Retrospective Studies

There are frequent applications for endoscopy in neurosurgery. However, endoscopic surgery in children has peculiar characteristics and is associated with different rates of success. In this study, the authors report on their experience with 134 consecutive endoscopy procedures performed in 126 patients<18 years of age. Between April 1993 and October 2007, 134 endoscopic procedures were performed in 126 children. Indications for surgery included brain tumors in 48 children, cystic lesions in 24, aqueductal stenosis in 23, various malformations in 20, hemorrhage and infarction in 6, and isolated ventricles in 5 children. In this long-term followup study, data were analyzed with respect to clinical and radiological success rates, as well as shunt dependence both in relation to lesion origin, and to the type of endoscopic procedure performed (endoscopic third ventriculostomy [ETV], septostomy, aqueductoplasty, or cystocisternostomy). Finally, the influence of patient age on the succ...

Objectives: Recent studies have suggested that survival following the Norwood procedure is influenced by anatomy and is worse for patients with hypoplastic left heart syndrome (HLHS), particularly aortic atresia (AA), as compared to other forms of functional single ventricle and systemic outflow tract obstruction. The current study was undertaken to evaluate our recent experience with the Norwood procedure and to evaluate potential predictors of operative and 1-year mortality. Methods: A retrospective study of risk factors for operative and 1-year mortality in 158 patients undergoing the Norwood procedure between January 1, 1998 and June 30, 2001. Results: HLHS was present in 102 patients (70 with AA) and other forms of functional single ventricle with systemic outflow tract obstruction in the remaining 56. Operative survival was 77% (122/158), 78% for patients with HLHS and 75% for patients with other diagnoses. Multivariable analysis identified birth weight (odds ratio (OR) 0.18/kg, 95% confidence limit (CL) 0.08-0.42, P , 0:001), associated cardiac anomalies (OR 4.45, 95% CL 1.50-13.2, P ¼ 0:001), total support time (OR 1.02/min, 95% CL 1.01-1.03, P ¼ 0:004), and extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) support (OR 17.8, 95% CL 4.40-71.0, P , 0:001) as predictors of operative mortality. The anatomic diagnosis (HLHS versus non-HLHS) was not a predictor of mortality, P ¼ 0:6). The Kaplan-Meier survival estimate at 1 year was 66% (95% CL 58-73%) and was not different for patients with HLHS compared to non-HLHS, P ¼ 0:5. For patients who have survived the Norwood procedure, survival to 1 year was 86% (95% CL 78-91%). Presence of an extra-cardiac anomaly or genetic syndrome (OR 2.70, 95% CL 0.98-7.41%, P ¼ 0:05) and presence of an additional cardiac defect (OR 3.99, 95% CL 1.67-9.57, P ¼ 0:002) were predictors of worse survival in the first year of life. Conclusions: The Norwood procedure is currently being applied to a heterogeneous group of patients. Operative and 1-year survival are equivalent for patients with HLHS and those with other cardiac defects. The presence of additional cardiac or extra-cardiac anomalies are predictors of poor outcome. q

Objective To assess the prevalence of domestic violence in pregnancy when midwives are trained to enquire about it routinely. Design A cross sectional study during a period after midwives had been trained to routinely enquire about it and a retrospective case note survey at an earlier period. Setting The maternity services of Guy's and St Thomas' NHS Hospital Trust in South London.

Although functional and clinical outcomes after total ankle arthroplasty have been promising, a steep learning curve has been recognized. In addition, the performance of concomitant hindfoot realignment procedures is controversial. The purpose of this study was to report on a single surgeon's experience with the first 50 total ankle arthroplasty procedures. We wanted to define the characteristics of the learning curve and whether the rate of complications was increased in patients who required complex reconstruction for preexistent foot and ankle deformities. This was a retrospective study of 50 cases with an average follow-up of 24.2 months. The patient population consisted of 18 men and 30 women with an average age of 57.6 years. Twenty-six percent of the cases had concomitant bony realignment procedures, while 20% had prior history of major hindfoot corrective procedures. There were 19 cases with intraoperative malleolar fractures, 12 cases that exhibited some degree of malalignment, and 6 cases of syndesmotic nonunion, and 8 ankles required early component revision. Minor wound complications that resolved with local wound care occurred in 9 cases, while 1 patient had a major wound complication requiring flap coverage. Each of these complications, other than wound complications, decreased with the surgeon's experience. Our results also indicate that the performance of major realignment procedures at the same time of implant arthroplasty is not associated with an increased incidence of complications. The results of this study suggest that total ankle arthroplasty is associated with a learning curve. Perioperative complications may potentially decrease with surgeon experience.

