Inferior vena cava reconstruction to alleviate back pain.

We present the case of a 38-year-old man with end-stage renal disease receiving hemodialysis via a left femoral loop graft who developed debilitating back pain. During a maintenance fistulogram, we found a completely occluded inferior vena cava and engorged lumbar veins. The patient underwent inferior vena cava reconstruction with stenting, which resulted in complete resolution of the engorged lumbar veins on venography and a significant reduction in his back pain. Engorgement of the lumbar veins can cause significant pain, and treatment of the underlying pathology can alleviate these symptoms.

Contexts of Concealment: Initial Validation of Three Disclosure Avoidance Process Measures.

The choice to withhold subjective distress reflects a multifactorial decision highly sensitive to context. Unfortunately, existing measures are built on unidimensional models (i.e., concealment-disclosure as a single, bipolar dimension) and operationalize the construct as a stable trait. In this article, we outline the development and initial validation of a self-report inventory that accounts for problem-context and assesses multiple processes central to both the concealment and disclosure of emotional distress. Exploratory analysis of pilot items in Study 1 (male student sample; N = 373) guided subsequent item development and revisions to our conceptual model. In Study 2 (mixed-gender community sample; N = 297), we refined the item-pool based on additional tests of latent scale structure and associations with concurrent criteria. In a final validation sample (Study 3; international community participants; N = 978), confirmatory factor analyses corroborated our hypothesized three-factor model (Privacy Management, Disclosure Desire, and Social Fear) and supported measurement invariance by sex. The three Contexts of Concealment Scales (CCS) were internally consistent and associated in expected directions with external indices of concurrent concealment, disclosure, depression, anxiety, loneliness, experiential avoidance, and self-stigma.

The Impact of Performance-Based Scripts on Men's Sexual Communication to Peers.

Gender norms related to sexual behavior have a pervasive impact on the psychosocial development of men. These norms have been theorized to influence the formation of male sexual scripts, including those that place high emphasis on performative abilities. While research has indicated that endorsing performance-based scripts can have negative consequences, little work has examined how this sexual ideology is communicated by men to their peer groups. Using structural equation modeling, the current study tested a model of openness to communicate sexual behavior that is incongruent with existing performance-based scripts. A sample of 424 men were recruited from a variety of Internet platforms to participate in a one-time online survey. Results demonstrated that endorsing performance-based scripts impeded men's ability to discuss sexual behavior with male peers, female peers, and sexual partners. Men's lack of transparency about particular sexual experiences may be contributing to harmful narratives that rigidly emphasize sexual performance.

The Association Between Masculinity and Nonsuicidal Self-Injury.

Several known risk factors for nonsuicidal self-injury (NSSI), such as negative emotionality and deficits in emotion skills, are also associated with masculinity. Researchers and clinicians suggest that masculine norms around emotional control and self-reliance may make men more likely to engage in self-harm. Masculinity has also been implicated as a potential risk factor for suicide and other self-damaging behaviors. However, the association between masculinity and NSSI has yet to be explored. In the current study, a sample of 912 emerging adults from two universities in the Northeastern United States completed a web-based questionnaire assessing adherence to masculine norms, engagement in NSSI, and known risk factors for NSSI (demographics and number of self-injurers known). Stronger adherence to masculine norms predicted chronic NSSI (five or more episodes throughout the life span) above and beyond other known risk factors. Adherence to masculine norms was related to methods of NSSI. Clinical implications are discussed, including discussions of masculine norms in treatment settings. Future research should examine what specific masculine norms are most closely linked to NSSI and other self-damaging behaviors.

"Mad Scared" versus "I Was Sad": Emotional expression and response in urban adolescent males.

Decades of masculinity research have concluded that society places higher demands on males to adhere to norms for low emotional expression; yet, countless studies find that emotional expression is integral to well-being. Unfortunately, this contradiction places boys and men in a tenuous position as they must navigate a bombardment of societal messages about the importance of emotional stoicism and invincibility. For urban adolescents, the situation is more complicated as they encounter environmental stressors that place greater emphasis on projecting a tough façade. Thus, our primary aim was to assess to what degree dyads of close adolescent male friends from urban, low-income neighborhoods are able to engage in emotional expression and response and to explore some of the underlying mechanisms and interpersonal processes. Qualitative findings from our sample suggest that urban boys exhibit a wide range of behaviors when participating in dyadic emotional disclosure and response, including being highly emotionally expressive and supportive in the context of close male friendship.

Pilot trial of gender-based motivational interviewing for increasing mental health service use in college men.

