Blood flow velocity in the femoral artery 1–3 years after catheterization. A prospective study in neonates and children

During the period 1987–1989 femoral artery cannulations were performed in 95 patients of whom 74 were neonates. Catheter sizes were 24 G (n= 28), 22 G (n= 54) and 20 G (n= 13). Median indwelling time was 3 days (range: 1–13 days). Catheter removal was due to perfusion related symptoms in 12 cases, malfunction in 16 cases and because they were no longer needed in 67 cases. One to three years after the catheterization event the systolic peak flow velocity in the femoral artery was analysed with a Doppler sonography system in 28 neonates and in 6 older children. Measurements were performed where the external iliac artery ascends from the pelvic fossa (proximal site) and in the common femoral artery which was considered to be the site for catheter introduction (puncture site). In the neonatal group (n= 28), there was a significant increase in the peak flow velocity at the puncture site in the catheterized leg (P < 0.05), as well as a signficant increase in the quota of the puncture and proximal site values in the catheterized leg (P < 0.05). In the catheterized leg, the peak flow velocity at the puncture site correlated positively with the length of the indwelling time (r= 0.467, P < 0.01). It is concluded that the use of the femoral artery for intra-arterial monitoring in neonates and children is clinically a safe method. The findings of peak systolic velocity may indicate damage to the vessel and/or adjacent vessel tissue present 1–3 years after the catheterization event.     

Hepatoblastoma—An attempt of histological subtyping on fine‐needle aspiration material

Hepatoblastoma (HB) is classified into epithelial, mixed (epithelial/mesenchymal), and small‐cell (anaplastic) type. Wnt/β‐catenin pathway plays a key role in hepatic development, regeneration, and tumorigenesis, and HB is known to present β‐catenin mutations (50–90%). The present study was undertaken to delineate the cytomorphologic features of HB and to evaluate the feasibility of subtyping of HB on fine‐needle aspiration cytology (FNAC). The expression of β‐catenin in these tumors was also evaluated both of histopathologic sections and on the aspirated material. Thirty‐three cases with fine‐needle aspirates of HB were retrieved over a period of 12 years. Cytologic diagnosis was reviewed in the light of clinicoradiological data, response to therapy, and subsequent histopathology. Immunochemistry for β‐catenin was performed in 19 of 33 cases on histopathologic sections (n = 10)/cell blocks (n = 6)/cytosmears (n = 3). Based on the cytologic features, the cases were divided into fetal HB (n = 17), embryonal HB (n = 4), combined epithelial HB (n = 8), and mixed HB (n = 4). Four cases of histopathologically proven mixed HB were reported as pure epithelial HB on FNAC, as mesenchymal elements were not represented in the cytology smears. Cytoplasmic as well as nuclear staining for β‐catenin was noted in a total of 10 of 19 cases. FNAC can accurately categorize epithelial HB; however, in mixed type, the accuracy depends on number of areas sampled. Cell block can be of help to perform ancillary investigations especially β‐catenin for both diagnostic and therapeutic purposes. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Informal social support in contexts of diversity: shaping the relationship between the public and the private sphere

This paper aims to re‐examine the social dimension of social support as the shared responsibility of social work and families in shaping social support rather than pressuring parents’ individual responsibilities, as this has been a significantly under‐theorised issue in social work research. In our qualitative study, we discuss parents’ experiences of informal social support in Centres for Children and Parents (CCP) in two cities in Belgium. During 2012, six discussion groups were held with 29 mothers, three fathers and one nanny who visited one of the CCP included in the project. A broad topic list was used, investigating parents’ first visit and motivations to return; their encounters with other children, parents and the professionals; and the actual role of the professional. Data were interpreted repeatedly using qualitative content analysis. The CCP focus on engaging with a wide diversity of parents of young children, not framed as ‘at risk’, reflecting the contemporary contexts of diversity in which these practices unfold. Our research shows that departing from an anti‐essentialist approach to diversity and heterogeneity may be productive for the promotion of both social support and social cohesion as it captures social issues such as diverse and changing norms and values, diverse and changing family compositions, lifestyles and situations, and diverse and changing biographical, socioeconomic and ethnic backgrounds of children and parents. As the CCP offer the opportunity of a confrontation between private issues and public concerns, social encounters between a diverse mix of families are experienced as supportive. While embracing parents’ perspectives regarding equity, reciprocity, agency and social cohesion, it becomes clear that these processes of interaction require facilitation by a specific professional. In this article, we attempt to unravel and discuss the possible role(s) of social work in generating informal social support.     

Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: a postal survey

BACKGROUND AND METHODS: A postal survey was mailed to the members of Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and French-Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220) to primarily investigate the impact of a recently published Cochrane report on the clinical use of albumin solutions in paediatric anaesthetic practice. At the same time, information regarding blood transfusion strategies and the use of intraoperative glucose containing maintenance solutions was gathered. RESULTS: The response rate of the survey was 38% and 25% for APA and ADARPEF members, respectively. Forty-one percent of APA members reported a reduced use of albumin containing solutions following the publication of the Cochrane report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin continues to be the most frequently used plasma expander in premature babies and neonates, whereas many colleagues use alternative colloids in infants and older children. A clear difference was observed in the 1-12-year-old age group between APA members favouring the use of gelatines and ADARPEF members who instead frequently use hetastarch solutions. ADARPEF members appeared to have a slightly more restrictive attitude towards blood transfusion and also reported more widespread use of erythropoetin (56% versus 9%, P < 0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared with APA members. Regarding intraoperative maintenance solutions, a large proportion of both APA and ADARPEF members still use high concentrations of glucose intraoperatively, even in older children.     

