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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. MethodsData 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. ResultsFifty-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.

Chapter 11 contains the first one thousand signs of the Simplified Sign System lexicon, alphabetized by each sign’s main gloss. Each entry in the lexicon includes a hand-drawn illustration of how that sign is formed, a listing of any synonyms or antonyms related to that sign, and a written description of how the sign is formed (i.e., the handshape(s), palm orientation(s), finger/knuckle orientation(s), location, and movement parameters of the sign). Also provided are a short memory aid to help learners remember the sign’s formation and a longer memory aid that describes the visual and iconic link between how the sign is physically formed and the meaning it conveys. Many of the longer memory aids also include a definition of the main gloss and some of that sign’s synonyms. If users of the system wish to look up a particular vocabulary item, term, or idiomatic phrase, an alphabetized Sign Index that integrates all of the main sign glosses with all of their listed synonyms and antonyms is provided at the end of the volume. This Sign Index directs readers to the page that contains the main sign entry, its written description, and its memory aids.

In Chapter 4, the authors begin an in-depth discussion of the use of signs with special populations, including an early study that occurred in the West of England in the 1840s with deaf students with intellectual disabilities. Various types of intellectual disability are identified, including fragile X syndrome, Williams syndrome, Down syndrome, and Angelman syndrome. The successes and failures of speech-based and sign-based interventions are covered for individuals with these syndromes (particularly the latter two) as well as in persons with multiple disabilities. The authors next move on to a discussion of the relatively sparse research related to teaching signs to children who have cerebral palsy. Recommendations for enhancing the sign-learning environment are provided so that all persons who use signs as an augmentative or alternative means of communication may derive the greatest benefit from their communicative interactions. In addition to maximizing the positive atmosphere in which signing individuals interact with others at school, at home, and in public, the authors suggest that the types of signs employed may also have an impact on whether or not signing is successful.