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Background: World Health Organization rehydration management guidelines (plan C) for severe dehydration are widely practiced in resource-poor settings, but never formally evaluated in a trial. The Fluid Expansion as a Supportive Therapy trial raised concerns regarding the safety of bolus therapy for septic shock, warranting a formal evaluation of rehydration therapy for gastroenteritis., Methods: A multi-centre open-label phase II randomised controlled trial evaluated two rehydration strategies in 122 Ugandan/Kenyan children aged 60 days to 12 years with severe dehydration secondary to gastroenteritis. We compared the safety and efficacy of standard rapid rehydration using Ringer's lactate (100 ml/kg over 3 h (6 h if < 1 year), incorporating 0.9% saline boluses for children with shock (plan C) versus slower rehydration: 100 ml/kg Ringer's lactate over 8 h (all ages) without boluses (slow: experimental). The primary outcome was the frequency of serious adverse events (SAE) within 48 h including cardiovascular, respiratory and neurological complications. Secondary outcomes included clinical, biochemical and physiological measures of response to treatment by intravenous rehydration., Results: One hundred twenty-two eligible children (median (IQR) age 8 (6-12) months) were randomised to plan C (n = 61) or slow (n = 61), with two (2%) lost to follow-up at day 7). Following randomisation mean (SD) time to start intravenous rehydration started was 15 min (18) in both arms. Mean (SD) fluid received by 1 hour was greater in plan C (mean 20.2 ml/kg (12.2) and 33.1 ml/kg (17) for children < 1 year and >- 1 year respectively) versus 10.4 ml/kg (6.6) in slow arm. By 8 hours volume received were similar mean (SD) plan C: 96.3 ml/kg (15.6) and 97.8 ml/kg (10.0) for children < 1 and ≥ 1 year respectively vs 93.2 ml/kg (12.2) in slow arm. By 48-h, three (5%) plan C vs two (3%) slow had an SAE (risk ratio 0.67, 95% CI 0.12-3.85, p = 0.65). There was no difference in time to the correction of dehydration (p = 0.9) or time to discharge (p = 0.8) between groups. Atrial natriuretic peptide levels rose substantially by 8 hours in both arms, which persisted to day 7. Day 7 weights suggested only 33 (29%) could be retrospectively classified as severely dehydration (≥ 10% weight loss)., Conclusion: Slower rehydration over 8 hours appears to be safe, easier to implement than plan C. Future large trials with mortality as the primary endpoint are warranted., Trial Registration: ISRCTN67518332 . Date applied 31 August 2016.

Introduction: Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests., Methods: Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥40 years without lung cancer., Results: In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010., Conclusions: The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial., (Published by Elsevier Inc.)

Background: Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty., Methods: We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings., Results: We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%)., Conclusions: The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group of children to the harm of fluid-bolus therapy.

Introduction: Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type., Methods: Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time., Results: We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites., Conclusions: Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs., (Published by Elsevier Inc.)

Purpose: To our knowledge it is unknown whether decreases in the prevalence of prostate specific antigen screening and prostate cancer incidence rates following the USPSTF (United States Preventive Services Task Force) recommendations against routine prostate specific antigen screening are similar across socioeconomic groups and United States census regions., Materials and Methods: We analyzed incidence rates and prostate specific antigen screening prevalence by age, race/ethnicity, disease stage, United States region and area level socioeconomic status. Annual percent changes were examined for changes in rates with time. The predicted marginal probability and 95% CIs were calculated to estimate changes in prostate specific antigen screening., Results: Incidence rates in men 50 years old or older decreased in all race/ethnic, regional and socioeconomic status groups. From 2007 to 2013 the overall incidence rates for localized cancer significantly decreased 7.5% per year (95% CI -10.5--4.4) at ages 50 to 74 years and 11.1% per year (95% CI -14.1--8.1) at ages 75 years or greater. In contrast, the incidence of distant stage cancer significantly increased 1.4% per year (95% CI 0.3-2.5) from 2008 to 2013 at ages 50 to 74 years but stabilized from 2011 to 2013 at ages 75 years or greater at 5.1% per year (95% CI -3.4-14.4). Distant stage disease rates increased with increasing poverty level at ages 50 to 74 years but not at 75 years or greater., Conclusions: The prostate cancer incidence of early stage disease decreased in men 50 years old or older while the rate of distant stage disease slightly increased in men 50 to 74 years old following USPSTF recommendations against routine prostate specific antigen screening. Further studies with additional years of data are needed to substantiate our findings and monitor the effects of the late stage disease increase on prostate cancer mortality rates., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background : Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods : We conducted a systematic review of randomised controlled trials (RCTs) on 18 th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results : Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions : Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines., Competing Interests: Competing interests: No competing interest were declared., (© 2017 Houston KA et al.)

