Prospective study of the MMPI-2 correction factor after mild head injury.

Gass (1991) proposed a correction factor composed of 14 MMPI-2 items that were characteristically endorsed by patients with closed-head injury. Their frequency of occurrence suggested that the items reflected the neurological rather than emotional consequences of head injury. The current study was designed to evaluate the interpretive significance of correction factor items after mild head trauma. Patients were examined immediately upon hospitalization and followed prospectively for at least 3 months. Correction factor items were endorsed more frequently during acute hospitalization than in the MMPI-2 standardization sample. At follow-up, none of the items were endorsed more often by patients with chronic mild head injury than by uninjured controls. These results suggest that the correction factor is sensitive to the acute neurological consequences of mild head trauma, but that these symptoms can typically be expected to resolve. Chronic endorsement of the items in this population is therefore most likely related to psychological factors.

Cognitive-behavioral prevention of postconcussion syndrome.

The symptoms of postconcussion syndrome (PCS) are persistent, and no empirically tested treatment is available. The treatment group (n = 29) in this study received a printed manual and met with a therapist prior to hospital discharge to review the nature and incidence of expected symptoms, the cognitive-behavioral model of symptom maintenance and treatment, techniques for reducing symptoms, and instructions for gradual resumption of premorbid activities. The control group (n = 29) received routine hospital treatment and discharge instructions. Both groups had sustained mild head injuries characterized by Glascow Coma Scale scores of 13-15 on admission without any measurable period of posttraumatic amnesia. Group assignment was random. Groups did not differ significantly on age, Glascow scores, litigation status, gender, or initial number of PCS symptoms. Patients were contacted 6 months following injury by an interviewer who was unaware of group assignment to obtain outcome data. Treated patients reported significantly shorter average symptom duration (33 vs. 51 days) and significantly fewer of the 12 symptoms at followup (1.6 vs. 3.1). Subjects were also asked how often each symptom had occurred in the previous week, and how severe the symptom typically was. The treatment group experienced significantly fewer symptomatic days (.5 vs. 1.3) and lower mean severity levels. Results suggest that brief, early psychological intervention can reduce the incidence of PCS.

A new minimally invasive technique for cholecystectomy. Subxiphoid "minimal stress triangle": microceliotomy.

OBJECTIVE: The authors devised a minimally invasive technique for cholecystectomy via microceliotomy that provides safety attainable with the open conventional approach and postoperative results comparable to laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has evolved as a minimally invasive outpatient procedure. Patients can return rapidly to preoperative status with minimal postoperative morbidity and pain, and the small scar size is cosmetically desirable. Unfortunately, there are reports of serious intraoperative complications, including injury to blood vessels, bowel, and the bile ducts, caused by failure to identify structures properly. The conventional cholecystectomy technique currently is relegated to patients on whom the laparoscopic procedure cannot be performed. METHODS: Cholecystectomy was performed through a 3-cm transverse high subxiphoid incision in the "minimal stress triangle." The location, anterior to Calot's triangle, was critical in providing a direct vertical view of the biliary ducts during dissection. Direct view cholecystectomy was performed using endoscopic instruments without pneumoperitoneum. Postoperative data were compared with both laparoscopic and open cholecystectomy results. RESULTS: Using the microceliotomy technique in the ambulatory setting, cholecystectomy was performed successfully in 99.3% (N = 143) of cases. Biliary leakage beyond the third postoperative day was caused by failure of clips or obstruction to bile flow. The postoperative morbidity, acceptability of scar, and analgesic requirements compare favorably with other techniques. Microceliotomy is cost effective. Portal hypertension is a contraindication for this procedure. CONCLUSIONS: The microceliotomy approach offers a viable, safe, and cost-effective alternative to the laparoscopic technique for cholecystectomy, especially when facilities for laparoscopy are not available or when the laparoscopic procedure cannot be performed.