Ventricular perforation associated with central venous introducer-dilator systems

BACKGROUND: An erythrocyte sedimentation rate (ESR) of at least 40 mm/h is considered an important requisite for the diagnosis of polymyalgia rheumatica (PMR). However, the relative frequency and clinical features of PMR in patients without a significantly increased ESR are unclear. METHODS: We performed a retrospective study of patients diagnosed as having PMR at the rheumatology divisions of 3 teaching hospitals. The diagnosis of PMR was established, regardless of the ESR, in 201 consecutive patients fulfilling the following criteria: (1) age 50 years or older, (2) severe proximal pain for more than 1 month in at least 2 of 3 areas: neck, shoulder, and/or pelvic girdles, and (3) rapid resolution of the syndrome while taking low-dose prednisone. Patients with giant cell arteritis were previously excluded from the study. The frequency and clinical features of patients with PMR and an ESR lower than 40 mm/h were analyzed. A comparative study between these patients and those with high ESRs was performed. RESULTS: An ESR lower than 40 mm/h was found in 41 patients (20.4%). These patients were younger (P = .02), were more frequently men (P = .006), and experienced a lower frequency of fever (P = .003) and weight loss (P = .07). Furthermore, these patients were characterized by an absence of anemia (P = .002) and a lower frequency of abnormal protein electrophoresis results (P < .001). Otherwise, their clinical syndrome, response to therapy, and frequency of relapses were similar to those of patients with classic PMR. In the entire population of 201 patients, the ESR was related to the length of treatment, number of areas involved, presence of fever, weight loss, and laboratory test result abnormalities, but it was unrelated to the duration of the illness prior to diagnosis. CONCLUSIONS: It is not uncommon to find a patient with PMR with an ESR lower than 40 mm/h. This syndrome is more frequent in men and it is clinically less severe than the classic form of PMR. Its recognition will allow these patients to benefit from an effective treatment with low-dose corticosteroids.     

Factors associated with atrial fibrillation in patients with mitral stenosis: a cardiac catheterization study

OBJECTIVE: The aim of this study was to characterize the adenosine A3 receptor agonist, N6-(3-chlorobenzyl)-5'-N-methylcarboxamidoadenosine (CB-MECA), evaluate its ability to reduce myocardial ischemia/reperfusion injury and determine the role of KATP-channel activation in A3 receptor-mediated cardioprotection. METHODS: Binding affinities and adenylate cyclase inhibition were examined in CHO cells expressing rabbit recombinant adenosine A1 or A3 receptors. Infarct size (normalized for area-at-risk; % IA/AAR) was measured in buffer-perfused rabbit hearts exposed to 30-min regional ischemia and 120 min of reperfusion. RESULTS: CB-MECA was 100-fold selective for A3 vs. A1 receptors (A3 Ki: 1 nM; A1 Ki: 105 nM). Five-min perfusion with CB-MECA before ischemia/reperfusion elicited a concentration-dependent reduction in infarct size (EC50: 0.3 nM). The CB-MECA-dependent cardioprotection (control: 58 +/- 2; CB-MECA: 21 +/- 3% IA/AAR) was unchanged by an A1-selective concentration of the antagonist, BWA1433, but was completely prevented (P < 0.05) by a nonselective (A1/A3) concentration (55 +/- 6% IA/AAR). The KATP channel inhibitors, glibenclamide and 5-HD, had no effect on control infarct size, yet significantly (P < 0.05) blunted the CB-MECA-dependent cardioprotection (glibenclamide: 49 +/- 6; 5-HD: 58 +/- 4% IA/AAR). CONCLUSIONS: CB-MECA is a novel 100-fold A3 receptor-selective agonist which should prove useful for elucidating A3-dependent mechanisms in the rabbit heart. Selective stimulation of adenosine A3 receptors with CB-MECA reduces myocardial ischemia/reperfusion injury via a mechanism which involves activation of KATP channels.     

A comprehensive program for mental health and behavioral medicine in a large children's hospital.

Primary health care services are differentiated from secondary or tertiary levels of care. Problems of illness-related psychopathology, sometimes called psychosomatic or behavioral medicine, are differentiated from traditional forms of emotional disturbances such as neurosis, psychosis, and personality disorders. It is shown how primary mental health care and behavioral medicine combine to form a special branch of child psychology known as pediatric, medical, or health care psychology. A program for work of this type in a large children's hospital is outlined. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for candidemia in a children's hospital

Candida species are increasingly important nosocomial pathogens in critically ill children. A 2.3-fold increase in the rate of nosocomial candidemia at our 200-bed tertiary care children's hospital prompted a study to identify risk factors for this infection. Twenty-six cases were identified between 1992 and 1993, representing 21% of all nosocomial bloodstream infections. Candida albicans was the most frequent isolate (58%), followed by Candida parapsilosis (27%). A case-control study revealed that there was a statistically significant association between the occurrence of candidemia and placement of a central venous catheter in the femoral vein (P = .03), the use of a tunneled central venous catheter (P = .05), and prolonged hyperalimentation (P = .04). Patients with candidemia also were noted to have candiduria more often than controls (P = .003) and were more likely to have had topical antifungal agents prescribed (P = .04). Multivariate analysis showed that hyperalimentation was an independent risk factor for the development of candidemia. We conclude that measures must be taken to reduce these risk factors whenever possible.     

