Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups (JINS, 2007, 13, 143-152.)

This study reports the effects of a 12-week multimodular cognitive rehabilitation training program on memory performance in two groups of older adults. In the Memory Training module, participants were instructed on the nature of memory and how to improve memory performance; internal and external strategies were described and practiced over the training sessions. Memory performance was assessed by four tests: Alpha Span, Brown-Peterson, Hopkins Verbal Learning Test - Revised (HVLT-R), and Logical Stories. One group received training on entry into the study (Early Training Group, ETG), the other after a 3-month delay (Late Training Group, LTG). The results showed no training-related improvement in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R), or recognition memory (HVLT-R). While the most direct analyses of a training effect (analyses of covariance) rarely demonstrated significant effects, exploratory analyses provided some evidence for a training benefit in several measures of secondary memory (Logical Stories; HVLT-R) and strategic processing (Brown-Peterson; Logical Stories; HVLT-R). Positive results were largely restricted to the ETG, possibly because the LTG lost motivation as a consequence of their delayed training. The results need to be treated with caution, but are promising for the rehabilitation of memory functioning in older adults.

In this study, we report changes in psychosocial function in two groups of older adults that participated in the experimental trial of our cognitive rehabilitation program. The results, based on tests that measured a range of psychosocial attributes, showed that, following training, participants improved in terms of overall well-being, as well as in specific areas that included perceived happiness, coping strategies, and quality of life. An important finding was that improvements were also observed in long-term follow-up testing. Both groups benefited from training, but the effect was greater in the group that received training before undergoing a control procedure. The results, which show that the benefits of our rehabilitation program extend into the psychosocial domain, underscore the potentially important relationship between psychosocial factors and cognitive performance in older adults.

Small bowel adenocarcinoma is a rare malignancy that accounts for a small percentage of gastrointestinal cancers. Diagnosis and management of small bowel adenocarcinoma can be challenging due to its rarity and nonspecific presentation. We present a case of a 51-year-old male with a history of intravenous drug use who presented with worsening abdominal pain and was found to have a small bowel obstruction. Exploratory laparotomy revealed a stricture in the jejunum caused by an intraluminal mass, which was resected. Pathological examination confirmed the diagnosis of intestinal type, moderately differentiated adenocarcinoma. This case highlights the importance of considering small bowel adenocarcinoma as a possible etiology in patients presenting with small bowel obstruction, particularly in high-risk individuals. Early diagnosis and complete resection remain the mainstays of treatment for improved outcomes in small bowel adenocarcinoma.

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the United States and is widely accepted due to its technical ease and effectiveness. Concomitant hiatal hernia repair, if detected during an LSG, is recommended. Intrathoracic sleeve migration (ITSM), a sliding hiatal hernia that develops after LSG, is a rare complication of this procedure. This report presents an early case of ITSM due to intermittent retching, resulting in postoperative incarceration of the proximal sleeve. The patient is a 28-year-old female who underwent concomitant LSG and hiatal hernia repair and was readmitted for acute entrapment of the proximal portion of the sleeve. The patient underwent re-operation with reduction of the proximal sleeve, and omentopexy was performed for stabilization. Intraoperative esophagogastroduodenoscopy was performed to ensure the detorsion and patency of the sleeve before the surgery. No additional hiatal hernia repair was attempted. ITSM with incarceration is an interesting phenomenon that is underrecognized and underreported. It can present postoperatively with reflux symptoms and poor oral tolerance. Failure to make an accurate diagnosis and intervene can result in prolonged hospitalization and poor patient outcomes.