The aim of this study was to systematically review the psychometric properties, interpretability and feasibility of self-report pain intensity measures for children and adolescents for use in clinical trials evaluating pain treatments. Databases were searched for selfreport measures of single-item ratings of pain intensity for children aged 3-18 years. A total of 34 single-item self-report measures were found. The measures' psychometric properties, interpretability and feasibility, were evaluated independently by two investigators according to a set of psychometric criteria. Six single-item measures met the a priori criteria and were included in the final analysis. While these six scales were determined as psychometrically sound and show evidence of responsivity, they had varying degrees of interpretability and feasibility. No single scale was found to be optimal for use with all types of pain or across the developmental age span. Specific recommendations regarding the most psychometrically sound and feasible measures based on age/developmental level and type of pain are discussed. Future research is needed to strengthen the measurement of pain in clinical trials with children. Ó

Main Outcome Measures: Failure of NOM (f-NOM). Results: A total of 164 patients (42%) were operated on immediately. Of the remaining 224 who were offered a trial of NOM, the treatment failed in 85 patients (38%). At the end, 64% of patients required surgery. Multivariate analysis identified 2 independent predictors of f-NOM: grade V BSI and the presence of a brain injury. The likelihood of f-NOM was 32% if no predictor was present, 56% if 1 was present, and 100% if both were present. The mortality of patients for whom NOM failed was almost 7-fold higher than those with successful NOM (4.7% vs 0.7%; P =.07). Conclusions: Nearly two-thirds of patients with grade IV or V BSI require surgery. A grade V BSI and brain injury predict failure of NOM. This data must be taken into account when generalizations are made about the overall high success rates of NOM, which do not represent severe BSI.

Matrix coils are based on Gugliemi detachable coils (GDC) but are covered with polyglycolic/polylactic acid. We present our experience regarding the immediate posttreatment results of aneurysm embolization using the 2 coil systems. We embolized 219 aneurysms in 187 patients with the use of GDCs and 145 aneurysms in 120 patients with the use of Matrix coils. Age, sex distribution, unruptured aneurysm cases, and multiple aneurysm cases were similar in the 2 groups. The percentage of patients in severe clinical condition was significantly higher in the Matrix group. The mean aneurysm size was slightly larger in the GDC group but the mean neck size was larger in the Matrix group. Satisfactory occlusion (at least 90%) was achieved in 95.9% of GDC-treated aneurysms and in 98.6% of Matrix-treated aneurysms. Procedure-related complications occurred in 19.6% of GDC procedures and in 15.6% of the Matrix ones resulting in procedure-related mortality and morbidity of 3.7% and 2.7% for the GDC g...

To evaluate the literature on the allergic cross-reactivity between penicillin, carbapenem, and monobactam antibiotics. A MEDLINE search (1950-June 2008) of the English literature was performed using the search terms beta-lactam, penicillin, monobactam, carbapenem, allergy, and cross-reactivity. References of review articles were also screened for inclusion. All articles in English from the data source were identified. Studies whose primary goal was to evaluate drug hypersensitivity and the potential for cross-reactivity were evaluated. Many patients have reported penicillin allergies that have not been verified by skin testing; many healthcare providers avoid the use of other beta-lactam antibiotics, namely carbapenems, in these patients due to fear of the potential for immunoglobulin E-mediated allergic cross-reactivity. A wide range of cross-reactivity between penicillins and carbapenems has been reported in various studies; however, more recent prospective studies have shown the...

