PURPOSE: To examine success and complication rates for ultrasound (US)-guided cannulation of the internal jugular vein (IJV) in comparison with blind techniques and to present the variations in anatomy of the IJV. MATERIALS AND METHODS: Data were prospectively collected for 869 cases of sonographically guided cannulation of the IJV. In all cases, the side of the puncture, procedural success or failure, and any immediate complications were recorded. In 764 (88%) cases, the number of passes required and whether a single- or double-wall puncture was used were recorded. In 690 (79%) cases, IJV diameter and depth were recorded, while its relationship to the common carotid artery (CCA) was noted in 659 (76%) cases. RESULTS: Cannulation was successful in 868 (99.9%) cases. Complications occurred in 20 (2.3%) cases. Eighty-seven percent of cannulations were achieved with one pass and 83% with a single-wall puncture. Success at first pass was significantly correlated with right-sided puncture and the diameter of the IJV. In 5.5% of cases, the IJV lay medial to the CCA, making successful cannulation with use of the landmark technique unlikely. CONCLUSIONS: US-guided cannulation of the IJV is superior to blind techniques, increasing the success rate and incidence of first pass cannulation and reducing the incidence of complications.

Adolescent↗

PubMedDate not supplied

Predicting post-traumatic symptoms in cardiac patients.

OBJECTIVE: The purpose of this study was to identify correlates and predictors of the symptoms of post-traumatic stress disorder (PTSD) in a cohort of patients with myocardial infarction, while the patients were in hospital and 3 months after infarction. DESIGN: Longitudinal, consecutive referrals were used. PATIENTS: From a possible 68 consecutive patients with a first myocardial infarction who completed questionnaires in hospital and survived to 3-month follow-up, 39 completed follow-up questionnaires. OUTCOME MEASURES: PTSD measures were taken in hospital and 3 months after discharge. Predictor variables were measures of mood taken in hospital and measures of the immediate cognitive and emotional reactions at the time of the infarct. RESULTS: Associations between the independent variables and PTSD symptoms were stronger at 3-month follow-up than while in hospital. At this time, the frequency of intrusive thoughts was predicted by the degree of fright at the time of the event (adjusted R(2) = 0.262; beta =.57; t = 3.30; P <.01) and positive affect scores (additional adjusted R(2) = 0.112; beta = -.37 t = -2.18; P <.05). The degree of physiologic arousal at the time of such flashbacks was predicted by levels of negative affect in hospital (adjusted R(2) = 0.174; beta =.46; t = 2.46; P <.05), which also predicted avoidance scores (adjusted R(2) = 0.203; beta =.48; t = 2.62; P <.05). CONCLUSIONS: Because many of the symptoms of PTSD are self-remitting, and intervening too early in the course of the disorder may exacerbate the disorder, it is important not to intervene too early or over-treat this disorder. Formal treatment may be useful if provided some months after discharge from hospital. If either secondary or primary care services are to treat myocardial infarction-related PTSD effectively, it is important to identify patients who are at risk for it. These data contribute to the development of a profile of patients at risk.

Cohort Studies↗

PubMedDate not supplied

A comparison of two microsporidian parasites in enterocytes of AIDS patients with chronic diarrhea.

Enterocytozoon bieneusi was first described by electron microscopy in 1985 in intestinal biopsies from an AIDS patient. It has subsequently been observed in many AIDS patients with chronic diarrhea from the U.S.A., Africa, and Europe. Morphologically, this parasite meets the criteria for being a microsporidian but has unique features justifying the creation of a a new genus and family. It has organelles not seen in microsporida before, i.e. elongated nuclei, electron-lucent inclusions, electron-dense discs, and development of multiple polar tubules in a single cell prior to the final cytokinetic process producing many sporoblasts. However, it produces typical microsporidian spores. Recently, a second type of microsporidian has been observed in similar biopsies from an AIDS patient which resembles an Encephalitozoon except that it secretes a fine network of material in which the developing organisms become embedded. During sporogony, each cell appears to be in a separate chamber. These two parasites are morphologically and pathologically compared.

Acquired Immunodeficiency Syndrome↗