Tetralogy of fallot with persistent fifth aortic arch: echocardiographic diagnosis.

Although persistent, fifth aortic arch (P5A) is an uncommon anomaly. Its incidence is unknown due largely to failure of recognition. Fundamental to its diagnosis is an adequate understanding of the various settings in which P5A may manifest. One of the more frequently reported manifestations of this unusual anomaly is a systemic-to-pulmonary connection in the presence of pulmonary atresia, with or without a ventriculoseptal defect. This report describes a new case of P5A in an infant with tetralogy of Fallot but not pulmonary atresia, which was diagnosed echocardiographically. The echo-Doppler characteristics of P5A in the presence of right ventricular outflow obstruction are described, and the implications regarding surgery for the accompanying defects are discussed. To the authors' best knowledge, the described case is the first reported instance of P5A in this specific setting.

Women referred for on-site domestic violence services in a managed care organization.

BACKGROUND: Limited data about victims of domestic violence in health care settings hinder development of appropriate services. A comprehensive program was established in a managed care organization to increase identification and referral of domestically abused female patients. METHODS: Female victims of domestic abuse were referred to a trained social worker for further assessment. Information about the women was obtained from clinical consultation forms; initial interviews conducted by social workers; a survey administered to a convenience sample of women seen by the program; and medical chart review. RESULTS: Of 265 women who agreed to a domestic violence referral, 177 (67%) were contacted for further evaluation. The study sample was ethnically diverse and included female victims seen for routine care, women who had been assaulted, women who had depression, and women with various somatic symptoms. Responses from 51 of the 177 women showed the most cited reasons for accepting referral were unhappiness with current situation, wanting to leave or change the situation, concern about children who witnessed abuse, and the suggestion by a health care practitioner that the patient's symptoms could be related to the abuse. Most reported having symptoms of depression in the previous year. CONCLUSIONS: Comprehensive programs in the health care setting can increase identification of victims of domestic abuse. This descriptive report provides a greater understanding of victims of domestic abuse, their presentation in the medical setting, their motivation for accepting referral, and issues which affect their recovery. Links between health care and community resources are necessary for effective intervention.