Adolescent contraception: review and guidance for pediatric clinicians

The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.     

Synthesis of Optically Active Photoresponsive Multifunctional Polymer Containing the Side‐Chain Azocarbazole Chromophore

Summary: A new optically active photochromic polymethacrylate containing the carbazole moiety, deriving from the chiral monomer (S)‐(4‐cyanophenyl)‐(3‐{9‐[2‐(2‐methacryloyloxypropanoyloxy)ethyl]carbazolyl})diazene [(S)‐ MLECA ] has been prepared and fully characterized with the aim to obtain a multifunctional derivative possessing at the same time chemical moieties suitable to NLO and optical storage, to chiroptical switches, and to photorefractive and photoconductive applications. Spectroscopic, thermal and chiroptical characterizations clearly indicate the occurrence of dipolar interactions between chromophores and the presence of an ordered chiral conformation of one prevailing helical handedness, at least for chain segments of the macromolecules.

Structure of poly[(S)‐ MLECA ].     

Chiroptical Switching Based on Photoinduced Proton Transfer between Homopolymers Bearing Side‐Chain Spiropyran and Azopyridine Moieties

A novel optically‐active polymeric methacrylate, bearing the (S)‐3‐hydroxy pyrrolidinyl group linked through the nitrogen atom to an azopyridine chromophore, was synthesized and investigated in combination with a polymeric methacrylate incorporating the photoisomerizable spiropyran chromophore in the side‐chain. In the presence of acid, this system can be operated in solution to modulate the protonation of the azopyridine moieties by photoisomerizing the spiropyran component. In addition to UV‐vis spectroscopy, the proton transfer process occurring between the macromolecular components can be also followed by CD spectroscopy, thus behaving as a chiroptical switch.

     

Headache Due to Spontaneous Intracranial Hypotension and Subsequent Cerebral Vein Thrombosis

Cerebral vein thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). When to suspect a thrombotic disorder during the course of intracranial hypotension is not fully elucidated. A 48‐year‐old woman was admitted because of SIH with no signs of CVT on neuroimaging. The occurrence of diplopia and blurred vision 12 days later led to the performance of further investigations, which revealed thrombosis of the left lateral sinus, in the absence of variations in the headache characteristics. Among the other 4 cases of SIH clearly preceding the occurrence of CVT reported so far, only one had a change in the headache pattern related to CVT development. Although a change in the characteristics of headache is considered a marker of CVT in patients with SIH, this is not invariably part of the clinical scenario. Any new neurologic finding on exam in the disease course should raise a suspicion of venous thrombosis, thus prompting further specific investigations.     

Thrombolysis in hemodynamically unstable patients: still underused: a review based on multicenter prospective registries on acute pulmonary embolism

Journal of Thrombosis and Thrombolysis - Hemodynamically unstable pulmonary embolism (PE) represents a complex and life-threatening event with a highly variable course and poor prognosis in the...     

Complicaciones del tratamiento de la oclusión del colon distal con prótesis endoluminales

Introduction

The high morbidity and mortality of emergency surgery, has led to the use of endoluminal self-expanding metal implants (stents) in the management of intestinal occlusion.The purpose of this study was to review the results of the management of intestinal occlusion treatment in a Colorectal Surgery Unit in those patients who had a stent implant, and the relationship between chemotherapy and complications.

Material and methods

A retrospective study was carried out on patients treated with a stent in a university hospital between 2004 and 2010.

Results

A total of 93 patients were treated, of which 77 were considered palliative for a stage IV neoplasm of the colon with non-resectable metastases or due to a performance status > 2. Other indications were 7 ASA IV patients with acute renal failure, 6 with benign disease, and 3 due to other causes.The technical and clinical success of the procedure was 93.5% and 78.5%, respectively. Delayed occlusion was 19.3% and perforation 6.4%. There was migration (2.1%) and intestinal bleeding (2.1%) and 1.1% with tenesmus. No significant differences were seen between complications and chemotherapy.The overall mortality was 17.2%.

Conclusions

Stents, as a definitive treatment option in palliative patients with and without chemotherapy, is an alternative treatment that is not exempt from complications. We believe that in patients with mortality risk factors and patients with tumours with non-resectable metastases it could be the initial treatment of choice.     

Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery

Background and objectives Peripheral vascular disease (PVD) is a major risk factor in candidates for cardiac surgery and can impact morbidity and mortality in the perioperative and follow-up period. Elderly patients with PVD may benefit from endovascular treatment prior to cardiac surgery. We sought to assess the common clinical settings requiring prophylactic endovascular treatment before coronary surgery in elderly patients, the results, and the mid-term impact on subsequent revascularization. Methods Between November 2002 and June 2006, 37 patients (25 males, mean age 79.9±8.3 years, mean serum creatinine 1.9±0.6 mg/dl) underwent endovascular repair of PVD before cardiac surgery. For each patient, diagnostic methods, indications for intervention, types of interventions, procedural success, and complications were recorded. Results Four clinical settings were identified: renal artery stenting prior to coronary surgery (7 patients), iliac artery angioplasty and stenting (10 patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting prior to utilization of ipsilateral arterial conduits bypass surgery (5 patients), and carotid artery stenting before coronary surgery (15 patients). Technical success was achieved in all patients (100%); complications included brachial artery occlusion (1 patient), minor stroke (2 patients), contrast nephropathy (1 patient), and minor bleeding at the puncture site (3 patients). All patients underwent successful coronary or valvular surgery; no patients died in the perioperative period. After a mean follow-up of 26.6±3.1 months, all patients are alive and free from anginal symptoms or valvular dysfunction without clinical or Doppler ultrasonography evidence of restenosis of the implanted peripheral vascular stents. Conclusions It is not unusual for elderly patients who are candidates for cardiac surgery to require endovascular intervention for significant PVD prior to coronary bypass or valvular surgery. The results showed a low complication rate. The cardiologists have a fundamental role, not only in the diagnosis of peripheral vascular stenosis, which was seen frequently in patients with significant CAD, but also in the appropriate endovascular management of these high-risk patients.     

Clinical management of stressors perceived by patients on mechanical ventilation

Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both.     

Synthesis and characterization of some poly[nitrilo-bis(phenylamino)phosphoranetriyl]s

Poly[nitrilo-bis(phenylamino)phosphoranetriyl]s ( 3a–d ) were synthesized and characterized in dilute solution and in the solid state. The synthesis was accomplished by thermal polymerization of of 2,2,4,4,6,6-hexachloro--triazatriphosphorane ( 1 ) at 240°C, followed by the reaction of the soluble product, poly(nitrilodichlorophosphoranetriyl) ( 2 ), with aniline or its derivatives. Elemental analyses show the presence of some residual chlorine, which, according to the IR spectra, does not seem to be ascribed to an incomplete substitution. All the polymers have intrinsic viscosities in tetrahydrofuran higher than 100ml g^?1, and high weight average molecular weights (M _w ≥ 7 · 10⁵). The molecular weight distribution is very broad (M _w/M _n ≥ 13,4) which could suggest either a branched structure or a complex mechanism of polymerization. From DSC measurements the glass transition temperatures are found to be between 70 and 98°C and the related values of specific heat increments, ΔC_,p, are between 0,13 J g^?1 K^?1 and 0,27 J g^?1 K^?1; the densities are in the order of 1,3 g ml^?1.