined in any U.S. region. Thirty-three Salmonella serovars were isolated from 156 samples from 34 species, all within Indiana County, Pennsylvania. Results suggest that herpetofaunas could potentially pose a threat to humans. Further understanding of Salmonella in herpetofaunas may prevent future human cases.
An H1N2 influenza virus was isolated from a pig during an outbreak of respiratory disease and abortion on an Indiana farm in November 1999. Results of phylogenetic analyses indicate that this virus is a reassortant between a recent classical H1 swine virus and the reassortant H3N2 viruses that have emerged among American pigs since 1998.
The Reitan-Indiana Neuropsychological Test Battery was administered to a sample of 116 normal children aged 5 to 7 yr. A principal components factor analysis showed that six different areas of functioning were being measured. The neuropsychological dimensions were identified as Analytic-Synthetic Visual-motor Ability, Perceptual Organization, Crossed Modality Motoric Efficiency, Directed Motor Speed, Patterned Critical Discrimination, and Strength. Regression equations for estimating a child's scores on the six factors were presented. The dimensions were related to previous factor-analytic studies with young children.
The Reitan-Indiana Neuropsychological Battery (RINB) was administered to a sample of children referred for educational and behavioral problems (N = 130). Subtest scores were standardized by age at 1-year intervals (6, 7, and 8 years). A principal components analysis (PCA) with promax rotation of 18 subtest scores produced a five-factor solution. Factor 1 emphasizes tactile/spatial functions, Factor 2 emphasizes concept formation and visual/spatial abilities, Factor 3 reflects motor strength, Factor 4 emphasizes sensory perception, and Factor 5 reflects motor speed. Principal factor analysis (PFA) of these data was performed to permit comparison with the PCA solutions. The PFA and PCA solutions were similar and major conclusions about factor structure were consistent.
This study presents a data set for a reference group on the Reitan-Indiana Neuropsychological Test Battery for Young Children. The data set is based on a sample of 224 children, ages 5 to 8 years, referred to a special services cooperative for academic or behavioral concerns during the years 1980 through 1993. Data are presented in terms of sample size, means, standard deviations, diagnostic classifications, and population characteristics. Previously published data sets are reviewed in comparison to this newly acquired data set. Potential advantages of this data set include the larger sample, contemporary data collection, and a sample drawn from a United States school-referred population.