Late presentation of aorto-right ventricular fistula and associated aortic regurgitation following penetrating chest trauma.

We present a case in which a 39-year-old man was assaulted in 2002 and sustained penetrating chest trauma. He was treated conservatively, and presented six years later with exertional dyspnoea and a continuous murmur. Echocardiography detected an aorta-right ventricular fistula and an important aortic regurgitation. The aorta-right ventricular fistula was repaired and the aortic valve was replaced with a mechanical prosthesis. Traumatic aorto-right ventricular fistulas and aortic regurgitation are often masked by the primary injury and may take months or years to become clinically evident.

Dying at home: emergency medications for terminal symptoms.

This article discusses the use of a medication kit at home for terminal symptoms. This innovation has been in place for more than two years at the Hospice of the Cleveland Clinic. There is no previously published information on this innovation in the literature.

Women and human services giving.

The first decades of the new century are expected to witness a dramatic increase in charitable giving. And women will be more influential than ever before in determining the beneficiaries of this giving. The purpose of the research reported in this article is to provide useful information for social workers involved in program fundraising by examining various factors that may influence women's future charitable giving to human services. Data for this study were taken from a representative national sample of 2,719 U.S. adults. The Gallup Organization conducted in-home face-to-face interviews in 1996 for the Independent Sector. The results of this secondary analysis indicate that people who give to human services, in contrast to those who do not, were more likely to be white women, have a higher income, and volunteer in human services. In addition, the analysis provides evidence that women are more committed to the role of charitable organizations in society and believe that they have the power to improve the welfare of others.

Corporate strategic philanthropy: implications for social work.

Corporate contributions to health and human services have declined from a high of 42.0 percent of total corporate giving in 1972 to 25.3 percent in 1994. At the same time, "strategic philanthropy" has become the state of the art in corporate contributions management. Strategic philanthropy is defined in this article as the process by which contributions are targeted to meet both business objectives and recipient needs. This concept represents the integration of philanthropy into the overall strategic planning of the corporation. This article describes a national survey of corporate philanthropy programs that examined the activities that characterize the strategic management of corporate philanthropy. Results suggest that corporations do not frequently evaluate their philanthropy programs. Social work professionals may use this information to increase their opportunities to provide evaluative input and to increase corporate funding of health and human services.

Atypical clinical presentation of bileaflet cardiac prosthetic valve dysfunction. Preliminary report.

Single-leaflet disc immobilisation in 3 patients with St Jude Medical prostheses and 1 patient with a Carbo Medics valve prosthesis resulted in mild mitral regurgitation without acute pulmonary oedema. Three patients presented with slowly worsening pulmonary congestion while 1 patient had neurological symptoms. Clinicians need to be aware of the possibility of single-leaflet failure in a bileaflet cardiac valve prosthesis, because haemodynamic deterioration occurs insidiously in these patients, resulting in atypical symptoms and signs.

Strategic philanthropy: an opportunity for partnership between corporations and health/human service agencies.

The study is a national survey of corporate philanthropy programs. The original problem underlying the study is the long-term decline in the percentage of total corporate contributions to health and human services. A questionnaire, mailed in May of 1993, was used to investigate the impact of strategic philanthropy on the relationship between corporations and health/human service organizations. Corporations strategically prioritizing their philanthropic support were expected to create new opportunities for partnerships between business and health/human service agencies. The survey resulted in a sample of 226 corporations. The results showed statistically significant support for the hypothesis that highly strategic philanthropy programs will be more likely to enter into a health/human service partnership than less strategic programs. The multiple regression analysis method was used to control for the effects of corporate size, industry type, the (corporate) contributions management organization, and United Way credibility. Based upon the results of the study, United Way is recommended to consider new roles for itself as a facilitator of partnerships between business and health/human service organizations.

Left atrial size--a risk factor for left atrial thrombi in mitral stenosis.

