Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.     

Subcostal echocardiography to determine right ventricular pacing catheter position and control advancement of electrode catheters in intracardiac electrophysiologic studies: M mode and two dimensional studies

To assess the value of subcostal echocardiography in determining the position of a right ventricular pacing catheter, M mode and two dimensional echocardiography was performed from four different locations in 30 patients. Subcostal M mode echocardiography had a higher detection rate of the pacing catheter than did the precordial M mode examination. However, with M mode echocardiography it was not possible to determine the position of the pacing catheter from any of the locations. The subcostal two dimensional echocardiography demonstrated the full length of the pacing catheter in the right heart chambers and its anatomic position in all patients and proved superior to the precordial approach. This technique allowed the detection of complications related to pacing catheters. A pacing catheter ejected from the ventricular cavity was found in the inferior vena cava. Perforation of the ventricular septum with a bipolar electrode for temporary pacing was also diagnosed.

Subcostal two dimensional echocardiography was used in 20 patients as an additional technique for controlling the advancement of electrode catheters in right heart intracardiac electrophysiologic studies. The electrode catheters were successfully positioned at all routine sites in all patients except one. Thus, subcostal two dimensional echocardiography has advantages over fluoroscopy in the determination of pacing catheter position and in controlling the advancement of electrode catheters in intracardiac electrophysiologic studies.     

Beneficial hemorheologic therapy of chronic peripheral arterial disorders with pentoxifylline: Results of double-blind study versus vasodilator-nylidrin

Pentoxifylline (Trental 400 mg coated tablets) and nylidrin HCl 3 mg were compared for clinical efficacy and safety in an 8-week randomized double-blind trial. The study was conducted in patients with peripheral arterial disease (Fontaine stage II or III), with 30 patients receiving pentoxifylline (23 returned for follow-up), and 30 patients receiving nylidrin HCl (24 returned for follow-up). Efficacy was assessed objectively in terms of walking performance (absolute walking time and walking distance on a treadmill ergometer) and by acral plethysmography. The clear improvement shown for both variables was greater and statistically significant (p ≤ 0.05) after treatment with pentoxifylline. Laboratory data provided no evidence to suggest any adverse effect of either treatment. Subjective side effects were reported by six patients in the pentoxifylline group and by three patients in the nylidrin HCl group.     

The health of immigrant women: Queensland women from the former Yugoslavia

A study of the social and health status of women from the former Yugoslavia was conducted in Queensland, Australia. Study participants were predominantly refugee women who had migrated to Australia between 1991 and 1996. A significant number of the women rated their health status as poor or fair. Most women did not perceive any change in health following migration, but more felt that their health had deteriorated than improved. Applying a social model of health, we explored the social contexts of countries of origin and destination that impact on women's health. We analyze how preimmigration trauma, settlement problems, health risk behaviors, and participation in screening programs affect women's health status and health needs. Data analysis indicated that government and nongovernment services can reduce the impact of preimmigration experience on health risk behaviors and poor health outcomes only to a limited degree. Since the low socioeconomic status of immigrants following immigration was identified by women as a main contributing factor to their poor health status, government support in tackling structural barriers in accessing the Australian labor market is essential to achieve positive health outcomes.     

Exploration of factors linked with high cervical cancer rates in women from the former Yugoslavia in Victoria,Australia

Objectives: The aim of the project was to identify the cervical screening rate and other factors that may be associated with high rates of cervical cancer in women from the former Yugoslavia compared to the general population in Victoria, Australia. Design: A cross-sectional survey was conducted by structured personal interviews of 42 Bosnian, 56 Croatian, 49 Macedonian, and 35 Serbian women, and 39 women who identified as Yugoslav or of mixed background. Self-report data were collected on Pap testing behaviour, estimated screening rate of each community, stage-based barriers to cervical screening, and women's theories about causes of cervical cancer within their community. Results: Women in this study had an acceptable screening rate, but barriers to cervical screening were similar to those of other groups. While Macedonian women believed more of their community had Pap tests than the other cultural groups, just under half were under-screened themselves. Smoking rates were very high for women in this study. The most common causes of cervical cancer suggested by women in the study were: a low screening rate, lifestyle stress, and chemicals. Conclusion: It is unlikely that the high cervical cancer rate in women from the former Yugoslavia is a result of under-screening, lifestyle stress, or chemicals. Smoking may well contribute to the cancer rate, however the most likely explanation is that cancers not previously detected in Yugoslavia are now being found, together with cervical abnormalities, within the systematic two yearly screening programme of PapScreen Victoria, in Australia.     

