Coronary Air Embolism During Removal of a Central Venous Catheter.

Coronary air embolism during removal of a central venous catheter.

Anaesthesiol Intensive Ther. 2012 Jan-Mar; 44(1): 21-24
Wo?ko J, D?browski W, Zadora P, Sawulski S, Tomaszewski A

Acute air embolism has been described during central venous cannulation, but it may also occur during catheter removal in a spontaneously breathing patient. We describe an episode of acute coronary ischaemia that occurred during CV catheter removal.A 23-year-old male, multiple trauma patient was treated over 27 days in an ITU. He required a tracheostomy, two weeks of mechanical ventilation, and several surgical interventions. On the 27th day, he was scheduled to be transferred to a low-dependency area and his CVC was removed from the left subclavian vein. After five minutes, the pressure pad was released from the site of cannulation; the patient started coughing and became dyspnoeic. He developed tachyarrhythmia with ST depression in the 2nd, 3rd and aVF leads, followed by marked ST elevation, and subsequently, ventricular fibrillation. The patient was placed in the Trendelenburg position and CPR was started. Normal sinus rhythm returned after three defibrillations. Echocardiography revealed the presence of a large amount of air bubbles within the left ventricle, which disappeared spontaneously within one minute. The patient quickly regained consciousness and his condition returned to normal within 12 h, with transient elevation of heart enzymes. Five days later, he was decannulated and transferred to the orthopaedic ward in a satisfactory condition.Air embolism during CV catheter removal is a rare event, but it may occur when a persistent tunnel remains after prolonged cannulation, associated with negative intrathoracic pressure created by a spontaneously breathing or coughing patient. In the case described, acute myocardial ischaemia occurred in the region supplied by the right coronary artery, which is located higher than the left one and is therefore more exposed to air bubbles. We could not demonstrate, however, the presence of a persistent foramen ovale, however some connection had to exist between the right and left sides of the heart in our patient.Special caution should be exercised during CV catheter removal, and the procedure should be always done with the patient placed in the Trendelenburg position. HubMed – depression


Validation of Psychometric Properties of the Persian Version of the Female Sexual Function Index.

Urol J. 2013; 10(2): 878-885
Ghassamia M, Asghari A, Shaeiri MR, Safarinejad MR

To examine the psychometric properties of a Persian language version of the Female Sexual Function Index (P-FSFI) amongst a sample of healthy Iranian women.All participants (562) completed a battery of questionnaires, including the P-FSFI, Depression Anxiety Stress Scales (DASS), Positive and Negative Affect Scales (PANAS), and Locke-Wallace Marital Adjustment Test (LWMAT). The dimensions of the P-FSFI and its convergent and divergent validity were examined, using principal component analysis and Pearson correlations, respectively. To examine the predictive validity of the P-FSFI, data collected from 562 healthy participants were compared with 108 women with sexual problems who completed the P-FSFI measure. The P-FSFI reliability was determined in two ways: calculating Cronbach alpha and measuring test-retest coefficients (with a 4-week interval).The results indicated that the P-FSFI is conceptualized within a-four factor model. These factors were named as: Sexual Response, Sexual Desire, Sexual-related Pain, and Sexual Satisfaction. Results also indicated that the P-FSFI and its 4 subscales had good internal consistency and test-retest reliability. Significant correlations in the predicted directions between the scores of the P-FSFI and its 4 subscales with the scores of DASS, PANAS, and LWMAT supported both the convergent and divergent validity for the P-FSFI. The results also indicated that the scores of the P-FSFI and its 4 subscales significantly differentiated women with and without sexual problems.In general, these findings support the reliability and the validity of the P-FSFI amongst Iranian healthy females. HubMed – depression


Chronic mild stress for modeling anhedonia.

Cell Tissue Res. 2013 Jun 26;
Wiborg O

Major depressive disorder is a complex disease implicating many brain circuitries. The clinical symptomatology is inconsistent and heterogenous and the pathogenesis is a complicated interplay of genetic and environmental factors. The episodic and recurrent nature of the disease, as well as the fact that several symptoms are only verbally expressed, make it challenging to establish valid and legitimate animal models of this disease. The purpose of this review is to provide some background knowledge and overview of valid rodent models of depression with an emphasis on our own experience with a chronic mild stress model in modeling of anhedonia and cognitive impairments associated with depression. In a final concluding remark, a ‘dying-forward’ hypothesis, for development of depression, is suggested on the basis of mainly our own data on a hippocampal pathology. HubMed – depression


The association between race and gender, treatment attitudes, and antidepressant treatment adherence.

Int J Geriatr Psychiatry. 2013 Jun 25;
Burnett-Zeigler I, Myra Kim H, Chiang C, Kavanagh J, Zivin K, Rockefeller K, Sirey JA, Kales HC

We examined the associations between treatment attitudes and beliefs with race-gender differences in antidepressant adherence.Subjects (n?=?186) were African-American and White subjects aged ?60?years, diagnosed with clinically significant depression, and had a new outpatient primary care recommendation for antidepressant treatment. Antidepressant adherence was assessed using the Brief Medication Questionnaire. Attitudes and beliefs were assessed using the Patients Attitudes Toward and Ratings of Care for Depression, two items rating perceived medication importance, and a modified version of the Stigma Scale for Receiving Psychological Help.African-American men and women had significantly greater concerns about antidepressants and significantly less understanding about treatment than White women. African-American men had significantly more negative attitudes toward healthcare providers than African-American and White women. African-American women were more likely than White men and women to endorse a medication other than their antidepressant as most important. Whereas some race-gender differences were found in personal spirituality, no group differences were found in perceived stigma. In a logistic regression model adjusted for key baseline variables, White women were significantly more adherent to antidepressants than African-American women (OR?=?3.05, 95% CI?=?1.06-8.81). Fewer concerns about antidepressants and indicating the antidepressant as the most important medication were both significantly associated with adherence. After including either of these two variables, the adherence difference between White women and African-American women was no longer significant (OR?=?2.56, 95% CI?=?0.84-7.80).Concerns about antidepressants and the importance of antidepressant medication are associated with adherence and are potentially modifiable through improved patient-provider communication, psycho-education, and therapeutic interventions. Copyright © 2013 John Wiley & Sons, Ltd. HubMed – depression