Colloquiam: Documents published in 2017

Effects of clinoptilolite treatment on oxidative stress after partial hepatectomy in rats

Scipedia content — Fri, 26 May 2017 12:07:54 +0200

Clinoptilolite is a natural zeolite crystal. Cytoprotective effects of clinoptilolite have been reported. However, so far there are no data about the effects of clinoptilolite treatment on oxidative stress after partial hepatectomy. In this experimental study, the effects of clinoptilolite treatment after partial hepatectomy on oxidative stress were evaluated. There were four experimental groups (n = 8): Group S, the sham group, Group H, the hepatectomy group, Group HC, the clinoptilolite treatment after partial hepatectomy group, and Group CS, the clinoptilolite-treated sham group. A 70% partial hepatectomy was performed for Group H and HC. Clinoptilolite (5 mg/kg) was given to the rats orally (via gavage tube) twice a day for 10 days after hepatectomy. Malondialdehyde (MDA), Cu-Zn super oxide dismutase (SOD), and glutathione (GSH) levels were assessed to evaluate oxidative stress. Plasma and liver tissue MDA levels of Group HC were significantly lower than the H group (p = 0.018 and p = 0.000, respectively). Liver tissue Cu-Zn SOD activity and GSH levels of Group HC were significantly higher than Group H (p = 0.003, p = 0.007, respectively). Clinoptilolite administration reduces oxidant activity and supports antioxidant response after partial hepatectomy.

Single port laparoscopic nephrolithotomy in a double collecting system kidney: The first case reported in Thailand

Scipedia content — Fri, 26 May 2017 12:07:48 +0200

The objective of this study is to report the first case in Thailand of a single port laparoscopic nephrolithotomy in a double collecting system of a right kidney. The operation was successfully done in a 49-year-old Thai female presented with a full staghorn kidney stone in the lower moiety of the duplex right kidney. Percutaneous nephrolithotomy was performed first but the removal of the lower calyceal branch and the rest failed because the access tract was lost. Then the residual stones were successfully removed by single port laparoscopic nephrolithotomy. This study proves that single port laparoscopic nephrolithotomy is technically feasible without additional skin incisions.

Management of peri-anal giant condyloma acuminatum—A case report and literature review

Scipedia content — Fri, 26 May 2017 12:07:42 +0200

Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity, however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA, in addition, they reviewed the literature over the last 10 years and compared with previous reviews.

Prognostic factors in Fournier gangrene

Scipedia content — Fri, 26 May 2017 12:07:37 +0200

Fournier gangrene is a necrotizing fasciitis, arising in the genital and perineal area. This entity is still associated with a high mortality rate despite improvements in antibiotic and surgical treatment. This is a retrospective study of all the patients diagnosed and surgically treated for Fournier gangrene at General University Hospital Ramon y Cajal between 1988 and 2008. Possible prognostic factors that could have any influence on the evolution of Fournier gangrene were analyzed. Seventy patients were analyzed, 62 males (88.6%) and 8 females (11.4%) with a mean age of 57.9 ± 13.5 years. Most frequent clinical manifestations were perineal pain (82.9%) and fever (60%). Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. Medical complications rate was 27.1% and mortality one 22.9%. Ethylism, coexistence of neoplasms, presence of skin necrosis, myonecrosis, abdominal wall affection, number of debrided areas, reoperations, concentration of creatinine in serum>1.4 mg/dL, and hemoglobin

Surgical morbidity in obese children

Scipedia content — Fri, 26 May 2017 12:07:33 +0200

In recent years, there has been a worldwide increase in childhood obesity. At present, pediatric surgeons manage a greater number of pediatric patients who are significantly overweight. Little data exist regarding the surgical challenges of obese children. This review study was designed to examine the relationship of obesity to surgical comorbidities, postoperative complications, and perioperative outcome in children, and to pediatric trauma. Obesity seems to be an independent risk factor in surgical-related pediatric morbidity and should be considered an important variable when looking at surgical outcomes in the pediatric population. Identification by and awareness among pediatric surgeons, of increased risk factors for peri/postoperative complications, will be crucial in optimizing the hospital stay and outcome of these children.

Neoadjuvant chemotherapy and salvage surgery for an aldosterone-producing adrenal carcinoma with inferior vena cava thrombus: Case report and literature review

Scipedia content — Fri, 26 May 2017 12:07:28 +0200

Inferior vena cava (IVC) thrombus is a rare presentation of adrenal carcinoma. Hyperladosteronism is rarely associated with it. We report a case of an aldosterone-producing left adrenal carcinoma with IVC thrombus and invasion of multiple organs, treated with neoadjuvant chemotherapy and salvage surgery. The patient is alive and asymptomatic after 46 months. Surgical aspects and therapeutic options are discussed and compared with the current medical literature. This is believed to be the first report of multiple organ resection combined with IVC thrombus removal for a functioning adrenal carcinoma.

Colonic volvulus detected by CT scan in a case with mental retardation and prune belly syndrome

Scipedia content — Fri, 26 May 2017 12:07:23 +0200

Colonic volvulus is a rare disease in children. Delayed diagnosis of the condition can often be fatal, especially in pediatric patients with mental retardation. We herein present the case of a female pediatric patient with colonic volvulus, prune belly syndrome, and mental retardation. Preoperative CT scans showed the characteristic signs of this disease. The volvulus occurred in the proximal colon of the colostomy. The release of the colonic volvulus and reconstruction of the colostomy were performed without the resection of the ischemic colon. The postoperative clinical course was uneventful.

A novel duct-lobular segmentectomy for breast tumors with nipple discharge using near-infrared indocyanine green fluorescence imaging

Scipedia content — Fri, 26 May 2017 12:07:18 +0200

A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that measured 17 mm in diameter with a dilated mammary duct. Contrast-enhanced magnetic resonance imaging showed an early-enhanced cystic tumor and a dilated mammary duct. We performed a duct-lobular segmentectomy using near-infrared indocyanine green (ICG)-fluorescence imaging. Under general anesthesia, a silicone tube was inserted into an orifice of a fluid-discharging mammary duct, and 1 mL dye-fluorescence liquid containing ICG and indigo carmine was injected into the mammary duct. A periareolar incision was made, and the fluorescence image of the demarcated mammary duct segment was obtained. The mammary duct segment was dissected, along with the demarcation line. The cystic lesion and dilated mammary duct were fully resected, and the pathological diagnosis was intraductal papilloma of the breast. We report that near-infrared ICG fluorescence could be applied for imaging of the mammary duct segment, and the fluorescence image allowed for easier duct-lobular segmentectomy for nipple discharge.

Colonic obstruction after ingested gravel and stone

Scipedia content — Fri, 26 May 2017 12:07:13 +0200

This case concerns a 10-year-old boy with a history of behavioral abnormality that arrived at our surgical emergency room with acute abdominal discomfort. The boy had acute colitis-like clinical symptoms resulting from ingested and retained foreign bodies in the colon. These foreign bodies (gravel and stones) had accumulated in the entire colon over a period of 1 year. Attempts to dislodge the foreign bodies from the rectum by mechanical means failed, therefore the possibility of surgical intervention was considered in view of the worsening colitis. However, the problem was finally resolved by repeated basketting by colonoscopy, antibiotics and later laxatives. The case is noteworthy because of the extent of the condition, difficulty of the decision-making, and the relative success of watchful conservative measures.

Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: A randomized clinical trial

Scipedia content — Fri, 26 May 2017 12:07:09 +0200

Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis is still widely practiced, like in our institute, a continuation of the era of open surgery. Recent studies reveal no advantage of routine use of antibiotic, and there is growing consensus against it. Besides cost, antibiotic increases emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial. This randomized clinical trial, conducted from October 1, 2009 to September 31, 2010 at Patan Hospital, included 154 patients in prophylactic antibiotic group (GrAP) with cefazolin 1 g IV as per existing practice and 156 in no antibiotic group (GrAPn). Symptomatic laparoscopic cholecystectomy patients of American Society of Anesthesiologist (ASA) 1 and 2 (without diabetes) were included. Patients with complicated gall stones (cholangitis, choledocholithiasis, and pancreatitis) and who required conversion were excluded. Wound was observed during follow-up within 1 week. Data on patient characteristics, use of antibiotic, bile spillage, and postoperative wound infection were entered in predesigned proforma. Microsoft Excel was used to analyze the data. In total, 310 patients were eligible for analysis, 154 in GrAP and 156 in GrAPn. Both groups were comparable in patient demographic and clinical characteristics such as average age (40.3 vs. 41.6 years) and sex (female 77.6% vs. 78.6%). Overall wound infection occurred in 4.8% (15/310). There was no significant difference in wound infections among the two groups (p = 0.442): GrAP 3.9% and GrAPn 5.8%. There was no mortality in this series. Routine preoperative antibiotic prophylaxis is not necessary in low-risk symptomatic gallstone patients undergoing laparoscopic cholecystectomy.

Intraperitoneal explosion following gastric perforation

Scipedia content — Fri, 26 May 2017 12:07:04 +0200

The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

Left-sided gallbladder: An incidental finding on laparoscopic cholecystectomy

Scipedia content — Fri, 26 May 2017 12:07:00 +0200

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. This is a report of a 50-year-old woman who was admitted to our department with a history of pain in her right upper abdomen. The physical examination showed tenderness in the right upper quadrant of the abdomen without a Murphys sign. Abdominal ultrasonography showed gall bladder stones without dilatation of the bile ducts. The patient underwent a laparoscopic cholecystectomy using the French position and four ports positioned as usual. We discovered a left-sided gallbladder located on the left of the round ligament. The gallbladder was excised as usual. Intraoperative cholangiogram showed neither dilatation of the bile ducts nor associated congenital anomalies of the biliary tree. The patient was discharged on the first postoperative day. Because routine preoperative examinations may not detect the anomaly, the latter may take surgeons by surprise during laparoscopy. Awareness of the unpredictable confluence of the cystic duct into the common bile duct and selective use of intraoperative cholangiography both contributed to the safe laparoscopic management of this unusual problem.

Duodenal GIST metastasized to skull and orbit managed by surgery – A case report

Scipedia content — Fri, 26 May 2017 12:06:54 +0200

We report a 26-year-old man with 6 years, history of duodenal gastrointestinal stromal tumor (GIST) with liver, peritoneum and lung metastases. He presented with left eye ptosis, diplopia, left facial numbness and a left temporal fossa mass that was confirmed to be GIST with left skull and left orbit metastases. Craniectomy with cranioplasty, tumor excision and decompression were performed. There was an improvement of his visual symptoms and facial numbness. To our knowledge, this is one of the few reports of surgical management of GIST, metastasized to skull and orbit, with good symptomatic relief.

Hepatic perivascular epithelioid cell tumor: Five case reports and literature review

Scipedia content — Fri, 26 May 2017 12:06:48 +0200

Perivascular epithelioid cell tumor (PEComa) is a rare tumor. Here, we present data regarding clinical presentations, diagnoses, management, and prognosis of five cases of hepatic PEComa between January 2002 and December 2008. Ultrasonography showed hyperechoic masses in all patients. Precontrast computed tomography (CT) showed that all lesions scanned were heterogeneous in density and were heterogeneously enhanced in arterial phase images. In two cases, magnetic resonance imaging showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. In enhanced scanning, lesions showed asymmetrical enhancement during arterial phase imaging. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and thick-walled blood vessels, and showed positive immunohistochemical staining for Human Melanoma Black-45. All patients underwent hepatectomy, and there was no evidence of recurrence or metastasis during the follow-up period.

Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures

Scipedia content — Fri, 26 May 2017 12:06:43 +0200

Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survivalof patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis. An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed. Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty. Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.

Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications

Scipedia content — Fri, 26 May 2017 12:06:38 +0200

Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate the results of LA in both complicated and uncomplicated cases of acute appendicitis. From January to December 2009, 94 patients with acute appendicitis underwent LA by the same surgeon using the three-port technique. Data were accumulated and compared between complicated and uncomplicated acute appendicitis. Of the 94 patients (45 women and 49 men), 19 had complicated and 75 uncomplicated acute appendicitis. The group with complicated acute appendicitis, as compared to the uncomplicated group, was significantly older (55.7 ± 20.5 years vs. 41.0 ± 18.0 years), and had a significantly increased operation time (117.6 ± 45.5 minutes vs. 78.2 ± 39.4 minutes), longer length of hospital stay (9.0 ± 3.3 days vs. 5.2 ± 6.0 days) and higher conversion rate (21.1% vs. 2.7%). No increase in surgical complications was noted in patients with complicated acute appendicitis, as compared to those with uncomplicated acute appendicitis. This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

Technical modification of retroperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism and clinical outcomes

Scipedia content — Fri, 26 May 2017 12:06:33 +0200

Standard laparoscopic adrenalectomy requires early control of the main adrenal vein, however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier.

Doctor–patient communication, knowledge, and question prompt lists in reducing preoperative anxiety – A randomized control study

Scipedia content — Fri, 26 May 2017 12:06:28 +0200

The aims of the study were to assess factors responsible for the reduction of preoperative anxiety in patients undergoing breast and abdominal surgeries. In particular, we investigated whether question prompt lists (QPL), patients’ knowledge, or the communication skills of surgeons had effects on anxiety reduction. Patients were randomly assigned to QPL and control groups. Anxiety was assessed on the State Trait Anxiety Inventory. Both groups showed significant reduction in anxiety between initial consultation and one day prior to surgery, with QPL patients showing a trend towards a greater reduction of anxiety after surgery and a significant reduction at the first outpatient follow-up. Satisfaction with consultation and the doctor’s ability to answer questions concerning diagnosis, and treatment were significantly associated with anxiety reduction. Effective anxiety reduction hinged on doctors’ communication abilities and patients’ satisfaction with the consultation.

