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The purpose of this paper is to illustrate the method of real-time data collection using a hand-held personal digital assistant (PDA) in the operating suite, hospital, and office. The technique for the placement of a round Atrium ProLite self-forming, layered polypropylene plug in 155 hernia repairs is described. The study measured postoperative pain by the number of pills used (6.6) and categorizes patient return to work according to sedentary, manual, and standing with an average return to work time of 15.6 days for unilateral repair and 20.4 days for bilateral repair. Return to normal daily activity was within 22.3 days for unilateral- and 28.5 days for bilateral repair.

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In a university program, surgical residents are trained to perform classic inguinal hernia repair. The necessity of this approach is discussed. In this study, polypropylene mesh was added to the repair in order to familiarize the resident with the properties and qualities of mesh. Three hundred seventy-one consecutive herniorrhaphies were performed using a precut mesh in patients weighing between 110 lbs and 285 lbs. All patients were seen postoperatively, and 120 were seen at 1 year. One recurrence and no major complications were noted. Deficient local collagen and properties of mesh prosthetics are discussed as part of the surgical resident curriculum.

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In this paper, we describe a new method for measuring the oral plethysmogram, and we assess its sensitivity and specificity under differing psychological stimulation. Finger and palate pulse amplitudes and blood pressure were monitored while individuals (N = 13) performed several tasks: mental arithmetic, nausea imagery, fear imagery, and anger imagery. Pulse pressure, having a major effect on pulse amplitude, was partialed out in analyses. Palate pulse amplitude increased significantly in response to the degree to which the individual felt irritated, judged, nauseated, or angry. In contrast, finger pulse amplitude changed significantly only in the arithmetic task and, unlike the palate, showed a decreased amplitude with increased irritation and being judged. Results indicate that the oral plethysmogram can serve as a reliable measure of oral mucosal vasomotor reactivity and that it has a different pattern of response specificity than does the finger.

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The effect of gambling and gaming on plasma levels of uric acid was studied. Blood samples were obtained from normal subjects while they gambled for money or while they played checkers without betting. There was an interaction of time and activity reflecting primarily an association of increased uric acid levels during gambling over time, compared with gaming and relaxation. This indicates that gambling can increase plasma levels of uric acid.

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In adults, serum uric acid is positively associated with blood pressure levels. It is also a predictor of the development of hypertension in normotensive adults. The purpose of this study was to examine the relation of serum uric acid to systolic and diastolic blood pressure in adolescents. The data, from Cycle III of the National Health Examination Survey, consisted of a national probability sample of 6768 youths, 12-17 years old, in the United States. With age, height, weight, and sexual maturity controlled, serum uric acid significantly predicted blood pressure in adolescents. This relationship of uric acid and blood pressure was evident in male, but not female, adolescents. In association with findings from adult studies, these results indicate that uric acid levels may be useful indicators of adolescents at risk for hypertension.

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The technique of laparoscopic cholecystectomy is, in many areas, replacing the standard open cholecystectomy as the method of choice. Many surgeons are accustomed to the use of peritoneal drainage following cholecystectomy. The authors have developed a simple, effective, and rapid, yet controlled method of placing drains into the abdominal cavity, using laparoscopic techniques.

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The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy.

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A precise method of placing synthetic material during inguinal hernia repair is described. The material is slit at the inferior position to the internal ring so that its continuity is least compromised.

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The role of suppressor effects in obscuring the relation of psychological variables and blood pressure was studied. Forty-five nonmedicated patients in a family practice rated themselves relative to their peers on a series of characteristics. Two of these, trapped and lonely, exhibited marked suppressor effects in their relationship with each other and resting blood pressure. Self-ratings of lonely exhibited a moderately strong positive association with ratings of trapped (r = .63) while only ratings of lonely showed a significant correlation with resting systolic blood pressure (r = .31). Yet when the suppressor effects of the ratings on feeling lonely were removed in the regression analyses, the ratings on feeling trapped showed a significant positive association with resting systolic pressure (r = .42). Similarly, while neither ratings on feeling lonely or on feeling trapped showed separately a significant association with resting diastolic pressure, when suppressor effects were removed in the regression analyses, the ratings of trapped were significantly associated with diastolic pressure in a positive direction (r = .34) and ratings of lonely were significantly associated in a negative direction (r = .33). The significance of this specific suppressor effect and the implications of suppression for psychosomatic research are discussed.

