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ImportanceDelays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis.ObjectiveTo evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer.Design, Setting, and ParticipantsThis retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery.ExposuresAny type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections.Main Outcomes and MeasuresThe primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable.ResultsA total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95% CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95% CI, 1.15-1.53; P P = .03).Conclusions and RelevanceThis cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients.

Diabetes Mellitus (DM) is a major cause of maternal, fetal, and neonatal morbidities. Our objective was to estimate the effect of both pre-pregnancy and gestational DM on the growth parameters of newborns in the Qatari population.In this population-based cohort study, we compared the data of neonates born to Qatari women with both pre-pregnancy and gestational diabetes mellitus in 2017 with neonates of healthy non-diabetic Qatari women.Out of a total of 17020 live births in 2017, 5195 newborns were born to Qatari women. Of these, 1260 were born to women with GDM, 152 were born to women with pre-pregnancy DM and 3783 neonates were born to healthy non-diabetic (control) women. The prevalence of GDM in the Qatari population in 2017 was 24.25%. HbA1C% before delivery was significantly higher in women with pre-pregnancy DM (mean 6.19 ± 1.15) compared to those with GDM (mean 5.28 ± 0.43) (P0.0001). The mean birth weight in grams was 3066.01 ± 603.42 in the control group compared to 3156.73 ± 577.88 in infants born to women with GDM and 3048.78 ± 677.98 in infants born to women with pre-pregnancy DM (P0.0001). There was no statistically significant difference regarding the mean length (P= 0.080), head circumference (P= 0.514), and rate of major congenital malformations (P= 0.211). Macrosomia (Birth weight4000 gm) was observed in 2.7% of the control group compared to 4.8% in infants born to women with GDM, and 4.6% in infants born to women with pre-pregnancy DM (P= 0.001). Multivariate logistic regression analysis demonstrated that higher maternal age (adjusted OR 2.21, 95% CI 1.93, 2.52, P0.0001), obesity before pregnancy (adjusted OR 1.71, 95% CI 1.30, 2.23, P0.0001), type of delivery C-section (adjusted OR 1.25, 95% CI 1.09, 1.44, P=0.002), and body weight to gestational age LGA (adjusted OR 2.30, 95% CI 1.64, 2.34, P0.0001) were significantly associated with increased risk of GDM.Despite the multi-disciplinary antenatal diabetic care management, there is still an increased birth weight and an increased prevalence of macrosomia among the infants of diabetic mothers. More efforts should be addressed to improve the known modifiable factors such as women's adherence to the diabetic control program. Furthermore, pre-pregnancy BMI was found to be significantly associated with gestational DM, and this is a factor that can be addressed during pre-conceptional counseling.

No previously published studies have reported on the placement and restoration of dental implants in a patient diagnosed with sarcoidosis. Patients with sarcoidosis may develop periodontitis as a manifestation of systemic disease and are therefore at increased risk of tooth loss. These patients are likely to want fixed dental prostheses, which may need to be supported by dental implants. The case presented is that of a 31-year-old female patient presenting with a missing maxillary central incisor and a sarcoidal process affecting the anterior maxilla, which had severely compromised the periodontium of the adjacent lateral incisor. The patient was successfully rehabilitated with an implant-retained prosthesis following a staged horizontal and vertical bone augmentation procedure. At the 4-year review, the implant restoration performed well with stable peri-implant bone levels. We conclude that dental implant rehabilitation in patients with sarcoidosis may be a predictable treatment option, depending on disease stability and concurrent systemic therapy, but these patients will require additional maintenance because of the possibility of an increased risk of peri-implantitis. The effects of sarcoidosis and its management on the success of dental implants are discussed to aid treatment planning for such patients.

Early mobilization (EM) is practiced for intensive care unit (ICU) patients in many hospitals in the Eastern Province in Saudi Arabia. Respiratory care professionals’ knowledge about using EM was, therefore, surveyed and investigated to improve and update its practice and ultimately to develop related regulations and policies. A survey including 156 respiratory care professionals was conducted using a validated questionnaire. The focus was on collecting information on participants’ relevant backgrounds and on proper use of EM. Knowledge and proper use of EM were calculated in relation to participants’ demographic and professional characteristics. The statistical analysis using analysis of variance and Student t-test showed that factors that affected knowledge of EM were the respiratory care professional’s age, gender, nationality, and years of experience in intensive care medicine. How many patients these professionals treated using EM also significantly correlated with their knowledge of EM. The survey showed the extent of respiratory care professionals’ knowledge about the proper use of EM. More importantly, the survey also identified important shortfalls in practice of some experienced medical practitioners.

