Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters

Background

Umbilical venous catheterization is a common procedure performed in neonatal intensive care units. Hepatic collections due to inadvertent extravasation of parenteral nutrition into the liver have been described previously in literature.

Objective

To recognize the clinicoradiologic features and treatment options of hepatic collections due to inadvertent extravasation of parenteral nutrition fluids caused by malpositioning of umbilical venous catheter (UVC) in the portal venous system.

Materials and methods

This is a case series describing five neonates during a 6-year period at a single tertiary care referral center, with extravasation of parenteral nutrition into the liver parenchyma causing hepatic collections.

Results

All five neonates receiving parenteral nutrition presented with abdominal distension in the second week of life. Two out of five (40%) had anemia requiring blood transfusion and 3/5 (60%) had hemodynamic instability at presentation. Ultrasound of the liver confirmed the diagnosis in all the cases. Three of the five (60%) cases underwent US-guided aspiration of the collections, one case underwent conservative management and one case required emergent laparotomy due to abdominal compartment syndrome. US used in follow-up of these cases revealed decrease in size of the lesions and/or development of calcifications.

Conclusion

Early recognition of this complication, prompt diagnosis with US of liver and timely treatment can lead to better outcome in newborns with hepatic collections secondary to inadvertent parenteral nutrition infusion via malposition of UVC.     

Views of healthcare consumer representatives on defensive practice: ‘We are your biggest advocate and supporter… not the enemy’

BackgroundThe patient–clinician interaction is a site at which defensive practice could occur, when clinicians provide tests, procedures and treatments mainly to reduce perceived legal risks, rather than to advance patient care. Defensive practice is a driver of low‐value care and exposes patients to the risks of unnecessary interventions. To date, patient perspectives on defensive practice and its impacts on them are largely missing from the literature. This exploratory study conducted in Australia aimed to examine the views and experiences of healthcare consumer representatives in this under‐examined area.MethodsSemi‐structured interviews were conducted with healthcare consumer representatives involved in healthcare consumer advocacy organisations in Australia. Data were transcribed and analysed thematically.ResultsNine healthcare consumer representatives participated. Most had over 20 years of involvement and advocacy in healthcare, including personal experiences as a patient or carer and/or formal service roles on committees or complaint bodies for healthcare organisations. Participants uniformly viewed defensive practice as having a negative impact on the clinician–patient relationship. Themes identified the importance of fostering patient–clinician partnership, effective communication and informed decision‐making. The themes support a shift from the concept of defensive practice to preventive practice in partnership, which focuses on the shared interests of patients and clinicians in achieving safe and high‐value care.ConclusionThis Australian study offers healthcare consumers'' perspectives on the impacts of defensive practice on patients. The findings highlight the features of clinician–patient partnership that will help to improve communication and decision‐making, and prevent the defensive provision of low‐value care.Patient or Public ContributionHealthcare consumer representatives were involved as participants in this study.     

Intolerance of uncertainty and obsessive-compulsive symptom expression

Background and objectivesResearch suggests a relationship between intolerance of uncertainty (IU) and obsessive-compulsive disorder (OCD), though this has been limited to self-report measures of OCD symptoms. The current investigation examined the relationship between IU and multiple symptom domains of OCD using self-report and in vivo assessments of OC symptoms.MethodsFive separate studies are presented in which undergraduate students (N = 603) were administered a self-report measure of IU and tasks related to either ordering and arranging, checking, washing, contamination avoidance, or neutralization.ResultsIntolerance of uncertainty was found to be significantly related to each self-report measure of the OCD symptom domains (ps < .01). Further, IU was predictive of performance on all in vivo tasks (ps < .05) except one concerning neutralizing/harm-related obsessions.LimitationsThis study relied on an unselected sample and was correlational in design.ConclusionsThe current study demonstrates that IU is related to multiple OC symptom dimensions. Future experimental research is warranted to evaluate the causal role of IU in OCD.     

Major depression after breast cancer: a review of epidemiology and treatment

OBJECTIVE: While many breast cancer patients experience "normal" distress, there is a subset who experience clinically significant depression. We examined the current knowledge about the prevalence, impact and treatment of major depression in women with breast cancer. METHOD: We reviewed the evidence for the prevalence of depression in women with breast cancer from the last 20 years and summarized the medical literature on the pharmacology and psychotherapy of depression in this population. RESULTS: Despite evidence that depression significantly impacts quality of life in breast cancer patients, few studies focus on the epidemiology and treatment of major depression. Treatment studies have focused on distress and mixed depressive states, with resulting lack of replicable studies showing treatment efficacy. Potential biological and psychosocial determinants of major depression following breast cancer are discussed in a proposed model. The need for further research on the epidemiology and treatment of major depression in this population is proposed. CONCLUSION: Major depression is a frequent but underrecognized and undertreated condition among breast cancer patients, which causes amplification of physical symptoms, increased functional impairment and poor treatment adherence. More research on the epidemiology and treatment of major depression in this population is needed.     

Temporomandibular joint fibrocartilage degeneration from unilateral dental splints

Objective

The objective of this study was to determine the extent to which altered loading in the temporomandibular joint (TMJ), as might be associated with a malocclusion, drives degeneration of articulating surfaces in the TMJ. We therefore sought to quantify the effects of altered joint loading on the mechanical properties and biochemical content and distribution of TMJ fibrocartilage in the rabbit.

Design

Altered TMJ loading was induced with a 1 mm splint placed unilaterally over the maxillary and mandibular molars for 6 weeks. At that time, TMJ fibrocartilage was assessed by compression testing, biochemical content (collagen, glycosaminoglycan (GAG), DNA) and distribution (histology), for both the TMJ disc and the condylar fibrocartilage.

Results

There were no changes in the TMJ disc for any of the parameters tested. The condylar fibrocartilage from the splinted animals was significantly stiffer and the DNA content was significantly lower than that in control animals. There was significant remodeling in the condylar fibrocartilage layers as manifested by a change in GAG and collagen II distribution and a loss of defined cell layers.

Conclusions

A connection between the compressive properties of TMJ condylar fibrocartilage after 6 weeks of splinting and the changes in histology was observed. These results suggest a change in joint loading leads to condylar damage, which may contribute to pain associated with at least some forms of TMJ disease.