In a follow-up study, 77 patients with predominant mitral stenosis were examined to investigate the role of left atrial (LA) enlargement in LA thrombi. Fifteen (19.4%) patients had LA thrombi. Of these, 2 (13.3%) were in sinus rhythm and 13 (86.7%) in atrial fibrillation. Fourteen (93.3%) of the patients with LA thrombi had an LA size > or = 4.8 cm. Only one (6.7%) patient had an LA size of 4.4 cm and was in atrial fibrillation. The median LA size in patients with LA thrombi was 5.2 cm compared with 4.75 cm in patients without LA thrombi (p < 0.01). The relative risk for LA thrombi in patients with an LA size > or = 4.8 cm compared with patients with an LA size < 4.8 cm was 10.0 (95% confidence interval 1.4 to 71.4). It was thus confirmed that LA enlargement > or = 4.8 cm is an independent risk factor for LA thrombi in patients with mitral stenosis.

Echocardiographic study of left atrial thrombi in mitral stenosis.

Sixty-nine patients with predominant mitral stenosis were examined by echocardiographic means to detect the presence of left atrial thrombi. Forty-nine of these patients were in sinus rhythm and twenty in atrial fibrillation. Four percent of patients in the sinus rhythm group and 45% of those in the atrial fibrillation group had left atrial thrombi. The two risk factors identified for left atrial thrombi in mitral stenosis were atrial fibrillation and left atrial enlargement.

Intracoronary thrombolysis and coronary angioplasty for evolving myocardial infarction.

At present experience in South Africa with coronary reperfusion during the acute phase of myocardial infarction is limited. Acute reperfusion of an infarct-related coronary artery was attempted in 55 patients using intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA). Intracoronary streptokinase infusion had reopened 25 to 40 totally occluded lesions but usually a residual severe stenosis remained. PTCA was subsequently attempted in 36 severely stenotic coronary arteries and 19 totally occluded coronary arteries. PTCA was successful in 48 of the 55 cases (87%). After 1 week vessel patency was present in 36 of the 39 patients who had early coronary artery re-assessment. Late restenosis occurred in 4 out of 14 cases. There were no procedure-related deaths. Normal global as well as regional left ventricular function was present in 15 cases after 1 week. Emergency PTCA alone or in combination with intracoronary thrombolytic therapy is efficacious in achieving coronary reperfusion. On follow-up, left ventricular function appeared to be well preserved in 27% of patients with patent infarct-related arteries.

Daily serial evaluation of left ventricular function with equilibrium radionuclide ventriculography following thrombolysis during acute myocardial infarction.

The changes in ventricular function after reperfusion by coronary thrombolysis are important when deciding about further definitive treatment necessary to ensure long-term vessel patency. The purpose of this study was to evaluate the early changes in left ventricular function after reperfusion. Left ventricular function was serially evaluated for 10 days in a group of 18 patients receiving intracoronary thrombolytic therapy for an acute myocardial infarction. Comparison of the global ventricular function in the successfully and unsuccessfully reperfused groups of patients showed significantly better function in the successful group than the unsuccessful group after the first day, which was maintained for the entire study period. Global and regional ventricular function in the successfully reperfused patients showed significant early improvement during the initial 72 h with maintenance of this improvement for the study period of 10 days. In the patients in whom reperfusion was unsuccessful, regional ventricular function showed no change, while the global function declined from day 5 to day 8 of the study period. This study then confirms the significant improvement in ventricular function after successful reperfusion. The time course pattern of the change in ventricular function indicates that the most significant improvement occurs within the first 72 h after reperfusion. These changes are similar to those previously reported in experimental animals.

Myocardial bridging as a cause of myocardial infarction. A case report.

There is controversy over the clinical significance of myocardial bridging. A case of symptomatic bridging of the left anterior descending coronary artery resulting in myocardial infarction is reported.

Successful coronary reperfusion with intracoronary streptokinase in a patient with coronary ectasia.

A case in which successful coronary artery reperfusion was achieved during an acute inferior wall myocardial infarction by means of infusion of streptokinase (Kabikinase; Adcock Ingram) into an ectatic right coronary artery is described. The pathogenic mechanisms resulting in occlusion of ectatic coronary arteries and the incidence of the condition are discussed and the importance of anticoagulation therapy in these patients is stressed.

Absolute left ventricular volume changes after sublingual nitroglycerine and nifedipine intervention.

