Gallstone ileus of the colon: leave no stone unturned.

A case of gallstone ileus of the colon with illustrative pictures is presented, making the physicians more aware of this rare entity. Furthermore, the use of imaging modalities for diagnosis and decision making in management strategy is discussed.

Sigmoid carcinoma in an inguinal hernia: a blessing in disguise?

Colorectal cancer is a rising problem, as the incidence increases with age. In most cases the goal of treatment is oncological resection followed by adjuvant chemotherapy in order to optimize the survival. In this case report we present a 93-year-old patient with a sigmoid carcinoma inside an irreducible inguinal hernia, which was diagnosed prior to surgery. We chose to perform a sigmoid resection through an oblique inguinal incision as a safer alternative to laparotomy.

Performance curve of basic skills in single-incision laparoscopy versus conventional laparoscopy: is it really more difficult for the novice?

BACKGROUND: Single-incision laparoscopy is a step forward toward nearly scarless surgery. Concern has been raised that single-incision laparoscopy is technically more challenging than conventional laparoscopy. This study researched the performance curves of novice trainees for single-incision laparoscopy (SILS) versus conventional laparoscopy for performing two basic tasks on a box trainer. METHODS: In this study, 20 novice participants performed two tasks (peg transfer and a dissection task) on a standard box trainer. All the participants practiced each task 11 times and were randomized in two groups. The first group performed the tasks on a box trainer through three incisions. The second group used a single-incision access with the same box trainer. The assessment scores for errors and time were recorded. The 2nd, 8th, and 11th runs of both tasks in both settings were assessed to objectify the gain in basic laparoscopic skills. RESULTS: The performance curves for both groups improved significantly in terms of both time and errors in performing the two tasks [P < 0.01, analysis of variance (ANOVA)]. For the first task, no significant difference in time between the two groups was observed at the top of the performance curve (mean, 212 ± 64 vs. 182 ± 48 s), but the SILS group performed with fewer errors (1.3 ± 1.5 vs. 2.7 ± 2.11). However, the difference was not significant (P = 0.10). The dissection task was performed faster in the SILS group (mean, 205 ± 78 vs. 243 ± 40 s; P = 0, 18) with fewer errors (0.7 ± 1.05 vs. 1.9 ± 2.1; P = 0. 12), but the difference was not significant. CONCLUSION: This study showed a significant improvement in basic skills for both the SILS and conventional laparoscopy settings after 11 repetitions. These data suggest that box training shows no significant difference between conventional laparoscopic and single-incision laparoscopic settings in terms of error or time in performing basic tasks at a low complexity level for the novice. These data also show significant improvement in basic skills over a relatively short period.

Seven years of biosolids versus inorganic nitrogen applications to tall fescue.

Repeated applications of municipal wastewater biosolids is cost effective for biosolids managers, but may lead to undesirable accumulations of nutrients or contaminants. We evaluated the effects of seven years of biosolids applications on tall fescue (Festuca arundinacea Schreb.) production and nutrient availability. We compared two types of Class A biosolids applied to tall fescue on a sandy loam in western Washington. Mean annual biosolids rates of 290, 580, and 870 kg total N ha(-1) yr(-1) were compared with inorganic N and zero-N controls using a randomized complete block design. We measured yield and N uptake for each forage harvest, plant tissue metals at selected harvests, soil nitrate each fall, diethylenetriaminepentaacetic acid (DTPA)-extractable metals after five years of applications, and soil pH, available P, and organic C after seven years. Forage yields increased with biosolids rate. Apparent nitrogen recovery (ANR) for biosolids averaged 18% in 1993 (Year 1), 35% in 1994, and 46% in 1999. The ANR for inorganic N averaged 62% from 1994-1999. Residual soil nitrate was less than 25 kg ha(-1) for all treatments through 1995, but increased beginning in 1996 for the high biosolids rate. Biosolids increased soil organic C levels by 2 to 5 g kg(-1) and Bray-1 P levels by 300 to 600 mg kg(-1) (0-15 cm depth). Plant tissue Zn increased from 24 to 66 mg kg(-1) at the highest application rate. Nearly all of the DTPA-extractable metals remained in the 0- to 8-cm soil depth.