Traumatic flap displacement and epithelial ingrowth after microkeratome-assisted laser in situ keratomileusis (LASIK) is a widely described potentially sight-threatening complication. However, this complication is rare when a femtosecond laser is used to create the LASIK flap. We present a case of epithelial ingrowth after late traumatic femtosecond-assisted LASIK flap dislocation. A 25-year-old woman presented to our emergency department after being scratched in the right eye by her cat. The patient had bilateral myopic femtosecond-assisted LASIK surgery 5 years previously with good postoperative visual acuity. Ocular examination showed nasal dislocation of the flap. Follow-up examinations showed epithelial ingrowth. She was referred for reconstructive surgery in which the epithelial ingrowth was removed and the flap repositioned. Follow-up examinations showed an excellent result.

Visual Abstract, Magnetoreception, the perception of the geomagnetic field, is a sensory modality well-established across all major groups of vertebrates and some invertebrates, but its presence in humans has been tested rarely, yielding inconclusive results. We report here a strong, specific human brain response to ecologically-relevant rotations of Earth-strength magnetic fields. Following geomagnetic stimulation, a drop in amplitude of electroencephalography (EEG) alpha-oscillations (8–13 Hz) occurred in a repeatable manner. Termed alpha-event-related desynchronization (alpha-ERD), such a response has been associated previously with sensory and cognitive processing of external stimuli including vision, auditory and somatosensory cues. Alpha-ERD in response to the geomagnetic field was triggered only by horizontal rotations when the static vertical magnetic field was directed downwards, as it is in the Northern Hemisphere; no brain responses were elicited by the same horizontal rotations when the static vertical component was directed upwards. This implicates a biological response tuned to the ecology of the local human population, rather than a generic physical effect. Biophysical tests showed that the neural response was sensitive to static components of the magnetic field. This rules out all forms of electrical induction (including artifacts from the electrodes) which are determined solely on dynamic components of the field. The neural response was also sensitive to the polarity of the magnetic field. This rules out free-radical “quantum compass” mechanisms like the cryptochrome hypothesis, which can detect only axial alignment. Ferromagnetism remains a viable biophysical mechanism for sensory transduction and provides a basis to start the behavioral exploration of human magnetoreception.

OBJECTIVES Immigration studies can shed light on hypertension development and reveal high-risk populations. To this end, we investigated the association between age at immigration and hypertension occurrence at adolescence among immigrants to Israel. METHODS We analyzed cross-sectional data on 2 681 294 adolescents assessed for mandatory military service at approximately 17 years of age between 1967 and 2016. The study population constituted of 410 488 immigrants with origins in Ethiopia, Middle East and North Africa, Former USSR and Western Countries. Age at immigration was categorized into 0-5, 6-11 and 12-19 years. Odds ratios (ORs) for hypertension were calculated according to age at immigration with Israel-born participants as controls. Models were made to account for possible confounders. Additionally, the study population was stratified by country of origin and each immigrant group referenced to Israel-born participants of the same origin. RESULTS In the fully-adjusted model, immigrants arriving until age 11 years had comparable ORs for hypertension to the Israeli-born reference group, whereas recent immigrants, arriving at age 12-19 years had a marked lower OR of 0.30 (95% CI 0.27-0.33; P

