Central venous catheter complications in 447 patients on home parenteral nutrition: an analysis of over 100.000 catheter days

RATIONALE: The purpose of this study is to report the frequency of central venous catheter (CVC) complications and to analyze the potential risk factors for complications requiring CVC removal in home parenteral nutrition (HPN) patients. METHODS: A questionnaire developed by the ESPEN HAN WORKING GROUP was distributed to 12 European centers to investigate the complications occurring during the period between January 1995 and December 2000 when HPN patients used their first CVC. The questionnaire collected informations related to the Home Parenteral Nutrition technique and the underlying disease. Factors affecting the time of CVC removal were jointly investigated using Cox's multivariable regression models. RESULTS: The study was performed on 447 patients for a total of 110869 CVC-days. Complications occurred in about 1/4 of patients, approximately half were infections and about half required Central Venous Catheter removal. The Cox analysis showed that using the CVC 7 times/week and implanted ports were associated with a hazard ratio of 3 and 2.8, respectively. A reduced risk of removal (of about 40%) was associated with using CVC also for non-nutritional purposes (P = 0.0016). CONCLUSIONS: Within the limits of this retrospective investigation, the type of CVC, the type of administration of HPN and the type of training are important factors associated with occurrence of complications or with CVC removal. However, in our opinion, proper care of the CVC, of preparation and administration of the nutritive admixture seem to be paramount for a safe management of HPN.     

Pertussis presenting as hoarseness in an adult

Pertussis is a rare condition in adults. This report describes a 65-year-old man presenting to the otolaryngology service with hoarseness secondary to pertussis. He had a history of worsening cough and hoarseness occurring over several weeks. Laryngoscopy showed significant erythema at the medial edges of the vocal folds. Stroboscopy demonstrated bilateral decreased amplitude and decreased mucosal wave of the vocal folds. Polymerase chain reaction testing of the sputum revealed Bordetella pertussis. The patient was started on azithromycin, and he reported gradual resolution of the chest and laryngeal symptoms over the next few months. Pertussis, or whooping cough, is not common in the United States because of childhood vaccination protocols. Nevertheless, otolaryngologists need to be aware of this condition as a possible cause of hoarseness.     

Genome-wide search for genes affecting the risk for alcohol dependence

Alcohol dependence is a leading cause of morbidity and premature death. Several lines of evidence suggest a substantial genetic component to the risk for alcoholism: sibs of alcoholic probands have a 3–8 fold increased risk of also developing alcoholism, and twin heritability estimates of 50–60% are reported by contemporary studies of twins. We report on the results of a six-center collaborative study to identify susceptibility loci for alcohol dependence. A genome-wide screen examined 291 markers in 987 individuals from 105 families. Two-point and multipoint nonparametric linkage analyses were performed to detect susceptibility loci for alcohol dependence. Multipoint methods provided the strongest suggestions of linkage with susceptibility loci for alcohol dependence on chromosomes 1 and 7, and more modest evidence for a locus on chromosome 2. In addition, there was suggestive evidence for a protective locus on chromosome 4 near the alcohol dehydrogenase genes, for which protective effects have been reported in Asian populations. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:207–215, 1998. © 1998 Wiley-Liss, Inc.     

The clinical estimation of suggestibility

Expectancies about the consequences of the suppression of behavior and about the effects of expressing emotions are proposed as sources of the “talking cure” which developed during Breuer's treatment of Anna o. and which later became known as the cathartic method. Although the argument is similar to one proposed by Ellenberger (1970, 1972) it sets out a more rational alternative to his explanation that the method was partly a creation of the mythopoetic unconscious. The analysis of the interaction between Breuer and Anna 0. makes explicit the expectancies underlying each of the steps through which the cathartic method developed and traces these expectancies to the general beliefs and the specific theoretical interests shared by them.