Men are considerably less likely to seek professional and nonprofessional help for mental disorders. Prior findings indicate that adherence to masculine norms contributes to stigma about internalizing disorders and help seeking. There are currently no empirically supported interventions for increasing help seeking in men with internalizing symptoms. To address this need, we conducted a pilot study of gender-based motivational interviewing (GBMI) for men with internalizing symptoms. GBMI is a single session of assessment and feedback integrating gender-based and motivational interviewing principles (Addis, 2012). College men (N = 35) with significant internalizing symptoms and no recent help seeking were randomized to either GBMI or a no-treatment control and were followed for 2 months. GBMI had a significant effect on seeking help from parents and a trend for seeking professional help, but did not have a significant effect on seeking help from friends or partners. The size of the effect of GBMI on professional and nonprofessional help seeking ranged from small to medium. GBMI shows promise for improving men's help-seeking behaviors and warrants further development and investigation.

Congenital Absence of Inferior Vena Cava in a Young Patient with Iliofemoral Deep Venous Thrombosis Treated with Ultrasound-accelerated Catheter-directed Thrombolysis: Case Report and Review of the Literature.

Absence of the inferior vena cava (AIVC) is a rare congenital anomaly and result from aberrant development during embryogenesis. Deep vein thrombosis (DVT) is a frequent finding in healthy young adults who are diagnosed with congenital AIVC. This condition is best diagnosed with color venous Doppler ultrasound and computed tomography angiography or magnetic resonance imaging, and managed using anticoagulation, mechanical catheter-directed thrombectomy, and thrombolysis. Catheter-directed thrombolysis (CDT) followed by systemic anticoagulation and use of compression stockings appears safe and effective in the treatment of patients who present with acute DVT and AIVC. We present a case report of DVT with underlying AIVC treated successfully with CDT and will review the relevant English literature.

A Pilot Trial of Gender-Based Motivational Interviewing for Help-Seeking and Internalizing Symptoms in Men.

There has been limited research on interventions addressing the psychosocial barriers to men's underutilization of formal and informal help. To address this gap in the literature, we report on the development of Gender-Based Motivational Interviewing (GBMI) for men with internalizing symptoms and present the findings of a pilot trial. GBMI is a single session of assessment and feedback that integrates gender-based and motivational interviewing principles. Community-dwelling men (N = 23) with elevated internalizing symptoms and no recent history of formal help-seeking were randomized to either GBMI or control conditions and were followed for three months. The effect of GBMI on internalizing and externalizing symptoms ranged from small to large across follow-ups. GBMI had a small to moderate effect on stigma. There was no effect on help-seeking attitudes or intentions. GBMI increased use of informal help seeking (e.g. parents and partners) and had no effect on formal help seeking. None of these findings were statistically significant. Study weaknesses included baseline differences in help-seeking variables between conditions. This initial evaluation suggested that GBMI shows promise for improving mental health functioning while further research is need to determine its effect on help-seeking.

Combined diazepam and HDAC inhibitor treatment protects against seizures and neuronal damage caused by soman exposure.

The occurrence of status epilepticus (SE) is considered the main cause of brain lesions and morphological alterations, such as hippocampal neuron loss, that result in chronic epilepsy. Previous work demonstrated the convulsive and widespread neuropathological effects of soman, an organophosphorus compound that causes SE and severe recurrent seizures as a result of exposure. Seizures begin rapidly after exposure, can continue for hours, and contribute to prolonged physical incapacitation of the victim. This study attempts to identify anticonvulsive and neuroprotective drugs against soman exposure. Male Sprague-Dawley rats were exposed to 1.0 LD(50) soman. EEGraphical and neuropathological (Fluoro-Jade B staining) effects were analyzed at 72 h post-exposure to soman and subsequent treatments with diazepam (DZP) alone or in combination with histone deacetylase inhibitors, suberoylanilide hydroxamic acid (SAHA) or valproic acid (VPA). The extent of brain damage was dependent on the length of SE and not on the number of recurrent seizures. DZP treatment alone decreased SE time and damage in hippocampus, amygdala, thalamus and cortex, but not in piriform nuclei. The combination of DZP and VPA 100 mg/kg showed more anticonvulsive effects, decreased SE time, and afforded more neuroprotection in the hippocampus, mainly the ventral portion. The combination DZP and SAHA 25 mg/kg was more neuroprotective, but not more anticonvulsant than DZP alone. The DZP combination with VPA HDAC inhibitor proved to be a good treatment for SE and neuronal damage caused by soman exposure.

Acute progression of multiple visceral artery aneurysms.

A 62-year-old male with multiple medical problems including a long-standing history of muscular dystrophy presented with recurrent abdominal and back pain of 2-month duration. Two consecutive mesenteric arteriograms were performed 3 weeks apart as part of the work-up and treatment. The latest study revealed a significant progression in the size and number of visceral artery aneurysms. No association between the patient's muscular dystrophy and rapid development of these aneurysms has been previously reported. The patient's overall health and vascular anatomy prohibited any therapeutic intervention. This case represents the highest number of visceral artery aneurysms (13 in total) reported in a single patient.