Background: Rehydration strategies in children with severe acute malnutrition (SAM) and severe dehydration are extremely cautious. The World Health Organization (WHO) SAM guidelines advise strongly against intravenous fluids unless the child is shocked or severely dehydrated and unable to tolerate oral fluids. Otherwise, guidelines recommend oral or nasogastric rehydration using low sodium oral rehydration solutions. There is limited evidence to support these recommendations. Methods: We conducted a systematic review of randomised controlled trials (RCTs) and observational studies on 15 th June 2017 comparing different strategies of rehydration therapy in children with acute gastroenteritis and severe dehydration, specifically relating to intravenous rehydration, using standard search terms. Two authors assessed papers for inclusion. The primary endpoint was evidence of fluid overload. Results: Four studies were identified, all published in English, including 883 children, all of which were conducted in low resource settings. Two were randomised controlled trials and two observational cohort studies, one incorporated assessment of myocardial and haemodynamic function. There was no evidence of fluid overload or other fluid-related adverse events, including children managed on more liberal rehydration protocols. Mortality was high overall, and particularly in children with shock managed on WHO recommendations (day-28 mortality 82%). There was no difference in safety outcomes when different rates of intravenous rehydration were compared. Conclusions: The current 'strong recommendations' for conservative rehydration of children with SAM are not based on emerging evidence. We found no clinical trials providing a direct assessment of the current WHO guidelines, and those that were available suggested that these children have a high mortality and remain fluid depleted on current therapy. Recent studies have reported no evidence of fluid overload or heart failure with more liberal rehydration regimens. Clinical trials are urgently required to inform guidelines on routes and rates of intravenous rehydration therapy for dehydration in children with SAM., Competing Interests: Competing interests: No competing interests were disclosed.

Background: The World Health Organization (WHO) rehydration management guidelines (Plan C) for children with acute gastroenteritis (AGE) and severe dehydration are widely practiced in resource-poor settings, yet have never been formally evaluated in a clinical trial. A recent audit of outcome of AGE at Kilifi County Hospital, Kenya noted that 10% of children required high dependency care (20% mortality) and a number developed fluid-related complications. The fluid resuscitation trial, FEAST, conducted in African children with severe febrile illness, demonstrated higher mortality with fluid bolus therapy and raised concerns regarding the safety of rapid intravenous rehydration therapy. Those findings warrant a detailed physiological study of children's responses to rehydration therapy incorporating quantification of myocardial performance and haemodynamic changes.  Methods: GASTRO is a multi-centre, unblinded Phase II randomised controlled trial of 120 children aged 2 months to 12 years admitted to hospital with severe dehydration secondary to AGE. Children with severe malnutrition, chronic diarrhoea and congenital/rheumatic heart disease are excluded. Children will be enrolled over 18 months in 3 centres in Kenya and Uganda and followed until 7 days post-discharge. The trial will randomise children 1:1 to standard rapid rehydration using Ringers Lactate  (WHO plan 'C' - 100mls/kg over 3-6 hours according to age, plus additional 0.9% saline boluses for children presenting in shock) or to a slower rehydration regimen (100mls/kg given over 8 hours and without the addition of fluid boluses). Enrolment started in November 2016 and is on-going. Primary outcome is frequency of adverse events, particularly related to cardiovascular compromise and neurological sequelae.  Secondary outcomes focus on clinical, biochemical, and physiological measures related to assessment of severity of dehydration, and response to treatment by intravenous rehydration., Discussion: Results from this pilot will contribute to generating robust definitions of outcomes (in particular for non-mortality endpoints) for a larger Phase III trial., Competing Interests: Competing interests: No competing interests were disclosed.

Objective: The objective of the study was to assess women's preferences for vaginal vs cesarean delivery in 4 contexts: prior cesarean delivery, twins, breech presentation, and absent indication for cesarean., Study Design: This was a cross-sectional study of pregnant women at 24-40 weeks' gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these 2 delivery approaches., Results: Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the 4 contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean delivery before choosing a planned cesarean delivery, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. Although uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-1 scale, with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable with those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity., Conclusion: Although most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently used to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to explore the relationship between strength of preference for vaginal delivery, delivery mode undergone, and postpartum depression., Study Design: We conducted a secondary analysis of data from a longitudinal study of delivery-mode preferences. During an interview between 24-36 weeks of gestation, participants were asked whether they preferred vaginal or cesarean delivery; the strength of this preference was measured by the standard gamble metric. Depression was assessed antepartum and at 8-10 weeks and 6-8 months after delivery by using the Patient Health Questionnaire (PHQ-9). The primary outcome was PHQ-9 score at 8-10 weeks after delivery. We used multivariable regression analysis to assess the effect of strength of preference for vaginal delivery and delivery mode undergone on postpartum depression., Results: Of 160 participants, 33.1% were nulliparous, and 30.6% had a previous cesarean delivery. Most of the participants (92.4%) preferred vaginal delivery, but the strength of preference varied substantially. The mean strength-of-preference score (0-1 scale; higher scores denote stronger vaginal delivery preference) was 0.658 (SD, ±0.352). A significant interaction emerged between the effects of delivery mode and vaginal delivery preference score on postpartum PHQ-9 score (P = .047). Specifically, a stronger preference for vaginal delivery was associated with higher PHQ-9 scores among women who underwent cesarean delivery (P = .027) but not among women who underwent vaginal delivery (P = .761). The interaction between delivery mode and vaginal delivery preference score was no longer significant at 6-8 months after delivery., Conclusion: Women who have a strong antepartum preference for vaginal delivery and deliver by cesarean may be at increased risk for depression in the early postpartum period., (Published by Elsevier Inc.)

