Electronic Structure of a Diiron Complex: A Multitechnique Experimental Study of [(dppf)Fe(CO) 3]+/0

Here we explore the electronic structure of the diiron complex [(dppf)Fe(CO)₃]^0/+ [1^0/+; dppf = 1,1'-bis(diphenylphosphino)ferrocene] in two oxidation states by an advanced multitechnique experimental approach. A combination of magnetic circular dichroism, X-ray absorption and emission, high-frequency electron paramagnetic resonance (EPR), and Mössbauer spectroscopies is used to establish that oxidation of 1⁰ occurs on the carbonyl iron ion, resulting in a low-spin iron(I) ion. It is shown that an unequivocal result is obtained by combining several methods. Compound 1⁺ displays slow spin dynamics, which is used here to study its geometric structure by means of pulsed EPR methods. Surprisingly, these data show an association of the tetrakis[3,5-bis(trifluoromethylphenyl)]borate counterion with 1⁺.

Endovenous laser ablation of saphenous vein is an effective treatment modality for lower extremity varicose veins

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed postoperatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28-69 years). Median operation time was 65 min (range 40-140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.

Endovenous Laser Ablation of Saphenous Vein is an Effective Treatment Modality for Lower Extremity Varicose Veins

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed post-operatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28–69 years). Median operation time was 65 min (range 40–140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.

Stress in carers of the elderly. A controlled study of patients attending a Sydney family medical practice

AIM

To examine stress in carers of the elderly who attended a solo family medical practice.

METHOD

Eighty-seven carers were compared with 102 non-caregiving controls. Subjects were asked to complete survey questionnaires either in the surgery or at home. The General Health Questionnaire (CHQ) was used to assess psychological morbidity, the Relative Stress Scale as a measure of subjective burden and information was collected on activities of daily living and instrumental activities of daily living.

RESULTS

No significant difference was found in GHQ scores, reflecting the high level of stress in this family practice sample (mean GHQ = 4.7, standard deviation = 6.2). Psychological morbidity in carers was associated with the provision of assistance with instrumental activities of daily living such as shopping, cooking and finances.

CONCLUSIONS

We suggest that because carers often encounter specific challenges which may be amenable to intervention, general practitioners should familiarise themselves with these issues, determine the caregiving status of their patients and provide information about community services to carers.

A mobile rehabilitation team program to assist patients in nursing homes rehabilitate and return to their homes

A slow-stream rehabilitation program for frail elderly patients was developed utilising nursing homes visited by a mobile rehabilitation team (MRT) based at the hospital from which these patients had been discharged following major illness. The nursing homes were able to provide physiotherapy and the MRT contributed medical, nursing, occupational therapy and social work support through weekly visits. The supported group and a control group (also discharged to nursing homes from the same hospital but unsupported) were matched for age, sex and ADL level. Outcomes for the two groups were compared and were significantly different. Of the supported group (N = 33), 64% (N = 21) were discharged home compared with only 9% (N = 2) of the 23 control subjects (chi2 = 15.6, df. = 1, P < 0.05). The potential for patient rehabilitation in a modestly supported nursing home was realised.

Maintaining quality of aged care in institutions: from structure to outcome

Maintenance of quality of care in Australian nursing homes has evolved, being initially concerned mainly with physical features of the buildings. Progress occurred when regulations were introduced for nursing practices, staff levels and procedures generally. In the present phase, the focus has been on outcome in terms of the quality of life of the residents. This is being achieved by laying down specific outcome standards and their implementation is controlled by an inspectorial system that has the capacity to apply sanctions.

Factors associated with falling in elderly hospital patients

Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling. The control subjects were matched for age (+/- 3 years), sex, patient type, and primary diagnosis. The examination was based on established assessments of posture, balance and gait, the musculoskeletal system, vision, cardiovascular status, and neurological function. Bivariate analyses revealed seven assessment measures that were significantly associated with falls: cognitive impairment, particularly impaired orientation; evidence of previous cerebrovascular accident; incoordination as measured clinically; inability to perform the 'Get-up-and-go' test, especially an inability to turn around after a 5-metre walk, and the use of psycho-active medications. Of these variables, impaired orientation, psycho-active drug use, evidence of stroke, and impaired performance in the 'Get-up-and-go' test were included in a stepwise logistic regression which correctly classified 80% of the patients into faller and non-faller groups. