Endovascular repair of abdominal aneurysms: Is this the method of choice?

BACKGROUND: The prevalence of abdominal aneurysms has increased due to the aging population, and endovascular repair has developed into an effective, less invasive treatment. METHODS/RESULTS: Two recent cases at the University of Texas-Houston highlight a variety of clinical considerations that allow informed decision-making regarding optimal treatment of abdominal aneurysms. A thorough discussion of recent data summarizes the current understanding and techniques regarding abdominal aortic aneurysm repair. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms has emerged as a viable and a safe alternative to surgical repair and may offer important advantages in a majority of patients with this disease.     

Hepatitis C in the workplace: a survey of occupational health and safety knowledge and practice in the beauty therapy industry

OBJECTIVE: To examine current knowledge and practice of occupational health and safety (OH&S) regarding hepatitis C in beauty therapy practice. METHODS: A questionnaire was sent to all beauty therapy practices identified through the Telstra Yellow Pages and distributed via beauty therapy product agencies. RESULTS: 119 questionnaires were completed by employers and employees in 99 beauty therapy practices in metropolitan Adelaide. Beauty therapists reported carrying out many practices that had exposed them to blood in the past. More than 80% of the procedures carried out by beauty therapists in the previous week were reported to have led to exposure to blood. 39.5% of respondents had not received information about OH&S practices related to blood spills and 77.5% of respondents had received no OH&S information about hepatitis C. Knowledge of hepatitis C and its transmission was poor, with 62% of respondents incorrectly identifying the prevalence of hepatitis C and respondents incorrectly identifying sneezing (28%), kissing (46%) and sharing coffee cups (42%) as a modes of transmission. 80% of beauty therapy practices had no OH&S representative. CONCLUSION: Beauty therapy practice can expose both operator and client to blood and is therefore a potential site for the transmission of blood-borne diseases including hepatitis C. OH&S information is inadequate in this industry and knowledge of hepatitis C is poor. IMPLICATIONS: Health promotion information about hepatitis C and OH&S practice to prevent transmission of blood-borne diseases is required.     

Feminist ethics and menopause: autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.     

Pathological changes after intravenous streptokinase treatment in eight patients with acute myocardial infarction

At necropsy five of eight patients (mean age 57 years) who died after intravenous streptokinase treatment for severe acute myocardial infarction (mean Peel index = 18) were found to have a patent infarct related coronary artery. Coronary artery stenoses were caused by fibrofatty atheromatous plaques; there were no residual thrombi in the lumen or acute intimal lesions. Three of these infarcts were of partial thickness (less than two thirds wall width) with sparing of the outer third of the myocardium and subendocardial zones. In the other three patients the infarct related coronary arteries remained histologically closed with residual lumen thrombi and underlying intimal lesions. Two infarcts were transmural. Six of the eight infarcts were noticeably haemorrhagic. Myocardial haemorrhage was confined to areas of necrotic myocardium and did not affect viable regions. These findings suggest that thrombus overlying a complex lesion may be more difficult to lyse than thrombus overlying a simple fibrofatty plaque. They also suggest that myocardial haemorrhage outside the infarct area, which might lead to cardiac rupture or delayed healing, does not usually occur.     

Variability of the Doppler gradient in pulmonary valve stenosis before and after balloon dilatation

The variability of the valve gradient measured by Doppler in pulmonary stenosis was compared with the variability of the gradient measured at catheterisation in 42 infants and children undergoing catheterisation with a view to balloon dilatation of the pulmonary valve. The maximum value measured by Doppler when the patient was unsedated was significantly higher than that measured when the patient was sedated for catheterisation, and the maximum gradient was significantly higher shortly after than several days later. In a patient with pronounced infundibular obstruction after dilatation the Doppler signal clearly showed that the obstruction was dynamic, with a superimposed lower fixed signal that correctly predicted the final low gradient. The Doppler gradient in an alert and unsedated patient may be a better measure of the true physiological value. The highest Doppler value so obtained is a more appropriate indicator of the need for balloon dilatation than a single catheter measurement. The result of dilatation is best assessed by Doppler measurement at least a day after the procedure.     

Fatal pontine metastasis: clinical, CT, MRI and pathological correlates

Progressive brainstem and cerebellar signs developed in a previously healthy 70-year-old man over a course of seven days. A pontine mass characterized by CT and MRI suggested an infiltrating primary pontine glioma. Gross postmortem examination showed a medullary-pontine hemorrhage. Microscopic analysis disclosed an undifferentiated large cell carcinoma which was found to originate from the lung. Differential diagnoses in cases of suspected brainstem lesions are given, including metastatic tumors which are rare when presenting as a solitary brainstem mass. Optimal patient management should be formulated on the basis of histopathological diagnosis rather than imprecise imaging data. Exact tissue diagnosis will also avoid an extensive and expensive search for an occult systemic cancer. The roles of radiation, chemotherapy and surgery are also discussed.