Two cases of arteriovenous fistula formation between the external iliac vessels following endovenous laser therapy.

Minimally invasive treatment of varicose veins is becoming increasingly popular with both patients and physicians. Endovenous laser therapy has been shown to be safe and effective but the rare complication of iatrogenic creation of arteriovenous fistulas has been described. One case of fistulation between the external iliac artery and vein has been published. We report two further cases and describe their management.

Heparin-induced thrombocytopenia in the presence of a heparin-bonded bypass graft.

The use of prosthetic grafts in below-knee bypasses may be necessary in patients with no available autologous vein and critical limb ischemia not amenable to angioplasty. Such conduits, however, have generally yielded disappointing results. A new, heparin-bonded, expanded polytetrafluoroethylene graft (Gore Propaten vascular graft) designed to provide resistance to thrombosis may be associated with decreased early graft failure and increased patency. A concern with exposure to heparin, and therefore heparin-bonded prostheses, is the development of heparin-induced thrombocytopenia (HIT). Although rare, this requires prompt graft removal. We present a case to highlight this serious complication and review the literature on this topic.

Allegations of children's involvement in ritual sexual abuse: clinical experience of 20 cases.

Twenty cases were evaluated in which allegations had been made of children being involved in ritual sexual abuse (RSA). A selection of case histories are presented together with a summary of the salient points in the other cases. Using a standard format developed for assessing the validity of allegations in sexual abuse cases, it was concluded that false allegations of ritual sexual abuse occurred in three-quarters of the cases and true allegations only in one-quarter. This high rate of false allegations is unlike the author's clinical experience in other cases of child sexual abuse where the rate of false allegations is much lower and similar to other published series. Reasons for the high rate of false allegations are discussed.

The effect of Skylab on the chemical composition of saliva.

The levels of specific proteins and electrolytes in stimulated whole saliva were monitored in Skylab crew members before and after each mission. With few exceptions, mission-associated compositional changes in saliva were relatively minimal. There were no changes in(formula see text), Cl-, albumin, or IgG concentrations. There were slight decreases in total protein coinciding with moderate saliva flow rate increases immediately before and after each flight. Other changes included diminutions in Na+ and lysozyme, and elevations in Mg++ and IgA. The IgA increase was the most pronounced mission-associated change observed.

Effect of Skylab missions on clinical and microbiologic aspects of oral health.

Clinical and microbiologic measures of oral health were assessed in all crew members of each Skylab mission. Clinical factors included preflight and postflight clinical services, provisions for in-flight emergency dental care, and the preflight and postflight monitoring of alterations in clinical indexes of oral health. Microbiologic measures included the preflight and postflight monitoring of changes in microbial populations at various intraoral sites. Problems involving preflight and postflight clinical services were minimal and easily resolved. In-flight dental problems requiring emergency self-treatment were not encountered. Moderate increases were observed in the in-flight increments of dental plaque, calcalus, and gingival inflammation. With the possible exception of gingival inflammation, mission-related changes in clinical indexes of oral health mainly corresponded to those of comparable periods under more conventional circumstances. Microbiologic assessments showed noteworthy elevations in counts of specific anaerobic components of the oral microflora, streptococci, neisseria, lactobacilli, and enteric bacilli. Since most microbial changes occurred after the preflight incorporation of the space diet, they were believed to be diet related. The most meaningful finding of the study was the relative absence of intraoral changes that are hazardous to one's health.