RANTES production by T cells and CD8-mediated inhibition of human immunodeficiency virus gene expression before initiation of potent antiretroviral therapy predict sustained suppression of viral replication.

A prospective blinded study was conducted to determine whether immunological differences exist between patients receiving potent antiretroviral therapy who are able to achieve and maintain an undetectable virus load (<50 copies/mL) and those who are not. Eleven patients receiving protease inhibitor-containing antiretroviral therapy were studied for 1 year. After analysis of all baseline samples, patient virus load was disclosed, and patients were classified as suppressors (those who maintained undetectable virus load for 1 year) and nonsuppressors. Baseline virus load and CD4+ T cell count did not differ significantly between the 2 groups. Levels of RANTES production by CD4+ and CD8+ T cells and CD8-mediated inhibition of human immunodeficiency virus type 1 gene expression before initiation of antiretroviral therapy were significantly associated with an undetectable virus load maintained for 1 year (P<.05). Thus, a functionally intact T cell-mediated immune system at the time of initiation of potent antiretroviral therapy may predict long-term virus suppression.

Relationships among absorbents on the reduction of grass silage effluent and silage quality.

Effluent from grass silage is a threat to water quality and a loss of valuable forage nutrients from dairy farms. Absorbents potentially reduce effluent loss when weather conditions are not ideal for field wilting. The objective was to determine the effectiveness of various absorbents at reducing silage effluent. First-harvest, direct-cut, perennial grass forage was ensiled with and without absorbents in medium-sized experimental silos for 3 consecutive yr. Silos contained 4.54 kg of grass and one of the following feed quality absorbents: 10% rolled barley, 10% dried and pelleted beet pulp, or alfalfa cubes at 10, 20, or 30%. Nonfeed quality absorbents used were 1% starch grafter polymer, 1% bentonite clay, and 10% newspaper. Silage from direct-harvest control forage produced the highest effluent losses, but the wilting of grass prior to ensiling or the mixing of grass with 30% alfalfa cubes nearly eliminated effluent. Silage pH was lowest when rolled barley or beet pulp was used as the absorbent and was highest for wilted grass. Silage dry matter was increased by wilting and by the use of barley, beet pulp, newspapers, or alfalfa cubes as absorbents. The addition of 10% newspaper greatly reduced in vitro dry matter digestibility and crude protein. Increased water-soluble carbohydrate concentrations were found for silage from grass forage treated with rolled barley, beet pulp, or alfalfa cubes prior to ensiling. Although bentonite clay and newspapers reduced effluent losses, greater water-soluble carbohydrate losses were found for these treatments compared with the direct control. Alfalfa cubes were found to be effective absorbents and did not reduce grass silage quality.

A pilot study of nevirapine, indinavir, and lamivudine among patients with advanced human immunodeficiency virus disease who have had failure of combination nucleoside therapy.

The effects of nevirapine, indinavir, and lamivudine in combination were studied among 22 human immunodeficiency virus (HIV)-infected patients with CD4 cell counts < or =50/mm3, whose options for antiretroviral therapy were limited by clinical or laboratory failure or toxicity with previous regimens. Median plasma HIV RNA was 5.16 log10 copies/mL at baseline, decreasing by a median of 3.12 log10 copies/mL at 24 weeks. Median baseline CD4 cell count was 30/mm3, increasing by a median of 95/mm3 at week 24. Adverse reactions led to drug discontinuation in 4 cases. Steady-state pharmacokinetic analysis in 17 patients was consistent with an interaction between nevirapine and indinavir. Nevirapine plasma levels were within the expected range, while indinavir levels were lower than expected. Despite this interaction, the combination of nevirapine, indinavir, and lamivudine was safe and well-tolerated and had substantial antiviral and immunologic effects lasting for the 24-week study.

Stavudine plus lamivudine in advanced human immunodeficiency virus disease: a short-term pilot study.

