Living with hepatitis C: A sociological review

This paper reviews international and Australian literature related to living with hepatitis C infection. At present scholarly research into this worldwide epidemic focuses on medical and scientific understandings of the virus and its effects on people's health-related quality of life. Exploration of the sociocultural impact of hepatitis C infection is for the most part absent from this literature. However, a nascent academic inquiry into living with hepatitis C infection points to a complex range of concerns regarding diagnosis, disclosure, stigmatization and discrimination against people with hepatitis C. The increasing association of hepatitis C infection with injecting drug use and the medicalization of those affected by the virus suggests a need for further social research. For example, injecting drug users' access to healthcare and information on reducing transmission are two important areas that are poorly understood. In this paper the authors argue for an expanded sociocultural understanding of hepatitis C to account for the material effects of medicalization, stigmatization and discrimination, and the sociocultural impact of treatment on the lives of people with hepatitis C infection. The article concludes with suggestions for future directions in social research to address the silence surrounding living with hepatitis C infection.     

Fehler und Zwischenfälle in der Intensivmedizin

Zusammenfassung Fehler sind in der Medizin h?ufig und die mit ihnen verbundene Morbidit?t, Letalit?t und ?konomischen Auswirkungen sind betr?chtlich [1, 2]. Epidemiologische Daten aus den USA berichten von 44 000–98 000 Todesf?llen j?hrlich infolge vermeidbarer medizinischer und organisatorischer Fehler und Zwischenf?lle. Die H?ufigkeit eines Fehlers, Zwischenfalls oder unerwünschten Ereignisses ist dabei, neben anderen Faktoren, abh?ngig von der Intensit?t der geleisteten Therapie und Pflege, dem Schweregrad der Erkrankung der Patienten und der Komplexit?t der organisatorischen Abl?ufe [3, 4]. Somit z?hlt die hochkomplexe Intensivmedizin zu einem der fehleranf?lligsten Bereiche der station?ren Krankenversorgung. Der folgende Beitrag führt vor allem in die Terminologie und Charakterisierung von Fehlern und Zwischenf?llen ein. Darüber hinaus werden noch verschiedene M?glichkeiten der Fehlererfassung skizziert und h?ufig auftretende Fehler und Zwischenf?lle in der Intensivmedizin sowie die zugrunde liegenden Ursachen dargestellt.      

Mechanical limitation of pulmonary blood flow facilitates heart transplantation in older infants with hypoplastic left heart syndrome.

OBJECTIVES: Progression of pulmonary vascular disease limits heart transplantation for hypoplastic left heart syndrome (HLHS) to early infancy. Our objective was to assess the impact of bilateral pulmonary artery banding (PAB) on the operative courses of HLHS infants transplanted at ages older than 4 months. METHODS: Courses of all HLHS patients in our center who remained listed to age >or=120 days before heart transplantation were assessed. Patients undergoing transplantation after standard management (control group) were compared to patients having a prior pulmonary blood flow limiting procedure (PAB group). RESULTS: Of 16 identified patients, one crossed over to stage I Norwood on day 185 and died post-operatively. Fifteen patients were transplanted at age >or=120 days (control group n=9, PAB group n=6). Four PAB patients had open PA band placement. Two PAB patients underwent experimental percutaneous bilateral internal pulmonary artery flow limiting device insertion. The PAB group mean age at banding was 141+/-54 days, and mean interval from PAB to transplant was 35+/-31 days (range 1.5-68 days). No differences in age at transplant, weight at transplant, warm graft ischemia time or total graft ischemia time were detected between groups. Mean times of mechanical ventilation (control 143+/-69h vs. PAB 44+/-13h), inhaled nitric oxide (control 126+/-70h vs. PAB 37+/-9h), inotropic support (control 171+/-64h vs. PAB 87+/-17h), intensive care unit (ICU) stay (control 8.3+/-2.7 days vs. PAB 4.5+/-1.4 days), and hospital stay (control 10.4+/-3.9 days vs. PAB 7.0+/-1.1 days) were all lower in the PAB group (P<0.05 all comparisons). Two control patients died, three required extracorporeal membrane oxygenation (ECMO), and six did not tolerate primary chest closure. No PAB patient died or required ECMO. All PAB patients tolerated primary chest closure. All PAB patients had widely patent branch pulmonary arteries with no re-interventions to date. All hospital survivors remain alive (mean follow-up, control 50.2 months, PAB 11.5 months). CONCLUSIONS: Pre-transplant mechanical limitation of pulmonary blood flow simplified management and reduced morbidity for HLHS patients undergoing heart transplantation at ages >or=4 months. This strategy extends the permissible transplant waiting time in older infants with HLHS.     

Semiautomatic segmentation and stenosis quantification of 3D contrast-enhanced MR angiograms of the internal carotid artery.

A technique is presented for the segmentation and quantification of stenosed internal carotid arteries (ICAs) in 3D contrast-enhanced MR angiography (CE-MRA). Segmentation with sub-pixel accuracy of the ICA is achieved via level-set techniques in which the central axis serves as the initialization. The central axis is determined between two user-defined points, and minimal user interaction is required. For quantification, the cross-sectional area is measured in the stenosis and at a reference segment in planes perpendicular to the central axis. The technique was applied to 20 ICAs. The variation in measurements obtained by this method in comparison with manual observations was 8.7%, which is smaller than the interobserver variability among three experts (11.0%).     

Role of Lipid in Sulfite-dependent Propofol Dimerization

Background: During long-term intravenous infusions, sulfite in sulfite-containing propofol emulsions can cause the peroxidation of lipid and dimerization of propofol. This study evaluated the role of lipid in sulfite-dependent propofol dimerization by determining the effects of individual fatty acids in soybean oil emulsion and peroxidized lipids in a model system.

Methods: Individual fatty acids, stearic (18:0), oleic (18:1), linoleic (18:2), linolenic (18:3), and arachidonic (20:4), were added to sulfite-containing propofol emulsion and incubated for 90 min at 37[degrees]C. Model systems containing soybean oil (100 [mu]l), water (900 [mu]l), propofol (10 mg/ml), and sulfite (0.25 mg/ml) composed of oils with different peroxide values were allowed to react for 60 min at room temperature. After the reactions, propofol dimer and propofol dimer quinone were analyzed by reversed-phase high-pressure liquid chromatography.

Results: Propofol did not dimerize when added to aqueous sulfite unless soybean oil was also included. The addition of the polyunsaturated fatty acids (linoleic, linolenic, arachidonic) to sulfite-containing propofol emulsion resulted in large increases of propofol dimerization compared with stearic or oleic acid. Using biphasic mixtures of soybean oil and aqueous sulfite, propofol dimerization increased with increasing peroxide content of the oil. In propofol emulsion, lipoxidase and ferrous iron in the absence of sulfite also caused the dimerization of propofol.