Aims To explore the relationship between the amount of resected Muller’s muscle–conjunctiva (MMCR) and clinical outcome in patients undergoing upper eyelid ptosis surgery. Methods 49 patients underwent 87 MMCR surgeries. The total areas of the specimen and of MM were measured in pixels. Results The average percentage of muscle tissue in relation to total excised tissue was 21%. Intraoperative MMC tissue measurements and postoperative improvement in eyelid position (delta marginal reflex distance 1 (MRD1)) were positively correlated (R=0.427, p=0.09). There was a weak correlation between total areas measured on the histological slides and the intraoperative MMCR values (R=0.3, p=0.057). Total histological areas did not correlate with the delta change in eyelid position or with the amount and percentage of resected muscle tissue and the extent of improvement in eyelid position (delta MRD1 )o rfinal eyelid position (postoperative MRD1). Conclusions Post-MMCR improvement in eyelid positions did not correlate with the percentage of MM in the excised tissue. We believe that the mechanism responsible for surgical outcome is plication or scarring of the posterior lamella and not the amount of resected MM. More lift in eyelid position can be anticipated when more tissue is excised by MMCR, and not when more muscle is excised.

Situs inversus totalis (SI) is a rare condition in which all visceral organs are arranged as mirror images of the usual pattern. The objective of this study was to determine whether SI individuals have reversed brain asymmetries. We performed a neuroimaging study on 3 SI subjects and 11 control individuals with normally arranged visceral organs. The language-dominant hemisphere was determined by magnetoencephalography. Left-hemispheric dominance was observed in 1 SI subject and all controls, whereas right-hemispheric dominance was observed in the remaining 2 SI subjects. Statistical analysis revealed that language dominance patterns in SI subjects were different from those in the controls, suggesting that the developmental mechanisms underlying visceral organ asymmetries are related to those underlying functional brain asymmetry. Anatomical brain asymmetries were determined by magnetic resonance imaging. SI subjects had the same planum temporale (PT) asymmetry pattern as the controls, but a reversed petalia asymmetry pattern. The inferior frontal gyrus (IFG) asymmetry pattern varied within both groups, indicating a relationship between the rightward IFG and right-hemispheric language dominance. These results suggest that the developmental mechanisms underlying visceral organ asymmetries are related to those underlying petalia asymmetry but not to those underlying PT and IFG asymmetries, and that brain asymmetries might develop via multiple region-dependent mechanisms.

In electroencephalographic (EEG) and magnetoencephalographic (MEG) signals, stimulus‐induced amplitude increase and decrease in the alpha rhythm, known as event‐related synchronization and desynchronization (ERS/ERD), emerge after a task onset. ERS/ERD is assumed to reflect neural processes relevant to cognitive tasks. Previous studies suggest that several sources of alpha rhythm, each of which can serve as an alpha rhythm generator, exist in the cortex. Since EEG/MEG signals represent spatially summed neural activities, ERS/ERD of the alpha rhythm may reflect the consequence of the interactions between multiple alpha rhythm generators. Two candidates modulate the magnitude of ERS/ERD: (1) coherence between the activities of the alpha rhythm generators and (2) mean amplitude of the activities of the alpha rhythm generators. In this study, we use a computational model of multiple alpha rhythm generators to determine the factor that dominantly causes ERS/ERD. Each alpha rhythm generator is modeled based on local column circuits in the primary visual cortex and made to interact with the neighboring generators through excitatory connections. We observe that the model consistently reproduces spontaneous alpha rhythms, event‐related potentials, phase‐locked alpha rhythms, and ERS/ERD in a specific range of connectivity coefficients. Independent analyses of the coherence and amplitude of multiple alpha rhythm generators reveal that the ERS/ERD in the simulated data is dominantly caused by stimulus‐induced changes in the coherence between multiple alpha rhythm generators. Nonlinear phenomena such as phase‐resetting and entrainment of the alpha rhythm are related to the neural mechanism underlying ERS/ERD. Hum Brain Mapp, 2010. © 2009 Wiley‐Liss, Inc.