Single-incision laparoscopic cholecystectomy: The first Malaysian experience

Scipedia content — Fri, 26 May 2017 12:06:22 +0200

Single-incision laparoscopic cholecystectomy (SILC) is an evolving concept in minimally invasive surgery. It utilizes the concept of inline viewing and a single incision that accommodates all of the working instruments. Here, we describe a single surgeons initial experiences of using this technique in a tertiary hospital. Between January and September 2010, 21 patients underwent SILC for symptomatic cholelithiasis. The umbilicus was the point of access into abdomen for all patients using a 2.0–2.5-cm incision. The surgeries were performed using the Covidien SILS port with a 30° angled scope and two 5-mm conventional laparoscopic instruments. Nineteen patients successfully underwent surgery (8 males and 11 females, mean age: 43 years). The mean body mass index was 25.9 kg/m2 (range: 19.0–38.2 kg/m2). The mean operative time was 89 minutes (range: 55–135 minutes). Minimal blood loss was noted in each patient. The mean length of the postoperative stay was 1.1 days (range: 1–3 days). No complications or mortalities were associated with the technique. The visual analogue score for pain at the 1-day and 6-week follow-up examinations was 2 (range: 1–7) and 0.6 (range: 0–3), respectively. At 6 weeks, the mean satisfaction score for the resultant scar was 8.8 (range: 4–10) and the mean overall satisfaction score was 9.2 (range: 7–10). The mean time until returning to work or normal activities was 8.8 days (range: 1–21 days). SILC is feasible and demonstrates a good clinical outcome.

Predictors of diabetes remission after bariatric surgery in Asia

Scipedia content — Fri, 26 May 2017 12:06:17 +0200

Obesity and type II diabetes mellitus (T2DM) are closely related and difficult to control by current medical treatment. Bariatric surgery has been proposed for inadequately controlled T2DM in association with obesity. However, prediction of successful T2DM remission after surgery has not been clearly studied in Asian patients. This information might be helpful for applying gastrointestinal surgery as metabolic surgery for T2DM. This was a retrospective clinical study. From January 2002 to December 2008, 88 consecutive patients with morbid obesity, who were enrolled into a surgically supervised weight loss program, and who had T2DM before surgery with at least 1 year complete follow-up data were included. Sixty-eight (77.2%) patients received gastric bypass procedures, and the remaining 20 (22.8%) received restrictive procedures. We analyzed the available information during the initial evaluation of patients who were referred for bariatric surgery, by logistic regression analysis and data mining methods for predictors of successful diabetes remission after surgery. Overall, 68 (77.2%) of the 88 patients had remission of their T2DM 1 year after surgery. Patients in the bypass group had a higher remission rate than those in the restrictive group [59/68 (86.7%) vs. 9/20 (45.0%), p = 0.000]. In univariate analysis, patients who had T2DM remission after surgery were younger, heavier, had a wider waist, less severe disease, shorter duration, and higher C-peptide levels than those without remission. Type of operation and T2DM duration remained independent predictors of success after multivariate logistical regression analysis (p

Preoperative embolization followed by palliative therapy for patients unable to undergo the complete removal of a chronic expanding hematoma–A case report

Scipedia content — Fri, 26 May 2017 12:06:12 +0200

We report herein a case of an 80-year-old female patient who presented with hemosputum and a left chest tumor. Owing to her medical history and imaging findings, we strongly suspected chronic expanding hematoma (CEH). Arteries feeding the mass were embolized prior to surgery to control intraoperative bleeding. We successfully inhibited the massive bleeding from the wall of the tumor and performed surgery rapidly and with minimal blood loss. Thus, preoperative embolization followed by palliative therapy is effective for controlling a CEH both intra- and post-operatively and should be considered an alterative treatment, especially for patients unable to undergo complete removal.

Esthesioneuroblastomas in an Asian population: Similarities and differences

Scipedia content — Fri, 26 May 2017 12:06:07 +0200

Esthesioneuroblastoma is an uncommon tumor that is described widely among the Caucasians. In Singapore, we see predominantly Asian patients with esthesioneuroblastomas. From our experience, we note significant and interesting differences between our data on Asian patients and the published ones on the Caucasian patients. A retrospective review of all patients who underwent craniofacial resection for esthesioneuroblastomas was conducted from January 1997 to January 2010. Relevant data were collected and statistical analyses were carried out to determine factors that predicted mortality or complications. Out of a total of 48 patients who underwent craniofacial resections, half had esthesioneuroblastomas (50%). There was a peak age distribution at the sixth decade of life and 62% of our patients were male. Both local and regional recurrence rate was 50%. Majority of our Asian patients who underwent craniofacial resections had esthesioneuroblastomas. There is a male predilection, and we do not see a bimodal age distribution that is commonly reported.

Cost-effective homemade specimen retrieval bag for use in laparoscopic surgery: Experience at a single center

Scipedia content — Fri, 26 May 2017 12:06:02 +0200

To offer an easily produced and cost-effective specimen retrieval bag that can be used to reduce the cost of laparoscopic surgery. From January 2005 to October 2009, 135 patients underwent laparoscopic surgery for adrenalectomy or prostatectomy, during which a homemade specimen retrieval bag was used. The retrieval bag was produced from a large sterile surgical glove, 2-0 nylon thread, and 1-0 RB-1 needle Vicryl thread. A purse-string suture at the opening of the bag was made using the nylon thread, and the bottom of the bag was double-tied using the tail of the Vicryl thread. The bag was introduced into the peritoneal cavity via a 12-mm port, and the specimen was enclosed with the use of two laparoscopic instruments. The bag was then extracted by extending the port incisional wound. We used a homemade retrieval bag to extract specimens from 110 patients who underwent robot-assisted laparoscopic radical prostatectomy and 25 patients who underwent laparoscopic adrenalectomy. The procedure was performed safely, and no bags were broken. No complications were observed after the operations such as wound infection, ileus, or intestinal adhesion. In our experience, our homemade endobag can be easily used by surgeons to extract specimens from the abdominal cavity. The total cost of hospitalization was also reduced for the patients. The homemade specimen retrieval bag is cost-effective and useful for the retrieval of intact specimens. It is also easy to make and safe to use.

Usefulness of sennoside as an agent for mechanical bowel preparation prior to elective colon cancer surgery

Scipedia content — Fri, 26 May 2017 12:05:57 +0200

We retrospectively evaluated the usefulness of sennoside as an agent for mechanical bowel preparation prior to elective colon cancer surgery. A total of 86 patients were given 12 mg of sennoside on the evening prior to resective surgery for colon cancer, followed by intravenous antimicrobial prophylaxis used on the day of surgery or until postoperative day 2. The incidence of surgical site infection in the study group was 4.7%, which was comparable to that in the historical control patients (3.5%, p > 0.99), who had received polyethylene glycol for mechanical bowel preparation prior to colon surgery. On multivariate logistic regression analysis, only body mass index (p = 0.04) was an independent significant factor affecting the surgical site infection. The intraoperative spillage was not influenced by the presence of stenosis, although the amount of fecal matter was higher in the upstream colon segment (p

The anatomy of the external branch of the superior laryngeal nerve in Koreans

Scipedia content — Fri, 26 May 2017 12:05:51 +0200

Preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy is important because its injury may lead to frequent occurrence of vocal fatigue and the inability to perform superenergetic phonation. Most studies on the anatomy of EBSLN have been performed in Western countries and, thus, have some limitations in their application to Koreans. We explored the anatomy of EBSLNs using intraoperative neuromonitoring (IONM) in Korean adults. Between August 2011 and December 2011, 50 patients underwent thyroidectomy at Korea University, Anam Hospital in Seoul, Korea. IONM was performed with the NIM response 3.0 system. Forty-two total thyroidectomies and eight lobectomies were performed with IONM and 92 EBSLNs were evaluated. Type I EBSLN was observed in 15 of the 92 nerves (16.3%), type IIa EBSLN was noted in 52 (56.5%) and type IIb EBSLN was noted in 25 (27.2%). Patients with types IIa and IIb were at higher risk of injuries and these types were more frequently observed (83.7%) compared with previous Western studies. We found that 35.9% of distal insertion sites of EBSLNs were located within 1 cm of the center of the cricoid cartilage. Surgeons should pay close attention to preserving the EBSLN during thyroidectomy in Korean patients because their EBSLNs are more frequently located beneath the superior thyroid vessels.

Diagnostic difficulties and treatment strategy of hepatic angiomyolipoma

Scipedia content — Fri, 26 May 2017 12:05:44 +0200

Based on a large series of histopathologically confirmed hepatic angiomyolipomas, we retrospectively studied the typical diagnostic features of hepatic angiomyolipoma and proposed a treatment strategy for this disease. From December 1997 to December 2007, 74 consecutive patients who received definitive treatment for hepatic angiomyolipoma, at a single tertiary center, were studied. There was a marked female predominance (54 females vs. 20 males) and the mean age was 42 years. Forty patients had no symptoms and the tumors were detected incidentally during a medical check-up. From this study, we proposed the typical diagnostic features of hepatic angiomyolipoma to be the absence of risk factors for malignancy, normal tumor marker levels, and typical imaging features on ultrasound (USG), abdominal contrast computed tomography (CT), or magnetic resonance imaging (MRI). Only 23% of patients could have been diagnosed before surgery using these features. One patient (1.4%) had a malignant angiomyolipoma, and died with distant metastases 14 months after surgery. After a median follow-up of 64 months, there was no recurrence in the other 73 patients. Patients with typical diagnostic features suggestive of hepatic angiomyolipoma could be observed with regular surveillance. Definitive treatment should be performed when the tumor has symptoms/complications, when the tumor is enlarging, or when a malignant lesion cannot be ruled out.

Surgical resection for hepatocellular carcinoma in pregnancy: A case report

Scipedia content — Fri, 26 May 2017 12:05:38 +0200

Hepatocellular carcinoma (HCC) occurring in pregnancy is very rare. The prognosis is usually poor because of unclear clinical presentation. A 30-year-old woman who suffered from HCC during pregnancy underwent hepatectomy twice, and resection for pulmonary metastasis once. A healthy infant was delivered after the first hepatectomy. Currently, she remains disease free 55 months after the second hepatectomy and 39 months after pulmonary metastatectomy. Moreover, she had another healthy infant 37 months after pulmonary metastatectomy. Aggressive resection of recurrent HCC may prolong life, and pregnancy should not alter the treatment strategy for HCC.

Aggressive management of massive hemothorax in patients on extracorporeal membrane oxygenation

Scipedia content — Fri, 26 May 2017 12:05:33 +0200

Massive hemothorax in patients on extracorporeal membrane oxygenation (ECMO) is potentially life threatening and remains a medical challenge. In this study, we present the clinical results of using aggressive management to treat a consecutive series of patients on ECMO whose conditions were complicated by massive hemothorax. Between November 2003 and February 2010, 14 adult patients on ECMO developed massive hemothorax that was unrelated to the cannulation problems of the ECMO circuit at National Taiwan University Hospital, Taipei, Taiwan. Information was obtained regarding patient demographics, disease course, and treatment. Aggressive treatment of hemothorax included blood component therapy, chest tube drainage, pleural epinephrine irrigation, and surgical intervention. The criteria for surgical intervention, video-assisted thoracoscopic surgery (VATS), or open-window thoracostomy included one-third or more of the thoracic cavity that had accumulated blood clots resulting in a compromised cardiopulmonary status, continuous blood loss > 300 mL/hour for 4 hours or more, or continued bleeding for 24 hours after persistent blood transfusion. All hemothoraces were unilateral. With coagulopathic correction, control of bleeding was obtained in two patients after decompression of the pleural cavity, four patients after pleural epinephrine irrigation, and eight of 14 patients required surgical intervention for blood clot evacuation. There were no specific findings except blood clot accumulation in each of the patients who underwent thoracotomy or VATS. Three of the eight patients required multiple operations to treat persistent bleeding. The in-hospital mortality rate was 36% (5 of 14 patients), one patient died of intractable bleeding and four deaths were related to multiple organ failure. Blood transfusion (Mann-Whitney U test, p = 0.039) and comorbidities such as bacteremia, septic shock, diabetic mellitus, and immunocompromised status (Fisher exact test, p = 0.031) were found to be significant and independent predictors of mortality. However, other factors such as age, complicated pneumothorax, and ECMO circuit duration were not statistically correlated with mortality. ECMO-related massive hemothorax usually occurred unilaterally and presented as a life-threatening condition. With intensive treatment, nearly two-thirds of the patients were saved. The most significant risk factor for mortality was the presence of a comorbidity such as sepsis, diabetic mellitus, or immunocompromised status.

Pediatric renal transplantation: Results and prognostic factors

Scipedia content — Fri, 26 May 2017 12:05:28 +0200

As renal transplantation may increase survival rates and improve quality of life for children with end-stage renal disease, we investigated the long-term outcomes and prognostic factors of pediatric renal transplantation. A retrospective study was conducted to review 25 pediatric renal transplantations, either from live or deceased donors, in our hospital from 1995 to 2008. The cumulative graft survival rate was calculated using the Kaplan-Meier method. Log rank tests were employed to identify categorical prognostic factors for graft survival of the pediatric renal transplantations, and Cox regression analysis for numeric factors. The mean age of our study subjects was 11.63 ± 3.76 years, and the mean follow-up period was 49.24 ± 33.72 months. The 12-month and 36-month graft survival rates were 92% and 82.14%, respectively. The rejection-free survival rates were 88% and 72.88% in the first and third years, respectively. All of the patients were alive during the follow-up period. Acute rejection (p = 0.0175) and male sex (p = 0.0384) were found to be significant factors for graft survival. For pediatric patients, we found that renal transplantation is now a safe and effective surgical procedure for children with end-stage renal disease. Acute rejection and male gender were identified as prognostic factors for poor graft survival.

