A minimally invasive technique for closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: two case reports

<p>Abstract</p> <p>Introduction</p> <p>In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA). This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery and can be a life-saving procedure.</p> <p>Case presentation</p> <p>In the first case, an anesthetist attempted ultrasound-guided access to the right internal jugular vein during the preoperative preparation of a 66-year-old Caucasian man. A 7-French (Fr) triple-lumen catheter was inadvertently placed into his arterial system. In the second case, an emergency physician inadvertently placed a 7-Fr catheter into the subclavian artery of a 77-year-old Caucasian woman whilst attempting access to her right internal jugular vein. Both arterial punctures were successfully closed by means of a percutaneous closure device (Angio-Seal). No complications were observed.</p> <p>Conclusions</p> <p>Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This report demonstrates two practical points that may help clinicians in decision-making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.</p

A Wake-Up Call: Information Contagion and Strategic Uncertainty

A successful speculative attack against one currency is a wake-up call for speculators elsewhere. Currency speculators have an incentive to acquire costly information about exposures across countries to infer whether their monetary authority's ability to defend its currency is weakened. Information acquisition per se increases the likelihood of speculative currency attacks via heightened strategic uncertainty among speculators. Contagion occurs even if speculators learn that there is no exposure. Our new contagion mechanism offers a compelling explanation for the 1997 Asian currency crisis and the 1998 Russian crisis, both of which spread across countries with seemingly unrelated fundamentals and limited interconnectedness. The proposed contagion mechanism applies generally in global coordination games and can also be applied to bank runs, sovereign debt crises, and political regime change

Seeking genetic determinants of selected metabolic disorders in women aged 45–60

Introduction and objective. The biochemical and anthropometric consequences of metabolic disorders exert an enormous effect on the functioning of people worldwide. The aim of this study is to assess relationships between biochemical and anthropometric parameters associated with metabolic syndrome, and the presence of the PPAR-γ rs1801282, the FTO rs9939609, and the MC4R rs17782313 polymorphisms in women aged 45–60. Materials and method. The study included 425 women, aged 45–59 years, from the general population of the West Pomeranian Province in north-west Poland. The research procedure involved a structured interview, anthropometric and blood pressure measurements, biochemical analysis of serum, and genetic analysis. Results. The carriers of the A/A genotype of the FTO polymorphism had higher LDL levels than their counterparts with the T/T genotype (p=0.01). The carriers of the T/T genotype of the MC4R polymorphism had lower non-HDL levels than those with the C/C and C/T genotypes (p=0.019). Weight was related to the C/C and the C/G + G/G genotypes of the PPAR-γ gene polymorphism (p=0.046). The model of inheritance for the MC4R polymorphism had a significant effect on TG (p=0.039) and non-HDL (p=0.05) levels. Conclusions. The genotypes analyzed in the study had only a slight direct effect on the biochemical and anthropometric abnormalities typical of metabolic disorders. Nonetheless, the risk alleles (A allele of the FTO rs9939609 and the C allele of the MC4R rs17782313) were found to be related to lipid metabolism disorders in 45–60-year-old women

Patient aggression towards health care professionals

Purpose: To estimate the frequency of aggressive behaviors in health care institutions, and determine their influence on emotional reactions of medical workers. Materials and methods: The study involved 201 health care professionals from the regions of Lower Silesia and Opole in Poland. The authors employed the exposure to patient aggression inventory, based on the questionnaires of Merecz and Nowicka & Kolasa; this inventory divides patient aggression towards medical workers into seven different forms. Results: In over 90% of cases, health care professionals fell victim to patient aggression in a workplace. It mostly took forms of verbal aggression, a raised voice and shouting. A physical attack was reported by 45.6% of the surveyed; it resulted in physical injuries in 27.9% of psychiatric hospital workers and 24.7% of general hospital workers. As a reaction to patients’ verbal aggression, medical workers usually calmly explained that such behavior was improper. Violence and aggressive behaviors of patients evoked workers’ anger, fear, a feeling of resignation and the loss of their sense of safety. In most case's victims of patient aggression either coped with the problem themselves or asked their co-workers and superiors for help. Conclusions: Aggressive behaviors of patients arouse in medical staff, mostly anger. Medical workers usually cope with patient aggression themselves; nurses more often than other health care professionals ask their superiors and co-workers for help. It is necessary to conduct further research into the problem of patient aggression towards medical staff so that actions ensuring safety for workers can be taken