Improving endothelial healing with novel chimeric mitogens.

BACKGROUND: Chimeric proteins may be used to direct cell-specific activity. Heparin-binding growth-associated molecule (HBGAM) binds to cell receptors that are relatively more robust on endothelial cells, and it may confer endothelial cell selectivity to potent angiogens such as fibroblast growth factor-1 (FGF-1). METHODS: By ligating fibroblast growth factor or its potent mutant, S130K, to HBGAM, we tested their effect on re-endothelialization after angioplasty injury by using a canine model. RESULTS: Both HBGAM/S130K- and HBGAM/FGF-1-treated arteries had increased neointimal mitotic index and re-endothelialization rates at 30 days compared with control arteries without inducing a significant increase in the neointimal thickness or the ratio of neointimal to medial thickness between treatment and control groups. CONCLUSION: HBGAM/S130K and HBGAM/FGF-1 facilitates endothelial healing without myointimal thickening after canine carotid artery balloon angioplasty injury. Application of these growth factors in fibrin glue may improve endothelialization clinically after angioplasty or endarterectomy.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Successful endovascular treatment of bleeding aortoenteric fistula: a case report.

Aortoenteric fistula (AEF) is an infrequent but disastrous complication of open abdominal aortic repair. Left untreated, it has a 100% fatality rate. The traditional approaches to the repair of secondary AEF (SAEF) are associated with average mortality rates of 21-59% and numerous major complications. Here, we report a case of acute gastrointestinal bleeding due to SAEF, successfully treated with endovascular stent graft repair. At 1-year follow-up, the patient was doing well without any signs of recurrent fistula. Endovascular treatment of AEF provides another treatment option that may be particularly valuable in patients whose comorbidities would preclude open repair.

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.

Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair: is the increased risk of spinal cord ischemia real?

Spinal cord ischemia after endovascular thoracic aortic repair remains a significant risk. Previous or concomitant abdominal aortic repair may increase this risk. This investigation reviews the occurrence of spinal cord ischemia after endovascular repair of the descending thoracic aorta in patients with previous or concomitant abdominal aortic repair. Over an 8-year period, 125 patients underwent endovascular exclusion of the thoracic aorta at the Mount Sinai Medical Center. Twenty-eight of these patients had previous or concomitant abdominal aortic repair. The 27 patients who underwent staged repairs all had cerebrospinal fluid (CSF) drainage during and following repair. This population was analyzed for the complication of spinal cord ischemia and factors related to its occurrence. Mean follow-up was 19.3 months (range 1-61). Spinal cord ischemia developed in four of the 28 patients (14.3%) who underwent endovascular thoracic aortic repair with previous or concomitant abdominal aortic repair, while one of 97 patients (1.0%) developed ischemia among the remaining thoracic endograft population. One patient with concomitant abdominal aortic repair developed cord ischemia that manifested 12 hr following the procedure. The remaining three patients with previous abdominal aortic repair developed more delayed-onset paralysis ranging from the third postoperative day to 7 weeks following repair. Irreversible cord ischemia occurred in three patients, with full recovery in one patient. Major complications from CSF drainage occurred in one patient (3.7%). Spinal cord ischemia occurred at a markedly higher rate in patients with previous or concomitant abdominal aortic repair. This risk continued beyond the immediate postoperative period. The benefit of perioperative and salvage CSF drainage remains to be determined.

Abdominal aortic aneurysm sac shrinkage after endovascular aneurysm repair: correlation with chronic sac pressure measurement.

OBJECTIVES: Abdominal aortic aneurysm (AAA) sac shrinkage after endovascular aneurysm repair (EVAR) is considered to be evidence of clinical success. Exclusion of the sac from systemic pressure is the likely cause of shrinkage. We report our continuing clinical experience with the use of a permanently implantable, ultrasound-activated remote pressure transducer to measure intrasac pressure and its correlation with changes in sac diameter over time. METHODS: Over a 22-month period, 21 patients underwent EVAR of an infrarenal AAA with implantation of an ultrasound-activated remote pressure transducer fixed to the outside of the stent-graft and exposed to the excluded aortic sac. Intrasac pressures were measured directly with an intravascular catheter and by the remote sensor at the time of stent-graft deployment. Follow-up sac pressures were measured by remote sensor and compared with systemic arterial pressure at every follow-up visit. Mean follow-up was 11.4 +/- 5.0 months (range, 1 to 26 months). Twenty patients had follow-up of > or =6 months. Mean pressure index (MPI) was calculated as the ratio of mean sac pressure to mean systemic pressure. RESULTS: Pressures could be obtained at all visits in 15 of the 21 patients. Fourteen of these 15 patients had follow-up of at least 6 months. Aneurysm sac shrinkage of >5 mm was seen in seven (50%) of these 14 patients. No aneurysm enlargement was observed in any patient. The MPI was significantly lower in patients with sac shrinkage at 6 months and at final follow-up. CONCLUSIONS: Endovascular aneurysm repair results in marked reduction of sac pressure in most patients. Patients with aneurysm shrinkage after EVAR have significantly lower MPI; however, the absence of sac shrinkage does not imply persistent pressurization of the sac. Further clinical follow-up will delineate the role of long-term sac pressure monitoring in surveillance after EVAR.