Cutaneous alternariosis in a renal transplant recipient: A case report and literature review

Scipedia content — Fri, 26 May 2017 12:05:22 +0200

Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. We recently treated a male renal transplant recipient with a cutaneous phaeohyphomycosis due to Alternaria species. The diagnosis was based on microscopy and culture of the skin lesions. Treatment with oral itraconazole for 5 weeks was ineffective, then clinical improvement was achieved by combination of amphotericin B wet-packing and systemic antifungal therapy with oral voriconazole. Alternaria species are ubiquitous plant-inhabiting saprobes, which are increasingly associated with opportunistic phaeohyphomycosis in immunocompromised individuals. To the best of our knowledge, this is the second case report noting sporotrichoid pattern as the manifestation of cutaneous alternariosis. In this context, we reviewed recent renal-transplant-related cutaneous alternariosis reported in the English-language literature during 1995 to 2011 to summarize its clinical features and outcomes, and to guide clinicians in the care of kidney transplant patients with cutaneous alternariosis.

IgG4-related hypophysitis presenting as a pituitary adenoma with systemic disease

Scipedia content — Fri, 26 May 2017 12:05:16 +0200

Hypophysitis is a rare inflammatory disorder that can mimic a pituitary tumor clinically or radiologically. Furthermore, immunoglobulin G4 (IgG4)-related systemic disease is only a just recently characterized disorder. It can manifest as a systemic disease involving multiple organs, including the pancreas, salivary glands, lungs, liver, bile duct, gallbladder, kidneys, and retroperitoneum. It is characterized by a high serum level of IgG4 clinically and dense lymphoplasmacytic infiltration with sclerosis and phlebitis histologically. Herein, we report the case of a man 66 years of age who presented with nausea, vomiting, and poor appetite with a body weight loss of 4 kg. Image study revealed a pituitary infundibulum mass, right-posterior mediastinal and paraspinal masses, as well as infiltrating masses in bilateral kidneys. Therefore, he received a thoracoscopic biopsy for the right-posterior mediastinal and paraspinal masses and a pathologic examination reported an IgG4-related inflammatory pseudotumor. Then, transsphenoidal removal of the infundibulum mass was performed. Histologically, the infundibulum mass represented a IgG4-related hypophysitis manifested as an infiltration of plasma cells, lymphocytes, histiocytes, and some eosinophils with a fair number of IgG4-immunoreactive plasma cells. After the operation was complete, the patient took 5 mg of prednisolone every 2 days for 3 months. A follow-up computed tomography scan revealed improvement of the infiltrating masses in the bilateral kidneys.

Onyx embolization of a lingual arteriovenous malformation

Scipedia content — Fri, 26 May 2017 12:05:11 +0200

Head and neck arteriovenous malformations (AVMs), including lingual AVMs, are unusual and rare. There are many treatment options including sclerotherapy, endovascular or percutaneous embolization, and surgical excision. A combination of preoperative embolization and surgical resection is commonly used for head and neck AVMs. However, in most cases, surgical resection causes significant morbidity. Single-modality approaches such as transarterial embolization are sometimes performed. Herein, we used the copolymer Onyx (ethylene–vinyl alcohol copolymer) as an embolizing agent and obtained satisfactory therapeutic outcomes. To our knowledge, this is the first report of lingual AVMs treated using Onyx embolization.

Use of indocyanine green for functional assessment of human hepatocytes for transplantation

Scipedia content — Fri, 26 May 2017 12:05:05 +0200

Hepatocyte transplantation is a promising alternative to liver transplantation in children with liver metabolic disorders and acute liver failure. Currently, it is difficult to assess rapidly hepatocyte function before transplantation. The aim of this study was to investigate whether the uptake and release of indocyanine green (ICG) by hepatocytes could be used. Human hepatocytes (106 cells) isolated from unused donor livers were incubated at 37°C for 30 minutes with ICG (0–2 mg/mL) in both cell suspension and on collagen-coated culture plates. Cells were then incubated in medium without ICG for 3 hours with supernatants collected at 1, 2 and 3 hours for measurement of ICG release. Cell viability was determined by trypan blue exclusion, (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay (mitochondrial dehydrogenase activity) and sulforhodamine B (SRB) assay (cell attachment). HepG2 cells were also used. ICG was taken up and secreted by hepatocytes with the release reaching a plateau level soon after 1 hour. Concentrations of ICG > 1.0 mg/mL had toxic effects on hepatocytes. Hepatocytes incubated with 1.0 mg/mL ICG had higher mitochondrial dehydrogenase activity compared to 0.5 mg/mL ICG or control cells (0.025 ± 0.0004 OD unit vs. 0.019 ± 0.0008 OD unit or 0.020 ± 0.002 OD unit, p

Pediatric trauma research in the Gulf Cooperation Council countries

Scipedia content — Fri, 26 May 2017 12:05:00 +0200

To review published pediatric trauma research from the Gulf Cooperation Council (GCC) countries so as to identify research fields that need to be enhanced. A MEDLINE search for articles on pediatric trauma from GCC countries during the period 1960 to 2010 was performed. The content of articles was analyzed, classified and summarized. Fifty-three articles were found and retrieved of which 18 (34%) were published in the last 5 years, 42 (79.2%) were original articles. The first author was affiliated to a university in 29 reports (54.7%), to a community hospital in 13 (24.5%) and to a military hospital in 10 (18.9%). All articles were observational studies that included 18 (34%) case-control studies, 18 (34%) case reports/case series studies, 8 (15.1%) prospective studies, and 7 (13.2%) cross sectional studies. The median (range) impact factor of the journals was 1.3 (0.5–3.72). No meta-analysis studies were found. A strategic plan is required to support pediatric trauma research in GCC countries so as to address unmet needs. Areas of deficiency include pre-hospital care, post-traumatic psychological effects and post-traumatic rehabilitation, interventional studies focused on a safe child environment and attitude changes, and the socioeconomic impact of pediatric trauma.

Recent role of Hassabs operation for cirrhotic patients: Combination with endoscopic procedure for varices

Scipedia content — Fri, 26 May 2017 12:04:54 +0200

Recently, endoscopic and radiological procedures for various symptoms related to cirrhosis have improved. Thus, the role of Hassabs operation (gastroesophageal decongestion and splenectomy) has changed for cirrhotic patients. Hassabs operation was performed on patients who had gastroesophageal varices that were difficult to control with balloon occluded retrograde transvenous obliteration or an endoscopic procedure, or had hypersplenism. Thirteen consecutive patients underwent this operation, and the outcomes of all patients were reviewed retrospectively. There was no operative morbidity or rebleeding varices. In the preoperative endoscopic injection sclerotherapy treated group (n = 6), only one patient (16.7%) developed recurrent varices. Mean platelet counts were significantly higher 6 months after surgery (201 ± 65 × 103/mm3) than preoperatively (64 ± 54 × 103/mm3). In patients with hepatocellular carcinoma, percutaneous therapies, such as radio frequency ablation, were safely performed with adequate therapeutic effect. Interferon therapy was given to patients with hepatitis C virus (HCV)-related cirrhosis without interruption. Hassabs operation is a satisfactory approach to controlling varices, especially when combined with preoperative endoscopic treatment. Platelet counts were significantly higher after surgery. This therapy was important for cirrhotic patients contraindicated for liver transplantation in that they could continue their therapy for hepatocellular carcinoma (HCC) and HCV as needed.

Bariatric surgery in Singapore from 2005 to 2009

Scipedia content — Fri, 26 May 2017 12:04:48 +0200

Obesity is a major public health concern worldwide, including Singapore. Bariatric surgery has grown in popularity to combat this situation, and innovations in this field have led to the emergence of new bariatric procedures. For the healthy growth of this specialized field of surgery, it is mandatory to audit the progress and state of bariatric surgery at regular intervals. An e-mail questionnaire survey was conducted in all the leading hospitals of Singapore practicing bariatric surgery between 2005 and 2009. All four hospitals to which the questionnaire survey was mailed responded. The responses from these hospitals were tabulated and analyzed. Between 2005 and 2009, a total of 278 bariatric procedures were performed on 151 men and 127 women with a mean age of 40.34 years (range: 18–64 years) by 12 practicing surgeons. The mean body mass index was 42.25 kg/m2 (range: 31.4–73 kg/m2). All the operations were performed laparoscopically. The most commonly performed procedure was adjustable gastric banding (81.65%), followed by sleeve gastrectomy (13.66%) and Roux en Y gastric bypass (3.95%). There is a flux of newer procedures in Singapore. Adjustable gastric banding, which was the only available procedure being performed in 2004, was gradually being replaced by other procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass in 2009.

Perioperative outcomes of laparoscopic and open distal pancreatectomy: Our institution’s 5-year experience

Scipedia content — Fri, 26 May 2017 12:04:42 +0200

Application of minimally invasive techniques in the surgical management of distal pancreatic lesions is increasing. Despite this, numbers of laparoscopic distal pancreatectomy remain low and limited to treatment of benign and premalignant lesions. Retrospective analysis of 31 patients who underwent distal pancreatectomy from 2005 to 2010. Patients were grouped according to mode of surgical access: open (ODP) or laparoscopic (LDP). Perioperative parameters were compared. Twenty-one (67.7%) patients underwent ODP and 10 (32.3%) LDP (median age 61, 80.0% females in LDP group, p = 0.030). Postoperative morbidity rate were comparable between the two groups. In the LDP group, there were significantly lower estimated blood loss (p

Total laparoscopic approach for the treatment of right colon cancer: A technical critique

Scipedia content — Fri, 26 May 2017 12:04:37 +0200

Total laparoscopic surgery is not a new concept, but it is not preferred generally for right colectomy. The aim of the study is to evaluate the outcomes, which are related with surgical technique after total laparoscopic right colectomy (TLRC) and laparoscopic-assisted right colectomy (LARC) for right colon cancer in 30 consecutive patients. Thirty patients with right colon cancer, half of which were treated with TLRC and half of which were treated with LARC, were compared with regard to patient demographics, operative and postoperative data, histopathologic findings, follow-up data, and the complications related to the surgical technique. There were 16 men and 14 women, median age was 63 years (range 41–86) with a body mass index (BMI) of 27 kg/m2 (range 20–33). There were no differences between the groups for BMI, harvested lymph node number, or distal and radial margins. The length of the incision and the length of the postoperative stay was shorter in the TLRC group (p = 0.000). Overall complications were higher in the LARC group than in the TLRC group (p = 0.014). The median follow-up was 28 months (range 5–99). In the late period, two patients in the LARC group were reoperated on. The cause of reoperation was internal herniation in one patient due to ileal twisting and incisional hernia in the other one. Our preliminary data indicate that TLRC could result in better outcomes for right colon cancer patients than LARC.

The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: Risk of infection and recurrence

Scipedia content — Fri, 26 May 2017 12:04:32 +0200

The aim was to evaluate the risk of infection and hernia recurrence for patients undergoing repair of ventral hernia (VH) with prosthetic mesh during colorectal resection. A retrospective review was performed of long-term outcomes for 40 patients who underwent mesh repair for VH during bowel resection between 2000 and 2007. Patients with recurrence (R) were compared with others (NR) and univariate and multivariate analysis of factors associated with recurrence and infection were determined. Forty patients (60% male, mean age 61 years) with colorectal cancer, diverticulitis and inflammatory bowel disease underwent repair with non-absorbable mesh. During the course of follow-up medical visits (median follow-up of 3.0 years, 25th percentile, 75th percentile: 1.8 years, 4.6 years), mesh infection rate was 22.5% and hernia recurrence rate 40%. R (n = 16) and NR (n = 24) had similar age, gender, body mass index, steroid use, smoking history, and drain use. A significantly greater proportion of R had diabetes (p = 0.04), larger fascial defect (p = 0.02), emergency surgery (p = 0.001), and wound infection (p = 0.001). On multivariate analysis, duration of follow-up (p = 0.001), comorbidity (p = 0.02), large defect size (p = 0.04), emergency surgery (p = 0.001) and development of infection (p = 0.001) were the only factors independently associated with recurrence. Use of non-absorbable mesh during colorectal resection should be very selective. Comorbidity, duration of follow-up, emergency operations, size of area covered and infection are independent factors associated with recurrence.