To evaluate the influence of diabetes mellitus (DM), chronic renal failure (CRF), and malignancies on the rate of bacteriuria and double J ureteric stent bacterial colonization.One hundred and twenty patients were included in this prospective study. Midstream urine samples for culture were obtained before ureteric stent insertion. Patients with negative culture were given ciprofloxacin 500 mg orally q 12 h for 5 days as a prophylaxis. All the stents were removed or changed as indicated after having voided midstream urine sample for culture on the day of stent removal. Stents were sent for culture. Culture was obtained from the outer surface of the stent by gentle scraping with a sterile scalpel. Significant bacteriuria was defined as a count of colony-forming units per milliliter of urine of10(5).The patients were between 20 and 74 years of age (mean 42.5 + or - 13) and the duration of stent insertion ranged between 14 and 120 days (52.5 + or - 7.2). In 29 patients (24.2%), double J stent bacterial colonization was positive (12 males and 17 females). Of these patients, 27 (22.5%) had positive urine cultures (11 males and 16 females). The most commonly isolated pathogen was Escherichia coli. DM, CRF, or malignancies showed a higher risk for bacteriuria and stent bacterial colonization.Immune-compromising diseases such as DM, CRF, and malignancies are proved to be risk factors for urinary tract infection and stent colonization in patients with ureteric stent insertion. Stent cultures are not needed as the same microorganisms grow in urine cultures.

To determine the time and location of lexico-semantic access, we measured neural activations by magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) and estimated the neural sources by fMRI-assisted MEG multidipole analysis. Since the activations for phonological processing and lexico-semantic access were reported to overlap in many brain areas, we compared the activations in lexical and phonological decision tasks. The former task required visual form processing, phonological processing, and lexico-semantic access, while the latter task required only visual form and phonological processing, with similar phonological task demands for both tasks. The activation areas observed among 9 or 10 subjects out of 10 were the superior temporal and inferior parietal areas, anterior temporal area, and inferior frontal area of both hemispheres, and the left ventral occipitotemporal area. The activations showed a significant difference between the 2 tasks in the left anterior temporal area in all 50-ms time windows between 200-400 ms from the onset of visual stimulus presentation. Previous studies on semantic dementia and neuroimaging studies on normal subjects have shown that this area plays a key role in accessing semantic knowledge. The difference between the tasks appeared in common to all areas in the time windows of 100-150 ms and 400-450 ms, suggesting early differences in visual form processing and late differences in the decision process, respectively. The present results demonstrate that the activations for lexico-semantic access in the left anterior temporal area start in the time window of 200-250 ms, after early visual form processing.

Electroencephalograms (EEGs) were recorded from eight Japanese speakers while they listened to Japanese and Spanish sentences (approximately 51 s each). The sentences were modulated in amplitude by a binary m-sequence and played forward or backward. A circular cross-correlation function was computed between the EEG signals and the m-sequence and averaged across subjects. Independent component analysis of the averaged function revealed a component source response which was obtained only for the comprehensible Japanese and not for the incomprehensible sentences. The present study has thus shown that a 1-min long EEG signal is sufficient for the assessment of speech comprehension.

Objective To evaluate the role of helical nonenhanced computed tomography (NECT) in the diagnosis of acute flank pain. Methods Seventy-five consecutive patients were analysed retrospectively for profile, loin pain, urine analysis and NECT findings. Diagnostic accuracy of NECT for urolithiaisis was calculated. The value of combined microhaematuria and NECT in the diagnosis of flank pain was also highlighted. The potential for identifying phleboliths and alternative diagnoses on NECT was also explored. Results There were 46 males and 29 females with an average age of 42.2 years. Forty-four patients presented with acute left flank pain. NECT carries a sensitivity and specificity of 96% for the diagnosis of stone disease. Combined with microhaematuria, NECT has 100% accuracy in picking up urinary tract stones. Conclusion NECT is the first imaging investigation of choice for the evaluation of patients presenting to the emergency department with flank pain and suspected renal colic.

The influence of seamlessness between the prestimulus alpha rhythm and poststimulus alpha ringing on the visual evoked potentials (VEPs) was investigated. Subjects passively viewed a series of 1000 flash stimuli with their eyelids closed, and their VEPs were recorded. The instantaneous phase angle of the alpha rhythm in each subject was calculated by using a two-cycle complex exponential sequence. VEPs were classified into four subsets according to seamlessness: how well the phase angle of the prestimulus alpha rhythm and the backward-extrapolated phase angle from poststimulus alpha ringing were synchronized. VEPs of each subset were averaged. A one-way repeated measures analysis of variance revealed that seamlessness significantly affected the amplitude of P100. Moreover, the level of seamlessness significantly affected the phase locking index. Two models for the generating evoked potentials have been proposed; one is the phase resetting model (Makeig, S., Westerfield, M., Jung, T.P., Enghoff, S., Townsend, J., Courchesne, E., Sejnowski, T.J., 2002. Dynamic brain sources of visual evoked responses. Science 295, 690–694) and the other is the evoked model (Makinen, V., Tiitinen, H., May, P., 2005. Auditory event-related responses are generated independently of ongoing brain activity. Neuroimage 24, 961–968). These results suggest that alpha ringing is possibly generated by the phase-resetting alpha rhythm and support the phase resetting model.