Purpose Cancer patients with bone metastases (BMets) are predisposed to skeletal complications. Bone-targeted therapies such as denosumab or intravenous bisphosphonates (IVBs) reduce the risk of these complications. This study characterized patterns of IVB use in these patients in the USA. Methods This was a retrospective, observational study using the Truven Health MarketScan® Commercial and Medicare databases (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). Subjects with ≥1 claims of diagnosis of breast, lung, or prostate cancer (BC, LC, or PC) and ≥1 claims of BMets diagnosis were included. The date of first BMet diagnosis claim was the "index date." Key exclusion criteria were diagnosis of other primary cancer, receipt of IVB, or <6 months continuous enrollment pre-index. Cumulative incidence of treatment initiation, interruption, and discontinuation were estimated. Proportions of IVB claims with chemotherapy administered on the same day and with renal monitoring within 2 weeks prior were summarized. Multivariate regressions assessing factors associated with IVB initiation were conducted. Results Cumulative incidence of IVB initiation at 12 months post-index was greatest for BC followed by PC and LC, and it declined with age in all tumor types, e.g., in BC from 62 % at age <50 years to 47 % at age ≥75 years. At 12 months, IVB treatment interruption ranged from 16 % (LC) to 31 % (PC), with discontinuation ranging from 46 % (BC) to 83 % (LC). Conclusions IVBs are used more frequently in patients with BMets secondary to BC than PC or LC. Many patients interrupt or discontinue IVB therapy within 12 months of initiation potentially impacting effectiveness.

Treatment with anti-resorptive agents over 13 months was associated with for three to fivefold lower bone mineral density changes and 1.5-fold increased risk of incidence fracture in vitamin D insufficient as compared to vitamin D repleted postmenopausal osteoporotic women. Introduction Several drugs were registered for the treatment of osteoporosis on the basis of clinical trials in which vitamin D repletion was a pre-requisite inclusion criteria and vitamin D supplements were used as adjunctive therapy. However, in routine clinical practice these supplements are not consistently recommended. Methods We studied 1515 women with postmenopausal osteoporosis under treatment with anti-resorbing agents (alendronate, risedronate, raloxifene) for 13.1 months with an adherence > 75%. The patients were classified as vitamin D deficient (N=514) or vitamin D repleted (N=1001) according to risk factors (N=1062) or the level of 25(OH) vitamin D [25(OH)D] above or below 50 nmol/l (N=453). Results Vitamin D deficient and vitamin D repleted subjects differed significantly for annualized spine and hip bone mineral density (BMD) changes adjusted for all available confounding factors (type of treatment, age, global calcium intake, baseline BMD values). One hundred fifty one patients suffered from a new incident clinical fracture. The adjusted odds ratio for incident fractures in vitamin D deficient as compared to vitamin D repleted women was 1.77 (1.20 -2.59, 95% CI; p=0.004). Conclusions Optimal vitamin D repletion seems to be necessary to maximize the response to anti-resorbers in terms of both BMD changes and anti-fracture efficacy.

Previous research has supported the immediate activation of patient's strengths (resource activation) as an important mechanism of change in psychotherapy. We designed a brief (10 min) priming procedure in which therapists' attention was focused on the patients' individual strengths before each therapy session (resource priming). In a preliminary study, the priming procedure was carried out before each of the first five sessions (N 5 20). Preliminary results indicated that this brief preparatory intervention boosted resource activation as perceived by independent observers, fostered attachment and mastery experiences by the patient, and improved therapy outcome at Session 20. Improvement was assessed in comparison to a pairwise matched, nonrandomized control group of patients treated previously with the same treatment protocol at the same clinic.

Background: Rejuvenation of the lower eyelid often requires tightening of excess skin and muscle and removal or transposition of orbital fat. Although transcutaneous lower blepharoplasty can accomplish these aesthetic demands, it has been associated with an increased risk of lower lid malposition. Routine lateral canthal support during lower blepharoplasty has recently been advocated to minimize this risk. This study reviewed the outcome of a surgeon's 10-year experience with primary lower transcutaneous blepharoplasty and lateral canthal support consisting of canthopexy, canthoplasty, and orbicularis suspension. Methods: A retrospective chart review of a primary lower transcutaneous blepharoplasty series over a 10-year period was performed. Patients with a history of prior eyelid surgery for blepharoplasty or midface lift were excluded. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical technique and management of complications were determined from operative reports and clinical notes. Results: There were 264 patients with a median follow-up of 264 days (range, 60 to 2410 days). Lid malposition requiring operative correction occurred in nine patients (3.5 percent). Additional complications included orbital hematoma in one patient (0.4 percent), chemosis in 32 patients (12.1 percent), and blepharitis in 10 patients (3.8 percent). Minor surgical revisions unrelated to lid malposition were performed on 31 patients (11.7 percent) for correction of subciliary incision cysts or granulomas, canthal suture inflammation, and canthal webbing. Conclusions: Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty to obtain the desired aesthetic result and maintain the natural appearance of the eyelid shape. The associated complication rate is acceptable. (Plast. Reconstr. Surg. 121: 241, 2008.)

