Citations

Studying goalies, who play a key position in hockey requires examining psychophysiologic variables and their relationship to performance during games when the outcome is important [15]. This investigation tested all three aspects of emotion (subjective, physiologic changes, and performance). Nine male goalies completed questionnaires and provided salivary cortisol before, during, and after each game. Heart rate (ECG signal) was integrated with the goalie's performance video. Goalies rated on Likert Scales; headaches, stomach aches, insomnia, nervousness, and awareness of heart pounding. Data from 16 games were obtained. Of nine, two goalies provided data on three games each; one goalie was classified as a responder and the other a non-responder, based on salivary cortisol levels (SCL). The responder's SCL increased 572% between baseline and post-period assessments, whereas SCL in the non-responder increased 50% above baseline. The responder's SCL increased 8 times baseline when he faced 16 shots in a period. The responder goalie's game heart rates (HRs) were 160,152, and 167 beats per minute (bpm) and the non-responder's HRs were 147, 132, and 142 bpm for three games. Game performance was similar for both goalies.

AbstractPurposeManagement of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications.MethodsThe outcome of patients who underwent treatment for anal fistula with the Surgisis® anal plug was retrospectively reviewed.ResultsTwenty patients were treated; three underwent concomitant anal advancement flap at the time of plug placement. Seventeen patients had a trans‐sphincteric fistula, and three had an anoperineal fistula. Ten patients had previously undergone failed surgical therapy to cure their fistula, including anal advancement flap in four, muscle interposition flap in two, fistulotomy in two, and cutting seton placement in two. Mean follow‐up was 7.4 months. Only 4 of 17 (24%) patients treated with the plug alone had closure of their fistula. Acute postoperative sepsis was seen in 5 of 17 (29%) patients treated with the plug alone. Four developed perianal abscesses that required incision and drainage, and one intersphincteric abscess was treated with antibiotics. Two of the patients who underwent concomitant anal advancement flaps and plug placement healed successfully.ConclusionsContrary to other published series, the use of the Surgisis® anal plug was associated with a low rate of fistula healing and a high incidence of perianal sepsis. The addition of a transanal advancement flap to the procedure may improve success rates.

Laparoscopic adrenalectomy is one of the most clinically important advances in the past 2 decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach to the adrenal is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients with corticotropin (ACTH) dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.