GPC-1 may serve as a predictor of perineural invasion and a prognosticator of survival in pancreatic cancer

Scipedia content — Fri, 26 May 2017 12:04:26 +0200

The purpose of this study was to investigate the expression of glial cell derived neurotrophic factor (GDNF), glypican-1 (GPC-1), and matrix metalloproteinase-9 (MMP-9), and their association with clinicopathologic characteristics as well as prognostic significance in pancreatic cancer. Immunohistochemical assessment of GDNF, GPC-1, and MMP-9 was performed in 62 cases of surgically resected pancreatic cancer. Perineural invasion in pancreatic cancer was observed by marking nerve fiber with S-100, while 16 normal pancreatic tissues were used as normal control. Correlations of GDNF, GPC-1 and MMP-9 expressions with clinicopathologic parameters were analyzed. A survival analysis was performed to find the prognostic significance. The expressions of GDNF, GPC-1 and MMP-9 in pancreatic cancer tissue were significantly higher than of those in normal pancreatic tissues (41/62 vs. 5/16 for GDNF, 35/62 vs. 2/16 for GPC-1, and 37/62 vs. 3/16 for MMP-9, p

Management of middle cerebral artery dissecting aneurysm

Scipedia content — Fri, 26 May 2017 12:04:20 +0200

Dissecting aneurysms of the intracranial carotid circulation were previously thought to occur primarily in young people presenting with cerebral infarction caused by arterial stenosis and occlusion. The appropriate management of dissecting aneurysms in the anterior circulation remains controversial, especially in patients who also present with cerebral infarction. However, recent studies have reported better outcomes for patients with middle cerebral artery (MCA) dissecting aneurysms involving surgically treated subarachnoid hemorrhage (SAH). The purpose of this study is to describe a case of spontaneous SAH from rupture of a dissecting aneurysm in the M2 segment observed in a 79-year-old man with no sign of an ischemic neurological deficit, and also to review the clinical and radiological features of cases reported since 1990. Our review of the literature identified 24 cases of MCA dissecting aneurysms after 1990. Of the patients in these cases, 15 (63%) presented with pure bleeding and 7 (29%) with ischemia, and two were detected incidentally. Our review also found that the outcome of patients presenting with pure bleeding differed from those with ischemia. Patients with an MCA dissecting aneurysm who presented with pure bleeding showed better outcomes if they had surgery than if they did not. In contrast, the appropriate management of patients with a dissecting aneurysm who present with ischemia remains controversial. Our review found that the clinical course of patients presenting with ischemia differed from that of patients presenting with pure bleeding. Most of the patients with ischemia underwent progressive deterioration. However, while the outcome for patients with ischemia treated surgically was relatively good, it remained poor compared to the outcome for patients who had been bleeding.

From multi-incision to single-incision laparoscopic cholecystectomy step-by-step: One surgeons self-taught experience and retrospective analysis

Scipedia content — Fri, 26 May 2017 12:04:14 +0200

Single-incision laparoscopic cholecystectomy (SILC) is emerging as an alternative to standard four-incision laparoscopic cholecystectomy (4ILC). This study presents one surgeons experience of SILC and a retrospective analysis of the data. Sixty-seven consecutive patients treated by a single surgeon and undergoing laparoscopic cholecystectomy (LC) for benign gallbladder diseases were enrolled. LCs were attempted with conventional instruments as follows: 24 three-incision laparoscopic cholecystectomies (3ILC), 10 two-incision laparoscopic cholecystectomies (2ILC), and 33 SILC. The procedure conversion rate into the SILC, 2ILC, and 3ILC groups was 9.1%, 0%, and 8.3% respectively. Operative time was significantly longer with SILC (111.1 ± 30.34 minutes) compared to 2ILC (79.1 ± 15.74 minutes) and 3ILC (80.2 ± 29.41 minutes) (p

Improvising hepatic venous outflow and inferior vena cava reconstruction for combined heart and liver and sequential liver transplantations

Scipedia content — Fri, 26 May 2017 12:04:07 +0200

Liver transplantation is a standard treatment for patients with familial amyloidotic polyneuropathy (FAP) with disease progression. Given the multiorgan involvement by amyloidosis, the heart is often involved. When poor cardiac function becomes prohibitive to liver transplantation, a combined heart-liver transplantation (CHLT) is the only realistic treatment. This article records a CHLT for a patient with FAP whose removed liver was immediately transplanted as an amyloidotic hepatic allograft (AHA) to a patient having hepatocellular carcinoma and cirrhosis in a sequential liver transplantation. In the CHLT, the heart and liver are donated by a deceased donor. The newly implanted heart did not tolerate cross clamping of the inferior vena cava (IVC), so a side-to-side anastomosis was performed to connect the IVC and that of the liver graft. Therefore, the AHA was devoid of an IVC. The infrarenal cava procured from the deceased donor was used for reconstruction of the AHA to match a whole graft used in routine deceased-donor liver transplantation. Venoplasty was performed using the graft right hepatic vein and the middle and left hepatic vein stump to form a single cuff. The reconstructed AHA was implanted to the recipient conveniently like a usual whole graft.

Wide composite resection of follicular thyroid carcinoma with metastases to sternum: Report of two cases

Scipedia content — Fri, 26 May 2017 12:04:01 +0200

Follicular thyroid carcinoma (FTC) with sternum metastasis is rarely reported. Conservative treatments always result in a poor prognosis. We report two cases of FTC presenting with a large symptomatic solitary metastatic lesion in the sternum. Surgical intervention included total thyroidectomy, combined with wide composite resection of the sternal manubrium, as well as the adjacent clavicular head and ribs. A large defect with exposed pericardium and great vessels was found post resection in both cases. Because the ipsilateral vessels were sacrificed, a contralateral extended pedicled pectoralis major adipofascial flap was designed and transposed to cover the underlying vital organs. The patients received both adjuvant I-131 and radiotherapy postoperatively. The treatment was uneventful, and the patients are well and asymptomatic 5 years after the treatment. Wide composite resection and appropriate adjuvant therapies may offer a survival benefit in patients with advanced FTC with sternum metastasis.

Undifferentiated embryonal sarcoma of the liver with focal osteoid picture—A case report

Scipedia content — Fri, 26 May 2017 12:03:55 +0200

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare primary liver tumor. Less than 100 adult cases were reported. It has female and right lobe preponderance. In pathological features, focal osteoid picture in UESL is never reported. We present a 63-year-old male patient with left lobe UESL with focal osteoid picture. He was admitted for a palpable solid mass, with left upper quadrant abdominal pain for 4 months. Abdominal computed tomography showed a huge well-circumscribed mass at left upper quadrant, 21.3 × 13 × 27.9 cm3 in size, with multiple septa in delayed phase. En bloc resection including lateral segmentectomy, splenectomy, and cholecystectomy were performed, but tumor rupture was noted. The pathologic diagnosis was ruptured UESL. The postoperative course was uneventful, and adjuvant radiotherapy without chemotherapy was performed. Peritoneal seeding with massive ascites was noted in the 9th month after operation. Even after receiving salvage chemotherapy, he died 1 year after operation. Early complete surgical resection with adjuvant chemotherapy may improve prognosis of UESL. But the overall survival of UESL did not improve until recently. We present this case along with a literature review of the clinical pictures, diagnosis, pathology presentation, pathologicogenesis of focal osteoid picture, treatment, and prognosis for UESL of another 23 new reported cases since 2007.

Liver transplantation for a renal transplantation recipient with secondary sclerosing cholangitis by choledochoduodenal fistula

Scipedia content — Fri, 26 May 2017 12:03:49 +0200

Choledochoduodenal fistula (CDF) complicated by peptic diseases or following surgical or endoscopic approaches of the common bile duct is not uncommon. However, it usually occurs without significant symptoms and can be well controlled with conservative treatment in normal immunized patients. Here we report a case involving a 58-year-old male patient with diabetic nephropathy, who received a choledocholithotomy for choledocholithiasis in November 2007 and renal transplantation in March 2008. The patient had recurring cholangitis during the 5 months following his renal transplantation. Cholangiography and liver biopsy revealed sclerosing cholangitis. The patient underwent liver transplantation (LT) in May 2009 because radiological and endoscopic procedures failed to control his jaundice. A proximal CDF was found during the LT procedures. We considered that the patients advanced secondary sclerosing cholangitis was induced by this fistula. At the 16 months' follow-up, the patient was surviving well and the graft remained intact. To our knowledge, this is the first report of a renal transplantation recipient receiving LT because of uncontrolled cholangitis caused by a CDF.

High-grade glioma in a patient with breast cancer

Scipedia content — Fri, 26 May 2017 12:03:42 +0200

Breast cancer is one of the most common origins of metastatic lesions in the central nervous system. Many patients with a breast cancer and concurrent brain tumor(s) were diagnosed to have a metastatic lesion or lesions in the brain, based exclusively on their image findings without further pathologic verification, and received radiotherapy alone thereafter. It is, however, possible that a different pathology such as primary brain malignancy, which actually warrants a specific treatment modality, may occur in such patients with an already known malignancy. We, herein, reported a 61-year-old female patient who suffered from an anaplastic oligodendroglioma 1 year after her diagnosis of breast cancer. Demographic data, characteristic imaging findings, treatment, and outcome of the patient were discussed.

The effect of sequential intermittent pneumatic compression of foot and calf on popliteal artery mean systolic blood flow in patients with intermittent claudication

Scipedia content — Fri, 26 May 2017 12:03:36 +0200

To determine the effect of intermittent pneumatic foot and calf compression on popliteal artery mean systolic blood flow in patients with intermittent claudication. The secondary objective was to determine the change in blood flow with posture. This was a cross sectional study carried out on claudication patients at the Vascular Laboratory, Department of General Surgery, Kuala Lumpur Hospital, from January 2009 to August 2009. The effect of posture (supine to sitting to standing) and the effect of intermittent pneumatic compression (IPC) of the foot and calf on popliteal artery flow immediately and 10 minutes post compression were studied. Fifteen patients were studied. There was a consistent drop in flow from supine to sitting and to standing in all patients. Immediately after IPC application there was an increase in flow ranging from 29–335% (p

Effect of postoperative fractionated radiotherapy on canine ePTFE graft neointima and anastomotic stoma healing: A preliminary experimental study

Scipedia content — Fri, 26 May 2017 11:59:59 +0200

The present study aimed to determine whether postoperative fractionated radiotherapy, at a total dose of 35 Gy, affected expanded polytetrafluoroethylene (ePTFE) graft anastomotic stoma healing and neointima formation. The subrenal abdominal aortas of 20 mongrel dogs were replaced with an ePTFE graft. The dogs were randomly divided into either a radiotherapy or nonradiotherapy control group. Grafts were harvested at 4 or 8 weeks after surgery. Hematoxylin–eosin staining, and immunohistochemistry tests for proliferating cell nuclear antigen (PCNA) and CD34 were undertaken to analyze the anastomotic healing and neointima formation. The patency rate of grafts was 100% in each group. No disunion, rupture, or aneurysm was observed in the anastomotic stoma. Eight weeks after surgery, the graft neointima and anastomotic vessel wall of the radiotherapy group were significantly thinner than those of the control group (p

Primary colorectal lymphoma: Case series and literature review

Scipedia content — Fri, 26 May 2017 11:59:55 +0200

Primary colorectal lymphoma is a rare disease that accounts for 0.16% of colorectal malignancies. Treatments include surgical intervention with or without chemotherapy. Outcome of this intervention among the Chinese population are lacking. Perforation resulting from chemotherapy may need further exploration. A retrospective review of patient records was performed among those who were diagnosed with colorectal malignancy in a single center from January 1998 to June 2009. Ten patients met Dawsons diagnostic criteria for primary colorectal lymphoma [0.66% (10/1516) of all colorectal malignancies]. The male-to-female ratio was 9:1, and median age at diagnosis was 76 years. The most common site was the cecum (n = 5). B-cell lymphoma was present in eight patients. Seven patients underwent surgical intervention. The median follow-up of all patients was 16.5 months. Median survival was 17 months and 13 months in the surgical and chemotherapy group, respectively. Primary colonic lymphoma is a rare disease. Surgical intervention appeared to be superior to chemotherapy alone, but the findings were limited by the small number of patients in this study. Whether surgery or chemotherapy should be offered first remains unknown and requires further research.

Blunt adrenal gland trauma in the pediatric population

Scipedia content — Fri, 26 May 2017 11:59:50 +0200

A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

Successful extirpation of thoracic pleural lipoma by single-port thoracoscopic surgery

Scipedia content — Fri, 26 May 2017 11:59:45 +0200

Video-assisted thorascopic surgery (VATS) is a common technique for thoracic operations. Surgery with access via a single port has gradually become popular. We herein report the unusual case of a 53-year-old Japanese male patient whose chest X-rays revealed an abnormal shadow, which continued to increase in size. The tumor was excised by single-port access surgery. The resected tumor was a pedunculated pleural mass, yellowish in color, and pathological diagnosis confirmed a lipoma. We describe the first known successful treatment by single-port VATS.

Surgical pitfalls in patients with Ehlers–Danlos type IV: A case of spontaneous sigmoid perforation in a 17-year-old male

Scipedia content — Fri, 26 May 2017 11:59:39 +0200

Ehlers–Danlos syndrome (EDS) is a group of well described connective tissue disorders in which collagen production is impaired. The surgical management of affected individuals remains challenging, with no general consensus. We report a case of spontaneous sigmoid perforation in a 17-year-old Eurasian male, in whom we subsequently established the diagnosis of EDS type IV (EDS-IV). We review the literature to discuss the clinical features and diagnosis, and the recommended therapeutic management.

Pelvic exenteration for men with locally advanced rectal cancer: A morbidity analysis of complicated cases

Scipedia content — Fri, 26 May 2017 11:59:35 +0200

The role of pelvic exenteration in locally advanced rectal cancer (LARC) has not been clearly defined. This procedure carries a mortality rate of approximately 10%. The challenges during pelvic surgery are different between men and women. The morbidity in men with LARC who received pelvic exenteration was analyzed. Medical records of men with LARC undergoing total pelvic exenteration or supralevator pelvic exenteration from January 1991 to December 2007 were retrospectively reviewed. A total of 23 cases were included in the analysis. Thirteen patients had primary cancer, 10 had recurrent cancer. Microscopically clear surgical margins were obtained in 14 patients (60.9%). Sixteen patients (69.6%) experienced major or minor postoperative complications. The overall in-hospital mortality rate was 8.7%. Ten patients (43.5%) died within 1 year after surgery. All 10 patients with early mortality experienced refractory complications and repeated surgeries. The longest survival of patients with margin involvement was 25 months. The correlation between involved surgical margins and 1-year mortality was statistically significant (p = 0.001). Resection margins with tumor involvement after pelvic exenteration is associated with poor prognosis and early mortality in men with locally advanced rectal cancer.