Influence of cigarette smoking on hormone and lipid metabolism in women in late reproductive stage

Małgorzata Szkup,1 Anna Jurczak,2 Beata Karakiewicz,3 Artur Kotwas,3 Jacek Kopeć,4 Elżbieta Grochans1 1Department of Nursing, 2Department of Clinical Nursing, 3Department of Public Health, Pomeranian Medical University in Szczecin, Szczecin, Poland; 4School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada Background: The aim of the study was to analyze lipid and hormone metabolism, body mass index (BMI), and age parameters in late reproductive stage women in relation to cigarette smoking.Methods: The study enrolled 345 healthy late reproductive stage women living in Poland; 13.33% were smokers. The first part of the study assessed lipid metabolism (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and hormone metabolism (estradiol [E2], follicle-stimulating hormone [FSH], and anti-M&uuml;llerian hormone [AMH] levels) in women in the early phase of the follicular menstrual cycle. The second part of study was carried out using the diagnostic survey method, with a standardized questionnaire (Primary Care Evaluation of Mental Disorders [PRIME-MD]) and the authors&rsquo; own research tools.Results: The women were aged 42.3&plusmn;4.5 years (mean &plusmn; SD). The BMI (24.8&plusmn;4.04&nbsp;kg/m2) did not differ significantly between the groups. The women who smoked cigarettes had a statistically significantly (p&lt;0.05) lower level of HDL as well as higher LDL and triglyceride levels (p&lt;0.05). Differences were also shown in hormone levels: non-smoking participants had statistically significantly higher levels of E2 and FSH (p&lt;0.05). In the group of non-smoking women, age was a predictor exerting a significant positive impact on the levels of total cholesterol, LDL, triglycerides, and AMH (p&lt;0.05). BMI contributed to a decline in HDL and triglyceride levels. In the group of smoking women, age significantly positively influenced the level of E2, and negatively influenced AMH. BMI was associated with a significant decrease in the HDL level.Conclusion: Smoking cigarettes affects the physical health of women in late reproductive stage through negative influences on lipid and hormone metabolism, among other factors. Age is an unmodifiable factor adversely affecting both lipids and hormones. Higher BMI has a negative influence on lipid metabolism in both groups of women in this study. Keywords: smoking, cholesterol profile, gonadal steroid hormone

The impact of selected demographic variables and disease on the causes and circumstances of femoral neck fracture

Introduction: Proximal femoral fractures are the major cause of hospitalization due to an injury among advanced age patients. Purpose: To analyse causes of femoral neck fractures. Materials and methods: The research material included medical documentation of 203 patients with femoral neck fractures. A research method employed in this study was an analysis of the documentation. A statistical analysis was performed using the chi-square test for independence. Results: The majority of women and men sustained an injury at home or on the way (62.5% and 46.2% respectively). Patients who had an injury at work were largely men. Most injuries were related to a disease. It has been observed that women considerably more often than men mentioned slipping as the cause of an injury (21.3% and 6.9% respectively). Men, on the other hand, more often than women incurred injuries as a result of falls (19.4% and 9. 5% respectively). The structure of an injury was similar irrespective of whether patients were diagnosed as having such diseases as diabetes, cataract and osteoporosis or not. Conclusions: There is a relationship between gender and the circumstances of an injury. Women more often sustain an injury at home, and men – at work. The circumstances and causes of injuries are not significantly related to diseases such as diabetes, cataract and osteoporosis