Chylous ascites in the setting of internal hernia: a reassuring sign

BACKGROUND: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS: Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS: Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS: Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Simplified Signs

Simplified Signs presents a system of manual sign communication intended for special populations who have had limited success mastering spoken or full sign languages. It is the culmination of over twenty years of research and development by the authors. The Simplified Sign System has been developed and tested for ease of sign comprehension, memorization, and formation by limiting the complexity of the motor skills required to form each sign, and by ensuring that each sign visually resembles the meaning it conveys.Volume 1 outlines the research underpinning and informing the project, and places the Simplified Sign System in a wider context of sign usage, historically and by different populations. Volume 2 presents the lexicon of signs, totalling approximately 1000 signs, each with a clear illustration and a written description of how the sign is formed, as well as a memory aid that connects the sign visually to the meaning that it conveys. While the Simplified Sign System originally was developed to meet the needs of persons with intellectual disabilities, cerebral palsy, autism, or aphasia, it may also assist the communication needs of a wider audience – such as healthcare professionals, aid workers, military personnel , travellers or parents, and children who have not yet mastered spoken language. The system also has been shown to enhance learning for individuals studying a foreign language. Lucid and comprehensive, this work constitutes a valuable resource that will enhance the communicative interactions of many different people, and will be of great interest to researchers and educators alike

Simplified Signs

Simplified Signs presents a system of manual sign communication intended for special populations who have had limited success mastering spoken or full sign languages. It is the culmination of over twenty years of research and development by the authors. The Simplified Sign System has been developed and tested for ease of sign comprehension, memorization, and formation by limiting the complexity of the motor skills required to form each sign, and by ensuring that each sign visually resembles the meaning it conveys.Volume 1 outlines the research underpinning and informing the project, and places the Simplified Sign System in a wider context of sign usage, historically and by different populations. Volume 2 presents the lexicon of signs, totalling approximately 1000 signs, each with a clear illustration and a written description of how the sign is formed, as well as a memory aid that connects the sign visually to the meaning that it conveys. While the Simplified Sign System originally was developed to meet the needs of persons with intellectual disabilities, cerebral palsy, autism, or aphasia, it may also assist the communication needs of a wider audience – such as healthcare professionals, aid workers, military personnel , travellers or parents, and children who have not yet mastered spoken language. The system also has been shown to enhance learning for individuals studying a foreign language. Lucid and comprehensive, this work constitutes a valuable resource that will enhance the communicative interactions of many different people, and will be of great interest to researchers and educators alike

Simplified Signs

Simplified Signs presents a system of manual sign communication intended for special populations who have had limited success mastering spoken or full sign languages. It is the culmination of over twenty years of research and development by the authors. The Simplified Sign System has been developed and tested for ease of sign comprehension, memorization, and formation by limiting the complexity of the motor skills required to form each sign, and by ensuring that each sign visually resembles the meaning it conveys.Volume 1 outlines the research underpinning and informing the project, and places the Simplified Sign System in a wider context of sign usage, historically and by different populations. Volume 2 presents the lexicon of signs, totalling approximately 1000 signs, each with a clear illustration and a written description of how the sign is formed, as well as a memory aid that connects the sign visually to the meaning that it conveys. While the Simplified Sign System originally was developed to meet the needs of persons with intellectual disabilities, cerebral palsy, autism, or aphasia, it may also assist the communication needs of a wider audience – such as healthcare professionals, aid workers, military personnel , travellers or parents, and children who have not yet mastered spoken language. The system also has been shown to enhance learning for individuals studying a foreign language. Lucid and comprehensive, this work constitutes a valuable resource that will enhance the communicative interactions of many different people, and will be of great interest to researchers and educators alike

3. Deaf Persons and Sign Languages

Before focusing more specifically on the Simplified Sign System that we have developed, it is important to first have a basic understanding of sign languages and the main group of persons who use them — Deaf people. To obtain this necessary background information, we strove to answer the following questions: what is the historical evidence for the use of sign languages among Deaf persons? How did educational programs for deaf students emerge, and what communication approaches did these progra..

2. Use of Manual Signs and Gestures by Hearing Persons

There are many situations in which spoken language communication is not feasible or successful, even if all persons involved have the physical ability to produce speech. In these cases, a viable option may be the use of signs or gestural communication; history provides multiple examples of the success of such a strategy. The early Europeans who landed on the shores of what to them was the New World encountered Native Americans with whom they could not effectively communicate through spoken la..

6. Sign-Communication Intervention in Adults and Children with Aphasia

In the previous two chapters, the research focus has primarily been on the sign acquisition of non-speaking or minimally verbal children. A number of these individuals learn to communicate effectively, often for the first time, through the use of manual signs. Furthermore, while gaining proficiency in sign communication, a substantial proportion of these children are also able to acquire some spoken language skills. In the present chapter, our principal focus changes to the acquisition and us..

7. Use of Manual Signs and Gestures by Hearing Persons

So far in this volume, we have discussed the history of the sign languages of Deaf persons and their recognition as true and genuine languages, as well as the unique richness of meaning that can be conveyed through a visual-gestural mode of communication. Signs also have proven to be beneficial to the larger hearing societies in which Deaf people live, as shown by our exploration of the use of signs by hearing persons in various historical contexts. These contexts included the initial interac..

8. Development of the Simplified Sign System

Background Information The original goal of the Simplified Sign project was to develop a system of manual signs that would enhance the communication skills of a number of hearing, but non-speaking, persons. Initially, the focus of the project was to create a sign vocabulary that would meet many of the needs of children with autism or with other disabilities such as cerebral palsy or Down syndrome. We felt that these children would benefit from a new sign-communication system that was easy to ..