Central venous catheters. Prospective surveillance of a hospital

OBJECTIVES: All the central venous catheters (CVC) inserted at the Saint-Antoine Hospital between December 5, 1994 and June 6, 1995 were prospectively studied in order to better define practices in the management of CVC and to determine the rate of catheter-related infections. METHODS: The following data were recorded for each CVC: insertion procedure, clinical data, catheter dressings, removal, catheter-related infections, bacteriological findings. Catheter-related infections were distinguished from probably catheter-related infections and localized skin infections. RESULTS: Among 325 patients, a total of 414 catheters were inserted. At the end of the surveillance period, 350 (85%) had been removed, 43 (10%) were still in place and 21 (5%) were lost to follow-up. Analysis of procedures such as cutaneous disinfection, routine replacement of the i.v. sets or changes of dressings showed wide variations between care units and within the same unit. The overall incidence of catheter-related infections was 0.24 per 100 days of catheterization. Infections occurred 29 +/- 34 days after insertion. Microorganisms responsible for catheter-related bacteremia were mostly Gram positive (84%) and Gram negative (16%). Sixty-two infections (15%) were clinically suspected by physicians, leading to the catheter removal in 84% of cases. Out of the 43 CVC sent to the laboratory, 29 (67%) were negative (i.e., "sterile") in quantitative culture of the tips as described by Brun-Buisson, suggesting that the CVC was unnecessarily removed. Bacteriological analysis ordered by physicians were not always relevant. For example, 76% of CVC received by the laboratory were systematically sent although they were not suspected of infections. Conversely, only 61% of exsudate formation at the insertion site were collected and analyzed. CONCLUSION: This study was designed to recall good guidelines to the hospital staff. Results will lead to the development of a better use of antiseptics and to the implementation of appropriate and standardized procedures to reduce risk infection.     

A multivariate study of attention dysfunction in schizophrenia.

Administered 5 tests purported to measure attention dysfunction to 60 schizophrenic and 60 nonschizophrenic male psychiatric patients. There was 30 chronic and 30 acute Ss in each group. The measures used were: size estimation, reaction time, and vigilance tasks, the Goldstein-Scheerer Object Sorting Test, and a proverb-interpretation task. Contrary to previous assumptions, these tests did not intercorrelate highly. In addition, individual-difference variables, as measured by staff ratings on the Psychotic Reaction Profile, failed to correlate significantly with task performance. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arteriovenous fistulae complicating central venous catheterization: value of endovascular treatment based on a series of seven cases

OBJECTIVES: To point out the usefulness and effication of endovascular treatment of arteriovenous fistulae complicating the insertion of central venous catheter. MATERIAL AND METHOD: Retrospective study of 7 cases treated between 1983 and 1993. The central venous catheterization had involved the right internal jugular vein in 5 cases and the right subclavian vein in 2 cases. RESULTS: Isolated endovascular therapy was performed in 5 cases. Surgery was necessary in 1 case to remove an hematoma. In another case, occlusion of a large AVF was performed during intraoperative endovascular temporary occlusion of the AVF. The choice of the occluding agent was primarily dictated by the hemodynamic and anatomical conditions (releasable balloons, coils). Vertebro-vertebral fistulae (3 cases) could be treated with patency of this vessel. No complications were encountered. CONCLUSION: Endovascular approach is a reliable and safe method to perform occlusion of post catheter AVF.     

The importance of the angulation and termination of external jugular vein in central venous catheterization in newborn

Escherichia coli O157:H7 were cultured in the presence of norepinephrine to generate conditioned media. The presence of a growth-inducing factor(s) in the conditioned media was examined by measurements of the ability of conditioned media to support the growth of fresh cultures of E coli O157:H7. Supplementation of fresh cultures with as little as 0.024% (v/v) norepinephrine conditioned medium resulted in increased growth as compared to controls, thereby indicating the presence of an autoinducer of growth. Analysis of the production kinetics for the autoinducer during the generation of conditioned media indicates that it differs from other more well characterized autoinducers. It is proposed that the neurohumoral environment of the host may contribute to the production of bacterial growth factors.     

Parent styles associated with children's self-regulation and competence in school.

This study assessed three dimensions of parent style, autonomy support, involvement, and provision of structure in 64 mothers and 50 fathers of elementary-school children in Grades 3–6, using a structured interview. Construct validity data for the interview ratings suggested that the three parent dimensions were reliable, relatively independent, and correlated with other parent measures in hypothesized ways. Aspects of children's self-regulation and competence were measured through children's reports, teacher ratings, and objective indices. Parental autonomy support was positively related to children's self-reports of autonomous self-regulation, teacher-rated competence and adjustment, and school grades and achievement. Maternal involvement was related to achievement, teacher-rated competence, and some aspects of behavioral adjustment, but no significant relations were obtained for father involvement. The structure dimension was primarily related to children's control understanding. Results are discussed in terms of the motivational impact of the parent on school competence and adjustment and in terms of transactional models of influence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A naturalistic study of children's social understanding.

