Palliative combined cutting and high-pressure balloon valvuloplasty in six dogs with severe, symptomatic subaortic stenosis.

INTRODUCTION/OBJECTIVES: Severe subaortic stenosis (SAS) is a congenital heart defect in dogs that often results in clinical signs and reduced survival. The objective of this study was to describe characteristics of dogs with severe, symptomatic SAS who underwent combined cutting and high-pressure balloon valvuloplasty (CB/HPBV). ANIMALS, MATERIALS, AND METHODS: Retrospective description of the clinical characteristics, CB/HPBV procedural deviations from reported methodology and outcomes in a series of six client-owned dogs with severe, symptomatic SAS. RESULTS: Breeds included two each of Newfoundland, Golden retriever, and German shepherd. Median age was 10.1 months (range: 5-72.3 months), and median weight was 25.5 kg (range: 21.8-36.4 kg). Before CB/HPBV, clinical signs were present in all dogs; four were managed for congestive heart failure (CHF). Three dogs had concurrent congenital heart disease. Median Doppler-estimated left ventricular outflow tract pressure gradient was pre-operatively 149.7 mmHg (range: 89.9-254.7 mmHg) and post-operatively 134.1 mmHg (range: 83.9-181.2 mmHg). Median aortoseptal angle was steep at 136° (range: 109-143°). Clinical improvement was documented in all dogs, based on temporary discontinuation of diuretics and/or owner-perceived reduction in clinical signs. At the time of writing, three dogs had died suddenly, one was euthanized because of recurrence of clinical signs, and one died in CHF. Median survival time was 26.4 months after procedure (range: 6.3-45.8 months). One dog remained alive at 44 months after procedure. CONCLUSIONS: Palliative CB/HPBV is a potential therapeutic option for dogs with severe, symptomatic SAS complicated by concurrent congenital heart disease, arrhythmias, or CHF.

Primary cardiac tumor presenting as left ventricular outflow tract obstruction and complex arrhythmia.

An adult female mixed breed dog presented for recurrent collapsing episodes over several weeks. Holter evaluation revealed periods of sinus arrest and echocardiography identified a soft tissue mass with subsequent severe dynamic obstruction of the left ventricular outflow tract. The patient was euthanized five days after presentation for severe dyspnea. Necropsy revealed an irregular mass circumferentially lining the left ventricular outflow tract as well as multiple myocardial metastases. The final diagnosis was an undifferentiated pleomorphic endocardial sarcoma.

An evaluation of a screening and brief intervention pilot project for hazardous and harmful drinkers within the accident and emergency department of Manchester Royal Infirmary.

Hazardous and harmful drinkers make up a significant percentage of A and E attendees, and brief interventions have been shown to reduce harm among this particular group. This paper evaluates a pilot project which introduced a screening and brief intervention programme within the A and E department. This project aimed to screen and offer brief interventions to attendees and to refer on to local alcohol services if required.

Multiple sclerosis: the relationship among self-esteem, social support, and coping behavior.

This study examines the relationship of self-esteem and social support to problem-focused coping behavior of 101 individuals with multiple sclerosis, a chronic progressive disease. Results included a significant relationship between self-esteem and problem-focused coping; a nonsignificant relationship between social support and problem-focused coping; and that self-esteem and social support taken together did not contribute significantly to problem-focused coping. Although the most frequently used coping strategies employed were problem focused, subjects did use combinations of problem- and emotion-focused strategies to deal with stressful encounters. The findings highlight the importance of assessing self-esteem, social support, and coping behavior of persons afflicted with multiple sclerosis and thus with the ever present potential for physical deterioration.

Multiple sclerosis: health-promoting behaviors of spousal caregivers.

This pilot study examined the relationship between health-promoting behaviors of spousal caregivers of individuals with multiple sclerosis (MS) and dependency needs of the afflicted spouses. The study sample included 20 subjects who were residing with their spouses and served as primary caregivers. The data were collected through a semistructured interview of caregiving spouses. The health-promoting lifestyle profile (HPLP) was used to measure health-promoting behavior. The Index of ADL was employed to measure independence in activities of daily living (ADL). Descriptive statistics were calculated for demographic, ADL and health-promoting variables. Pearson product-moment correlations were employed to assess the relationship between the care recipient dependency needs and the health-promoting behavior of the caregiving spouse. Findings revealed a significant inverse relationship between level of recipient dependency and health-promoting behavior of the caregiver (r = -.394, p < .04). Further examination of health behaviors revealed that caregiving wives reported higher total frequency of health-promoting behaviors than did their husband counterparts. Additional analyses revealed subjects scored highest on the self-actualization dimension and lowest on the exercise dimension of the HPLP scale.