The short-term effects of stavudine (d4T) plus lamivudine (3TC) were evaluated among 48 human immunodeficiency virus-infected patients for whom zidovudine therapy had failed or who could not tolerate zidovudine. Patients were followed for 8 weeks after initiation of open-label d4T plus 3TC. Four patients discontinued therapy, because of neutropenia (1), hepatitis (1), or neuropathy (2). Reduction in virus load was -0.86 (+0.3 to -3.4) log10 copies/mL and CD4 cell increase was 30 (-100 to +290) cells/mm3. Virologic response was associated with a higher CD4 cell count, no prior exposure to d4T and 3TC, and no previous AIDS-defining illness. Virus load reduction for patients naive to 3TC and d4T was -1.47 (-0.14 to -3.37) log10 copies/mL. Short-term use of d4T plus 3TC is safe, well-tolerated, and associated with virologic and substantial immunologic benefits. Further evaluation of d4T and 3TC in combination is warranted.

The effect of phenylephrine on Müller muscle. A blepharogram study of eyelid motion.

PURPOSE: The blepharogram technique is used to study the effect of a drug on blinking. The authors show that ocular instillation of phenylephrine, a stimulant of Müller muscle of the eyelid, accelerates the up phase of the blink. METHODS: Motion of a tiny search coil glued to the eyelid moving in a weak magnetic field modifies an induced alternating current which is amplified and used to display the position of the upper eyelid in degrees on the ordinate of a graph with time in milliseconds on the abscissa. The graph is called a blepharogram. Blepharogram studies and individual blink analysis show the effect of phenylephrine on eyelid motion (blinking). RESULTS: Instillation of phenylephrine accelerated the up phase of the blink in all ten experimental subjects. In 65% of subjects, phenylephrine also produced or increased newly described N and M blepharogram patterns. CONCLUSION: This is the first instrumental detection of the effect of a pharmacologic agent on eyelid motion. The blepharogram technique provides insight into eyelid physiology and can be used to study any neuromuscular condition that affects eyelid motion.

Pseudophakic retinal detachments. The relationships between retinal tears and the time following cataract surgery at which they occur.

The types and locations of retinal tears associated with 268 pseudophakic retinal detachments were studied as a function of the time at which they occurred following cataract surgery. Retinal detachments occurring more than two years following cataract extraction were significantly more likely to have their most posterior retinal break located at the posterior margin of the vitreous base than at or behind the equator. This distribution of tears was not observed in detachments occurring within six months of cataract surgery, with equatorial tears being significantly more common in early onset detachments than in those occurring after two years. The anterior tears which cause most retinal detachments long after cataract extraction are due to persistent chronic traction upon the vitreous base rather than to acute posterior vitreous detachment.

In vivo digestibility of corn and sunflower intercropped as a silage crop.

Six nonlactating Holstein cows in a 3 x 3 Latin square total collection digestion trial were used to evaluate three low DM (less than 26%) silage types: 1) corn; 2) corn and sunflower intercropped and 3) sunflower. Feeding periods consisted of a 7-d adjustment followed by a 5-d collection period. Dry matter intake was similar for the three treatments; 12.5, 12.1, and 12.0 kg, respectively. Percent apparent digestibilities for DM, NDF, and N for corn and corn-sunflower were similar and greater than for sunflower: DM (69.6, 68.2, 57.4); NDF (68.1, 61.5, 51.6); and N (66.3, 66.5, 63.6). No differences were observed for digestibilities of ADF, hemicellulose, starch, or for N retention. Percent ether extract digestibility was greatest for corn-sunflower and sunflower silage when compared with digestibility of corn silage (82.5, 77.9, vs. 66.3). Major changes in rumen fermentation patterns were not observed as evidenced by rumen molar proportions of propionate, isobutyrate, isovalerate, valerate, or acetate to propionate ratios. No difference was observed for rumen NH3 N (2.7, 3.2, 4.1 mg/dl, respectively). Corn and sunflower intercropped silage had intermediate concentrations of fat, fiber, and protein when compared with those of corn or sunflower silages.