Perforation of the ascending aorta: a late complication of superior vena cava stenting.

Intravascular stenting of the superior vena cava (SVC) is an established therapy in patients with SVC syndrome. Late complications include re-occlusion, stent infection, migration, and perforation. Affection of the greater thoracic vessels is rare and life-threatening when it occurs. We present a case of ascending aorta laceration as a late complication of SVC stenting. Surgical therapy included excision of the aortic lesion and pericardial patch repair. This case illustrates successful management of a complication after palliative stenting of the SVC.

Discussion of neuroleptics and psychosocial treatment.

The author discusses the Neuroleptics and Psychosocial Treatment issue of the Schizophrenia Bulletin from the viewpoint of a practicing clinician. The clinical implications of each of the review articles are assessed in turn, and conclusions derived from the articles are summarized.

Harry Stack Sullivan colloquium: Sullivan's Clinical contribution during the Sheppard Pratt era--1923--1930.

HARRY STACK SULLIVAN came to The Sheppard and Enoch Pratt Hospital in Towson, Maryland, upon the initiative of Ross McClure Chapman, who had been appointed superintendent of the hospital in 1920. Sullivan had been at St. Elizabeths Hospital in Washington, D.C., where he had been associated with the foremost clinicians during there heyday of St. Elizabeths--William Alanson White, Edward J, Kempf, Ernest Hadley, and Lucile Dooley. Under Chapman's sponsorship Sullivan enjoyed complete autonomy in being able to set up a special unit at Sheppard, with free rein to hire his own nursing personnel. Although the date usually given for the initiation of his work at Sheppard is 1923, there is some indication from the correspondence with Chapman that he might have started as early as the latter part of 1922, either Novemeber or December. At the time, he was a quite young 30 or 31. Of special interest to us today is the fact that Sullivan arranged to have a stenographer take down a number of his interviews with patients during the years 1926 and 1927. These interviews, plus the routine records of staff conferences, including verbatim records of the case presentation, questioning of the patient, and various staff members' comments, constitute the bulk of the data for my presentation. This material enables us to develop some idea of Sullivan's clinical approach to a variety of psychiatric syndromes, as represented either by direct interview or by case conference comments 50 years ago. In this presentation I will outline Sullivan's approach to various clinical topics, and will include sample interviews which illustrate his clinical interviewing technique at that time.