Efficacy and safety of photoselective vaporization of the prostate in patients with prostatic obstruction induced by advanced prostate cancer

Scipedia content — Fri, 26 May 2017 11:59:30 +0200

We evaluated the efficacy and outcome of laser photoselective vaporization of prostate (PVP) in patients with voiding difficulty due to prostatic obstruction induced by advanced prostate cancer (PC). We retrospectively studied the records of 13 patients with advanced PC and prostatic obstruction with a mean prostate volume of 65.0 ml. All of the 13 patients received PVP between 2006 and 2010 due to the symptoms of voiding difficulty or acute urinary retention (AUR, N = 10) refractory to medical treatment. Perioperative safety and functional results were evaluated. Lasering time ranged from 24 to 20 minutes (mean 67 ± 26), during which 66–423 KJ (mean 172 ± 95) of laser energy was delivered. All patients could resume voiding function with a mean catheterization time of 3.0 days. Our preliminary results suggest that PVP is a safe and effective procedure for relieving prostatic obstruction without intraoperative blood transfusion, water intoxication, or other complications in patients with advanced prostate cancer.

Characterization of hepatocellular carcinoma recurrence after liver transplantation: Perioperative prognostic factors, patterns, and outcome

Scipedia content — Fri, 26 May 2017 11:59:23 +0200

Liver transplantation (LT) is known to be a promising treatment for patients with liver cirrhosis associated with hepatocellular carcinoma (HCC). This study, however, found that HCC recurrence remains to be a concern. A total of 126 HCC patients who had undergone LT between January 2000 and December 2009 were retrospectively reviewed. The clinicopathological features of the patients were analyzed by univariate and multivariate analyses to determine prognostic factors. Patients who had HCC recurrence were further analyzed in terms of recurrent pattern, management, and outcome. Seventeen patients (13.5%) exhibited HCC recurrence following LT. Univariate and multivariate analyses identified two prognostic factors: tumor number > three [hazard ratio (HR) = 3.249] and presence of microvascular invasion (HR = 4.336). Among patients with HCC recurrence, 15 out of 17 (88%) patients developed extrahepatic metastasis shortly after recurrence. The survival of patients after HCC recurrence was dismal with 18.3 months of median survival. Multiple tumors (>three) are an important prognostic factor for HCC recurrence following LT, but an accurate assessment of tumor status by pretransplantation radiological examination is required. The outcome of patients with HCC recurrence after LT remains very poor because of a tendency of HCC to recur as extrahepatic metastasis.

The effect of perceived risk on the combined used of alcohol and marijuana: Results from daily surveys

Scipedia content — Fri, 26 May 2017 11:09:41 +0200

Studies looking at the association between perceived risk and simultaneous use of alcohol and marijuana are scarce. The present study has three purposes: (1) to examine the association between alcohol and marijuana use at the daily level, (2) to document how this association varies by the perceived risk of using alcohol and marijuana simultaneously, (3) to test whether the association varies by college attendance. 89 young adults (Mean Age = 18.3 years, SD = 0.5) participated between October 2012 and May 2013. Participants completed a 30-min survey followed by 14 brief daily surveys in each of three waves. Alcohol use on a given day was associated with increased odds of marijuana use that day, especially among young adults with lower perceived risk. For college students, the association between alcohol and marijuana was weaker than for non-students. Alcohol and marijuana use were associated at a daily level, especially among young adults with lower perceived risk and those who were not attending college.

Heavy cannabis use and attentional avoidance of anxiety-related stimuli

Scipedia content — Fri, 26 May 2017 11:09:37 +0200

Cannabis is now the most widely used illicit substance in the world. Previous research demonstrates that cannabis use is associated with dysfunctional affect regulation and anxiety. Anxiety is characterised by attentional biases in the presence of emotional information. This novel study therefore examined the attentional bias of cannabis users when presented with anxiety-related stimuli. The aim was to establish whether cannabis users respond to anxiety-related stimuli differently to control participants. A dot-probe paradigm was utilised using undergraduate students. Trials contained anxiety-related stimuli and neutral control stimuli. Eye-tracking was used to measure attention for the stimuli. Results indicated that cannabis users demonstrated attentional-avoidance behaviour when presented with anxiety-related stimuli. The findings suggest a difference in processing of emotional information in relation to neutral information between groups. It would appear that cannabis users avoid anxiety provoking stimuli. Such behaviour could potentially have motivational properties that could lead to exacerbating anxiety disorder-type behaviour.

Cigarette smoking, problem-gambling severity, and health behaviors in high-school students

Scipedia content — Fri, 26 May 2017 11:09:32 +0200

Smoking and gambling are two significant public health concerns. Little is known about the association of smoking and gambling in adolescents. The current study of high-school adolescents examined: (1) smoking behavior by problem-gambling severity and (2) health-related variables by problem-gambling severity and smoking status. Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by problem-gambling severity (Low-Risk Gambling [LRG], At-Risk/Problem Gambling [ARPG]) and smoking status (current smoker, non-smoker). Analyses examined the smoking behavior of ARPG versus LRG adolescents as well as the smoking-by-problem-gambling-severity interactions for health and well-being measures (e.g., grades, substance use). Chi-square and logistic regression analyses were used, the latter controlled for gender, race/ethnicity, school grade, and family structure. More adolescents with ARPG than LRG reported regular smoking, heavy smoking, early smoking onset, no smoking quit attempts, and parental approval of smoking. ARPG and LRG adolescents who smoked were more likely to report poor grades, lifetime use of marijuana and other drugs, current heavy alcohol use, current caffeine use, depression, and aggressive behaviors and less likely to report participation in extracurricular activities. The association between not participating in extracurricular activities and smoking was statistically stronger in the LRG compared to the ARPG groups. Post-hoc analyses implicated a range of extracurricular activities including team sports, school clubs, and church activities. Smoking was associated with poorer health-related behaviors in both ARPG and LRG groups. Interventions with adolescents may benefit from targeting both smoking and gambling.

Online-specific fear of missing out and Internet-use expectancies contribute to symptoms of Internet-communication disorder

Scipedia content — Fri, 26 May 2017 11:09:26 +0200

Some of the most frequently used online applications are Facebook, WhatsApp, and Twitter. These applications allow individuals to communicate with other users, to share information or pictures, and to stay in contact with friends all over the world. However, a growing number of users suffer from negative consequences due to their excessive use of these applications, which can be referred to as Internet-communication disorder. The frequent use and easy access of these applications may also trigger the individuals fear of missing out on content when not accessing these applications. Using a sample of 270 participants, a structural equation model was analyzed to investigate the role of psychopathological symptoms and the fear of missing out on expectancies towards Internet-communication applications in the development of symptoms of an Internet-communication disorder. The results suggest that psychopathological symptoms predict higher fear of missing out on the individuals Internet-communication applications and higher expectancies to use these applications as a helpful tool to escape from negative feelings. These specific cognitions mediate the effect of psychopathological symptoms on Internet-communication disorder. Our results are in line with the theoretical model by Brand et al. (2016) as they show how Internet-related cognitive bias mediates the relationship between a persons core characteristics (e.g., psychopathological symptoms) and Internet-communication disorder. However, further studies should investigate the role of the fear of missing out as a specific predisposition, as well as specific cognition in the online context.

Smoke signals: The decline of brand identity predicts reduced smoking behaviour following the introduction of plain packaging

Scipedia content — Fri, 26 May 2017 11:09:20 +0200

This study tests a social identity based mechanism for the effectiveness of plain tobacco packaging legislation, introduced in Australia in December 2012, to reduce cigarette smoking. 178 Australian smokers rated their sense of identification with fellow smokers of their brand, positive brand stereotypes, quitting behaviours and intentions, and smoking intensity, both before and seven months after the policy change. Mediation analyses showed that smokers, especially those who initially identified strongly with their brand, experienced a significant decrease in their brand identity following the introduction of plain packaging and this was associated with lower smoking behaviours and increased intentions to quit. The findings provide the first quantitative evidence that brand identities may help maintain smoking behaviour, and suggest the role of social-psychological processes in the effectiveness of public health policy.

Ordinary people associate addiction with loss of free will

Scipedia content — Fri, 26 May 2017 11:09:15 +0200

It is widely believed that addiction entails a loss of free will, even though this point is controversial among scholars. There is arguably a downside to this belief, in that addicts who believe they lack the free will to quit an addiction might therefore fail to quit an addiction. A correlational study tested the relationship between belief in free will and addiction. Follow-up studies tested steps of a potential mechanism: 1) people think drugs undermine free will 2) people believe addiction undermines free will more when doing so serves the self 3) disbelief in free will leads people to perceive various temptations as more addictive. People with lower belief in free will were more likely to have a history of addiction to alcohol and other drugs, and also less likely to have successfully quit alcohol. People believe that drugs undermine free will, and they use this belief to self-servingly attribute less free will to their bad actions than to good ones. Low belief in free will also increases perceptions that things are addictive. Addiction is widely seen as loss of free will. The belief can be used in self-serving ways that may undermine peoples efforts to quit.

Pilot outcome results of culturally adapted evidence-based substance use disorder treatment with a Southwest Tribe

Scipedia content — Fri, 26 May 2017 11:09:10 +0200

Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given that they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview. In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post-baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment. Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedgess g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = − 0.66) and 5 of the 7 Addiction Severity Index domains (range of g = − 0.42 to − 0.98) also emerged. Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

The association between at-risk gambling and binge drinking in the general Swedish population

Scipedia content — Fri, 26 May 2017 11:09:04 +0200

While the association between problem gambling and alcohol use disorders has been studied previously, little is known about the association between risk gambling and risk drinking. This study aimed at examining the association between at-risk gambling and binge drinking in the general Swedish population and to test whether this association remained after controlling for demographic factors. The data was part of a larger ongoing survey in the general Swedish population. Respondents (N = 19 530) were recruited through random digit dialing and interviewed about their alcohol habits (binge drinking), at-risk gambling (the Lie/Bet questionnaire) and demographics (gender, age, education, residence size, marital status, labor market status, country of origin and smoking). There was an association between lifetime at-risk gambling and current (12 months) weekly binge drinking for both men (OR = 1.73, CI 95%: 1.27–2.35) and women (OR = 2.27, CI 95%: 1.05–4.90). After controlling for demographics this association no longer remained significant (OR = 1.38, CI 95%, .99–1.90 for men and OR = 1.99, CI 95%: .94–4.66 for women). Age and smoking had the largest impact on this association. At-risk gambling and binge drinking are associated behaviors. However, it seems as if this association may be confounded by demographic variables. We hypothesize that similarities in personality profiles and health aspects could account for an additional part of the association.

Culture and age influences upon gambling and problem gambling

Scipedia content — Fri, 26 May 2017 11:08:59 +0200

This study aimed to (i) examine the prevalence and types of gambling, (ii) establish prevalence of ‘pathological’ gambling, (iii) explore the correlates of gambling, and (iv) establish psychiatric and physical comorbidity in a sample of older adult gamblers (≥ 60 years) in contrast to younger gamblers in a representative population sample in Singapore. This paper reports the results of a secondary analysis of data from a representative community survey of 6616 participants, of which 2252 had engaged in gambling activities at least once in their lifetime. 48.9% of older adults reported lifetime gambling. Older gamblers were more likely to be males, married or widowed (vs. never married), with pre-primary, primary and secondary education (vs. university), economically inactive (vs. employed) and had personal annual income of SGD $19, 999 and below (vs. SGD $50, 000 and above). Older gamblers had significantly higher rates of betting on horses, playing numbers or betting on lotteries, and playing Mahjong. After adjusting for demographic variables in multiple logistic regression analyses, gamblers aged 60 years and older had significantly lower odds of having pathological gambling than those in the younger age group (OR = 0.4). Older gamblers had significantly higher odds of having diabetes (OR = 3.2), hypertension (OR = 4.9), and any comorbid chronic physical condition assessed in this study. For the majority of older adults, gambling remains a recreational activity that is entertaining and a way of socialization. However, one must remain cognizant of the possible risks for some to develop disordered gambling.

The relative contribution of metacognitions and attentional control to the severity of gambling in problem gamblers

Scipedia content — Fri, 26 May 2017 11:08:54 +0200

The present study explored the relationship between metacognitions, attentional control, and the severity of gambling in problem gamblers. One hundred and twenty six problem gamblers completed the Depression Anxiety Stress Scales 21, the Meta-Cognitions Questionnaire 30, the Attentional Control Scale, and the Problem Gambling Severity Index. Results revealed that negative affect, four out of five metacognitions factors (positive beliefs about worry, negative beliefs about thoughts concerning danger and uncontrollability, cognitive confidence and beliefs about the need to control thoughts), and all attentional control factors (focusing, shifting and flexible control of thought) were correlated, in the predicted directions, with the severity of gambling. The same metacognitions were also found to be correlated, in the predicted directions, with attention focusing, however only negative beliefs about thoughts concerning danger and uncontrollability and cognitive confidence were found to be correlated with attention shifting and flexible control of thought. A hierarchical regression analysis showed that beliefs about the need to control thoughts were the only predictor of the severity of gambling controlling for negative affect. Overall these findings support the hypotheses and are consistent with the metacognitive model of psychological dysfunction. The implications of these findings are discussed.