Objectives To determine the late complications and consequences for renal function, vitamin and acid-base metabolism after application of the Mainz Pouch I (MZP-I) technique in children and young adults. Patients and methods To November 1994, the MZP-I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (≤20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow-up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1–10.5). Results At the last examination, 23 of 55 (42%) pre-operatively dilated RUs had improved, 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre-operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re-operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1 , B2 , B6 , E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre-operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm. Conclusion The MZP-I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long-term protection of the upper urinary tract.

Purpose Emergency double-J (DJ) stenting following “uncomplicated” ureteroscopic (UURS) stone treatment is both morbid and costly. Our study aims at identifying those patients who are more likely to require such an extra procedure. Handling of this complication will also be highlighted. Materials and Methods 319 cases of UURS cases were selected out of 903 patients, who were admitted for URS stone treatment at King Abdullah University Hospital during the period from May, 2003 to December, 2010. Thirty-eight of them (11.9%) had emergency post-URS DJ stenting within 24 hours of discharge. The medical records of all UURS cases were retrospectively reviewed. Comparison in demographic and stone-related variables was made using 2-paired t-test with P < 0.05. Operative findings of 38 stented patients were outlined. Results Significant risk factors for emergency stenting were noted in males with larger (>1.5 cm) and proximal stones (38 stented vs. 281 unstented). Operative risk factors among the 38 patients were: initial procedure time > 45 minutes (42.1%), ureteral wall edema (21.1%), repeated access for stones > 1.5 cm (21.1%), impacted stone (10.5%) and ignored or missed stones/fragments (4.6%). Conclusions The need for emergency DJ stenting following UURS stone treatment is not uncommon. The routine insertion is impractical and weakly-supported. With risk-factor stratification, selective and individualized DJ stenting policy is recommended.

In communication, language can be interpreted differently depending upon the emotional context. To clarify the effect of emotional context on language processing, we performed experiments using a cross-modal priming paradigm with an auditorily presented prime and a visually presented target. The primes were the names of people that were spoken with a happy, sad, or neutral intonation; the targets were interrogative one-word sentences with emotionally neutral content. Using magnetoencephalography, we measured neural activities during silent reading of the targets presented in a happy, sad, or neutral context. We identified two conditional differences: the happy and sad conditions produced less activity than the neutral condition in the right posterior inferior and middle frontal cortices in the latency window from 300 to 400 ms; the happy and neutral conditions produced greater activity than the sad condition in the left posterior inferior frontal cortex in the latency window from 400 to 500 ms. These results suggest that the use of emotional context stored in the right frontal cortex starts at ∼300 ms, that integration of linguistic information with emotional context starts at ∼400 ms in the left frontal cortex, and that language comprehension dependent on emotional context is achieved by ∼500 ms.

The purpose of this study was to determine the prevalence of ED and its health-related correlates in a nonselected population from a Mediterranean country. The abridged 5-item version of the international index of erectile function (IIEF-5) was used as a diagnostic tool. A total of 905 men aged 18 years and above from Jordan were included in the study and answered the questions about medical history, lifestyle habits and sexual behavior. A logistic regression model was used to identify significant independent risk factors for ED. In this sample the prevalence of all degrees of ED was estimated as 49.9%. In this group of men, the degree was mild in 25%, moderate in 13.5% and severe in 11.4%. The prevalence of severe ED increased from 2.7% in men in their twenties to 38.6% in their sixties and 46% in those aged 70 years and above. Age is the single most significant risk factor. Other important risk factors include lower household income, physical inactivity, obesity, smoking, diabetes mellitus hypertension and ischemic heart disease. This study provides a quantitative estimate of the prevalence and the main risk factors for ED in our region. This condition, which represents a source of distress, should be evaluated more effectively by rigorous and standardized methods, particularly as effective treatments are now available.

