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Complex abdominal wall reconstruction is an emerging subspecialty yet, despite the abundance of abdominal wall hernias requiring treatment and the increasing complexity of this type of surgery, there are few opportunities for surgeons to gain subspecialist training in this field. In this paper we discuss the need for focused training in complex abdominal wall reconstruction, outline some of the problems that may be hindering the availability of such opportunities and propose potential solutions to these issues.

Computed tomography (CT) scanning is the imaging modality of choice when planning the overall management and operative approach to complex abdominal wall hernias. Despite its availability and well-recognised benefits there are no guidelines or recommendations regarding how best to read or report such scans for this application. In this paper we aim to outline an approach to interpreting preoperative CT scans in abdominal wall reconstruction (AWR). This approach breaks up the interpretive process into 4 steps-concentrating on the hernia or hernias, any complicating features of the hernia(s), the surrounding soft tissues and the abdominopelvic cavity as a whole-and was developed as a distillation of the authors' collective experience. We describe the key features that should be looked for at each of the four steps and the rationale for their inclusion.

The radial forearm free flap (RFFF) is a versatile flap offering many reconstructive options for head and neck defects. Its low bulk, ease of dissection, and excellent vascularity are among its advantages. Its low flap loss and complication rates offer the best choice for the reconstruction of oral, oropharyngeal, and hypopharyngeal lining. Evaluation of collateral circulation to the hand is important to avoid distal ischemia and donor site morbidity. Pulse oximetry can be used to augment Allen's test to assess collateral supply to the hand. This cost-neutral technique can be used in routine preoperative screening prior to RFFF surgery.

We study the magnetic relaxation rate Γ of the single-molecule magnet Mn(12)-tBuAc as a function of the magnetic field component H(T) transverse to the molecule's easy axis. When the spin is near a magnetic quantum tunneling resonance, we find that Γ increases abruptly at certain values of H(T). These increases are observed just beyond values of H(T) at which a geometric-phase interference effect suppresses tunneling between two excited energy levels. The effect is washed out by rotating H(T) away from the spin's hard axis, thereby suppressing the interference effect. Detailed numerical calculations of Γ using the known spin Hamiltonian accurately reproduce the observed behavior. These results are the first experimental evidence for geometric-phase interference in a single-molecule magnet with true fourfold symmetry.

Central oxytocin administration has a profound facilitatory effect on the patterning of the milk-ejection reflex in the lactating rat. Lesion and microinjection studies indicate that this action is, in part, mediated via a population of limbic neurones in the bed nuclei of the stria terminalis and ventrolateral septum, which have been shown to possess oxytocin receptors and to be activated by selective oxytocin-receptor agonists in vitro. In vivo electro-physiological recordings reveal that some of these neurones display cyclical activity which is highly correlated to each milk ejection, and are rapidly activated following i.c.v. administration of oxytocin. coincident with the facilitation of milk ejection activity. A hypothetical model is proposed in which this population of limbic neurones serves to gate the activity of a pacemaker which, in turn, coordinates the bursting of hypothalamic magnocellular neurones. The oxytocin innervation of these neurones and their expression of oxytocin receptors increases in the post-partum period, and the resultant enhanced sensitivity leads to a greater facilitatory response during lactation. Inhibitory opioid and noradrenergic inputs which converge on these oxytocin-sensitive neurones may function to switch off the facilitatory circuit during periods of stress. Thus, this population of limbic neurones participates in the regulation of neuroendocrine activity during lactation by providing an appropriate degree of feedback to alter the patterning of the milk-ejection reflex.

We study the magnetic relaxation rate Γ of the single-molecule magnet Mn(12)-tBuAc as a function of the magnetic field component H(T) transverse to the molecule's easy axis. When the spin is near a magnetic quantum tunneling resonance, we find that Γ increases abruptly at certain values of H(T). These increases are observed just beyond values of H(T) at which a geometric-phase interference effect suppresses tunneling between two excited energy levels. The effect is washed out by rotating H(T) away from the spin's hard axis, thereby suppressing the interference effect. Detailed numerical calculations of Γ using the known spin Hamiltonian accurately reproduce the observed behavior. These results are the first experimental evidence for geometric-phase interference in a single-molecule magnet with true fourfold symmetry.

The radial forearm free flap (RFFF) is a versatile flap offering many reconstructive options for head and neck defects. Its low bulk, ease of dissection, and excellent vascularity are among its advantages. Its low flap loss and complication rates offer the best choice for the reconstruction of oral, oropharyngeal, and hypopharyngeal lining. Evaluation of collateral circulation to the hand is important to avoid distal ischemia and donor site morbidity. Pulse oximetry can be used to augment Allen's test to assess collateral supply to the hand. This cost-neutral technique can be used in routine preoperative screening prior to RFFF surgery.

Birth order and family size are two environmental variables that have a marked effect on the later personality (cf. Schachter, 1959). As the occurrence of extra-sensory perception (ESP) seems influenced by various attitudinal and personality factors (cf. Schmeidler & McConnell, 1958), an investigation was undertaken to ascertain whether the manifestation of ESP ability (operationally defined as the attainment of extra-chance scores on a test involving guessing the order of a concealed random sequence of symbols) might be related to birth order and also family size.

Enhancement of nonspecific host defenses against bacterial challenge has been a long-standing goal often thwarted by variable efficacy, inconsistent bioassay, and paradoxic immunosuppression. Muramyl dipeptide provides enhanced survival after intravenous challenge with less than 8 x 10(3) Klebsiella, as well as improved local control of infection at sites of intramuscular bacterial injection, with and without a surgical foreign body. No depression of host response was seen over wide ranges of doses and intervals. Muramyl dipeptide provides a new order of efficacy and safety and warrants continued careful assessment.

The following case report is presented as an unusual case of congenital glaucoma which provided an opportunity for clinicopathologic study. Report of Case A 6-pound female infant was born in the 38th week of pregnancy. At birth her eyes had an unusual bluish haze and dilated pupils. An ophthalmological opinion was requested. The child was seen several times between the 2d and 35th day of life—under anesthesia on the 4th and 20th days. A diagnosis of congenital glaucoma was entertained; because intraocular pressures were at an equivocal level only, no ocular treatment was carried out. The child developed intestinal obstruction and died on the 45th day of life. The clinical findings were as follows: Corneas. —The corneas were cloudy, more centrally than peripherally. This appeared to be stromal rather than epithelial. It did not clear with topical glycerin drops. The average of several measurements of the corneal diameters by either