The roles of library liaisons in a problem-based learning (PBL) medical school curriculum: a case study from University of New Mexico.

The relationships between problem-based learning (PBL) curricula and libraries have generated a substantial number of journal articles, but few have addressed the importance of the interaction between health science libraries and PBL curricula. This article attempts to contribute to this dimension through a description of the roles of library liaisons. First we describe the evolution of the liaison roles beginning 2 years prior to the implementation of a PBL curriculum. We then describe the core responsibilities of liaisons at the University of New Mexico (UNM) with mention of other innovative roles developed by some liaisons.

Adnexal torsion in children.

Adnexal torsion is rare in children and is usually reported as small series or case reports. We reviewed a series of 19 consecutive cases of children aged 3 to 19 years (mean, 9.6 years) who were treated in our institution between 1977 and 1988. Thirteen patients presented with torsion of a previously normal adnexa, while six presented with torsion of a diseased adnexa. The right adnexa was involved in 84% of cases. Detorsion with recovery of vascularization of the adnexa was possible in only four cases. All patients presented with lower abdominal pain, and onset was sudden in 78% of cases with an average of 5.2 days between the first symptom and hospital admission and a mean delay of 30.2 hours between consultation and surgical intervention. A previous history of abdominal pain was present in nine cases. Nausea or vomiting were present in 84% of cases. An abdominal mass was palpable in 42% of the patients and was associated with a delay in surgical intervention. Ultrasound confirmed the presence of a mass in 94% of cases. The preoperative diagnosis was accurate in 37% of cases, and the most common inaccurate diagnosis was appendicitis or appendiceal abcess. Our series confirms the predominance of right-sided lesions as reported in the literature. It is not clear whether this is an anatomic phenomenon or whether the suspicion of appendicitis leads to the more frequent diagnosis of right-sided lesions, whereas many left-sided adnexal torsions are being missed. We therefore advocate pelvic ultrasound in female patients who present with left lower quadrant pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastroschisis: a 15-year experience.

Between January 1, 1971 and December 31, 1985, 59 cases of gastroschisis were treated at Hôpital Sainte-Justine in Montreal. In the period before 1978, 6 of 19 patients (31.6%) were closed primarily at the time of surgery and 13 of 19 patients (68.4%) had silon pouch closure. After 1978, 33 of 40 patients (82.5%) had primary closure and 7 of 40 (17.5%) had a silon pouch. Our overall mortality rate was 13.6%. The complication rate for the primary closure group was 25.6% with a 12.8% (5/39) mortality rate, interestingly, in the higher birth weight group. Those closed with a silon pouch had a 75% complication rate, mostly infectious, with 15% mortality. Neither low birth weight nor gestational age influenced mortality. A significant difference in the length of hospital stay was observed. This was 33.6 days for the primary closures and 56 days for the silon pouch closures. Our series demonstrates a definite favorable trend in the results of treatment of this malformation. The most important factor affecting these results is a change in surgical approach. Primary abdominal wall closure, being usually possible, should always be attempted. We also note an association between high birth weight and death due to bowel dysmotility.

Multiple-flap anoplasty in the treatment of rectal prolapse after pull-through operations for imperforate anus.

Rectal prolapse is a frequent complication after pull-through operations for high imperforate anus. Mucosal prolapse causes soiling, occasional bleeding, and pain. Simple resection of the redundant mucosa is unsatisfactory and leads to frequent recurrences or strictures. In 1982, Millard and Rowe reported a technique designed to correct rectal prolapse using two perineal flaps, thus providing a skin-lined anal canal. We have operated on two patients using the same technique. A three-flap anoplasty was used in nine other patients. With an average follow-up of 13 months, none of out patients presented recurrence of the prolapse or a significant stenosis. This procedure is safe and physiologically sound. The skin-lined anal canal provides some sensation where it is lacking. The functional and esthetic results are gratifying and we are now using the three-flap anoplasty as a primary procedure in the correction of high imperforate anus.

[Gastric volvulus in children]. / Volvulus gastrique chez l'enfant.

Until 1980, 300 cases of gastric volvulus had been reported in the literature. Of these only 50 had presented in children. The disease is considered rare. We reviewed our experience at Sainte-Justine, in the last 30 years and found 10 cases, all of which diagnosed since 1980. Four patients were under one year of age. The other six were between 3 and 17 years old. In five the presentation was acute and three had had similar previous episodes. In 5 patients the presentation was chronic and in four of these the symptoms dated from birth. Seven associated anomalies were present in 6 cases. Diagnosis was made by x-rays. Eight patients were treated successfully with gastropexy. One premature baby was treated medically. Perhaps this entity is more common than generally thought. It should be suspected in an infant with regurgitation or vomiting and failure to thrive, and in a child with chronic, intermittent or acute upper abdominal pain and distension.

