SUMMARY BackgroundUp to 40% of patients who present with acute severe ulcerative colitis (UC) fail to make an adequate response to intravenous corticosteroids. Ciclosporin or infliximab are currently employed as salvage therapy in this clinical scenario.

The purpose of this study was twofold: (a) to empirically evaluate the effects of a 21-day wilderness therapy program (WT) on the defense styles, perceived psychosocial stressors (expressed concerns), dysfunctional per sonality patterns, clinical syndromes, and maladaptive behaviors of 109 troubled adolescents, as measured by the Defense Style Questionnaire-40, Millon Adolescent Clinical Inventory (MACI), and Youth Outcome Questionnaire-2.0 (Millon, 1997); and (b) to begin to identify the types of clinical concerns on Axes I, II, and IV for which wilderness therapy is most effective. Wilderness therapy resulted in statistically significant improve ment on immature defense and maladaptive behavior scores, and on the Expressed Concerns, dysfunctional Personality Patterns, and Clinical Syndromes scores of subjects. Moderate to large effect sizes were found for a wide range of clinical concerns on Axes I, II, and IV. The most striking finding of this study is that WT appears to facilitate positive characterological change in adolescents with clinically elevated MACI Personality Patterns scores. Short-term interventions leading to characterological change are virtually unheard of in the personality literature. Future research is needed to confirm whether or not WT is effective for treating budding personality disorders.

This study found that RE occurred at a similar rate in patients treated with ADR and ALIF with BMP. The overall rate of RE after retroperitoneal anterior lumbar surgery was higher than expected, which underscores the importance of counseling patients about this risk and specifically questioning patients about the symptoms of RE at postoperative visits.

No abstract

LEVY et al.1 described "aortico-left ventricular tunnel" as an abnormal communication that begins in the ascending aorta above the level of the coronary arteries, bypasses the aortic valve, and terminates in the left ventricle, resulting in aortic insufficiency. The authors described three cases and stated that four similar cases had been previously described. A review of the original papers2-5 suggests, however, that in three instances the history and anatomic findings were more compatible with rupture of a congenital aneurysm of a sinus of Valsalva than with an aortico-left ventricular tunnel. Levy et al.' made the point that in their three cases, and in another previously described by Edwards,3 the tunnel originated or joined the ascending aorta above the sinus of Valsalva and the sinuses were normal. Furthermore, evidence of the presence of the tunnel appeared during infancy, suggesting that it was present at birth and not the result of a postnatal rupture.An abnormal communication between the aorta and the left ventricle may also be secondary to a rupture of either a congenital or acquired aneurysm of a sinus of Valsalva. Congenital aneurysms usually come to the attention of the physician only after rupture into one of the adjacent cardiac chambers, although the diagnosis prior to rupture can be made by angiocardiography.6 Up to 1961 Sakakibara and Konno7 found 52 well-documented cases of aneurysm of the sinuses of Valsalva with rupture, and in three of these, 564 an aneurysm of the right sinus had ruptured into the left ventricle. The average age of rupture, as ascertained by history and physical examination, of the entire 52 cases was 32 years, and the youngest with rupture into Case Report This white male infant was first seen at the age Circulation, Volume XXXI, April 1965 From the