Objective: The examination of lung cancer by histology type is important for monitoring population trends that have implications for etiology and prevention, screening and clinical diagnosis, prognosis and treatment. We provide a comprehensive description of recent histologic lung cancer incidence rates and trends in the USA using combined population-based registry data for the entire nation., Materials and Methods: Histologic lung cancer incidence data was analyzed from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Standardized rates and trends were calculated for men and women by age, race/ethnicity, and U.S. Census region. Rate ratios were examined for differences in rates between men and women, and annual percent change was calculated to quantify changes in incidence rates over time., Results: Trend analysis demonstrate that overall rates have decreased, but incidence has remained stable for women aged 50 or older. Adenocarcinoma and squamous cell carcinoma were the two most common histologic subtypes. Adenocarcinoma rates continued to increase in men and women, and squamous cell rates increased in women only. All histologic subtype rates for white women exceeded rates for black women. Histologic rates for black men exceeded those for white men, except for small cell carcinoma. The incidence rate for Hispanics was nearly half the rate for blacks and whites., Conclusion: The continuing rise in incidence of lung adenocarcinoma, the rise of squamous cell cancer in women, and differences by age, race, ethnicity and region points to the need to better understand factors acting in addition to, or in synergy with, cigarette smoking that may be contributing to observed differences in lung cancer histology., (Published by Elsevier Ireland Ltd.)

Surveys on knowledge of eyewitness issues typically indicate that legal professionals and jurors alike can be insensitive to factors that are detrimental to eyewitness accuracy. One aim of the current research was to assess the extent to which judges, an under-represented sample in the extant literature, are aware of factors that may undermine the accuracy and reliability of eyewitness evidence (Study 1). We also sought to assess the knowledge of a jury-eligible sample of the general public (drawn from the same population as the judges) and compared responses from a multiple choice survey with a scenario-based, response-generation survey in order to investigate whether questionnaire format alters the accuracy of responses provided (Study 2). Overall, judges demonstrated a reasonable level of knowledge regarding general eyewitness memory issues. Further, the jury-eligible general public respondents completing a multiple choice format survey produced more responses consistent with experts than did participants who were required to generate their own responses. The results are discussed in terms of the future training requirements for legal professionals and the ability of jurors to apply the knowledge they have to the legal context., (Copyright © 2013 John Wiley & Sons, Ltd.)

The present set of experiments aimed to investigate the effects of negative emotion on specific aspects of eyewitness recall and recognition performance. The experience of emotion was manipulated between subjects, with participants either viewing a crime scenario (a mugging) or a neutral scenario (a conversation). Eyewitness recall was categorized into descriptions of the perpetrator, critical incident, victim, and environmental details. The completeness and accuracy of eyewitness recall across categories of detail were measured in Experiment 1. A significant main effect of negative emotion was found for the completeness of recall. Furthermore, a significant main effect of the completeness of eyewitness statements was found, but not for their accuracy. However, these main effects were qualified by a significant interaction between emotion and category of detail recalled. Specifically, emotional participants provided a more complete description of the perpetrator than neutral participants; however, they were less able than their neutral counterparts to describe what the perpetrator did to the victim. In light of these findings, Experiment 2 investigated whether enhanced completeness of perpetrator descriptions during recall translated into an enhanced ability to recognize the perpetrator from a photographic lineup by emotional compared with neutral participants. Results from Experiment 2 suggest that while emotional participants again provide a more complete description of the perpetrator, they are less able than their neutral counterparts to recognize the perpetrator from a photographic lineup. Results are discussed in terms of a retrieval motivation hypothesis of negative emotional experience and the possible consequences for eyewitness testimony., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Introduction: To assess changes of success rate, fluoroscopy time, and complication rate for six supraventricular tachycardia pathways/ mechanisms, data from the Pediatric Radiofrequency Catheter Ablation Registry were grouped into two eras (1991-1995; 1996-1999)., Methods and Results: Data from the early era and the late era were compared using the Chi-square test for the outcomes of success rate and complication rate and using the Student's t-test for the outcome of mean fluoroscopy time. In the Registry as a whole, ablation failure rates fell from 9.6% in the early era to 4.8% in the recent era, a reduction of 50% overall. Improved success rates were found for posterior septal, right free-wall, and left free-wall pathways and for AV nodal reentry, whereas anterior septal pathways and atrial ectopic-focus tachycardia did not show improvement. Mean fluoroscopy time overall decreased 21% from 50.9 +/- 39.9 minutes to 40.1 +/- 35.1 minutes. Individually, the improvement in fluoroscopy time was found for all but the atrial ectopic-focus tachycardia mechanism. The complication rate decreased from 4.2% to 3.0%, with significant decreases for left free-wall and posterior septal pathways., Conclusion: Patient selection strategies to optimize radiofrequency ablation outcomes in children, which have been based on the previously published Registry data, should be reconsidered in light of these new, updated data. The lack of uniform improvement provides the impetus for further research and development of new approaches and technologic advances so that further improvement can be achieved.