This study was performed with the aim of determining the diagnostic profile of newborns with hypotonia and of analyzing the usefulness of different procedures in the diagnostic process. One hundred thirty-eight hypotonic newborns were identified through the search of hospital records in a 10-year period: 121 (88%) had central hypotonia and 13 (9%) had peripheral hypotonia, whereas 4 (3%) remained unclassified. Analysis of the contribution of clinical data and results of investigations led to the construction of an algorithm, by which all cases in the group were diagnosed. Step 1, which included clinical data and results of examinations, solved 50% of all diagnosed cases. Neuroimaging techniques made up step 2 and contributed to the diagnosis in 13%. Step 3 was accomplished by a search through Oxford Medical Databases, which yielded the final diagnosis in 9%, whereas karyotyping and fluorescent in situ hybridization for Prader-Willi syndrome comprised step 4 and contributed to the di...

To study incidence and distribution of deciduous molar ankylosis. study design: longitudinal retrospective study. A total of 512 consecutive subjects (aged 5 to 15 years) were examined at the Orthodontics and Paediatric Dentistry Department of the Genoa University School of Dentistry; for each subject an ortopantomography x-ray was taken. Thirty-four children were affected by deciduous molars ankylosis (6.6%). A statistically significant difference was revealed between the distributions: the lower deciduous molars were ankylosed more frequently than the upper ones (P &lt; 0.001); the second deciduous molars were ankylosed more frequently than the first molars (P &lt; 0.001). No statistical significance was found between sex and number of infraoccluded teeth (P = 0.74). This study found an incidence of deciduous molar ankylosis of about 6.6%; the lower deciduous molars and second deciduous molars were ankylosed more frequently (P &lt; 0.001).

PURPOSE: To evaluate the postoperative clinical outcomes and higher-order aberrations (HOAs) in eyes with astigmatism greater than 2.00 diopters (D) that had laser in situ keratomileusis (LASIK) using a non-wavefront-guided aberration-free ablation profile.

To evaluate the results of our method of surgical treatment of traumatic knee dislocation with injury to the posterolateral corner by use of a standardized protocol. Twenty-five consecutive patients presented with a grossly dislocated or reduced knee. Five of these patients were not included in this series. The remaining 20 patients were treated by primary arthroscopic reconstruction. The anterior cruciate ligament (ACL) was reconstructed using gracilis tendon reinforced with artificial ligament (Ligament Augmentation and Reconstruction System [LARS] ligament); the posterior cruciate ligament (PCL) was reconstructed with semitendinosus tendon and reinforced with LARS ligament; and the posterolateral corner was treated using the gracilis and semitendinosus tendons from the uninjured knee. Twenty patients returned for subjective and objective evaluation at a minimum of 24 months after surgery. Early mobilization through continuous and active exercise was started on the fourth day postoperatively. At a mean follow-up of 44 months, the mean Lysholm score was 90 points, the mean score on the survey of daily activities was 90 points, and the sports activities score on the knee outcome survey averaged 80 points. By the rating of Meyers et al. the results were excellent in 6 patients, good in 10 patients, fair in 3 patients, and poor in one patient. The final International Knee Documentation Committee (IKDC) rating was not normal in any knee. The mean loss of extension was 2° (range, 0° to 3°) and loss of flexion was 12° (range, 10° to 15°). By using the described method of arthroscopically assisted reconstruction of the cruciate ligaments and the posterolateral corner, 80% of the patients had good subjective results and functional stability, and according to the IKDC scale, 45% of knees were nearly normal, 45% were abnormal, and 10% were severely abnormal. No patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s rating returned to normal. Level IV, therapeutic case series.

To compare the clinical outcomes of cryopreservation according to the indications for freezing and the outcomes of the fresh cycle from which the embryos were derived. Retrospective study. Private assisted-reproduction unit. Three thousand, three hundred and sixty-eight embryos in 702 frozen-thawed embryo transfer (ET) cycles. Clinical outcomes of frozen-thawed ET cycles in which embryos were derived from fresh conception cycles (n = 436), from fresh nonconception cycles (n = 180), or where the fresh cycle was cancelled due to impending ovarian hyperstimulation syndrome (OHSS) (n = 86). Cryosurvival, clinical pregnancy, and implantation rates. Despite similar cryosurvival rates and the transfer of a similar number of embryos, significantly higher clinical pregnancy and implantation rates were obtained in the fresh-conception and OHSS groups. The implantation potential of frozen-thawed embryos that were not selected in a prior fresh cycle was comparable to that of embryos selected for fresh transfer. The success of frozen-thawed ET depends on the outcome of fresh ET and the indications for cryopreservation. Success is similar to that of fresh ET cycles in patients who had all their embryos frozen due to impending OHSS.