A masked priming paradigm has been used to measure unconscious and automatic context effects on the processing of words. However, its spatiotemporal neural basis has not yet been clarified. To test the hypothesis that masked repetition priming causes enhancement of neural activation, we conducted a magnetoencephalography experiment in which a prime was visually presented for a short duration (50 ms), preceded by a mask pattern, and followed by a target word that was represented by a Japanese katakana syllabogram. The prime, which was identical to the target, was represented by another hiragana syllabogram in the "Repeated" condition, whereas it was a string of unreadable pseudocharacters in the "Unrepeated" condition. Subjects executed a categorical decision task on the target. Activation was significantly larger for the Repeated condition than for the Unrepeated condition at a time window of 150-250 ms in the right occipital area, 200-250 ms in the bilateral ventral occipitotemporal areas, and 200-250 ms and 200-300 ms in the left and right anterior temporal areas, respectively. These areas have been reported to be related to processing of visual-form/orthography and lexico-semantics, and the enhanced activation supports the hypothesis. However, the absence of the priming effect in the areas related to phonological processing implies that automatic phonological priming effect depends on task requirements.

The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders.The literature was reviewed to highlight points of consensus and debatable points regarding best practice in LS, looking at issues such as bleeding and conversion, splenomegaly, splenic retrieval techniques, types of instruments used, hand-assisted LS (HALS), complications, approaches, accessory spleen and splenosis. Our goal was to share our experience with LS and compare it with other reports.LS has emerged as the standard of care for elective splenectomy for benign haematological diseases. However, doubts have been raised regarding the suitability of patients with splenomegaly for LS. There is also uncertainty about its efficacy in major trauma. HALS has emerged as an option for safe manipulation and splenic dissection.We performed 25 consecutive LSs at King Abdullah University Hospital (KAUH), Jordan, from 2001 to 2008. Patient demographics, operative time, intra- and postoperative complications, conversion rate, additional procedures and length of hospital stay were retrospectively reviewed.The mean age of the patients was 38.8 years (range 11-77 years), mean operative time was 132 minutes (90- 170 minutes), and length of hospital stay was 2.9 (standard deviation 2.7) days. One case was converted to open surgery (5%). There was 1 case of superficial wound infection in the series (5%), and no deaths.LS is a well- accepted minimally invasive procedure, but knowledge and skill are required to perform it with minimal morbidity and mortality.

Neural activity during inner speech of meaningless syllable sequences was measured with MEG and fMRI from eight right-handed subjects who executed a delayed-response task. An fMRI-constrained MEG multi-dipole analysis showed that active neural sources were detected at latencies of about 200-300 ms after cues near the posterior superior temporal sulcus and were more numerous in the right hemisphere than in the left hemisphere. Since the subjects were cued to repeat inner speech of meaningless sequences stored in verbal working memory, the activity in the right (language-nondominant) hemisphere suggested that the task required processing of more prosodic features such as pitch and rhythm than phonemic features.

To review the ureteric injuries resulting from obstetric and gynecologic procedures with a comparative analysis of current pertinent literature.From January 1994 -December 1997, the medical records of all patients who sustained ureteric injuries as a result of obstetric or gynecologic procedures and managed at the Princess Basma Teaching Hospital, North of Jordan were reviewed. The clinical presentations, investigations, features of injury and treatment modalities were studied.There were 17 patients with 19 ureteric injuries incurred during obstetric or gynecologic procedures during the study period. Patients were relatively young and presented with loin pain. The left lower ureter was injured in 11 cases. Hysterectomy, alone, accounted for 13 injuries mainly in association with malignancy. Deliveries, in general, were associated with very low rate of injury. Ureteric ligation was the most common mechanism of injury (47%). Injuries were intraoperatively recognized in 41.2% (7/17) of cases. Patients were treated by either endourological or formal surgical repair. The overall success rate after an average of 32.3 months of follow-up was achieved in 89.5% (17/19). This outcome was not significantly altered by either the features of injury or by the treatment schedules.Iatrogenic ureteric injury is still a major cause of harm and concern. The time taken to detect the injury remains the most important morbidity-related factor. Recent trends towards earlier intervention and the use of various endourological means of repair deserve support and promotion.

