Pulmonary Artery Catheter-Associated Thrombosis

Transesophageal echocardiography has become increasingly important in the assessment of critically ill patients. We report a 39-year-old patient who was incidentally noted to have a large right intraatrial thrombus associated with an indwelling pulmonary artery catheter identified by transesophageal echocardiography. This led to eventual catheter removal by open venotomy. Careful examination of intravascular devices during transesophageal echocardiography may lead to early diagnosis of catheter-associated thrombosis and thus alter management appropriately.     

Does post-withdrawal cue exposure improve outcome in opiate addiction? A controlled trial

A controlled trial studied whether cue exposure prevented relapse in opiate addiction. Subjects were randomly allocated to one of two inpatient treatment settings: a drug dependence unit with a special 10 week program and 4 weeks in a behavioural/general treatment unit without such a program. In each setting, following drug-withdrawal, subjects had either cue exposure for at least six sessions over 3 weeks, or a control condition. Subjects were followed up twice, at about 6 weeks and 6 months post-treatment. 186 subjects were randomly allocated; 69 were assessed post-detoxification, and of these 43 completed cue exposure or control treatments. Cue exposure and control subjects did not differ in cue reactivity. This was evaluated post-treatment for cue exposure subjects and at a comparable time point for controls. All groups showed a significant decrement in cue-elicited craving, withdrawal responses and negative mood. Cue exposure and control subjects did not differ at either of the two follow up interviews.     

Soluble and participate activators of complement and granulomatous pulmonary reactions

In order to test the hypothesis that the histological changes of extrinsic allergic alveolitis result from non-specific activation of the complement cascade we studied pulmonary reactions to equivalent doses of soluble and particulate activators of complement in rats. A single intratracheal instillation of zymosan, a particulate activator of the complement system, produced a florid granulomatous pneumonitis which was maximal at 5 days. This granulomatous reaction did not appear to be associated with the development of hypersensitivity to zymosan. Complement depletion by cobra venom factor did not suppress the granulomatous reaction. Equivalent doses of soluble activators of complement failed to produce any inflammatory changes in the lung. Large doses of immune complex produced an acute, complement dependent, haemorrhagic alveolitis which was maximal at 8 hr and which resolved completely by 48 hr. We conclude that the late granulomatous pulmonary reaction to intra-tracheally administered zymosan is not due to an immune response, or a consequence of direct activation of the alternative pathway of complement, but is of ‘foreign body’ type. We urge caution in drawing conclusions regarding the pathogenesis of the allergic alveolitides on histological appearances alone.     

Analysis for Trichothecenes in Samples from Southeast Asia Associated with "Yellow Rain"

Analysis for Trichothecenes in Samples from Southeast Asia Associatedwith "Yellow Rain" WATSON, S. A., MIROCHA, C. J., AND HAYES,A. W. (1984). Fundam. Appl. Toxicol. 4, 700–717.     

Adolescent Suicide: Assessment and Intervention

Understanding how to prevent suicide, the third leading cause of adolescent death, is the focus of this article. To prevent suicide, the nurse assesses risk factors, covert messages, overt suicide clues, and intervenes with the adolescent and family. Suicide risk and hopelessness decrease as suicidal youths learn to clarify problems, rally significant others, expand resources and use safe coping strategies. Interventions include a no-suicide contract, family therapy and school suicide prevention programs. Nurses can identify the youth at risk for suicide awl, in many cases, provide the therapy that helps prevent suicide. Vignettes illustrate strategies that effectively reduce suicide risk.