Who are They? A Descriptive Study of Adolescents in Wilderness and Residential Programs

Although residential and wilderness treatment programs are growing in popularity, little is known about the adolescents placed within them. This study analyzed a random sample of 473 psychological evaluations of adolescents in residential and wilderness treatment centers for participants' cognitive functioning, aggression, family history of mental health, substance abuse, trauma, past treatment experiences, and reasons for current placement. The results suggest that participants were primarily delinquent, substance-abusing, and oppositional. Results also revealed nearly a third of the sample reported self-harming behaviors and nearly half reported recent traumatic events. The profile of this population carries important implications for residential treatment providers.     

Arterial manifestations of Beh?et disease

Beh?et disease is an uncommon systemic process that appears most often in the third or fourth decade of life. It is characterized by recurrent orogenital ulcers and ocular and cutaneous inflammatory lesions. Cardiovascular involvement, which may be arterial or venous, is rare but carries a particularly poor prognosis. Three new cases are reported, and they are characterized by typical orogenital and cutaneous manifestations and associated severe vasculitis. The arterial findings in these cases were occlusions and aneurysms and pseudoaneurysms of the aorta and pulmonary, brachiocephalic, and visceral arteries. From these cases and those previously reported, arterial involvement in Beh?et disease can be characterized by saccular aneurysms or occlusions of multiple large vessels in young adults.     

Long-term results and quality of life in patients treated with transjugular intrahepatic portosystemic shunts

OBJECTIVE: The purpose of our study was to determine long-term survival, shunt patency, and quality of life in patients after creation of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: We followed up 103 patients who underwent TIPS for a mean of 20.10 +/- 25.58 months (range, 1 day-92 months). Various statistical methods were used to analyze long-term survival, shunt patency, and correlation with Child-Pugh classification and indications for TIPS. The Rand 36-Item Health Survey 1.0 was used to assess quality of life over time. RESULTS: The cumulative survival rate was 68%, 60%, 50%, 41%, and 41% at years 1-5, respectively. The cumulative survival rate was significantly higher for patients classified as Child-Pugh class A or B versus those classified as class C (p < 0.01), as well as for patients with the original indication of variceal bleeding versus refractory ascites or hydrothorax (p < 0.01). No significant difference in survival rates was found between patients with Child-Pugh A and those with Child-Pugh B. The cumulative primary patency rate was 50%, 34%, 21%, 13%, and 13% at years 1-5, respectively, with assisted patency rate of 80%, 61%, 46%, 42%, and 36%. Cumulative secondary patency rate was 85%, 64%, 55%, 55%, and 55% at years 1-5. Mean follow-up time in 33 patients who completed quality-of-life questionnaires with one follow-up was 17.46 months. Scores after TIPS in all nine of the health categories were higher than those preprocedure with statistically significant improvement in four categories. The second follow-up was completed by 21 patients at a mean of 30.58 months after TIPS creation. Both scores after TIPS were higher than those before TIPS, and scores in five categories were further improved at the second surveillance (p < 0.0, only for health change), whereas in four categories, the scores were slightly worse. CONCLUSION: TIPS has positive efficacy both for controlling bleeding or ascites and for improving the quality of life. The precise impact of TIPS on long-term survival, however, requires further clarification.     

Focal granulomatous (Crohn's) colitis: radiologic-pathologic correlation

In patients with Crohn's disease, early or localized lesions of the colon, termed 'focal granulomatous colitis', may give rise to small and often relatively inconspicuous nodular or tumor-like contour defects in conventional barium enema studies. This radiologic sign, first illustrated by Ettinger [7], has received scant attention in the literature. The present communication is intended to re-emphasize the radiologic appearances of focal granulomatous (Crohn's) colitis in conventional barium enema examinations, provide pathologic correlation, and illustrate by selected case reports the clinical significance of recognizing this particular radiologic abnormality.     

Equipment choices,technical aspects and pitfalls of percutaneous transluminal angioplasty

Previously published papers on percutaneous transluminal angioplasty (PTA) have emphasized results rather than techniques. This review deals with equipment choices, technical aspects and pitfalls observed during the first 200 PTAs at the Brigham and Women's Hospital. Specific topics discussed include: (1) catheters kept in stock in the laboratory, (2) choice of approach and entry into the artery, (3) techniques for crossing stenoses, (4) dilatation of the lesion, (5) drugs used during the procedure, and (6) proper performance and interpretation of the postangioplasty arteriogram. Supported in part by USPHS grants HL20895, GM18674, and HLO7334