Traditionally there is a concern about the possibility of developing testicular tumors as a consequence of undescended testis. This study was conducted to investigate the correlation between testicular tumors and undescended testis.Medical records of all patients with testicular germ cell cancer were seen and examined at the Princess Basma Teaching Hospital, Jordan University of Science and Technology, Irbid, Jordan, between 1990 and 2000 (group 1) for any evidence of undescended testis. All males with undescended testis attending the infertility clinic during the period 1999-2001 (group 2) were re-evaluated for any evidence of testicular tumors. The operative records of all patients who had surgery for undescended testis during the past 30 years (group 3) were reviewed and the patients were contacted to see if any of them developed testicular tumor as expected.Forty-four patients with testicular germinal cell tumors; mean age at diagnosis were 32.6 years (range 20-50) were identified. All patients had unilateral involvement and none of them were found to have tumors in undescended testis. The tumor was in the scrotum in all patients. None of the 117 infertile patients with undescended testis had clinical or ultrasonic evidence of testicular tumors. Two thousand nine hundred and nineteen patients had an operation for undescended testicle in the past 30 years, average of 97.3 operations annually. Median age at surgery for undescended testis was 7.7 years (range 2-29 years). None of the 2071 patients who were traceable developed testicular tumor.We found no evidence to support that patients with undescended testis are at a higher risk than the general population to develop testicular cancer.

The hepatitis C virus infection (HCV) is the most frequent cause of hepatic infection in Europe. In Italy, anti-HCV positivity values are extremely variable, depending on the age and geographic location of the population being analysed. The aims of the study were: (1) evaluating positivity for anti-HCV antibodies in various age groups and determining the HBsAg in a mountainous and predominantly farming area in central Italy; (2) assessing some anamnestic and clinical variables through a questionnaire, submitted during the taking of blood samples, in order to determine HCV exposure and risk factors for the target population. 344 subjects selected by random sampling among 3308 people, older than 16, were considered as the target population. A prevalence study was carried out. The sources of data were: blood samples taken to carry out the HCV positivity test; a questionnaire including items about exposures at risk and case-historical and clinical patient data. The risk of infection was evaluated by a multiple logistic regression model. The inferred HCV+ prevalence rate is 22.4/100 (95% confidence interval (CI): 20.8-24.1). An increasing age trend is shown with a higher positive predominance among females (28.99/100 vs. 14.29/100 in males). The positive HBsAg prevalence in the examined survey is 1.2/100. Variables associated with the HCV occurrence are case history of pneumonopathy (OR: 4.9) and exposure to parenteral therapies with glass syringes (OR: 3.3). This study is consistent with literature about the hypothesis of a north-south geographic gradient in the hepatitis C occurrence in Italy. Data clearly show the effects of the inappropriate use of medical or surgery practices on the population, with particular reference to the use of glass syringes. No elements prove that the farming features of the area may be predictive of HCV infection risk. The extent of the recorded prevalence values calls for the implementation of programmes aimed at detecting clusters or population areas at risk.

Prospective evaluation of the long term effect of leaving the hernial sac open without ligation on the recurrence rate of indirect inguinal hernia repair.During the period from July 1987 to July 1990, a total of 60 consecutive patients with 64 indirect inguinal hernia were entered into this prospective study. The indirect inguinal hernia was repaired using Maloney technique with excision of the hernial sac proximally as deep as possible without any attempt to ligate or transfix the sac. All patients were followed up at regular intervals.During the 3-year period, a total of 64 indirect inguinal hernia in 60 consecutive patients were repaired. Their ages ranged between 15-85 years (mean of 50 years). The follow up ranged from 9-12 years (a mean of 10 years and 5 months). Four patients died of unrelated causes. There was no clinically documented case of recurrence in the remaining 56 patients.This study, although not controlled, confirmed that non-ligation of the proximal sac during indirect hernia repair was not associated with an increase rate of recurrence.