The haemodynamic effects of two vasodilators, sublingual nitroglycerine and nifedipine, on absolute end-diastolic volume, end-systolic volume, stroke volume (SV), heart rate, systolic blood pressure (SBP), cardiac output (CO) and corresponding cardiac indices were measured in two different groups, each consisting of 20 ischaemic heart disease patients, with gated blood pool scintigraphy. A control study was done in 5 ischaemic heart disease patients without intervention. Direct measurement of left ventricular (LV) volume was done by correcting LV activity for tissue attenuation utilising a geometric method. With nifedipine intervention only SBP (125.25 +/- 19.8 mmHg) showed a significant mean decrease (11 mmHg). The other measured parameters did not change significantly. With nitroglycerine all the parameters except LV ejection fraction showed significant changes. Mean CO decreased by 8% while mean SV decreased by 16%. The results in the control group showed excellent repeatability. The absolute haemodynamic changes of future cardiac drugs might easily be measured in vivo by this non-invasive technique.

Radionuclide evaluation of left ventricular function in a distantly located intensive coronary care unit.

Regular evaluation of left ventricular (LV) function is important in assessing patients in an intensive coronary care unit (ICCU). An adapted first-transit (FT) technique was applied to 21 patients for calculation of LV ejection fraction (LVEF). In this method the radionuclide is administered directly into the right pulmonary artery through a Swan-Ganz catheter. High-quality LV images are obtained because of minimal activity in the right ventricle and left lung. Data were acquired on a distantly located on-line computer system to restrict equipment in the ICCU. LVEF from FT compared well with LVEF from gated blood pool studies (r = 0.91) but gave consistently lower values. The adapted FT method ensures improved counting statistics during LVEF determination and facilitates evaluation of LV wall motion in the ICCU patient.

Plasma pyridoxal-5'-phosphate levels in myocardial infarction.

In 34 patients with acute myocardial infarction (MI) plasma pyridoxal-5'-phosphate (PLP) levels were significantly lower (5.22 +/- 1.88 ng/ml) than those in an age- and sex-matched control group (11.5 +/- 2.03 ng/ml). In another group of patients who had clinical and angiographic evidence of ischaemic heart disease but had not had an MI plasma PLP levels were not significantly different from those in the control group (10.07 +/- 2.98 ng/ml). However, plasma high-density lipoprotein cholesterol levels in this group (0.75 +/- 0.28 mmol/l) as well as in the MI group (0.76 +/- 0.28 mmol/l) were significantly lower than those in the control group (1.26 +/- 0.23 mmol/l). On follow-up, all of 15 patients who had had an acute MI showed a continuous decrease in plasma PLP levels of approximately 50% during the first 48 hours after admission. Sixteen healthy volunteers subjected to a period of prolonged fasting (+/- 30 hours) displayed a decrease of approximately 43% over this period. We conclude that an acute reduction in plasma PLP levels occurred during the acute phase of MI. Other factors, for example prolonged acute starvation, may also produce a rapid decrease in plasma PLP levels.

Left ventricular function evaluation using radionuclide methods in the intensive coronary care unit.

We describe an adapted first-transit (FT) technique to perform left ventricular ejection fraction (LVEF) measurements on patients with Swan-Ganz catheters in the intensive cardiac care unit (ICCU). The radionuclide is introduced directly into the right pulmonary artery through the catheter. High-quality images of the left ventricle are obtained owing to minimal activity in the right ventricle and left lung. LVEF measurements obtained by FT compared well with measurements obtained from gated blood pool studies (r = 0.91) but gave consistently lower values. The adapted FT method improves LVEF determination and left-ventricular wall motion evaluation in the ICCU patient.

Traumatic aorta-vena cava fistula detected with radionuclide angiocardiography. A case report.

Diagnosis of a traumatic aorta-superior vena cava fistula in a 54-year-old man is reported, and the value of radionuclide angiocardiography in detecting and localizing the lesion is described.

Lysis of a coronary embolus by intracoronary streptokinase. A case report.

A patient presenting with an acute myocardial infarction, probably caused by a coronary artery embolus after aortic valve replacement, was treated by intracoronary thrombolysis with streptokinase. Restoration of antegrade flow in the previously totally occluded vessel was followed by an uncomplicated recovery and evidence of good preservation of left ventricular function.