Managing latex-free mitral valve replacement

The management of cardiac surgery patients with latex allergy can be challenging. We describe successful mitral valve replacement in a latex-allergic patient using an integrated multidisciplinary approach. We also provide a list of some available latex-free products or latex-free alternatives.     

Cross-cultural adaptation and validation of the NASS outcomes instrument in Spanish patients with low back pain

Objectives: The aim of the study was to evaluate validity, reliability, responsiveness and practicality of the NASS-AAOS (North American Spine Society—American Academy of Orthopaedic Surgeons) questionnaire in patients with low back pain. Methods: The sample included 70 patients with herniated disk, stenosis, chronic low back pain of unknown etiology or acute low back pain. They were assessed twice before treatment (test–retest) and a third measure six months to one year afterwards. Results: The mean time of administration was 24 and 20 min for the test and post-treatment evaluation, respectively. Cronbachs alpha coefficient was between 0.78 and 0.92 on the baseline test and 0.90 or higher on the post-treatment evaluation. The test–retest reproducibility was 0.95 (0.91–0.98) for neurological symptoms, 0.82 (0.63–0.91) for pain/disability and 0.63 (0.25–0.82) for expectations. The associations with other measures and clinical criteria were generally moderate to high and in the expected direction. The effect size for pain/disability in combination with neurological symptoms was 2.02 for patients who improved versus an effect of –0.09 in patients who were stable between test and retest; the area under the curve on this joint scale was 0.81 (0.69–0.90). Conclusions: The instrument is valid, sensitive to clinical changes and reliable for comparisons between groups, but further study is needed for its application in monitoring individual patients.     

Interferon alfa treatment for pregnant women affected by essential thrombocythemia: case reports and a review

OBJECTIVES: In the past essential thrombocythemia was considered a disease of the elderly. At present, the number of young people suffering from this disease is growing, with a slightly higher frequency in females. We investigated the effects of interferon alfa therapy in these patients. STUDY DESIGN: We describe 9 pregnancies in 4 women affected by essential thrombocythemia. RESULTS: Four pregnancies were carried out without interferon alfa therapy, and resulted in 2 intrauterine deaths, 1 spontaneous abortion, and 1 neonatal death. Interferon alfa was given during another 5 pregnancies; among them, 2 ended in preterm deliveries with normal infants, and 3 in full-term deliveries. The literature is reviewed. CONCLUSION: Our cases and published series suggest that fetal outcome is improved by therapy, and that interferon alfa may be the best therapeutic option.