Neonatal brain: color Doppler imaging. Part II. Altered flow patterns from extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO), a lifesaving procedure in neonates with severely impaired lung function, requires ligation of the right common carotid artery. In an investigation of the collateral pathways that maintain perfusion of the brain after right common carotid artery ligation, ten infants were studied with color Doppler imaging during and after ECMO. The circle of Willis was seen in all infants, and in every case there was retrograde flow in the distal internal carotid artery and the proximal (A1) segment of the anterior cerebral artery. Bilateral flow in the middle cerebral arteries and in distal branches of the anterior cerebral arteries was also seen, documenting flow to both cerebral hemispheres.     

Nutrition and the homeless person

Homeless persons include men, women, and children who are among the poorest of America's poor. A review is provided of the eating patterns of the homeless, their special nutritional problems, and controversial nutritional issues involving them. Also discussed are ways in which community health nurses (CHNs) can (a) help upgrade the nutritional standards of community-based shelters and other facilities which feed the homeless, and (b) provide suggestions to such food providers to improve the social climate during mealtimes.     

Self-efficacy and activity level following cardiac surgery

Self-efficacy expectations were measured in 149 recovering cardiac surgery patients to determine whether in-patient education and telephone monitoring during convalescence enhanced perceptions of cardiac efficacy and reported activity. Significant differences were found for experimental patients in self-efficacy expectations for walking between 4 and 8 weeks (P = 0.02) and between 8 and 24 weeks (P = 0.05) following surgery. Experimental patients also reported higher levels of general activity at 4 weeks (P = 0.05) and 8 weeks (P = 0.02) as well as more walking and lifting at 8 weeks (P = 0.01 and P = 0.0008, respectively). By 12 weeks, treatment differences were no longer significant except for continued higher general activity levels (P = 0.03) for experimental patients. Self-efficacy expectations, summed for all physical activities, at at 8 weeks were found to be a significant predictor of self-reported activity at 12 weeks, contributing 14.8% of the 34.8% explained variance (R2 change = 0.1479; F = 26.58; P less than 0.0001). Self-efficacy expectations summed for all physical activity at 8 weeks were also significant predictors of self-reported activities at 24 weeks, contributing 8.5% of the variance (R2 change = 0.0847; F = 14.48; P = 0.0002). A New York Heart Association functional class at 4 and 8 weeks was an independent predictor of self-reported activity at 12 weeks, as was 8 week functional class for self-reported activity at 24 weeks. Mood state did not contribute to explained variance in the regression models.(ABSTRACT TRUNCATED AT 250 WORDS)     

Uniting to improve end-of-life care

Survey results measure the impact of a national invitational nursing conference on end-of-life care.     

Synthetic exendin-4 (exenatide) significantly reduces postprandial and fasting plasma glucose in subjects with type 2 diabetes

Despite the advent of new treatments, glucose control in the type 2 diabetes population is unsatisfactory. AC2993 (synthetic exendin-4; exenatide), a novel glucose-dependent insulinotropic agent, exhibited notable antidiabetic potential in two clinical studies in patients with type 2 diabetes. In study A, 24 subjects received sc injections of study medication (0.1 micro g/kg AC2993 or placebo) twice daily with meals for 5 d. Statistically significant reductions in mean postprandial circulating concentrations of glucose, insulin, and glucagon occurred following treatment with AC2993. In study B, 13 subjects receiving a single dose of study medication (0.05, 0.1, or 0.2 micro g/kg AC2993 or placebo) following an overnight fast had reduced fasting plasma glucose concentrations during the subsequent 8-h period. The relative glucose and insulin concentration profiles were consistent with glucose-dependent insulinotropism. AC2993 was well tolerated. Mild transient headache, nausea, and vomiting were the main adverse events. In conclusion, AC2993 acutely and markedly reduces fasting and postprandial glucose concentrations in patients with type 2 diabetes. During fasting, glucose-dependent enhancement of insulin secretion and suppression of glucagon secretion are the predominant mechanisms, and postprandially, slowing of gastric emptying is additionally operative. This robust antidiabetic effect warrants further evaluation of AC2993.     

Giant pleural fibroma with an abdominal vascular supply mimicking a pulmonary sequestration

A 37 -year-old woman was found to have a giant mass in her right chest with an abnormal abdominal vascular supply at preoperative workup. Suspecting a pulmonary sequestration, the lesion was embolized and then removed through a standard thoracotomy. A broad-based, vascularized pedicle connected the mass to the diaphragm. Final pathology demonstrated a solitary fibrous tumor of the pleura with no malignant features. We believe this is the first case of solitary fibrous tumor of the pleura with a direct vascular supply from the abdominal aorta at the level of the renal arteries reported in the literature.