Synthesis of Maternal Transfer of Mercury in Birds: Implications for Altered Toxicity Risk

Maternal transfer is a predominant route of methylmercury (MeHg) exposure to offspring. We reviewed and synthesized published and unpublished data on maternal transfer of MeHg in birds. Using paired samples of females' blood (n = 564) and their eggs (n = 1814) from 26 bird species in 6 taxonomic orders, we conducted a meta-analysis to evaluate whether maternal transfer of MeHg to eggs differed among species and caused differential toxicity risk to embryos. Total mercury (THg) concentrations in eggs increased with maternal blood THg concentrations; however, the proportion of THg transferred from females to their eggs differed among bird taxa and with maternal THg exposure. Specifically, a smaller proportion of maternal THg was transferred to eggs with increasing female THg concentrations. Additionally, the proportion of THg that was transferred to eggs at the same maternal blood THg concentration differed among taxonomic orders, with waterfowl (Anseriformes) transferring up to 382% more THg into their eggs than songbirds (Passeriformes). We provide equations to predict THg concentrations in eggs using female blood THg concentrations, and vice versa, which may help translate toxicity benchmarks across tissues and life stages. Our results indicate that toxicity risk of MeHg can vary among bird taxa due to differences in maternal transfer of MeHg to offspring.

Laparoscopic repair of poststernotomy subxiphoid epigastric hernia

BACKGROUND

The repair of a subxyphoid hernia is a difficult procedure that nonetheless results in a high rate of recurrence. The laparoscopic approach is a promising new technique for more efficacious treatment of this condition. This is the first report in the English-language literature to describe the use of this approach for the correction of poststernotomy subxiphoideal hernia.

METHODS

Information was retrieved from the patients' hospitalization and outpatient clinic files. Of 984 patients who had a median sternotomy, 10 developed a substernal subxiphoid epigastric hernia. These patients had all been treated laparoscopically using Gore-Tex mesh.

RESULTS

Nine patients were admitted electively and one urgently. The fascial defect sizes were 4-15 cm (mean, 8.5) in length. Intraabdominal content was adherent to the hernia in six patients; in the other four cases, the defect was adhesion free. In four patients, an incidental surgical procedure was performed (three cholecystectomies and one inguinal hernia repair using the trans abdominal preperitoneal [TAPP] technique). The operations lasted 25-120 min (average, 55). No death occurred as a result of the operations, and none of the operations was converted to an open procedure. Three patients had minor postoperative complications. During 20-42 months of follow-up, one patient suffered a recurrence.

CONCLUSIONS

Laparoscopic repair of a poststernotomy subxiphoideal epigastric hernia is feasible and has a low rate of minor complications. Our review of the literature indicates that this technique produces a better outcome than the conventional open repair.

Use of adjustable silicone gastric banding for revision of failed gastric bariatric operations

BACKGROUND

Revision of gastric bariatric operations is sometimes technically difficult and may fail to achieve prolonged weight reduction. The use of the adjustable silicone gastric banding (ASGB) offers a new approach for these revisions.

METHODS

ASGB was performed as a revisional procedure on 37 patients whose initial bariatric operations were as follows: silastic ring vertical gastroplasty (21), gastric bypass (12), horizontal gastroplasty (3) and vertical banded gastroplasty (1).

RESULTS

The length of the procedure varied from 55 to 145 minutes (mean 83 minutes). Intraoperative complications included two fundic tears which were sutured without any postoperative sequelae. Five patients needed reoperation during the first postoperative year due to gastric volvulus (1), tubing tear (1) and development of postoperative ventral hernia (3). BMI fell from 44.8+/-SD 8.07 to 33.4+/-6.9 kg/m2 for patients operated with BMI higher than 35 kg/m2 and from 29.2+/-3.32 to 25.4+/-2.8 kg/m2 for patients operated with BMI lower than 35 kg/m2.

CONCLUSIONS

ASBG can be performed with revisions with an acceptable complication rate and postoperative weight reduction.

Silastic ring vertical gastroplasty by minilaparotomy

BACKGROUND

The incision length has significant influence on the postoperative course after silastic ring vertical gastroplasty (SRVG).

METHODS

A technique is described in which SRVG can be performed through a minilaparotomy incision.

RESULTS

110 patients were operated with this technique during 1996. No remarkable intraoperative or postoperative complications were encountered. Postoperative weight loss has been satisfactory.

CONCLUSIONS

Performance of SRVG through a minilaparotomy is feasible. The technique is recommended for surgeons familiar with the operation through the formal incision.

The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture

BACKGROUND

Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition.

METHODS

During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused herniation of the intraabdominal contents.

RESULTS

In all three cases, laparoscopy succeeded in identifying the diaphragmatic defect, so that the herniated viscera could be released and the defect repaired primarily or with a prosthesis. The intraoperative and the postoperative courses were uneventful; there were no significant complications.

CONCLUSION

Laparoscopy has an important role in the surgical treatment of missed diaphragmatic ruptures.

Humor and pain management. A review of current literature

The purpose of this article is to provide a review of current literature related to humor and pain management. A brief review of the benefits of humor on the body is followed by a literature review of articles on humor and pain management, including research articles and scholarly articles on the topic. Research studies on the use of humor with both acute and chronic pain will be reported. The review of scholarly unresearched articles will include articles giving guidelines for humor use, suggested humor assessment guidelines, discussion of the nurse's role with humor use, and implementation strategies via humor carts and rooms.