[Treatment of acute perforated appendicitis with intraperitoneal cefazolin]. / Le traitement de l'appendicite aiguë perforée avec la céfazoline intrapéritonéale.

Until recently intra-abdominal sepsis following surgery for perforated appendicitis has remained a frequent occurrence. In 1975 Fowler reported an incidence of one intra-abdominal abscess in 36 perforated appendicitis treated with a protocol consisting of saline irrigation at surgery, followed by intraperitoneal administration of cephaloridine q. 6 hours for 48 hours. The same antibiotic was then given i.v. for 72 hours. He concluded that this method was an effective way to minimize post-op intra-abdominal abscess, and that the intraperitoneal route was more effective, for this purpose, than systemic administration. More recently, with better knowledge of the role of anaerobes, improved results have also been obtained by adding clindamycin or metronidazole to the antibiotic regimen. A prospective study based on two groups of patients randomly assigned to two protocols was undertaken. The study group consisted of 45 children operated for perforated appendicitis with abscess or generalized peritonitis. These patients were treated with Fowler's protocol. Because it is less nephrotoxic and is active against the same organisms, cefazolin was used instead of cephaloridine. The control group consisted of 43 patients, also operated for perforated appendicitis, treated with saline irrigation at surgery, with either i.v. gentamycin or tobramycin and clindamycin or metronidazole for an average of 7.8 +/- 3.1 days. Both groups were fairly well matched in terms of age, sex, severity of disease, and bacterial flora. They showed an identical 6% post-op intra-abdominal sepsis rate. Days before afebrile, days under gastric suction, complications and average hospital stay were comparable in both groups. The wound infection rate was 20% in the study group and 9% in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

CT localization of an aldosteronoma in a 10-year-old boy.

Primary aldosteronism in children under 16 years of age is usually due to adrenal hyperplasia. We could find only seven cases in the literature where it was caused by a solitary adrenal adenoma; all but one were female. We describe the case of a 10-year-old Caucasian boy in whom a unilateral adrenal adenoma was demonstrated by high resolution computed tomography (CT) alone. The literature is reviewed.

The anterior perineal approach for pull-through operations in high imperforate anus.

Recent widespread interest in a new approach to imperforate anus is ample testimony to the difficulty of the classical operations and to the unsatisfactory results. In the early seventies, Mollard began to use an anterior perineal approach to high imperforate anus as an alternative to the sacrococcygeal pull-through. It entails a semicircular retroscrotal incision allowing direct access and visualization of the urethra and puborectalis sling. Since 1976 we have switched to the anterior perineal approach. We now have experience with 30 patients, 27 males and 3 females. Two of the females had complicated cloacal anomalies, and three teenage patients were reoperated for incontinence following previous unsuccessful pull-throughs. Of the 27 primary operations, there were 17 with an uneventful early postoperative course. There were two major and eight moderate or minor complications. There was no mortality. A 3-year follow-up is available in 14 patients. The results are good in 8, fair in 4 and poor in 2. The advantages of this technique are threefold: it allows clear visualization and precise identification of the puborectalis sling; the dissection proceeds parallel to and with constant vision of the urethra, avoiding injury to it; and it obviates the need to change the position of the patient during the procedure. This operation is easier and safer than the sacral approach, it avoids cutting through the puborectalis sling as recently described, and, finally, it respects the criteria established by Stephens.

[Intussusception. 188 treated patients during 22 years (author's transl)]. / L'invagination intestinale. 188 malades traités au cours d'une période de 22 ans.

This is a review of 188 cases of intussusception collected in 4 separate studies over an 18 year period and compared with each other. An early diagnosis by the pediatrician, the immediate consultation of a pediatric surgeon to detect signs of peritoneal irritation and to attend the barium enema and a well trained pediatric radiologist are essential for success with the barium enema technic of reduction. The percentage of successful reduction by this method increased to 72% in 1972-1974 and then dropped to 56% during the following year. The main factor for this change was the implication of less experienced radiology residents.

[Same-day surgery in Sainte-Justine Hospital (author's transl)]. / La chirurgie d'un jour à l'hôpital Sainte-Justine.

Out patient surgery is becoming more and more popular with experience. A series of 7,250 operations performed during one year at Ste-Justine Hospital forms the basis of the presentation. A wide variety of procedures are now done by the pediatric surgical specialities on an out patient basis. Proper selection of patients, operations and families is mandatory. A low complication rate of 1.2% can be expected as well as high patient, family and staff satisfaction.

Hematoma of bowel and cellulitis of the abdominal wall complicating herniography.

Two complications of herniography are presented: a hematoma of bowel causing intestinal obstruction, and a cellulitis of the abdominal wall causing septicemia. A technical error probably caused the hematoma and gastroenteritis played a role in the cellulitis. We have now narrowed our indications for herniography. We think it should be reserved for more difficult diagnostic problems such as recurrent inguinal hernia, recurrent hydrocele or eventration of the diaphragm.