Dynamic social support networks of younger black men who have sex with men with new HIV infection.

Rising rates of HIV infection among younger black men who have sex with men (YBMSM) in the USA have generated a public health emergency. Living with HIV requires deep and persistent social support often available only from close confidants. Enlisting endogenous support network members into the care of HIV-infected YBMSM may help shape sustainable supportive environments, leading to long-term improvements in mental and HIV-specific health outcomes. The present study examined trends in support network change over time after new HIV diagnoses among 14 YBMSM. Participants completed a social network survey that utilized sociograms to record support confidants (SCs) preceding HIV diagnosis and at one and nine months postdiagnosis. Reported SCs included family of origin, friends, sex partners, and other associates. Analysis revealed three distinct patterns of change: high gain, high turnover, and stable networks. These patterns offer valuable insights into the social support of YBMSM during the period following diagnosis. This research underscores a growing movement to embrace key support figures in the lives of YBMSM, who may be critical to promoting overall health and adherence to HIV-care.

Intravenous streptokinase in acute myocardial infarction at the community hospital: a six-year experience.

The efficacy of intravenous streptokinase in the initial management of acute myocardial infarction was evaluated over a 6-year period in 130 patients admitted to 3 community hospitals. Most patients were admitted within 2 hours of onset of symptoms and received 1.5 million units of streptokinase over a 30- to 60-minute period. Clinical observations and serial creatine phosphokinase-MB were indicative of vessel patency in 115 (88%) of the patients after initiation of thrombolysis. Of this group, 105 underwent catheterization, and recanalization was demonstrated in 97 (92%). Fifty percent of the patients who underwent reperfusion were subsequently maintained with medical therapy; 50% underwent either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. Major morbidity was confined to hematomas; no cerebral bleeding was encountered. There was 1 early death from cerebral thrombosis and 2 late deaths, 1 to cancer and 1 to myocardial infarction. These findings suggest the benefit of intravenous streptokinase thrombolysis in patients with acute myocardial infarction presenting within 3 hours of onset of pain, unless specific potential bleeding problems exist or in the case of certain very elderly persons. In addition, the trial demonstrated the feasibility of triaging patients who have undergone lytic therapy to a central facility for catheterization and management.

Left ventricular pseudoaneurysm secondary to infection after coronary bypass surgery.

We present a case of left ventricular pseudoaneurysm following coronary bypass surgery. The cause was infection, dating from the bypass procedure 1 1/2 years before. Repair of pseudoaneurysm in a patient with a bypass is complicated by the presence of grafts which should be protected from injury. Details of successful management in this case are presented.

Myocardial revascularization in patients with chronic renal failure.

Symptomatic coronary artery disease in patients with chronic renal failure can complicate their management in a dialysis program. Hypotension associated with hemodialysis and the anemia of chronic renal disease can produce anginal episodes refractory to medical management. Untreated coronary artery disease may be a contraindication to renal transplantation in an otherwise acceptable candidate. We have encountered three cases of coronary artery disease severe enough to necessitate coronary bypass in patients from our long-term hemodialysis program. All three patients had uncomplicated postoperative courses, none had perioperative infarction, and in all three patients postoperative angiography demonstrated patency of all grafts. One patient subsequently underwent successful renal transplantation; the other two patients have continued in hemodialyses since bypass. We believe our experience and the reported experience of others confirm the feasibility of coronary bypass grafting in patients with chronic renal failure.

Percutaneous (nonsurgical) supported angioplasty in unprotected left main disease and severe left ventricular dysfunction.

A 69-year-old patient with the equivalent of severe, unprotected left main coronary artery disease associated with marked left ventricular dysfunction with ventricular aneurysm who had Class IV angina, underwent supported angioplasty utilizing a total percutaneous approach. The patient tolerated occlusion of his main left coronary artery for a total of 7 minutes without difficulty, during dilatation of left anterior descending and two circumflex lesions. He was discharged the following day, symptom free.

Objective elaluation of bypass surgery in patients with acute coronary artery disease.

80 patients with acute coronary artery disease, including 70 patients with PIA, 8 patients with acute myocardial infarction, and 2 patients with cardiogenic shock, underwent bypass surgery. The surgical mortality rate was 1.4% in patients with PIA and during an average follow-up period of 15 months none of the patients died of cardiac disease. Ventricular function, as indicated by systolic ejection fraction and segmental wall motion, was noted to improve in many patients. Postoperative studies showed the internal mammary artery to be superior to the saphenous vein graft for left coronary bypass procedures. This was demonstrated by 100% patency of internal mammary artery grafts to the left anterior descending coronary artery. We believe that when a patient presents with one of the syndromes of acute coronary artery disease such as unstable angina, severe chest pain suggestive of infarction without infarction, status anginosis, recurrent ventricular tachycardia or acute myocardial infarction complicated by evidence of potential extension, cardiogenic shock, heart block or rupture, these patients deserve at least coronary and left ventricular cineangiographic studies with hemodynamic evaluation. Our experience to date suggests that myocardial revascularization and catheterization carry a lesser risk than that of medical treatment.

Spontaneous closure of residual ventricular septal defect following surgical repair of ventricular septal defect complicating acute myocardial infarction.

Spontaneous closure of ventricular septal defects in patients with congenital heart disease is well documented. Also, successful closure of ventricular septal defects complicating myocardial infarction performed in the acute phase have been reported, although the mortality rate is high. Intra-aortic balloon pumping has been helpful in this regard, as it was in our patient. Our case is of interest in that it demonstrates the possibility of spontaneous closure of a residual ventricular septal defect resulting from rupture of the interventricular septum, secondary to acute myocardial infarction, partially closed at surgery. Clearly, the residual defect was small in that the patient was substantially benefitted by surgery and the postoperative catheterization revealed a small 5% step-up in oxygen saturation at the right ventricular level.