Examined developmental aspects of social understanding in 3 related contexts: a one-to-one interview, a real-life activity group, and related group discussions. 24 2nd, 3rd, 4th, and 5th graders, homogeneous with respect to level of reflective social understanding (as expressed in the interview), were assigned to each of 4 small activity groups. Each group met for 12 consecutive school weeks in adult-supervised after-school cooperative group activities and discussions about group functioning. Discussions from each group meeting were coded for instances of verbally expressed communicative competencies. Results suggest a relation between level of social understanding, reflectively expressed, and frequency of competent communications expressed in the course of the group discussions. Ss' strategies for task-related negotiations were also coded. The number of developmentally advanced strategies was significantly lower for the group of young Ss with low-level reflective social understanding as compared to the other 3 groups. Results are discussed in the context of problems associated with assessing developmental levels of social understanding in natural settings. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Features of style classification: A multivariate experimental analysis of children's responses to drawings.

Investigated the sensitivity of 48 children (aged 6–11 yrs) to the formal or stylistic properties of line drawings. Particular emphasis was placed on a detailed analysis of Ss' classifications through the use of multidimensional scaling and multiple-regression analyses. Ss were asked to judge the similarity of 12 line drawings that were specially prepared to vary along 3 dimensions (thickness, amount of shading, and expressiveness), which were shown to be salient in 12 adults' discriminations. The scaling and regression analyses confirmed that the youngest Ss were able to make systematic stylistic comparisons utilizing the 3 dimensions of line variation contained in the drawings. The significance of this finding is discussed in relation to research on children's perception of multidimensional relations. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebrovascular pathology: inpatient study in a community hospital. A prospective study

We present the preliminary results of six months cerebrovascular pathology follow-up carried out at the Sant Boi Local Hospital as from when a Neurological Unit was set up within the Internal Medecine Service. For this purpose we drew up a prospective study based on questionnaires. A total of 69 neurological patients (2.45% of all those hospitalized) were studied, 62.3% of whom suffered acute stroke. Diagnostic and therapeutic activities were analyzed with regards to the afore mentioned pathology, as well as various data of an epidermiological nature. Lastly we present the experimental multidisciplinary approach to acute stroke as performed during hospitalization by the Internal Medecine Service, Convalescence Unit and an Interdepartmental Socio-Sanitary Functional Unit.     

Usefulness of central venous oxygen saturation monitoring during cardiopulmonary resuscitation. A comparative case study with end-tidal carbon dioxide monitoring

The usefulness of continuous monitoring of central venous oxygen saturation (ScvO2) in comparison with the capnogram during cardiopulmonary resuscitation (CPR) was demonstrated in a cardiac arrest patient. ScvO2 and end-tidal carbon dioxide (ETCO2) decreased following cessation of chest compression or increased during recovery of systemic circulation. During the complete stasis of systemic circulation, when defibrillation was done, ScvO2 did not change, while ETCO2 gradually decreased. However the larger decrease in ScvO2 temporally occurred when chest compression was resumed. And also the ScvO2 monitoring had great advantage to detecting peripheral tissue oxygenation. ScvO2 seems to be no less accurate and reliable monitoring than the capnogram during CPR procedures. Since the capnogram is non-invasively and easily used in cardiac arrest patients, ScvO2 monitoring combined with the capnogram is a more preferable method for assessing the efficacy of ongoing CPR.     

Expressions of children's grief: A qualitative study.

Explored the use of guided imagery as a tool to facilitate the expression of children's grief. The children in the study were participating in open-ended, age specific, grief groups. Nine children (aged 4–14 yrs) participated in pre- and post-guided-imagery drawings. The Rosebush drawing itself and the feelings engendered by drawing appeared to be the most important element in assessing change. At discharge, the children's drawings showed greater integration. It was concluded that the Rosebush technique can be an aid in understanding the grief process of the child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implantable catheter systems. Experiences with 1000 patients with central venous ports

OBJECTIVE: To assess retrospectively duration of functioning and rate of complications of a totally implantable venous access system used for long-term chemotherapy. PATIENTS AND METHODS: Between 1985 and 1993, a central venous access system (Port-a-Cath) had been implanted subcutaneously for long-term chemotherapy in 1000 patients (479 males, 521 females; mean age 49 [15-86] years). Follow-up observations lasted until the end of the chemotherapy or the removal of the system. RESULTS: Mean time of functioning of the catheter system was 284 (2-1563) days. The complication rate was 12.8%: catheter infection in 4.9% and catheter thrombosis in 3.2%. A further 4.7% of patients had less common complications (malfunction, catheter dislocation, skin necrosis, catheter break or disconnection, pneumothorax). A total of 119 (11.9%) systems had to be removed because of complications. The rates of infection and of other complications were significantly lower in patients with solid tumours (2 and 4%, respectively) than in those with haematological disease (6 and 8%) (P < 0.05 for each). CONCLUSION: Totally implantable venous access systems are suitable for long-term chemotherapy and cause few complications.