The fly Drosophila melanogaster is one of the most intensively studied organisms in biology and serves as a model system for the investigation of many developmental and cellular processes common to higher eukaryotes, including humans. We have determined the nucleotide sequence of nearly all of the approximately 120-megabase euchromatic portion of the Drosophila genome using a whole-genome shotgun sequencing strategy supported by extensive clone-based sequence and a high-quality bacterial artificial chromosome physical map. Efforts are under way to close the remaining gaps; however, the sequence is of sufficient accuracy and contiguity to be declared substantially complete and to support an initial analysis of genome structure and preliminary gene annotation and interpretation. The genome encodes approximately 13,600 genes, somewhat fewer than the smaller Caenorhabditis elegans genome, but with comparable functional diversity.

A vital message to convey to health care providers and to women who struggle with urinary incontinence is that female urinary problems may be significantly improved, reversed, or prevented by judicious application of current technologies. Control of female incontinence is particularly important in light of the aging trend and the need to prevent excess disability; therefore, any way in which women can be assisted in maintaining physical functioning, including voluntary control of urination, is important to avoid the dire physical and psychosocial consequences that accompany incontinence.

Fibrin deposition in response to bacterial peritonitis appears to predispose to residual infection in the peritoneal cavity. Our previous studies have demonstrated that intraperitoneal fibrinolysis using human recombinant tissue plasminogen activator (t-PA) prevented abscess formation in a rat intra-abdominal sepsis model. To investigate the potential adverse side effects of its use in the peritoneal cavity, the effect of t-PA on colonic anastomotic wound healing and on systemic coagulation parameters was examined in the rat. T-PA did not adversely affect colonic healing five and ten days after anastomosis. In animals infected intraperitoneally at the time of the anastomosis, t-PA reversed the inhibition of healing induced by perianastomotic abscesses at five days. This effect was mediated by the ability of t-PA to prevent perianastomotic abscess formation. After intraperitoneal administration, t-PA had no effect on prothrombin and partial thromboplastin times in either uninfected or infected animals and there was no evidence of clinical bleeding related to its use. These studies suggest that intraperitoneal fibrinolysis using t-PA may provide a safe, effective form of adjuvant therapy in the management of fibrinopurulent peritonitis.

The use of fibrin sealant has been advocated to enhance the healing of high-risk intestinal anastomoses. Colonic anastomoses were performed in 162 rats randomly assigned to four groups: control animals with or without fibrin sealant applied to the anastomosis and steroid-treated animals with or without fibrin sealant. At five days postoperatively, the use of steroids alone significantly reduced the anastomotic bursting pressure (ABP) and enhanced abscess and adhesion formation. The addition of fibrin sealant to the anastomosis in steroid-treated animals did not improve ABP and, in fact, further increased abscess formation. In control animals, the use of fibrin sealant also reduced ABP and enhanced abscess and adhesion formation. By ten days, there was no difference in ABP among the groups, and the rate of abscess formation was reduced in all groups. These findings indicated that short-term treatment with steroids delayed colonic anastomotic healing. Fibrin sealant did not enhance the integrity of these high-risk anastomoses. The present data do not support the use of fibrin sealant in high-risk colonic anastomoses.

A woman, now 59 has been followed for 13 years with several manifestations of Behçet's disease. These were aphthous stomatitis, genital ulcers, uveitis causing blindness, recurrent erythema nodosum, and synovitis. In 1970 a poorly differentiated diffuse lymphocytic lymphoma appeared and was treated with radiotherapy. In 1976 she developed a mixed cryoglobulinemia and an immune complex mediated vasculitis manifested by purpura and neuropathy which improved on prednisone and chlorambucil therapy. The subsequent course of her lymphoproliferative disorder suggest that it was in fact benign.