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The experience of laparoscopic cholecystectomy in 79 patients with acute cholecystitis is described. This group is subdivided into acute and severe acute cholecystitis. These categories are defined. Six percent of our patients with acute disease and 30% of our patients with severe acute disease were converted to open cholecystectomy. Those patients who were converted to open cholecystectomy are discussed. The four port technique and decompression of the gallbladder is described. We conclude that acute cholecystitis should not be a contra-indication to the well-trained laparoscopic surgeon.

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Common duct stones present a special problem to the surgeon when he performs a laparoscopic cholecystectomy. We describe a method of exploring the common duct and extracting stones. The procedures for opening of the common duct, removal of stones, and the placement of a T-tube are carefully outlined.

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Clinicians have long observed an anecdotal association of Parkinson's disease with stoic, industrious, and inflexible personality traits, both premorbidly and after the onset of motor symptoms. In this study, using the Tridimensional Personality Questionnaire, we found significantly less novelty-seeking behavior (behavior thought to be dopamine-dependent) in Parkinson's disease patients than in matched controls, but no differences between groups in behaviors thought to be dependent on serotonin and norepinephrine. We discuss the literature and propose a mechanism that may explain the relationship between brain dopaminergic systems and personality in Parkinson's disease.

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The relationship of style of anger expression to physiological reactivity was examined in 45 nonmedicated subjects during their performance of three tasks with contrasting response demands. The primary physiological focus was on forearm muscle vascular resistance (FMVR) with forearm muscle blood flow (FMBF), digital pulse volume (DPV), digital vascular resistance (DVR), heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), and electrodermal frequency (EF) monitored. Family Expressed Anger, i.e. the overtness of anger expression in the subject's family of origin, was related to FMVR such that the more anger was expressed in the family of origin, the greater the vasoconstriction during Mental Arithmetic and the less the vasoconstriction during Anger Imagery. Self Expressed Anger, i.e. the degree to which others were aware when the subject was feeling angry, was related to SBP and DBP during Vigilance with a lesser degree of anger expression going with greater blood pressure increases. The meaning of these findings in relation to task appraisal and task demand is discussed.

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Forty-five nonmedicated subjects rated on analog scales the anger they experienced at home and at work (Experienced Anger). They also rated the extent to which others were aware of their anger (Expressed Anger) and the extent to which anger had been expressed in their families or origin (Family Expressed Anger). They were then physiologically monitored during a 2-min relaxation period that followed habituation to the laboratory setting. For the group as a whole, Expressed Anger was inversely related to systolic (SBP) and diastolic (DBP) blood pressure while Family Expressed Anger was inversely related to SBP only. When the sample was divided into normotensive and hypertensive subgroups, the normotensives showed significant associations between Experienced Anger and SBP, Expressed Anger and DBP, and Family Expressed Anger and SBP. The hypertensive subgroup showed no significant associations. Both males and females showed a significant association between Expressed Anger and DBP, but only females showed this relationship with SBP. It is concluded that coping with anger by conscious inhibition of its expression is associated with increases in both systolic and diastolic blood pressure.

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The relationship between skeletal age and cognitive ability was examined in a probability sample representative of 12- to 17-year-old males in the United States. Skeletal age was measured by radiographic determination of bone maturation. Cognitive development was assessed by WISC Vocabulary and Block-design subtests. The analyses demonstrated a significant positive relationship between skeletal age and cognitive development, with chronological age controlled.

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This study examined the relation of the Type A scale and of the three factors of the Jenkins Activity Survey to the cardiovascular responses of twenty-six subjects during two stressful tasks. The two tasks were reaction time (RT) and paced arithmetic (PA) and the sample was drawn from a general medical practice. While heart rate correlated directly with the subject's score on the Hard Driving and Competitive Factor (H), diastolic blood pressure response to PA was inversely related to the subject's Type A and factor H scores. This paradoxical inverse relation remained highly significant when the diastolic pressure in the rest preceding PA was statistically controlled.

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