Early developmental, temperamental and educational problems in ‘substance use disorder’ patients with and without ADHD. Does ADHD make a difference?

Scipedia content — Fri, 26 May 2017 11:08:49 +0200

The prevalence of ADHD among patients with substance use disorder (SUD) is substantial. This study addressed the following research questions: Are early developmental, temperamental and educational problems overrepresented among SUD patients with ADHD compared to SUD patients without ADHD? Do this comorbid group receive early help for their ADHD, and are there signs of self-medicating with illicit central stimulants? An international, multi-centre cross-sectional study was carried out involving seven European countries, with 1205 patients in treatment for SUD. The mean age was 40 years and 27% of the sample was female. All participants were interviewed with the Mini International Neuropsychiatric Interview Plus and the Conners' Adult ADHD Diagnostic Interview for DSM-IV. SUD patients with ADHD (n = 196, 16.3% of the total sample) had a significantly slower infant development than SUD patients without ADHD (n = 1, 009, 83.4%), had greater problems controlling their temperament, and had lower educational attainment. Only 24 (12%) of the current ADHD positive patients had been diagnosed and treated during childhood and/or adolescence. Finally, SUD patients with ADHD were more likely to have central stimulants or cannabis as their primary substance of abuse, whereas alcohol use was more likely to be the primary substance of abuse in SUD patients without ADHD. The results emphasize the importance of early identification of ADHD and targeted interventions in the health and school system, as well as in the addiction field.

Alcohol reduction in the first trimester is unrelated to smoking, patient or pregnancy characteristics

Scipedia content — Fri, 26 May 2017 11:08:41 +0200

Studies show alcohol-preferring mice reduce their alcohol intake during pregnancy, this study questions if the same is true for humans. The current investigation compares womens pre-pregnancy and first trimester alcohol consumption, examines if women with problem drinking diminish their alcohol intake during pregnancy, and determines if prenatal alcohol reduction is associated with characteristics of pregnancy, patients or smoking. 126 participants in weeks 1–12 of pregnancy, recruited from Obstetric and Family Practices, completed a survey during their initial prenatal visit including two gender-specific AUDITs (Alcohol Use Disorders Identification Tests) querying current and pre-pregnancy alcohol use. AUDIT-C (AUDIT items 1–3) scores measuring pre-pregnancy and first trimester alcohol consumption were compared, analyzed and tested using general linear model repeated. A p ≤ 0.05 was accepted as significant. Most participants were multiparous, Caucasian high school graduates experiencing nausea and vomiting. Pre-pregnancy alcohol use was significantly (p = 0.019, Fishers exact) higher among women seeing obstetricians. Pre-pregnancy AUDIT-C scores (m (mean) = 2.22, sd (standard deviation) = 2.19) were significantly higher (p

Age of first use of energy beverages predicts future maximal consumption among naval pilot and flight officer candidates

Scipedia content — Fri, 26 May 2017 11:08:37 +0200

Energy drinks are popular beverages that can have adverse long-term health effects when consumed by children and adolescents. This study sought to determine if the age of first energy drink use in a U.S. military population is predictive of the maximum number of energy drinks consumed during a single day and/or single occasion (operationally defined as a couple of hours, e.g., a night out, during studying or sport session). Student U.S. naval aviator and naval flight officers who reported past-year use of energy drinks (N = 239) were surveyed to determine various measures of energy drink consumption. Age of first consumption was predictive of the maximum number of energy drinks consumed during a single occasion within the past year. Within this sample, the age range between 13 and 16 years appeared to be a critical period with results indicating that people who began consuming energy drinks during this period were 4.88 times more likely to consume high quantities (four or more) of energy drinks during a single occasion when compared to those who started consuming energy drinks between the ages of 20–23. Likewise, persons who began to consume energy drinks between the ages of 13–16 are 2.48 times more likely to consume high quantities of energy drinks during a single occasion than those who started between the ages of 17–19. There was no difference between 17 and 19 year olds and 20–23 year olds. Age of first use was not correlated to daily average intake or daily maximal intake of energy drinks. A lower age of first energy drink use suggests higher risk of single-occasion heavy episodic consumption in this military population. Researchers should further explore the relationship of early onset energy drink consumption and potential future health risks.

Individual differences in implicit learning abilities and impulsive behavior in the context of Internet addiction and Internet Gaming Disorder under the consideration of gender

Scipedia content — Fri, 26 May 2017 11:08:31 +0200

In three consecutive studies, we aimed to investigate the relationship between problematic Internet use (PIU), Internet Gaming Disorder (IGD) and implicit learning abilities, and impulsivity/risk-taking among online video gamers and control participants. In study 1, male visitors, recruited at the “Gamescom” in Cologne (2013), filled in a short version of the Internet Addiction Test (s-IAT), the Online Gaming Addiction Scale (OGAS), and completed an experimental task to assess implicit learning abilities. In study 2, a group of WoW gamers and control participants completed the same set up, in order to replicate the results of study 1. Study 3 used a modified version of the experiment to measure impulsivity/risk-taking in a group of healthy participants. In study 1, results revealed a significant negative correlation between the s-IAT score and the measure of implicit learning among male Gamescom participants. In study 2, the s-IAT and WoW addiction scores were negatively correlated with implicit learning only in male WoW players, which mirrors the results from study 1. In study 3, the OGAS score was positively correlated with the experimental measure of impulsivity/risk-taking. In the current research project, deficient implicit learning was linked to PIU only in male participants with (a tendency towards) IGD. These findings might help to disentangle some opposing results on this relationship, when considering the gender of participants. Furthermore, higher risk-taking tendencies were associated with IGD among healthy participants, thus, suggesting the potential of risk taking as a predictor of IGD in a non-gamer population.

Prospective recovery of cannabis use in a psychotic population: A qualitative analysis

Scipedia content — Fri, 26 May 2017 11:08:26 +0200

There is growing evidence for natural recovery from cannabis use by people with psychosis, but mechanisms underpinning it need further exploration. This study prospectively explored this issue. Twenty-two people with psychosis and cannabis misuse were recruited: 19 provided data for at least one follow-up assessment, and 13 of these (68%) reduced or ceased using cannabis. A semi-structured interview with the latter group explored reasons for initiating the attempt, strategies they employed, and context/s where any relapse occurred. Interpretative phenomenological analysis was used to identify themes. Participants who reduced or ceased cannabis use had fewer negative symptoms at Baseline, and were more likely to only use cannabis. Major reasons for starting an attempt were worsening mental health, relationship and lifestyle difficulties. Effective strategies fell into psychological, relationship, lifestyle and medication themes. Only three participants reported a relapse: triggers involved substance-using peers, relationship difficulties, and problems with negative emotions including ones from past trauma. An encouragingly high rate of maintained reductions in cannabis use was seen. Increased awareness of the benefits across multiple life domains from addressing cannabis use may be critical to the initiation and maintenance of attempts, both to maximise motivation, and avoid over-dependence on improvements in any single domain. Negative symptoms, multiple substance use, dysphoria and pressure from substance-using peers clearly offer additional challenges for control.

Systematic analysis of changes in cannabis use among participants in control conditions of randomised controlled trials

Scipedia content — Fri, 26 May 2017 11:08:21 +0200

Cannabis remains the most used illegal substance across the globe, and negative outcomes and disorders are common. A spotlight therefore falls on reductions in cannabis use in people with cannabis use disorder. Current estimates of unassisted cessation or reduction in cannabis use rely on community surveys, and few studies focus on individuals with disorder. A key interest of services and researchers is to estimate effect size of reductions in consumption among treatment seekers who do not obtain treatment. Effects within waiting list or information-only control conditions of randomised controlled trials offer an opportunity to study this question. This paper examines the extent of reductions in days of cannabis use in the control groups of randomised controlled trials on treatment of cannabis use disorders. A systematic literature search was performed to identify trials that reported days of cannabis use in the previous 30 (or equivalent). Since all but one of the eight identified studies had delayed treatment controls, results could only be summarised across 2–4 months. Average weighted days of use in the previous 30 days fell from 24.5 to 19.9, and a meta-analysis using a random effects model showed an average reduction of 0.442 SD. However, every study had at least one significant methodological issue. While further high-quality data is needed to confirm the observed effects, these results provide a baseline from which researchers and practitioners can estimate the extent of change required to detect effects of cannabis treatments in services or treatment trials.

Foods and dietary profiles associated with ‘food addiction’ in young adults

Scipedia content — Fri, 26 May 2017 11:08:16 +0200

The impact of Internet-based specific activities on the perceptions of Internet addiction, quality of life, and excessive usage: A cross-sectional study

Scipedia content — Fri, 26 May 2017 11:08:10 +0200

Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants' preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use. A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (Mage = 30 years, SD = 10.84) were recruited online via several English-speaking online forums. Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved. The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

Confirmatory factor analysis of the Spanish version of the Gamblers' Beliefs Questionnaire in a sample of Argentinean gamblers

Scipedia content — Fri, 26 May 2017 11:08:06 +0200

Introduction: Cognitive distortions are related to gambling frequency and gambling severity. Having a culturally sensitive measure to assess cognitive distortions will facilitate the early detection of people who might be at risk of developing problematic gambling behaviors. The Gamblers' Beliefs Questionnaire was translated into Spanish (GBQ-S) but no previous study explored the structure of the GBQ-S in a non-US sample with different levels of gambling involvement. Aim: The present study examined the factor structure of the GBQ-S in a community sample of gamblers from Argentina. It also analyzed the association between cognitive distortions and type of gambling activity and frequency of gambling behaviors and the predictive utility of the GBQ-S on gambling severity. Participants: 508 youth and adults completed the GBQ-S. Results: The CFA showed an overall acceptable fit to the data confirming the proposed two-factor model. Scores of the two GBQ sub-scales were positively and significantly correlated with scores on gambling severity. Cognitive distortions have a significant effect on gambling severity after controlling for frequency of engagement in gambling activities. Luck and perseverance, but not illusion of control, was positively related to gambling severity. Discussion: scores measured by the GBQ-S exhibit adequate psychometric properties for the accurate assessment of cognitive distortions across adults and youth from the general community of Argentina.

People Control Their Addictions : No matter how much the “chronic” brain disease model of addiction indicates otherwise, we know that people can quit addictions – with special reference to harm reduction and mindfulness

Scipedia content — Fri, 26 May 2017 11:08:01 +0200

The world, led by the United States, is hell bent on establishing the absence of choice in addiction, as expressed by the defining statement that addiction is a “chronic relapsing brain disease” (my emphasis). The figure most associated with this model, the director of the American National Institute on Drug Abuse, Nora Volkow, claims that addiction vitiates free will through its effects on the brain. In reality, while by no means a simple task, people regularly quit their substance addictions, often by moderating their consumption, usually through mindfulness-mediated processes (Peele, 2007). Ironically, the brain disease models ascendance in the U.S. corresponds with epidemic rises in opiate addiction, both painkillers (Brady et al., 2016) and heroin (CDC, n.d.), as well as heroin, painkiller, and tranquilizer poisoning deaths (Rudd et al., 2016). More to the point, the conceptual and treatment goal of eliminating choice in addiction and recovery is not only futile, but iatrogenic. Indeed, the National Institute on Alcohol Abuse and Alcoholisms epidemiological surveys, while finding natural recovery for both drug and alcohol disorders to be typical, has found a decline in natural recovery rates (Dawson et al., 2005) and a sharp increase in AUDs (Grant et al., 2015).

Effects of evaluative context in implicit cognitions associated with alcohol and violent behaviors

Scipedia content — Fri, 26 May 2017 11:07:56 +0200

A large body of literature has substantiated the relationship between alcohol use and violent behaviors, but little consideration has been given to implicit interactions between the two. This study examines the implicit attitudes associated with alcoholic drinks and violent behaviors, and their relationship to explicit reports of problematic behaviors associated with alcohol use. The Go/No-Go Association Task (GNAT, Nosek & Banaji, 2001) was used to test the effect of distracters (noise) on implicit cognitions associated with alcoholic drinks and violent behaviors. Data was collected from 148 students enrolled in a Midwestern university. Irrespective of contextual distractions, participants consistently exhibited negative implicit cognitions associated with violent behaviors. However, context impacted the valence of cognitions associated with alcoholic beverages. Implicit cognitions associated with alcoholic beverages were negative when nonalcoholic beverages were used as distracters, but were positive when licit and illicit drugs were used as distracters. Implicit cognitions associated with alcoholic drinks were correlated with implicit cognitions associated with violent behaviors and explicit measures of problem drinking, problem drug-related behaviors, and measures of craving, to name a few. Evaluative context can have an effect on the expressed appraisal of implicit attitudes. Implications, limitations, and future directions for using the GNAT in addictions research are discussed.