Malthusian Pressures,Genocide, and Ecocide

Abstract

Historical models postulate that genocide cannot occur without the ideology and decisions of its authoritarian perpetrators and the indifference of bystanders. These models do not address genocidal risks from ecocide. Study objectives were to assess 1) the role of Malthusian pressures in recent genocides, 2) the role of ecocide and ecologic abuse in creating these pressures, and 3) strategies for prevention and deterrence. Analysis of reports, demographic studies, and time trends in recent genocides and recent ecocidal events from ecologic abuse suggests that Malthusian pressures and zero-sum rivalries over water, arable land, or natural resources by themselves do not lead to genocide. Such pressures may have exacerbated the political and socioeconomic predictors in Rwanda and Darfur, but not in former Yugoslavia. However, collapse of socioeconomic and governmental infrastructures following genocide can leave behind massive sustained damage to carrying capacity and sustainability. Surviving victims, if they return to their environments, will remain at risk for persecution. Ecocide—the large-scale destruction, depletion, or contamination of natural ecosystems—can result in widespread damage to health, survival, fertility, reproduction, and sustenance, and forced flight. International early warning and effective response systems are needed to deter or prevent political decisions to carry out genocide. Such systems must include long-term measures to resolve zerosum conflicts over environmental resources and to prevent toxic risks to vulnerable populations and destruction of habitat by deliberate or wanton ecologic abuse, which itself should be redefined as a crime against humanity.     

Working ability of mentally ill people in times of social crisis

In Yugoslavia a special commission evaluates the working abilities of insured ill people. In the last 14 years the number of people referred to this commission has increased. For people assessed as being unable to work the most frequent diagnoses have been psychiatric and cardiovascular diseases. All individual requests for retirement on partial or full pension based on mental disorder (n = 1563) made in 1982 in Bosna and Herzegovina were studied. People who were awarded pensions were also followed up. The results obtained indicated that the willingness to retire is widespread among insured people, quite often regardless of the actual impairment of their working abilities. Data are interpreted in the light of the severe socioeconomic crisis Yugoslavia has been experiencing through the last decade.     

Occupational and environmental health in eastern Europe: challenges and opportunities

As the nations of Eastern Europe undergo political and economic transitions, they face considerable occupational and environmental health challenges. Although occupational health services are relatively well developed, environmental health services and policies are not. There are major needs in the areas of education and training, supplies and equipment, and policy development. In addition, privatization poses a variety of new challenges and dangers to occupational and environmental health. This commentary discusses the challenges that face Eastern European nations, and describes opportunities for collaboration among scientists, policymakers, labor, management, and community groups in the United States and Eastern Europe.     

Monitoring health in the war-affected areas of the former Yugoslavia, 1992-1993

In October 1992 the World Health Organization (WHO) set up ahealth monitoring programme in the former Yugoslavia to obtaininformation on communicable disease upon which to base decisionsabout medical aid requirements. This paper covers the firstyear of the programme (October 1992–October 1993) anddetails the steps taken to set it up. Information was soughtfrom personal contacts, ‘ad hoc’ sources (UnitedNations agencies and non-governmental organizations) and thehealth authorities of the regions of former Yugoslavia. An attemptwas made to establish a sentinel monitoring system to provideroutine data to allow health predictions to be made. A bulletinwas produced to disseminate surveillance results and healthadvice. The system obtained sufficient data (mostly from ‘adhoc’ sources) for WHO to take informed decisions aboutmedical aid but the sentinel system was not established successfully.