Background: Although debate exists about the treatment of sepsis, few disagree about the benefits of early, appropriately targeted antibiotic administration. Study Objectives: To determine the appropriateness of empiric antimicrobial therapy and the extent to which therapy would be altered if the causative organism for sepsis was known at the time of administration. Methods: This was a retrospective cohort study, conducted in an academic Emergency Department (ED), on consecutive positive blood cultures between November 1, 2008 and February 1, 2009. Blood cultures and the appropriateness of administered antimicrobial therapy were evaluated. Therapy choices were categorized based on whether or not a physician, complying with antimicrobial guidelines, would have made changes to empiric antibiotic therapy had the causative organism initially been known. Results: There were 90 positive blood cultures obtained from 84 patients. Of these, 21.1% (n = 19) were considered contaminants. The final categorization of empiric antibiotics given in the ED for the remaining blood culture results were: 1) therapy would be changed to narrower-spectrum antibiotics (n = 34, 55.7%); 2) therapy would be changed because the organism was not covered (n = 13, 21.3%); and 3) therapy would remain the same (n = 14, 23.0%). There was 90.2% inter-rater agreement for these classifications (p < 0.0001), with a kappa of 0.84. Polymerase chain reaction analysis had a statistically significant advantage (p < 0.0001) over Infectious Disease Society of America protocols in facilitating accurate antimicrobial therapies. Conclusion: This study confirms the need for more rapid and accurate laboratory methods for bloodstream pathogen identification. Ó 2013 Elsevier Inc.

The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.

Przysługujący widmom wywrotowy, niemalże rewolucyjny potencjał został odsunięty oraz zagubiony poprzez pozbycie się tej kontrowersyjnej kategorii z terytorium metafizyki i zbyt pośpieszne odesłanie jej do przestrzeni badań nad literaturą, sprowadzając ją jedynie do roli użytecznego, bezpiecznego narzędzia interpretacji.

Książka Andrzeja Marca odzyskuje niepokojący charakter widmontologii i ponownie wprowadza widma do myśli metafizycznej. Czym nawiedzona i przeniknięta jest tradycyjna metafizyka, co właściwie ją dręczy, nie daje spokoju oraz nieustannie podmywa jej stabilność?

Kategoria widma Derridy posłużyła Marcowi przede wszystkim do rozważań nad charakterem współczesności i przeobrażeń, jakie dokonały się w obrębie myśli ponowoczesnej. Współczesna kultura, zdaniem Marca, stała się miejscem powstawania widm, nieustannie powracających z przeszłości. Uznając, że nie jesteśmy już w stanie tworzyć utopijnych wizji przyszłości, autor stara się zdać sprawę z widmowego charakteru współczesnej kultury, analizując m. in. strategie vintage, retro, nurt no future w kulturze lat 70. czy nurt fantastyki naukowej w literaturze.

Peritonitis is caused most commonly by perforation of the hollow viscus and grave consequences of the dis-ease are attributed to the microbial infection of the perito-neal cavity. Factors predicting outcome in cases of perfo-ration peritonitis are well known and have been well ...

Vascular problems such as thrombosis and stenosis of the hepatic artery, portal vein, and hepatic vein are serious complications after living-donor liver transplant and can cause increased morbidity, graft loss, and patient death. The aim of this study was to assess the incidence, treatment, and outcome of recipient vascular complications after living-donor liver transplant in a single Egyptian center. Between November 2006 and March 2014, we performed 226 living-donor liver transplants for 225 patients at Dar Al Fouad Hospital in 6th of October City in Egypt. Review of all patients with vascular complications was performed. In 20 of 225 recipients (8.9%), there were vascular complications that occurred from day 0 to 14 (mean, 5.6 ± 3.4 d). Complications included isolated hepatic artery thrombosis in 7 patients (35%), isolated portal vein thrombosis in 6 patients (30%), isolated hepatic vein stenosis in 3 patients (15%), and isolated hepatic artery stenosis in 1 patient (5%). Combin...