In 20 healthy subjects, auditory evoked magnetic fields were measured over the entire head, using a helmet-shaped 66-channel MEG system linked to MRI. When the left or right ear was stimulated by 60 msec 2 kHz tones, the prominent 100 msec response (N100m) appeared significantly earlier in the contralateral hemisphere than in the ipsilateral one. In 16 cases, the N100m dipolar field patterns were clear in both hemispheres, overlapping each other across the midline. The N100m sources were estimated using a 2-dipole model in a spherical conducting medium with the size and location of the sphere determined individually according to the MRI images. No differences were found between the contralateral and ipsilateral N100m dipole positions in one hemisphere. When superimposed on MRI, the N100m dipoles were located precisely on the upper surface of bilateral temporal lobes with a standard deviation of 2.2 mm in the superior-inferior direction. In 16 right handed males, the right hemispheric N100m dipoles were 6 mm anterior to the left hemispheric dipoles. The whole head MEG is suitable to see small but significant differences of bilateral cerebral function, with exceptionally high spatial resolution, confirmed by the MRI-linked system.

Since 1993 to July 1994, 374 patients underwent a Mainz Pouch procedure in their hospital. The follow up is between 4.2 +/- 2.6 years. The authors used this technique as well for bladder augmentation, bladder substitution as continent diversion. If possible, the appendix will be used for creating the continence system.

Authors compared MR anatomy and magneto-encephalographic (MEG) functional methods in locating auditory cortex in 20 normal volunteers and 56 patients with intracranial structural lesions. Auditory evoked response was measured over the entire head, using a helmet shaped 64 channel MEG system. In each subject, three dimensional MR image was obtained with identical coordinate system of MEG. Best fit sphere to each subject's head was calculated from MRI data. Signal source of auditory evoked MEG was estimated using a two dipole model in the best fit sphere. Position and orientation of dipoles were superimposed on each subject's MRI. Both left and right dipolar patterns appeared about 100 ms after unilateral auditory stimuli (N100m) in 19 normal subjects and 47 patients. These dipolar patterns overlap each other across the midline. A two dipole model successfully localized bilateral N100m dipoles in the upper surface of superior temporal planes. N100m response was missing unilaterally in 1 normal subjects and 9 patients inspite of normal audiometry findings, suggesting sub-clinical auditory dysfunction. The MR-linked whole head MEG is a non-invasive tool to localize source of auditory evoked N100m response even in the case with intracranial structural lesions.

This paper describes a procedure of cellular dissociation which allows the isolation of single cells from the human heart while preserving their integrity and physiological function necessary for electrophysiological studies in vitro. During open heart surgery, biopsies were obtained from the right atrium of the beating heart in 16 patients immediately before starting the extracorporeal circulation. The tissue was immediately placed in a cardioplegic solution at 4 degrees, and subsequently in a free-calcium solution at 20 degrees from 20' to 30'. It was then exposed to the proteolytic action of Collagenase type I and Protease type VII (Sigma Chemical Co., St Louis, USA) at 35 degrees for a maximum of 5 hours. The cells were finally transferred into a Tyrode solution at room temperature. With this method we obtained up to 70% of intact human myocytes, 40% of which calcium-tolerant. The subsequent electrophysiological studies performed showed that the cells maintained their morphological and physiological properties.

Clinical effectiveness of Aztreonam was studied. This new monobactam antimicrobial agent was tasted in the treatment of post-operative infectious complications of cardiac surgical sternal wounds. Ten patients (4 men and 6 women, age range 20 to 68 years) were entered into the study. All had a Pseudomonas aeruginosa infection of sternum or sternum and ribs and all underwent an extensive regional surgery of the infection wound and received a topical and/or IV treatment with Aztreonam. In all cases we obtained a satisfactory result, with complete eradication of the infection. Both local and systemic tolerance to the drug were excellent and no side-effect was registered. Therefore Aztreonam can be considered an active and safe antibiotic for the treatment of sternal and/or costal postsurgical infections by Pseudomonas aeruginosa.

Recent policy changes have limited immigrants' access to insurance and to health care. Fewer noncitizen immigrants and their children (even U.S.-born) have Medicaid or job-based insurance, and many more are uninsured than is the case with native citizens or children of citizens. Noncitizens and their children also have worse access to both regular ambulatory and emergency care, even when insured. Immigration status is an important component of racial and ethnic disparities in insurance coverage and access to care.