Multiple sclerosis: the role of social support and disability.

This descriptive study explores the types and sources of social support and examines the relationship between types and sources of social support and physical disability and length of illness of 101 individuals with multiple sclerosis. The Norbeck Social Support Questionnaire was used to examine functional support (affect, affirmation, and aid) and structural support (size of network, duration of relationships, and frequency of contact). Findings reveal that subjects perceived "moderate" to "quite a bit" of affect (love, respect, and admiration) but only "moderate" to "little" amounts of affirmation (support of one's thoughts or actions) and tangible aid. Results of multivariate analysis of variance carried out on 44 subjects reveals that subjects perceived more support from spouse/partner than from any other source. Correlational analysis indicates that subjects with higher levels of disability perceived less overall support from spouse/partner and family. Findings also indicate that subjects with a longer period of illness perceived less amount of affect and affirmation and had less contact with network members.

Multiple sclerosis: stressors and coping strategies in spousal caregivers.

Community health nurses, who have frequent and prolonged contact with patients afflicted with chronic disease, play a central role in the assessment and care of patients and their families who must deal with the many ramifications of long-term disease. The importance of multiple sclerosis in health care is a result of its worldwide prevalence rate of 57.9 per 100,000 population, its tendency to occur in the young adult, and its chronicity. This exploratory study was designed to describe the stressors of caregivers of individuals with multiple sclerosis, to identify coping behaviors used by caregivers, and to explore the relation between caregiver stress and caregiver coping behavior. The study sample included 20 caregiving spouses of individuals with multiple sclerosis. The data were collected through a semistructured interview of caregiving spouses. Caregiver coping behavior was measured with the Ways of Coping Checklist (Folkman & Lazarus, 1980), and caregiver stress was measured with the Caregiver Strain Index (B. C. Robinson, 1983). Descriptive statistics were calculated for each of the demographic and disability variables. Pearson product-moment correlations were employed to assess the relation between caregiver coping behavior and caregiver stress. Findings revealed significant correlations between caregiver stress and caregiver coping behavior. These findings indicate that as stress in the caregiving role increases, there is an increase in the use of various forms of coping behaviors, both problem focused and emotion focused. Types of stressors and coping strategies used by caregivers are described, and nursing implications are discussed.

If Freud's theory be true....

If Freud's theory of defense and repression is true, it is proposed that the manifest content of his conscious thought (his theory) would not accurately represent his real thoughts. It would rather distort, disguise, and hide them. Freud's own special method of analysis and interpretation, which rejects the manifest meaning of conscious thought, would have to be used to gain insight into his "real,'' but still hidden, thoughts. Wherever Freud's manifest thoughts, rather than his real thoughts, have shaped subsequent theories of therapy and clinical practice, re-appraisal of these later theories and practices is recommended. Resolving this misunderstanding of Freud's thought may facilitate integration of clinical theory.

Analysis of the int-1, int-2, c-myc, and neu oncogenes in human breast carcinomas.

We have examined the DNA obtained from 100 primary breast carcinomas for oncogene markers which might have predictive value for poor prognosis. Ninety-six of the tumors were analyzed for the presence of restriction fragment length polymorphisms (RFLPs) previously identified in the int-2 gene. An 8.4-kilobase BamHI fragment and a 3.9-kilobase PstI fragment specific for the int-2 gene, in the absence of other restriction fragments, was found in 17 of 50 (34%) lymph node-negative patients and in 27 of 44 (61%) lymph node-positive patients. This combination of int-2 RFLPs (8.4/3.9) was found in a significantly different proportion (P = 0.02) of patients with greater than 3 positive lymph nodes compared to patients with fewer positive lymph nodes, suggesting that these RFLPs may be valuable for distinguishing among node-negative patients for chemotherapy. In contrast, the observed low frequency of int-1, int-2, neu, and c-myc amplification limited their usefulness as clinical predictors of disease recurrence.

Prospective clinical trial of a human tumor cloning system.

A prospective clinical trial was performed to evaluate the usefulness of a human tumor cloning system for selecting single-agent chemotherapy for patients with advanced cancers. Six hundred four single-agent trials were performed in the 470 patients whose tumors were submitted for drug sensitivity testing. Only 246 of these 604 trials (41%) could be directed by the cloning system results because of inadequate tumor growth and other difficulties. In these 246 prospective trials, there was a 60% true positive and an 85% true negative rate for predicting for response or lack of response of an individual patient's tumor to the single agent. There was also a relationship between the percentage of decrease in survival of tumor colony-forming units and the probability of a clinical response of the patient's tumor to the same drug used in vivo. Despite these encouraging findings, work to improve tumor growth and additional prospective clinical trials of the system are needed before the system can be recommended for routine clinical use.