Psychological stress does not affect plasma catecholamines in subjects with cardiovascular disorder

Whereas the effects of cardiac transplantation on the catecholamine response to physical exercise have been studied previously, the impact on psychological stress is unknown. Here, the arterial catecholamine response to the Stroop test of patients with an orthotopic heart transplant (OHT) was compared with that in subjects who had received a coronary artery bypass graft (CABG) or who were in heart failure and destined for a heart transplant (HF). Subjects were tested whilst sitting and their usual drug therapy was maintained. The Stroop test increased subjects' subjective tension but did not affect arterial concentrations of adrenaline or noradrenaline in any group of subjects. Also, the concentration of both catecholamines was significantly higher in OHT and CABG subjects than in the HF group, but their relative concentration was unaffected by cardiovascular status or stress. It is concluded that the absolute concentrations of arterial catecholamines, but not their relative concentrations, depend on clinical status. Moreover, under these test conditions, subjects with a history of cardiovascular disorder do not show the normal catecholamine response to psychological stress.     

The role of advanced practice nurses in surgical services

Many of the changes in health care delivery systems have had detrimental effects on nurses; however, some of these same changes are providing opportunities for acute care advanced practice nurses. Advanced practice nurses ensure continuity of care, manage use of resources, and coordinate patient services, which often results in cost savings. This article describes how advanced practice nurses in the department of surgery at Memorial Health Care, Worcester, Mass, are caring for surgical patients with acute and chronic conditions.     

Serum cytokine levels in heart allograft recipients: correlation with findings on endomyocardial biopsy

We report the first double-blind, placebo-controlled continuation study comparison of a neuroleptic (haloperidol < or = 6 mg), monoamine oxidase inhibitor (MAOI) antidepressant (phenelzine < or = 90 mg), and placebo in 54 patients with borderline personality disorder. Continuation medication trials of 16 weeks followed 5 weeks of acute therapy. Haloperidol continued to be effective beyond the acute phase only for the treatment of irritability. Higher levels of depression, hypersomnia, and leaden paralysis were noted in the haloperidol group than in the phenelzine and placebo groups. The dropout rate during the first half (8 weeks) of the continuation study was significantly higher for the haloperidol group (64%) than for the placebo group (28%) (p < .05). Phenelzine demonstrated very modest efficacy beyond that noted in the acute phase for the treatment of depression and irritability. Phenelzine was shown to have an activating effect on measures of excitement and reactivity.     

Caregivers and HIV infection. Services and issues

Because of the complexity of their illness, patients infected with HIV may require many services to facilitate the management of the disease. The primary care provider must understand and facilitate the services that are needed and needs to be familiar with the individuals responsible for the care of each patient. There are many stresses that have been identified in HIV caregiving, for informal caregivers and health care workers. These stresses are described, and suggestions for appropriate interventions are outlined.     

IVC filter tilt and asymmetry: comparison of the over-the-wire stainless-steel and titanium Greenfield IVC filters

PURPOSE: A comparison of tilting, caval coverage, asymmetry, and insertion problems with the over-the-wire stainless-steel and titanium versions of the Greenfield filter. MATERIALS AND METHODS: The study compared 104 stainless-steel and 141 titanium Greenfield inferior vena cava (IVC) filter insertions. The angle the sheath and deployed filter made relative to the cava, as well as filter strut distribution, were determined from spot films. The proportionate caval coverage was computed from the cavogram (anteroposterior projection). Mean filter tilts, subgrouped by insertion site, and caval coverage were compared with the Student t test, whereas strut patterns were analyzed with a contingency table. RESULTS: The filter caval and sheath caval angles correlated. The filter caval angles varied with insertion site, but were lowest with a right jugular approach. Caval coverage was identical with both designs. The stainless-steel version resulted in a more uniform distribution of struts in comparison with the titanium version. The incidence of insertion problems was not significantly different between the filter types. CONCLUSIONS: While IVC filter tilting was not improved with the newer design, the pattern of struts was more uniformly symmetric with the stainless-steel device. The right jugular insertion site was associated with the lowest filter caval angles and the most symmetric pattern of struts.     

Surgical management of patients with osteogenesis imperfecta: 10 years'' experience

INTRODUCTION: Chondromas are rare intracranial tumors. The authors present two cases of intracranial intradural chondroma, one originating from the falx cerebri and the other from the dura mater of the convexity. METHOD AND RESULTS: Diagnostic procedures, including magnetic resonance imaging, and surgical findings are described. In both cases, pre-operative diagnosis could have been at least suspected, and the tumor was completely removed, without recurrence after a follow-up of many years. The pathogenesis and pathological findings are discussed, and cases from the literature are reviewed. CONCLUSION: Benign intradural chondroma has a good prognosis, with no recurrence after surgical excision in most cases.