Our objective was to study the phenotype evolution of X-linked adrenoleukodystrophy (X-ALD) and the relation between axonal degeneration and cerebral demyelination. Although different X-ALD phenotypes are recognized, little is known about their evolution. Neuropathological and electrophysiological studies have shown that X-ALD is a disease with mixed features of axonal degeneration, leading to myeloneuropathy, and a severe inflammatory reaction in the cerebral white matter, resulting in demyelination. Retrospectively, 129 men with X-ALD were studied who were 1) at least 20 years presently or at the time of death, and 2) regularly monitored. Phenotype assignments were made at diagnosis and at present, or at death, using medical history and findings of neurological examination. Handicap was studied with the modified Rankin scale, and cerebral abnormalities with the X-ALD MRI severity (Loes) score. The mean follow-up interval was 10.1 ؎ 5.0 years. Among 32 patients neurologically asymptomatic at diagnosis, 16 (50%) developed neurological deficits. Among 68 adrenomyeloneuropathy (AMN) patients initially without clinical brain involvement, 13 (19%) additionally developed cerebral demyelination. In a subset of 60 AMN patients, a moderate handicap evolved over a period of 16.2 ؎ 8.9 years. Among 13 AMN patients with additional definite or probable cerebral involvement at diagnosis, eight died and one remained in a vegetative state. Most of the 16 patients with the cerebral phenotypes deteriorated. There is a high risk for adult neurologically asymptomatic patients to develop neurological deficits and for AMN patients to develop cerebral demyelination. Axonal degeneration and cerebral demyelination emerge in X-ALD independently of each other. This may have implications for the phenotype classification, the search for modifying factors, and the development and evaluation of new therapies.

In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back-wall plasty (n = 21), back-wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y-graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow-up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1-and 3-year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety.

Purpose: To test the relationship between nurses' perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge. Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design. Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates. Findings: Controlling for hospital and nurse characteristics, a positive geriatric nurse practice environment was associated with positive geriatric care delivery (F=4,686, p<.0001) but not geriatric nursing knowledge. The independent contribution of all three dimensions of the geriatric nurse practice environment (resource availability, institutional values, and capacity for collaboration) influences care delivery for hospitalized older-adult patients. Conclusions: Organizational support for geriatric nursing is an important influence upon quality of geriatric care. Clinical Relevance: Hospitals that utilize an organizational approach addressing the multifaceted nature of the GNPE are more likely to improve the hospital experience of older adults. [Key words: acute care, geriatric nursing, nurse practice environment, quality of geriatric care]

Positional asphyxia refers to a situation where there is compromise of respiration because of splinting of the chest and/or diaphragm preventing normal respiratory excursion, or occlusion of the upper airway due to abnormal positioning of the body. Examination of autopsy files at Forensic Science SA revealed instances where positional asphyxia resulted from inadvertent positioning that compromised respiration due to intoxication, multiple sclerosis, epilepsy, Parkinson disease, Steele-Richardson-Olszewski syndrome, Lafora disease and quadriplegia. While the manner of death was accidental in most cases, in one instance suicide could not be ruled out. We would not exclude the possibility of individuals with significant cardiac disease succumbing to positional asphyxia, as cardiac disease may be either unrelated to the terminal episode or, alternatively, may result in collapse predisposing to positional asphyxia. Victims of positional asphyxia do not extricate themselves from dangerous situations due to impairment of cognitive responses and coordination resulting from intoxication, sedation, neurological diseases, loss of consciousness, physical impairment or physical restraints.

Sexual assault survivors with post-traumatic stress disorder (PTSD) were assessed for frequency of nightmares, measured retrospectively on the Nightmare Frequency Questionnaire (NFQ) and prospectively on nightmare dream logs (NLOG). Retrospective frequency was extremely high, averaging occurrences every other night and an estimated number of nightmares greater than ®ve per week. Test±retest reliability data on the NFQ yielded weighted kappa coef®cients of .85 (95% CI, .74±.95) for nights and .90 (95% CI, .83±.97) for nightmares. Correlations between retrospective and prospective nightmare frequencies ranged between .53 (P :001) for nights and .63 (P :001) for nightmares. Correlations between frequency and distress measures (anxiety, depression, post-traumatic stress) yielded coef®cients ranging from (r :28±.53). Compared with intrusive, cumbersome and time-consuming prospective measurements, the NFQ appears reliable, convenient, and equally useful in assessing nightmare frequency in a group of sexual assault survivors. Nightmare frequency, prevalence, distress and impairment are discussed. #