Internet use and adolescent binge drinking: Findings from the Monitoring the Future study

Scipedia content — Fri, 26 May 2017 11:07:51 +0200

To investigate the relation between Internet use and binge drinking during early and middle adolescence. This is a cross-sectional study of a sub-sample of 8th and 10th graders from the Monitoring the Future (MtF) study, which annually surveys a nationally representative sample of U.S. youth on their attitudes, behaviors, and values. This study includes data from 21, 170 8th and 24, 362 10th graders who participated between 2007 and 2012 and were asked questions about Internet use and binge drinking. In fully adjusted models, we found a dose response relation between hours of recreational Internet use (i.e. outside work or school) and binge drinking which was stronger for 8th than 10th graders. Compared to

Exploring the alcohol-behaviour link: Myopic self-enhancement in the absence of alcohol consumption as a function of past alcohol use

Scipedia content — Fri, 26 May 2017 11:07:46 +0200

Dual process accounts of the alcohol-behaviour link hypothesise that differences in drinking patterns will moderate the effects of exposure to alcohol-related cues on behaviour, such as when a placebo is administered. We test this hypothesis by adapting a paradigm used in alcohol myopia research to examine the effects of alcohol-related priming on self-enhancement behaviour amongst social drinkers. Participants were asked to engage in a computerised self-rating task prior to being exposed to alcohol related and/or motivational primes. A staged computer error then occurred, and participants were then asked to complete their self ratings again – this method allowed for an immediate assessment of the impact of alcohol and motivational primes on self enhancement. As predicted by alcohol myopia theory, the overall effect of priming with alcohol-related cues was not significant irrespective of response-conflict manipulations. However, drinker type moderated this effect such that heavier drinkers self-enhanced more after exposure to alcohol-related cues, but only in high-conflict conditions. This suggests that the efficacy of a placebo may be significantly moderated by individual differences in reactions to alcohol-related stimuli, and that dual process accounts of the effects of alcohol on behaviour better explains this variation than alcohol myopia theory.

‘Neknomination’: Predictors in a sample of UK university students

Scipedia content — Fri, 26 May 2017 11:07:42 +0200

To identify prevalence and predictors of participation in the online drinking game ‘neknomination’ amongst university students. A convenience sample of 145 university students participated in a study about drinking behaviours, completing a questionnaire about their participation in neknomination, the Alcohol Use Disorders Identification Test, and the Resistance to Peer Influence Scale. Out of 145 students sampled, 54% took part in neknomination in the previous month. Mann–Whitney U tests revealed significantly higher scores on the Alcohol Use Disorders Identification Test, and significantly lower scores on the Resistance to Peer Influence Scale, for those who had participated in neknomination. A significant correlation was also shown between specific peer pressure to neknominate, and engagement in neknomination. A logistic regression analysis indicated that scores on the Alcohol Use Disorders Identification Test, but not the Resistance to Peer Influence Scale, predicted classification as an individual who participated in neknomination. We found that over half of respondents had participated in a neknomination game in the past month, with almost all male respondents having done so. Participation in neknomination was strongly associated with general hazardous drinking behaviour but not with resistance to peer influence. Further research is needed to understand the role of engagement with social media in drinking games and risky drinking.

The importance of analogue zeitgebers to reduce digital addictive tendencies in the 21st century

Scipedia content — Fri, 26 May 2017 11:07:36 +0200

Analogue zeitgebers such as wristwatches and alarm clocks are essential for structuring everyday life. Since the dawn of the digital revolution – particularly since the advent of the smartphone – mobile phones have increasingly replaced analogue zeitgebers as a means of telling time. This functionality may prove problematic, in that it may contribute to the overuse of digital media (e.g. when checking the time turns into extended use of other smartphone utilities, including Internet-based applications). Of N = 3084 participants, 45% reported wearing a wristwatch and 67% used an analogue alarm clock. We observed that participants who reported using analogue zeitgebers used their mobile-/smartphone significantly less. Use of analogue zeitgebers may prove a practical tool for therapeutic and preventative interventions for problematic Internet use in an increasingly digital age.

Internet use and problematic Internet use among adolescents in Japan: A nationwide representative survey

Scipedia content — Fri, 26 May 2017 11:07:30 +0200

Japan is assumed to have serious health and social problems due to Internet overuse, but little is known about the actual conditions. This study was conducted to investigate the prevalence of problematic Internet use (PIU) and associated Internet use in adolescents in Japan. A nationwide survey of adolescent Internet use was conducted in 2012 and 2013. The participants were 100, 050 students from randomly selected junior and senior high schools nationwide who gave valid responses to a self-reported questionnaire. The questionnaire included questions on Internet use and the Japanese version of the Youngs Diagnostic Questionnaire (YDQ) as well as other questions related to lifestyle habits. Internet users were classified by gender according to three categories on the basis of their YDQ scores: adaptive use, maladaptive use, and PIU. The estimated prevalence of PIU was 6.2% in males, 9.8% in females, and 7.9% in total, it closely correlated with female gender, school grades, and number of Internet hours. The following common and gender-specific applications that conferred a risk of PIU were identified: downloading (both genders), online gaming (males), social networking services, blogs, and bulletin boards (females). A cross-sectional survey using YDQ of a large number of high school students yielded a PIU prevalence of 7.9% in Japan. This study showed that problems associated with Internet overuse have already become serious, therefore, planning and implementation of prevention and control measures is urgently required.

Associations between social identity diversity, compatibility, and recovery capital amongst young people in substance use treatment

Scipedia content — Fri, 26 May 2017 11:07:24 +0200

This study explored associations between group memberships and recovery capital amongst 20 young adults aged 18 to 21 years in residential alcohol and drug treatment. Participants completed an interviewer administered research interview based on measures of recovery capital and a social networks assessment mapping group memberships, group substance use, and relationships between groups. Higher personal and social recovery capital was associated with lower diversity of group memberships, a higher number of positive links between groups, and greater compatibility of lower substance-using groups with other groups in the network. Higher compatibility of heavier-using groups was also associated with having a higher number of negative, antagonistic ties between groups. These findings indicate that it is higher compatibility of a lower substance-using social identity and lower-using group memberships that contributes to recovery capital. Further, positive ties between groups and lower diversity of group memberships appear to be key aspects in how multiple social identities that are held by young adults relate to personal and social recovery capital.

Traits associated with internet addiction in young adults: Potential risk factors

Scipedia content — Fri, 26 May 2017 11:07:19 +0200

The present study sought to determine whether certain personality traits associated with problematic substance use may also characterize young adults who report problematic internet use. An index of internet addiction as well as measures of traits previously linked to problematic substance use were administered to a sample of 86 young adults aged 18–30 years. Measures included the Internet Addiction Test (IAT), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), Depression Anxiety and Stress Scales (DASS-21), Toronto Alexithymia Scale (TAS-20), and the Fear of Intimacy Scale (FIS). Results indicated that IAT scores were significantly positively correlated with TAS-20, DASS-21, SPSRQ and FIS scores, as predicted. When age, gender and negative mood were controlled in a hierarchical regression, sensitivity to punishment (SP), sensitivity to reward (SR) and FIS significantly contributed to variance in IAT in the final model. SP partially mediated the relationship between TAS-20 and IAT, whereas no such mediation was indicated for SR or FIS. Present findings suggest that alexithymia and reward sensitivity may be important risk factors for internet addiction as for problematic substance use, whereas sensitivity to punishment may account for at least part of the association between alexithymia and problematic use of the internet.

An exploration of online behaviors and social media use among hookah and electronic-cigarette users

Scipedia content — Fri, 26 May 2017 11:07:13 +0200

The purpose of this study was to explore the relationship between social norms and attitudes towards ENDS and hookah and use of these products. We conducted surveys with hookah and ENDS users who regularly used the Internet and social media and analyzed the primary social media account (e.g. Facebook) of each participant, coding all references to nicotine or tobacco products. The survey included domains on perceived favorability, perceived vulnerability and subjective norms. We surveyed 21 ENDS users and 20 hookah users. Both groups used the Internet to look up information about their respective tobacco product (95% for hookah vs. 90% for ENDS). Seventy percent of hookah users had references to hookah on their social media profiles while 43% of ENDS users had references to ENDS on their page. The majority of both groups were exposed to content posted by friends in their social media network about their respective products online. Those who posted on social media about hookah and those who read about ENDS online had lower perceived vulnerability to the health risks associated with tobacco products. Hookah and ENDS users actively use the Internet and social media to obtain and share information about nicotine/tobacco products. Study participants who use hookah were more likely to share photos and discuss hookah related activities via social media than those who use ENDS. Social networks also represent valuable and untapped potential resources for communicating with this group about risks and harm reduction related to emerging nicotine/tobacco products.

Daily tobacco smoking, heavy alcohol use, and hashish use among adolescents in southern Sweden: A population-based multilevel study

Scipedia content — Fri, 26 May 2017 11:07:08 +0200

The aim of this study was to investigate school contextual effects on daily tobacco smoking, heavy alcohol use and hashish use among adolescents, using multilevel analyses adjusting for individual-level factors. The 2012 public health survey among adolescents in Skåne includes pupils in ninth grade in primary school (predominantly 15–16 years old) and second grade in secondary school (gymnasium) (predominantly 17–18 years old). Multilevel logistic regressions were performed. The prevalence of all three behaviors was higher in the second grade in the gymnasium. Several sociodemographic, psychosocial and parental factors were associated with these behaviors. In the ninth grade, variance partition coefficients (VPCs) for tobacco smoking decreased from 10.2% in the empty model to 1.9% in the fully adjusted model, for heavy alcohol use from 6.5% to 6.3%, while VPCs for hashish increased from 9.9% to 11.0%. In the second grade, VPCs for daily tobacco smoking decreased from 13.6% in the empty model to 6.5% in the fully adjusted model, VPCs for heavy alcohol use decreased from 4.6% to 1.7%, and VPCs for hashish use increased from 7.3% to 8.3%. Daily tobacco smoking (in both grades) and heavy alcohol use in the second grade in the gymnasium may be preventable by actions directed against individual-level protective factors including social capital, social support and peer/parent behavior and attitude, while interventions directed at school contexts may be more important for alcohol use in the ninth grade and hashish use in both grades.

Evaluating the relationship between explicit and implicit drinking identity centrality and hazardous drinking

Scipedia content — Fri, 26 May 2017 11:07:04 +0200

Drinking identity strength (how strongly one views oneself as a drinker) is a promising risk factor for hazardous drinking. A critical next step is to investigate whether the centrality of drinking identity (i.e., the relative importance of drinking vs. other identity domains, like well-being, relationships, education) also plays a role. Thus, we developed explicit and implicit measures of drinking identity centrality and evaluated them as predictors of hazardous drinking after controlling for explicit drinking identity strength. Two studies were conducted (Ns = 360 and 450, respectively). Participants, who self-identified as full-time students, completed measures of explicit identity strength, explicit and implicit centrality, and the Alcohol Use Disorders Identification Test (AUDIT). Study 1a evaluated two variants of the implicit measure (short- vs. long-format of the Multi-category Implicit Association Test), Study 1b only included the long form and also assessed alcohol consumption. In Study 1a, implicit and explicit centrality measures were positively and significantly associated with AUDIT scores after controlling for explicit drinking identity strength. There were no significant differences in the implicit measure variants, but the long format had slightly higher internal consistency. In Study 1b, results replicated for explicit, but not implicit, centrality. These studies provide preliminary evidence that drinking identity centrality may be an important factor for predicting hazardous drinking. Future research should improve its measurement and evaluate implicit and explicit centrality in experimental and longitudinal studies.

Mood changes after watching pornography on the Internet are linked to tendencies towards Internet-pornography-viewing disorder

Scipedia content — Fri, 26 May 2017 11:06:59 +0200

Internet-pornography-viewing disorder (IPD) is considered one type of Internet-use disorder. For IPDs development, it was assumed theoretically that a dysfunctional use of Internet pornography to cope with depressive mood or stress might be considered to be a risk factor. To address the effect of Internet pornography use on mood, an online study with three measuring points with a sample of male participants was conducted. Participants were investigated regarding their tendencies towards IPD, personal use of Internet pornography, general mood, perceived stress, and their Internet pornography use motivation. Moreover, participants were asked regarding their current mood, sexual arousal, and need to masturbate before and after they watched Internet pornography self-determinedly in a private environment. Data showed that tendencies towards IPD were associated negatively with feeling generally good, awake, and calm and were correlated positively with perceived stress in daily life and using Internet pornography for excitation seeking and emotional avoidance. Self-determined use of Internet pornography in their private environment was accompanied by changes in mood and indicators of sexual arousal. Moreover, tendencies towards IPD were negatively related to mood before and after Internet-pornography use as well as an actual increase of good and calm mood. The results showed effects of watching Internet pornography on mood and sexual arousal which can be considered having reinforcing effects for the user. Thus, the results are in line with theoretical assumptions on IPDs development, in which the positive (and negative) reinforcement received by Internet-pornography use is related to cue-reactivity and craving reactions.

Hangover resistance in a Canadian University student population

Scipedia content — Fri, 26 May 2017 11:06:55 +0200

Resistance to alcohol hangover may be a risk factor for alcohol use disorder. Previous research to establish the prevalence of hangover resistance in a drinking population has either not used comparable intoxication levels or has considered hangover resistance over a limited time frame. The purpose of this study was to examine the prevalence of lifetime hangover negative (LHN) drinkers across comparable eBAC values ranging from 0 to 500 mg/dl. Students at an eastern Canadian university were surveyed about their heaviest drinking episode in the past month and indicated whether they had ever experienced a hangover in their lifetime (LHN) and, if they had, the hangover severity they experienced the next day. eBACs were calculated and the percentage of LHN drinkers was computed at each 10 mg/dl eBAC increment from 0 to 500 mg/dl. Most LHN drinkers (58% female, 71% male) had an eBAC on their heaviest drinking occasion below 80 mg/dl. Above eBACs of 80 mg/dl, 5.8% of female and 5.1% of male drinkers were lifetime hangover negative. The results suggest that only a small percentage of heavy drinkers lay claim to being lifetime hangover negative.