Promoting positive change in the face of adversity: experiences of cancer and post‐traumatic growth

The increasing population of cancer survivors underscores the need to develop a complete understanding of the survivorship experience, including positive aspects. The aim of this study was to explore people's experiences of cancer to assess the relevance of the post‐traumatic growth (PTG) construct and to identify potentially modifiable factors that may promote PTG. Group interviews were conducted with 15 people (eight men, seven women) aged between 36 and 85 who had been diagnosed with cancer and completed treatment. Participants identified that while a cancer diagnosis is a traumatic event and has an immense impact, there is potential for PTG. Participants described examples of positive change within their relationships, perceptions of self and life in general perception, and spirituality. Various modifiable factors were identified as enabling participants to experience growth including social support, finding information, complementary therapy use, lifestyle changes and physical activity. Modifiable factors such as physical activity and searching for information have the potential to influence the development of PTG by providing cancer survivors with an opportunity to regain control. Encouraging and developing research that examines the relationship between modifiable factors and PTG will assist in the development of interventions that address the unique needs of cancer survivors.     

Depression Care Need Among Low-Income Older Adults: Views from Aging Service Providers and Family Caregivers

This study reports findings from focus group discussions with aging service providers and family caregivers about low-income ambulatory or homebound older adults' depressive symptoms and barriers to seeking treatment. It also reports the participants' suggestions about interventions for depression that can be integrated into existing aging service settings or implemented in older adults' homes, as well as the type of training the aging service providers need if they are to provide services for depression. Participants identified social isolation, loneliness, and loss and grief as major correlates of depression in older adults. Barriers to seeking treatment included older adults' denial of or lack of understanding about depression, a sense of stigma, financial worries, and lack of mobility. Suggested depression treatments included brief cognitive behavioral interventions, friendly visitors, and physical exercise. Bachelor's-level service providers expressed their need and desire for training in mental health assessment and brief psychotherapy.     

Short and long term outcome of percutaneous transluminal coronary angioplasty in unstable versus stable angina pectoris: A report of the 1985–1986 nhlbi ptca registry

In a cohort of 1,720 consecutive patients from the National Heart, Lung, and Blood Institute, Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry (August 1985–May 1986), we compared 768 patients (45%) with stable angina and 952 patients (55%) with unstable angina pectoris. Unstable angina patients exhibited at least one of the following characteristics: new onset angina, rapidly progressing angina, angina at rest, angina refractory to medication, variant angina, acute coronary insufficiency, or angina recurring shortly after an acute myocardial infarct. The distribution of single- and multi-vessel disease was similar among stable and unstable angina patients; multi-vessel disease predominated. Average severity of stenosis and incidence of tubular and diffuse stenosis morphology were higher among patients with unstable angina (both p<0.001). Patient success rates were similar in stable and unstable patients. However, on a per lesion basis, overall angiographic success rate and average reduction of severity of stenosis in successfully dilated lesions were significantly higher among patients with unstable angina (both p<0.001). Incidence of major patient complications (p<0.01) and of emergency coronary bypass surgery (p<0.05) were also higher in patients with unstable angina but consistent with their more precarious clinical condition and stenosis morphology. During a two year follow-up, the cumulative distributions of death, myocardial infarct, repeat PTCA, and coronary bypass surgery were not significantly different in patients with stable angina compared to patients with unstable angina. Comparison of the current PTCA Registry cohort with the cases reported in the 1979–1982 Registry revealed a 19% higher success rate for both stable and unstable angina patients. Major complication rates decreased between time periods for stable but not for unstable angina patients. Incidence of emergency bypass surgery decreased more for stable than for unstable angina patients. Coronary angioplasty is indicated in properly selected patients with unstable angina and both single-and-multi-vessel coronary disease.     

Monoclonal IgM Cold Agglutinins with Anti-Pr1d Specificity in a Patient with Peripheral Neuropathy

A patient with a demyelinating sensory motor polyneuropathy secondary to IgM paraproteinaemia is reported. The paraprotein binds to the gangliosides GD1b, GT1b, GQ1b and GD3, all of which contain disialosyl groups with the sequence NeuAcα2–8NeuAcα2–3Gal. The paraprotein also acts as a cold agglutinin recognising the sialic-acid-dependent Pr_1d antigenic determinant of the red cell membrane glycophorins. In this and in similar cases that have been reported, the coexistence of anti-Pr cold agglutinins and peripheral neuropathy suggest that they might be the causative agents of the disease.     

Involvement of a Ca 2+ Channel Gene in Familial Hemiplegic Migraine and Migraine With and Without Aura

A gene for familial hemiplegic migraine, a subtype of migraine with aura, was assigned to chromosome 19p13. In this region, we identified a brain-specific P/Q-type calcium channel α1a-subunit gene, CACNA1A, with 47 exons covering 300 kb. Sequencing of all exons and their flanking surroundings revealed polymorphic variations, including a (CA)0-repeat anti a (CAG)n-repeat in the 34 untranslated region. In patients with familial hemiplegic migraine, we found four different missense mutations in conserved functional domains. One of the mutations has occurred on two different haplotypes in unrelated familial hemiplegic migraine families. Moreover, in episodic ataxia type 2, we found two mutations disrupting the reading frame. Thus, familial hemiplegic migraine and episodic ataxia type 2 can be considered as allelic channelopathies. Involvement of this familial hemiplegic migraine locus in migraine with and without aura was demonstrated by sib-pair analysis. We showed an increase of shared marker alleles of locus D19S394 , which is tightly linked to the gene. The association between the α1A calcium channel and familial hemiplegic migraine, and the increase of shared alleles in migraine-affected sib-pairs, have uncovered a new pathway for the pathophysiology of migraine. This finding may provide a rationale for the development of specific prophylactic therapy for migraine and other (paroxysmal) cerebral disorders.