Pulmonary veno-occlusive disease: diagnosis during life in four patients

Pulmonary veno-occlusive disease is a rare form of primary pulmonary hypertension of unknown aetiology. Four cases were diagnosed in young patients. The diagnosis was suspected on the basis of clinical, radiological, echocardiographic, and catheter evidence and confirmed by taking a lung biopsy sample. In all patients the histology showed obstruction of the pulmonary veins by intimal fibrosis. The clinical course of all patients has been one of progressive deterioration. Although there is no specific treatment for this disease, to establish the diagnosis during life is of great importance in overall clinical management, including counselling the patient and family.     

Cardiovascular effects of carbon dioxide in ventilated preterm infants

Sick preterm infants may, under certain conditions, demonstrate blood pressure passive cerebral blood flow in response to changes in arterial carbon dioxide tension. Blood pressure in turn depends on cardiac output and peripheral resistance. A Doppler technique for assessing cardiac output compared favourably in terms of reproducibility to a thermodilution technique in a group of infants undergoing cardiac catheterization for congenital heart disease. Doppler was subsequently used to monitor changes in cardiac output following an increase in arterial carbon dioxide tension of 1 kPa in 25 ventilated preterm infants. Blood pressure increased significantly (p = 0.006). However, heart rate did not change significantly (p = 0.16) and, in addition, both stroke and minute volume decreased (p = 0.023, p = 0.02, respectively). This suggests that accompanying changes in components of peripheral resistance exert important effects on blood pressure in the preterm neonate in response to changes in arterial carbon dioxide tension.     

Human health concerns from pet ownership after a tornado

INTRODUCTION: Although 50% to 60% of North American households own pets and many of these pets are considered family members, there is little information on the impact of pet ownership on pet-owning families affected by disasters. METHODS: This case report describes some of the effects of a tornado on 17 families whose dwellings were destroyed. The setting was a typical urban trailer park. RESULTS: After a tornado at the Sagamore Village Trailer Park in north central Indiana, 104 families were evacuated. Seventeen (16.3%) of these families owned pets. For 14 families (13.5%), pet ownership had an important impact on the families' recovery from the tornado. Public- and mental-health concerns that arose from pet ownership included failure to evacuate a dangerous site, attempts to re-enter a dangerous site, separation anxiety leading to psychosomatic disturbances, and the need for additional animal care. CONCLUSIONS: In urban disasters, the behaviors of families with a human-animal bond are likely to pose a significant risk to their own and others' health and safety in urban disasters. In this small study of families affected by a tornado, the most prominent public-health concerns were failure to evacuate because of a pet and attempts of re-entry to save a pet; the most common mental-health concerns resulted from separation anxiety from a pet and refusal to accept medical treatment until a pet's well-being can be assured. These are thought to be typical issues that will arise out of the human-animal bond in urban disaster situations and differ considerably from traditional public-health concerns over dog bites, spread of zoonotic diseases, and human food contamination. Medical disaster preparedness planning should consider the substantial effects that the human-animal bond is likely to have on human recovery from large-scale urban disasters.     

Psychosocial needs of women infected with HIV

This article describes an exploratory social work study that examined the psychosocial needs of HIV seropositive (HIV+) Caucasian women. A questionnaire was used to obtain both qualitative and quantitative data from the sample of 12 women. Further, more substantive data were obtained through in-depth interviews with 6 of the sample. Analysis of the data indicated a variety of needs which were both psychosocial and instrumental in nature. These included: information and support (especially at the time of diagnosis); assistance from health care professionals and friends; planning for present and future care of children; financial assistance; adjustment to the loss of employment; and finding accommodations. A majority of the women wanted increased contact with other HIV+ women. The need for more counselling and services specific to women and mothers was also expressed. Three interviewees were older widows whose husbands had died of AIDS. They appeared to have some unique issues. A number of dominant themes emerged from the in-depth interviews: the experience of being HIV+; experience with professional and service providers; help and support; experiences of parents; and finally, the emotional impact of being HIV+.     

The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years

Background

There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component.

Temporary Balloon Occlusion for Hepatic Arterial Flow Redistribution during Yttrium-90 Radioembolization

This case series describes an approach for radiation segmentectomy–style treatment of hepatic tumors fed by arteries unsuitable for catheterization. The 15-patient cohort (17 cases from 2015 to 2018) included those diagnosed with liver tumors (14 hepatocellular carcinoma, 1 cholangiocarcinoma, 1 renal-cell carcinoma, and 1 metastatic colorectal carcinoma) and chosen for radioembolization via a multimodal approach. In each case, a balloon microcatheter was used to temporarily redistribute intrahepatic flow during infusion for enhanced radioembolic agent delivery to the tumor. A median of 199 Gy was delivered to a median of 3% of total liver volume. Based on modified Response Evaluation Criteria In Solid Tumors, 11 cases had complete responses and 6 had partial responses.