Impact of binge alcohol on mortality among people who inject drugs

Scipedia content — Fri, 26 May 2017 11:06:48 +0200

While the impacts of illicit drug use on mortality have been well described, the impact of poly-substance that includes alcohol has received less attention. We examined the impact of binge alcohol use on mortality among a cohort of people who inject drugs (PWID) in a Canadian setting. Using data derived from a prospective cohort study of PWID in Vancouver, Canada recruited between May 1996 and November 2013. We ascertained dates and causes of death through a confidential linkage with the provincial registry and examined the impact of binge alcohol use. The primary outcome of interest was all-cause mortality. We used Cox proportional hazard regression to determine factors associated with mortality, including socio-demographic characteristics, drug use patterns and other risk behaviours. During the study period, 2550 individuals were followed (844 of whom were HIV positive at baseline) for a median of 75.4 months (interquartile range 37.9–113.2). Of these, 795 (31%) participants reported binge alcohol use at some time during the study period. In multivariable analyses, binge alcohol use remained independently associated with all-cause-mortality (adjusted hazard ratio = 1.41, 95% confidence interval: 1.06–1.88) after adjustment for other drug use patterns. Binge alcohol use was associated with time to all-cause mortality among PWID in this setting. Since alcohol use is often overlooked as a risk factor for mortality among this population, these findings highlight the continued need to incorporate addiction treatment and public health interventions and policies that address binge alcohol use to reduce alcohol related-harms.

Booze and butts: A content analysis of the presence of alcohol in tobacco industry lifestyle magazines

Scipedia content — Fri, 26 May 2017 11:06:41 +0200

Advertising influences peoples health behaviors. Tobacco companies have linked tobacco and alcohol in their marketing activities. We examined how depictions of alcohol were placed in lifestyle magazines produced by tobacco companies, and if these references differed depending on the magazine’s orientation, if it was towards men, women, or if it was unisex. Content analysis of 6 different tobacco industry lifestyle magazines (73 issues), including 73 magazine covers, 1558 articles, 444 tobacco ads, and 695 non-tobacco ads. 14 of 73 (19%) magazine covers featured alcohol, 581 of 1558 (37%) magazine articles mentioned alcohol, 119 of 444 (27%) tobacco ads showed alcohol images, and 57 of 695 (8%) non-tobacco ads portrayed alcohol. Male-oriented magazines (Unlimited, CML, and Real Edge) contained the most alcohol references, and the references were mainly beer, mixed drinks, and liquor or spirits. Female-oriented magazines (All Woman and Flair) contained the fewest alcohol references, and wine and mixed drinks were the major types of alcoholic beverage portrayed. For the unisex magazine (P.S.), the frequency of alcohol references fell between the male- and female-oriented magazines, and the magazine most frequently mentioned mixed drinks. Frequent depictions of smoking and drinking in tobacco industry lifestyle magazines might have reinforced norms about paired use of tobacco and alcohol among young adults. The pairing of tobacco and alcohol may particularly target young men. Anti-tobacco interventions need to address the co-use of tobacco and alcohol, change the social acceptability of smoking in social settings, and tailor anti-tobacco messaging by gender.

Do online assessed self-report and behavioral measures of impulsivity-related constructs predict onset of substance use in adolescents?

Scipedia content — Fri, 26 May 2017 11:06:36 +0200

To prospectively predict the onset of use of alcohol, cigarettes and marijuana among Dutch adolescents, using behavioral and self-report measures of impulsivity-related facets. Specifically, we investigated whether behavioral measures of impulsivity predicted the onset of substance use above and beyond self-report measures of impulsivity and sensation seeking in an online sample. Self-report and behavioral data from 284 adolescents (195 girls, mean age = 14.8 years, SD = 1.26) were collected at four time points over a period of two years, using an online survey system. Impulsivity-related facets were assessed at time point 1 with the Delay Discounting Task, the Balloon Analogue Risk Task and the Passive Avoidance Learning Task. We conducted logistic regression analysis to examine whether behavioral and self-report measures uniquely predicted onset of alcohol use, heavy episodic drinking, smoking and marijuana use. Onset of cigarette smoking was associated with behavioral assessment of impulsive decision making, but not after controlling for self-reported impulsivity and sensation seeking. Behavioral measures were sometimes associated with, but appeared not to prospectively predict, the onset of substance use in this online sample after controlling for self-report measures. Based on the present results, the added value of online behavioral assessment of impulsivity-related factors in the prediction of onset of substance use was not confirmed. We suggest that factors specific to each behavioral task underlie their lack of prediction and suggest that future research addresses limitations of current behavioral tasks to increase their validity in online testing.

Sociodemographic predictors of latent class membership of problematic and disordered gamblers

Scipedia content — Fri, 26 May 2017 11:06:31 +0200

This paper reports a series of analyses examining the predictors of gambling subtypes identified from a latent class analysis of problem gambling assessment data, pooled from four health and gambling surveys conducted in Britain between 2007 and 2012. Previous analyses have indicated that gambling assessments have a consistent three class structure showing quantitative and potentially qualitative differences. Bringing this data together is useful for studying more severe problem gamblers, where the small number of respondents has been a chronic limitation of gambling prevalence research. Predictors were drawn from sociodemographic indicators and engagement with other legal addictive behaviours, namely smoking and alcohol consumption. The pooled data was entered into a multinomial logistic regression model in which class membership was regressed along a series of demographic variables and survey year, based on previous analyses of gambling prevalence data. The results identified multiple demographic differences (age, general health, SES, being single, membership of ethnic minority groups) between the non-problem and two classes endorsing some problem gambling indicators. Although these two groups tended to share a sociodemographic profile, the odds of being male, British Asian and a smoker increased between the three groups in line with problem gambling severity. Being widowed was also found to be associated with the most severe gambling class. A number of associations were also observed with other addictive behaviours. However these should be taken as indicative as these were limited subsamples of a single dataset. These findings identify specific groups in which gambling problems are more prevalent, and highlight the importance of the interaction between acute and determinant aspects of impulsivity, suggesting that a more complex account of impulsivity should be considered than is currently present in the gambling literature.

Do addicts have free will? An empirical approach to a vexing question

Scipedia content — Fri, 26 May 2017 11:06:26 +0200

This paper addresses two overlapping questions: Do addicts have the capacity to voluntarily quit drugs? And do individuals knowingly pursue courses of action that they realize are bad for them, such as excessive drug use? I propose two testable versions of free will. First, the observation that activities differ in the degree to which they are susceptible to the influence of their consequences (e.g., costs and benefits) has proven a useful criterion for classifying behavior as voluntary or involuntary. Thus, we can ask if drug use in addicts is influenced by its consequences. For instance, do laws that promise legal sanctions for drug use reduce drug use in addicts? Second, the philosopher Harry Frankfurt proposed a definition of free will that takes into account desires and self-reflection. I propose that addicts who do not want to desire drugs and successfully stop craving drugs pass his test. Dependence on illicit drugs typically ends after about four to six years. Dependence on cigarettes and alcohol persists for much longer, but most smokers and alcoholics eventually voluntarily quit using. Smokers and heroin addicts can voluntarily regulate their drug cravings as a function of the availability of their drug of choice. They have the capacity to pass Frankfurts test of free will. Addicts have free will as defined by the capacity to voluntary quit using drugs and to voluntarily regulate their cravings.

The importance of social identities in the management of and recovery from ‘Diabulimia’: A qualitative exploration

Scipedia content — Fri, 26 May 2017 11:06:21 +0200

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort. Transcripts from five online focus groups with 13 members of an online support group for individuals with ‘Diabulimia’ were thematically analysed. Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery, these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions. While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

Young adult smokers' neural response to graphic cigarette warning labels

Scipedia content — Fri, 26 May 2017 11:06:15 +0200

The study examined young adult smokers' neural response to graphic warning labels (GWLs) on cigarette packs using functional magnetic resonance imaging (fMRI). Nineteen young adult smokers (M age 22.9, 52.6% male, 68.4% non-white, M 4.3 cigarettes/day) completed pre-scan, self-report measures of demographics, cigarette smoking behavior, and nicotine dependence, and an fMRI scanning session. During the scanning session participants viewed cigarette pack images (total 64 stimuli, viewed 4 s each) that varied based on the warning label (graphic or visually occluded control) and pack branding (branded or plain packaging) in an event-related experimental design. Participants reported motivation to quit (MTQ) in response to each image using a push-button control. Whole-brain blood oxygenation level-dependent (BOLD) functional images were acquired during the task. GWLs produced significantly greater self-reported MTQ than control warnings (p

Effects of repetitive imagination of alcohol consumption on craving in alcohol-dependent patients: A pilot study

Scipedia content — Fri, 26 May 2017 11:06:07 +0200

In the majority of patients with alcohol use disorder (AUD), the clinical course is characterized by multiple relapses to drinking, frequently preceded by intense craving for alcohol. The present pilot study aimed to assess the effects of a repetitive imaginary cue-exposure protocol in reducing craving in recently abstinent alcohol-dependent patients. Sixty-four patients were randomly assigned to six intervention groups and were instructed to repetitively imagine: i) drinking a glass of their preferred alcoholic drink (low vs. high number of repetitions), or ii) drinking a glass of water (low vs. high number of repetitions), or iii) performing an analogous movement or performed no imagination. Additionally, 10 healthy controls were instructed to repetitively imagine drinking a glass of their preferred alcoholic drink (high number of repetitions). The levels of craving before and after intervention were measured using the Alcohol Urge Questionnaire (AUQ) and the Visual Analogue Scale for Craving (VASC). Repetitive imagination of alcohol consumption did not lead to a significant decrease in craving in alcohol-dependent patients as measured by the AUQ and VASC. In contrast, healthy controls showed a nearly significant decrease of the urge to drink alcohol after applying the protocol with a high number of repetitions. The findings of this pilot study might indicate an aberrant ability to habituate to alcohol-related stimuli in patients with AUD compared to healthy subjects. Future studies in larger samples are needed to further explore the effectiveness of imaginary cue-exposure interventions in alcohol dependence.

Rasch model of the GAIN substance problem scale among inpatient and outpatient clients in the city of São Paulo, Brazil

Scipedia content — Fri, 26 May 2017 11:06:02 +0200

This study used the Rasch model to evaluate the psychometric properties of the Portuguese version of the Substance Problem Scale (SPS) of the “Global Appraisal of Individual Needs - Initial” for use in Brazil. The SPS measures alcohol and drug problem severity within a DSM-IV-TR framework. The goal of the Rasch analysis was to assess scale dimensionality, item severity, and differential item functioning (DIF). Data was collected from 40 inpatients and 70 outpatients in São Paulo, Brazil. The Rasch model fit and DIF by gender and level of care were examined. The SPS fit the Rasch model, with no items distorting the measure. Only three of the sixteen items performed differently between men and women and three performed differently by level of care. The results were compatible with those from Rasch analyses of the American English and Canadian English versions of the scale. The Portuguese version of the SPS is, thus, valid for use in Brazil, both with men and women in inpatient and outpatient programs.

Implicit and explicit drinker identities interactively predict in-the-moment alcohol placebo consumption

Scipedia content — Fri, 26 May 2017 11:05:57 +0200

Having an identity as a ‘drinker’ has been linked to increased alcohol-related harm, self-reported consumption and self-reported intention to engage in risky drinking behavior. These effects have been observed when identities have been measured using explicit measures (e.g. via questionnaires) and implicitly (e.g. using Implicit Association Tests [IATs] adapted to measure identity). Little research has used actual behavioral measures to measure alcohol consumption in-the-moment, nor compared the effects of implicit and explicit identities directly. Participants' (n = 40) implicit and explicit identities associated with being a drinker were measured. Attitudes towards ones own drinking were measured explicitly. Participants completed a Pouring Taste Preference Task [PTPT] involving the consumption and rating of non-alcoholic wine. This provided a behavioral measure of intention (pouring), a behavioral measure of consumption and a measure of the implementation of intention into behavior. Results showed an interactive effect of implicit and explicit identities on attitudes and behavior. Explicit identities predicted attitudes towards drinking, but not behavior. Neither identity predicted the amount poured. Implicit identities predicted the amount consumed. A greater proportion of wine poured was predicted by higher implicit identities when explicit identities were absent. These results suggest that explicit identities may be associated more with those beliefs about drinking that one is aware of than behavioral intention. In addition, explicit identities may not predict behavioral enactment well. Implicit identity shows effects on actual behavior and not behavioral intention. Together this highlights the differential influence of reflective (explicit) and impulsive (implicit) identity in-the-moment behavior.

A test of the Social Identity Model of Cessation Maintenance: The content and role of social control

Scipedia content — Fri, 26 May 2017 11:05:52 +0200

Engagement with self-help groups is a predictor of positive outcomes for those attempting to control their addictive behaviours. In common with other groups, self-help groups have to manage non-normative (‘deviant’) behaviour to ensure the social values of the group remain preserved, and the group can fulfil its aims. These processes may protect group members from relapse. Drawing on the Social Identity Model of Cessation Maintenance, the current study asked a number (n = 44) of attendees of fellowship (AA/NA/CA) and of SMART groups to list behaviours they saw as normative and deviant, and rate a variety of responses to deviant behaviours. Costs of relapse to both the self and the group were also measured alongside self-efficacy regarding cessation and identity as both an active addict and as a member of a self-help group. Results suggest that social control responses to deviance grouped into education, punishment and avoidant type responses. More social control was perceived by highly identifying self-help group members. Educational responses were seen as used by groups more extensively than other responses. Punishment responses were mediated by the perceived costs an individuals relapse incurred on the rest of the group. These findings inform our understanding of what standards of normative and deviant behaviour self-help groups hold, and how they react to violations of such norms. They also have a number of implications for practitioners and facilitators in regard to using social identities as part of the treatment process.