Social scientific paradigms of masculinity and their implications for research and practice in men's mental health.

Clinical researchers and practitioners are increasingly aware of the need for quality theory, research, and intervention in men's mental health. Successful work in this area requires an understanding of the multitude of ways that gender, and more specifically masculinities, can be conceptualized beyond a sole focus on sex differences between men and women. Drawing from a range of social sciences in addition to psychology, the authors consider several theoretical, research, and clinical directions that can follow from social learning, psychodynamic, social constructionist, and feminist paradigms. It is concluded that thinking deeply and critically within different paradigms of masculinity is critical for progress in both research and practice.

The Reasons for Depression Questionnaire (RFD): UK Standardization for clinical and non-clinical populations.

Recent research into reason giving for depression has illustrated the importance of client beliefs about the cause of their depression. Reasons given have been found to be associated with level of depression, perceived credibility of treatments and therapy outcome. It has been suggested that giving reasons for depression is a form of rule-governed behaviour and as such can cause the depression to be harder to treat (i.e. the reasons become functionally true for the individual). This study investigates the reliability and validity of the Reasons for Depression Questionnaire (RFD; Addis, Truax, & Jacobson, 1995), a 48-item self-report measure developed to measure explanations for the causes of depression. The study provides preliminary normative data for both clinical (n = 123) and non-clinical (n = 105) UK samples. The data indicate high reliability for all subscales including a further subscale (biological) added since the measure was initially developed. Certain subscales correlate significantly with level of depression and specific aspects of self-esteem. This supports the validity of the measure and suggests that it is measuring a distinct concept rather than significantly overlapping with individuals' general beliefs about themselves.

First experience in human beings with a permanently implantable intrasac pressure transducer for monitoring endovascular repair of abdominal aortic aneurysms.

OBJECTIVES: Endovascular stent graft repair of abdominal aortic aneurysms (AAAs) prevents rupture by excluding the aneurysm sac from systemic arterial pressure. Current surveillance protocols after endovascular aneurysm repair (EVAR) follow secondary markers of sac pressurization, namely, endoleak and sac enlargement. We report the first clinical experience with the use of a permanently implantable, ultrasound-activated remote pressure transducer to measure intrasac pressure after EVAR. METHODS: Over 7 months, 14 patients underwent EVAR of an infrarenal abdominal aortic aneurysm with implantation of an ultrasound-activated remote pressure transducer fixed to the outside of the stent graft and exposed to the excluded aortic sac. Twelve patients received modular bifurcated stent grafts, and 2 patients received aortouniiliac devices. Intrasac pressures were measured directly with an intravascular catheter and by the remote sensor at stent-graft deployment. Follow-up sac pressures were measured with a remote sensor and correlated with systemic arterial pressure at every follow-up visit. Mean follow-up was 2.6 +/-1.9 months. RESULTS: Excellent concordance was found between catheter-derived and transducer-derived intrasac pressssure intraoperatively. Pulsatile waveforms were seen in all functioning transducers at each evaluation interval. One implant ceased to function at 2 months of follow-up. In 1 patient a type I endoleak was diagnosed on 1-month computed tomography (CT) scans; 3 type II endoleaks were observed. Those patients with complete exclusion of the aneurysm on CT scans had a significant difference in systemic and sac systolic pressures initially (P <.001) and at 1 month (P <.001). Initial sac diastolic pressures were higher than systemic diastolic pressures (P <.001). The ratio of systemic to sac systolic pressure increased over time in those patients with complete aneurysm exclusion ( P <.001). Four of 6 patients with no endoleak and greater than 1-month follow-up had diminution of sac systolic pressure to 40 mm Hg or less by 3 months. CONCLUSION: This is the first report of a totally implantable chronic pressure transducer to monitor the results of EVAR in human beings. Aneurysm exclusion leads to gradual diminution of sac pressure over several months. Additional clinical follow-up will be necessary to determine whether aneurysm sac pressure monitoring can replace CT in the long-term surveillance of patients after EVAR.