Housing market bubbles and urban resilience: Applying systems theory.

In this paper, we aim to connect the academic discourses of housing market and urban resilience. For this purpose, we discussed the housing market and its performance within the broader housing system, with a specific attention to the transient state of the housing market bubble. Through a systematic literature review, the housing system is framed based on the involved actors and their interactions. This systems theory based view is then used to provide a broader definition of the variations in the market performance within the urban resilience literature. In this sense, the theoretical underpinning of the literature of resilience within the systems and the observed variations in the housing market performance is discussed in view of shocks and stressors to the system, as well as equilibria and responses to disturbances. The aim is to provide a foundation for an alternative theoretical framework that focuses on interactions within the market and can be used to understand the impact of the housing market's financial drivers on urban resilience.

Durability, reliability, viability: 48 year-survival of a Starr-Edwards mitral valve.

We report a case of 67 year-old female with a 48-year survival of a Starr-Edwards valve at mitral position. The patient underwent Starr-Edwards mitral valve replacement at age of 19 years for mitral stenosis secondary to severe rheumatic valve disease. The patient had experienced a progressive decline in her functional status with increasing dyspnoea on exertion over a two-week period to eventual development of severe shortness of breath at rest prior to hospitalisation. Transoesophageal echocardiogram revealed severe para-prosthetic and intravalvular mitral valve regurgitation. The patient underwent explantation of Starr-Edwards valve and replacement with a mechanical prosthesis. Our case details the longest reported survival of a Starr-Edwards prosthetic valve at mitral area.

Paradoxical embolism interrupted.

A 41 year-old African-American male presented with syncope preceded by shortness of breath at outside facility and transferred to us for management of extensive pulmonary embolism with unstable vital signs. Electrocardiogram showed sinus tachycardia with S1Q3T3 pattern. A transthoracic echocardiogram revealed a freely mobile strand like mass in the left atrium. A transoesophageal echocardiogram showed a very large freely mobile thrombus extending from a patent foramen ovale in to the left atrium. He underwent emergent surgery for the extraction of clot followed by thromboembolectomy from both pulmonary arteries. He made a remarkable recovery and was discharged after seven days of hospital stay.

Cardiac auscultation in sports medicine: strategies to improve clinical care.

Cardiac auscultation is an important part of the preparticipation physical examination of athletes. Sudden death remains a rare but tragic event among athletes. The most common cause of sudden death among young athletes in the United States continues to be hypertrophic cardiomyopathy, which may or may not present with a typical heart murmur. Many clinicians do not possess sufficient proficiency in recognizing abnormal heart murmurs. New insights in the field of auditory learning suggest that cardiac auscultation is more of a technical skill than an intellectual one. Intensive repetition of abnormal heart murmurs has been shown to improve proficiency in cardiac auscultation markedly. Sample audio files of two important murmurs, i.e., an innocent murmur and hypertrophic cardiomyopathy, are provided online with this review.

Giant saphenous vein graft pseudoaneurysm: treatment with a vascular occlusion device.

We report the case of a 74-year old male who was evaluated for progressively enlarging right heart border on serial chest radiographs. Computed tomography of the chest revealed a pseudoaneurysm arising from the saphenous vein graft (SVG) to the posterior descending artery with mass effect on the right atrium. Coronary angiography showed severely compromised distal flow and an angiographically small territory at risk. Using a minimally invasive, catheter-based approach, an Amplatzer Vascular Plug II occlusion device was utilized successfully for embolizing the SVG pseudoaneurysm.

Hodgkin's lymphoma in Pakistan: a clinico-epidemiological study of 658 cases at a cancer center in Lahore.

OBJECTIVES: To study the clinico-epidemiological profile of Hodgkin's lymphoma (HL) in Pakistan. PATIENTS AND METHODS: We retrospectively studied all histopathologically proven cases of HL, who presented between Dec 1995 to June 2003 at Shaukat Khanum Memorial Cancer Hospital and Research Hospital (SKMCH & RC). All the relevant information was obtained through the hospital based cancer registry and medical records of the selected patients. RESULTS: Six hundred and fifty eight histopathologically confirmed cases of HL were identified. There were 505 males and 153 females, with a male to female ratio of 3.3: 1. Patients ranged in age from 1 year - 84 years. The mean age at presentation was 23.8 years. Three hundred and twenty cases (48.6%) belonged to age group 18 years of age. Histopathologically, mixed cellularity (MC) constituted 63.8% of cases, followed by nodular sclerosis (NS) 19.9%, lymphocyte predominant (LP) 7.3% and lymphocyte depleted (LD) 1.2%. Early stage (stage I and II) disease was present in 43.9% of patients at presentation, while 56.1% patients presented with advanced stage (stage III and IV). The majority of patients (81.2%) presented with cervical lymphadenopathy. CONCLUSION: The clinico-epidemiological pattern of Hodgkin's lymphoma in Pakistan manifested is similar to that observed in other developing countries, with male predominance, mixed cellularity as the commonest histological type, advanced stage at presentation and absence of bimodal age distribution.