Internal hemipelvectomy

Until recently, tumours involving the pelvis were usually treated by hemipelvectomy, otherwise called "hindquarter amputation". A more recent approach of treating these tumours is the 'conservative hemipelvectomy', which consists of removing the tumour and sparing the lower extremity. A patient with Ewing's sarcoma of the pelvis underwent such a procedure. The femoral head was fixed temporarily to the remaining parts of the acetabulum and the iliac wing by a Steinman pin. The Steinman pin was removed 6 weeks after the operation and the patient was then put into traction for another 6 weeks. Weight-bearing was gradually allowed after 3 to 6 months. The patient remodelled a neoacetabulum, which gave sufficient stability to the hip joint. Walking without external help was possible. The patient presented with a 2 cm limb-shortening. No local recurrence was observed during a follow-up of 30 months. This experience with internal hemipelvectomy shows an encouraging result in terms of tumour control and gait function.

Gallbladder volvulus: a case report. Could the ultrasound be the key of the early diagnosis?

Gallbladder volvulus is a rare disease which may affect the elderly. It mimics clinically an acute cholecystitis, but the ultrasound signs may provide an early diagnosis: a very large, anteriorly floating gallbladder, with very thickened, multi layered wall, could orientate the physician to this rare disease. We present one case of gallbladder volvulus with its radiological signs. The symptoms, the etiology and the radiological examinations are discussed.

[Lymphoid hyperplasia of the intestine in children. 15 cases]

Fifteen cases of nodular lymphoid hyperplasia (NLH) of the bowel in patients aged 17 months to 15 years are reported. Fourteen patients had NLH confined to the small bowel and one had involvement of both the small bowel and colon. Mean age at diagnosis was 10 years. The most common presenting symptoms were intestinal manifestations (86%). Diagnosis was suspected upon roentgenographic studies in one case and digestive endoscopy in ten cases. Histologic confirmation was obtained in all fifteen patients. Immunohistochemical studies, done in 8 patients, demonstrated a paucity of IgA plasmocytes in one patient with an immune deficiency and a polyclonal plasmocyte population with mainly IgA plasmocytes in the seven other patients. Five patients had a deficiency in humoral immunity, with variable expression hypogammaglobulinemia in three patients and IgA deficiency in two; intestinal giardiasis was found in eight patients. Histologic outcome was documented in five cases; evidence of NLH disappeared in only one patient. Metronidazole improved clinical symptoms in most instances.

Transfer of persistence across behaviors

Two experiments tested the applicability to human beings of findings with animals that the number of performances required for the reinforcement of one behavior affects the subsequent effort expended in other instrumental behaviors. In the first experiment, adult depressed psychiatric patients worked on a sorting task for the approval of a staff psychologist. The time spent and the work completed were increased by prior approval from a ward attendant for each completion of several custodial tasks, as compared to the ward attendant's approval for each completion of a single task or a no-pretreatment control condition. In the second experiment, preadolescent learning-disabled students who were required to read and spell correctly a greater number of words per reward token later spent more time and completed more work for reward tokens in mathematics, and handwriting. Two alternative interpretations of these results are evaluated: (a) The degree of accustomed effort per reinforcer becomes a learned component of behavior, or (b) high effort increases the habituation of frustration-produced disruptive responses. The results suggest that individual differences in general persistence may arise, in part, from an accumulation of effort training in the natural environment.