Explore the vast range of titles available.

Small bowel obstruction is a common surgical emergency and frequent cause of hospitalization. Internal hernias account for less than 6% of all small bowel obstruction cases. Less frequently, hernias through the broad ligament of the uterus can occur and account for only 4-7% of total internal hernia cases. We report a case of a small bowel hernia through broad ligament of the uterus in a young female. Multiple diagnostic modalities suggested a ruptured ovarian cyst as the most probable cause for her abdominal pain. However, her symptoms were much more severe than an ovarian cyst would normally produce. Therefore, a diagnostic laparotomy was performed, which found a small intestine hernia through the left broad ligament of the uterus. The diagnosis of intestinal hernias, specifically through the broad ligament, is often delayed due to the infrequent occurrence, varied presentation, and difficulty of confirmation on computed tomography (CT) scan. Surgery is the gold standard for the diagnosis and treatment of internal hernias. This article draws attention toward a rare and potentially life-threatening cause of abdominal pain.

Radiological imaging including abdominal ultrasound and CT scan will demonstrate solid, highly vascular masses with potential invasion of adjacent structures.3 The standard of care remains surgical resection with microscopically negative margins. Recurrence rates range from 18 to 40 per cent, and increase when the tumor is located in the retroperitoneum or mesentery; this decreases with complete resection and small (<3 cm) tumor size.4 There is no evidence to support chemotherapy after complete resection.4 IMT is a rare, fast-growing, locally aggressive tumor with high prevalence in the pediatric population. Because of its aggressive behavior, and high recurrence rates, early diagnosis and prompt surgical resection is paramount.

Benefits of operative repair include both cosmetic and psychological improvement for the patient, but studies show that correction may prevent future cardiopulmonary dysfunction.1 Children with PE may not exhibit any symptoms at a young age due to the pliability of their chest wall.

Aggressive donor management protocols have evolved to maximize the number of procured organs. Our study assessed donor management time and the number and types of organs procured with the hypothesis that shorter management time yields increased organ procurement and transplant rates. We prospectively analyzed 100 donors managed by a regional organ procurement organization (OPO) during 2007 to 2008. Data included patient demographics, number and types of organs procured and transplanted, patient management time by the OPO, and achievement of donor pre-procurement goals. One hundred consecutive organ donors were managed with a mean age 41 ± 18 years and mean management time 23 ± 9 hours; 376 organs were procured and 327 successfully transplanted. Donors managed greater than 20 hours yielded significantly more heart (5 vs 26, P < 0.01) and lung (6 vs 40, P < 0.01) procurements, more organs procured per donor (3.2 ± 1.4 vs 4.2 ± 1.6, P < 0.01), and more organs transplanted per donor (2.6 ± 1.5 vs 3.7 ± 1.8, P < 0.01) than those managed 20 hours or less. No difference in the attainment of donor management goals was observed between these populations. Contrary to our initial hypothesis, donor management times greater than 20 hours yielded increased organ procurement and transplant rates, particularly for hearts and lungs, despite no differences in the achievement of donor preprocurement management goals.

Discusses the four foci of studies undertaken in the 1980s to enhance learning among US children national standards, classroom analysis, nonschool influences, & employer education. The top-down strategy of national standards augmented by a systemic approach received & retains considerable support. The bottom-up analysis through classroom studies revealed that the use of school time frustrated imaginative learning activities & indicated a need for more freedom for individual schools. Studies of nonschool elements, including families & communities as sources of learning, suggested that school should remain academic in focus, with the social capital of the community utilized as a complement. Other studies examined the transition from school to work & the impact of federal (eg, Job Corps) & private/local apprenticeship programs. It is concluded that the rapid changes occurring in the society at large, including multiculturalism & changing assumption about gender roles, require continued study. M. Greenberg

The intensive drive to promote national standards and assessments has gathered support from unproven connections between U.S. economic success and the nature of learning in schools. Now that teachers are being challenged to produce a bottom-up sea-change in their own classrooms, Uncle Sam's presence in the back of the room may be a growing problem for teachers' morale. (MLH)

Academic objectives are important, but more attention must be given youngsters' social, physical, emotional, and moral development. Schools are struggling to teach children whose home life is anxiety-ridden and learning-unfriendly. Because taxpayers resist generosity to poor families alone, we must design social programs to help all families and provide equitable school funding. The six national education goals are inadequate. (MLH)

Views President Bush's America 2000 plan as a rhetorical masterpiece with minimal public input and maximum government interference. Examines program recommendations regarding teacher improvement, choice, the New American Schools Development Corporation, and national testing. Discusses three omitted topics: school finance, growing youth poverty, and cultural and racial diversity in U.S. society. (25 references) (MLH)