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

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

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

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

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

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

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

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

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

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

Accurate self-evaluation is central to a family physician's professional growth both during and after the residency training period. Self-evaluations of residents' interviewing skills, as demonstrated in videotaped interviews with simulated patients, were compared to multiple faculty evaluations as part of an annual assessment. Means for resident evaluations were lower and showed greater variations than faculty ratings but correlated significantly in several areas. Inter-rater reliability coefficients were highest when criteria were most specific. Residents benefited from the opportunity to compare and discuss their perceptions with those of objective and competent raters.

A patient is presented who manifested two previously undescribed complications of chlorpromazine therapy: a transient pericardial friction rub and "pseudo-giant P waves". After slowing of the heart rate, the "giant P-waves" proved to be superimposed U and P-waves. His history demonstrates the protean and at times unusual complications of chlorpromazine therapy and illustrates the dramatic therapeutic effects diphenhydramine may have in reversing some of this toxicity.

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

As a step toward defining psychosocial areas in which resident training in family medicine is needed, this study assessed the concerns patients had about the emotional health of their families. A questionnaire was developed to survey the patient concerns (ie, worries or perceived problems) for the developmental, psychological, and social functioning of their families. Patients in three family practice settings were administered the questionnaire while waiting for their appointments. Sixty-four percent of the patients perceived one or more areas of concern in their families. Close to half (48.9 percent) had concerns about themselves. Concerns about the emotional well-being of spouses were identified by 39.5 percent of those having spouses, and for children, 38.2 percent of those having children. Also, 39.7 percent expressed concern about their parents' emotional health. Further, while only 3.5 percent of the patients were given a psychiatric diagnosis, 26.5 percent of the charts contained notes revealing psychosocial problems at some patient visit. The results point to a major need for family physicians to develop skills in child, adult, and family evaluation of psychosocial functioning.