Experience with early TEVAR treatment of uncomplicated type B aortic dissection.

The current paradigm for the treatment of chronic type B aortic dissection involves primarily medical treatment. The patients are then followed for sequelae like progressive dissection or aneurysmal degeneration, selecting this subgroup for further intervention. The European Collaborator Registry, the Talent Thoracic Retrospective Registry, and several meta-analysis showed that the uncomplicated type B dissection patients who underwent thoracic endovascular aortic repair (TEVAR) outperformed their counterpart in the complicated group. The INSTEAD trial, the first randomized trial to examine whether TEVAR is better than medical management in the chronic stable dissection patients, showed no benefit early on although mid-term data might show some benefit. Clearly more randomized controlled trials are necessary to create a paradigm shift. In the United States, the FDA approved TEVAR devices are for the descending thoracic aortic aneurysm and transection only. The use of these devices for dissection is off-label or for investigation only. As future study might broaden the use of TEVAR for the chronic dissection patients, the use of TEVAR in hybrid surgery and in the ascending aorta is also broadening the indication for this technology. With two decades of innovation behind, TEVAR will continue to evolve and innovate in the years ahead.

Attitudes and behavior of HIV-infected patients concerning dental care.

This preliminary, descriptive study investigated the behavior and attitudes of HIV-infected patients concerning dental care. A self-administered, anonymous questionnaire was completed by 101 of 102 consecutive HIV-infected adults (mean age 36 years). Since the diagnosis of HIV infection, 81 respondents reported that they had sought dental care; 54 reported visiting a dentist at least once a year; 41 had changed dentists; and 62 reported current mouth problems, for which 45 were receiving treatment. Forty per cent of all respondents were receiving treatment in a hospital dental department. The use of hospital facilities was not associated with advanced HIV disease. Seventy per cent of participants were satisfied with the dental treatment they had received since they were diagnosed with HIV (18 per cent had no opinion, and 12 per cent were dissatisfied). Twelve per cent were concerned that their HIV seropositivity would not be kept confidential. While 87 per cent of participants had disclosed their HIV-seropositivity to their current dentist, 29 per cent believed that the dentist could be reluctant to provide treatment if they did so. Some patients reported changing dentists or not seeking care based on their fear that dentists would be reluctant to provide treatment. Fifteen per cent of patients who had sought dental care reported that they were refused treatment because they had HIV. Participants were more likely to have received dental care within the previous year if they reported being able to afford treatment, or had dental insurance (p < 0.01). Because more than 33 per cent of respondents had incomes below the poverty line, it is likely that economic factors limit the access to dental care for patients with HIV. More research is required using a larger sample and a random selection of participants.

HIV-infected patients and dental care: nondisclosure of HIV status and rejection for treatment.

OBJECTIVE: To investigate reports of nondisclosure of HIV-seropositivity to dentists by HIV-infected patients and their rejection for dental treatment. STUDY DESIGN: An anonymous self-administered questionnaire was completed by 101 consecutive consenting HIV-infected patients. RESULTS: Eighty percent of respondents (mean age, 36 years) had visited a dentist since their HIV diagnosis; 15% of these reported that they had been refused treatment because the dentist did not want to treat HIV-infected patients. Rejection was reported by 25% of respondents with heterosexual and 14% with homosexual risk factors, 11% of recipients of blood or blood products, and 8% with unknown or multiple risk factors. Refusal was not associated with economic factors. Nondisclosure of HIV-seropositivity to their current dentist was reported by 13% of respondents. No respondents attending hospitals or health units reported nondisclosure, compared with 18% of respondents attending private dental offices (p < 0.05). CONCLUSION: More research is required with a larger sample to improve generalizability and to permit subgroup analysis.

[Technical note on the demonstration of rheumatoid factor by immunofluorescence]. / Note technique sur la mise en évidence du facteur rhumatoïde par immuno-fluorescence.

The authors present a new technic to point out the rheumatoid factor by immunofluorescence and compare this technic and the others to classical technics of agglutination. This technic allows to avoid the absorption of rheumatoid factor in the serological reactions using the immunofluorescence.

[Double heterozygous Hb O Arab/beta-thalassemia in a Tunisian child]. / Double hétérozygotie Hb O Arab/beta thalassémie chez un enfant tunisien.

A study realized in a Tunisian family of 22 persons has revealed a double heterozygoty Hb O Arab/beta(0) thalassemia in a child of 16 years old. The father of this child presents a beta thalassemia and his mother is haemoglobine O Arab homozygote.