Development of a systematic approach to conversion of the ileoanal pouch into continent ileostomy.

Based on practical experience, a systematic approach to conversion of ileal J-pouches into continent ileostomies is developed by defining three types of conversion surgery, each with two subtypes. Type 1 refers to conversion without pouch reconstruction, type 2 to partial pouch reconstruction, and type 3 to complete pouch reconstruction. The subdivisions (a and b) take into account whether the afferent loop of the former pelvic pouch (a) or a higher ileal/jejunal segment of the small intestine (b) is used in conversion and/or reconstruction. The six resulting surgical variants are shown in schematic illustrations with accompanying descriptions of technical details to provide the specialized surgeon with comprehensive technical guidance.

Quality, stability, and safety data of packed red cells and plasma processed by gravity separation using a new fully integrated hollow-fibre filter device.

Background. We developed a completely closed system based on gravity separation without centrifugation steps for separation of whole blood. With this new system we compared quality and stability of the processed blood components (PRC and plasma) with respect to classical preparation. Furthermore the cost-effectiveness of this hollow fibre system was evaluated. Study Design and Methods. Whole blood collections of 15 regular blood donors were used for component preparation using the U shaped hollow fibre filter device. Results were compared to 15 whole blood preparations using centrifugation. The following parameters were evaluated: total hemoglobin, leukocyte counts, the serum concentration of total protein, lactate dehydrogenase (LDH) and potassium. Furthermore ATIII, vWF and F VIII were analyzed at different timepoints. Results. packed red cells: the data directly after separation and after 42 days of storage are in line with the guidelines of the council of Europe. Plasma. all plasma quality data are in line with the guidelines of the council of Europe for quality assurance of plasma, except for a low protein amount (factor 0.75). Conclusion. Separation of whole blood on a clinical scale in this new closed system is feasible, however the plasma protein content must be optimized.

Youth leadership at PPNC.

PIP: Planned Parenthood of Nassau County (PPNC) employs a wide range of local programs to assist young people in developing the skills necessary to make responsible decisions and help them become good leaders in the future. The mission that underpins their work with the youth is to help them recognize the powerful positive impact they can have on their peers, friends, loved ones, and families. For the last 16 years, peer education has played an essential role in the programs and services of PPNC for teens. The Teen Advocate Project (TAP) has trained and supported dozens of local youth who have in turn participated in several outreach and education activities. The PPNC also created the Teen Info Line, a telephone peer support service operated by and for teens. Along with the TAP, PPNC operates three other successful components of its education programs targeting the youth and their families: 1) male involvement program, 2) multicultural education program, and 3) substance awareness/sexual health education program. In recognizing that its mission to help the youth must not stop at the county border, PPNC established the Global Institute for Training in 1992 to develop youth leadership programs throughout sub-Saharan Africa, the Caribbean, and Eastern Europe.^ieng

Where there is no village: teaching about sexuality in crisis situations.

PIP: The author conducted a training program on adolescent sexuality education and reproductive health for the staff of the humanitarian and relief agencies serving the refugee camps in Africa's Great Lakes region. Participants reported that, for many adolescent refugees, exploitative sex is inextricably linked to survival. Displaced youth are often sexually victimized in exchange for food, shelter, and protection. Participants identified numerous factors that adversely affect the sexual health of adolescent refugees: migration-related disruptions in the transfer of sexual health information; a state of cultural limbo, in which refugees are part of neither the country they fled nor the new culture; use of unaccompanied minors as a source of cheap labor; dangerous misinformation regarding HIV/AIDS and other sexually transmitted diseases; a high prevalence of unintended pregnancy and unsafe abortion; unequal power dynamics in the camps; stereotypical gender roles that promote sexual exploitation and violence; tacit acceptance of child marriage; and the fact that United Nations High Commission on Refugees-supported schools cover only elementary education. An important first step toward improving this situation is more awareness on the part of key change agents about the health, social, and emotional needs of adolescent refugees. Specific recommendations include the provision of contraceptives and other sexual health services to adolescent refugees, training of grass-roots educators to work with parents and peer educators to work with youth, standardization of program development and implementation guidelines, creation of advocacy groups, focus group discussions with the target population, and recreational and social programs to promote self-esteem and personal development.^ieng

Culture and sexual scripts out of Africa. A North American trainer's view of taboos, tradition, trouble and truth.

PIP: The author's experiences in sub-Saharan Africa draw attention to the importance of cultural respect to the creation of effective sex education programs. The obstacles related to health and sexuality in Africa--taboos against discussing sexuality, acquired immunodeficiency syndrome (AIDS), uncontrolled fertility rates, poor access to contraception, child sexual abuse, sepsis from illegal abortion, female genital mutilation, sex discrimination, and rape--are overwhelming. Massive migration to urban areas has weakened connections to the extended family and village elders, leaving young Africans to attempt to sort out traditional African values from emerging Western concepts. Male dominance makes it impossible for most African women to insist that their partners practice safe sex, and the persistence of female circumcision further empowers men to control female sexuality. To ensure that sexuality curricula reflect a culture's belief system, there must be input from youth, parent educators, religious leaders, and local government and community leaders. All programming must be available to both literate and illiterate individuals, and educators should be trained in the local dialect. It is advisable to work with a counterpart indigenous to the target area. Knowledge of a culture's sexual script is mandatory. Also essential are interventions that foster desensitization about the open discussion of sexuality. Finally, outside educators should be aware that taboos and rituals that commemorate rites of passage generally serve a specific, useful purpose and should be respected.^ieng

Counteraction of cyanide poisoning by thiosulphate when administering sodium nitroprusside as a hypotensive treatment.

A 42-year old patient received a continuous infusion of sodium nitroprusside (SNP) at a dosage rate of 600 microgram/min for approximately four days. On the third day of treatment a dangerous high level of cyanide was measured in the blood. When an additional continuous infusion of sodium thiosulphate at five times the molar concentration of the SNP was given, this cyanide level dropped over a period of 7h to one-seventh of its initial value. The thiosulphate did not reduce the effectiveness of the SNP in lowering the blood pressure.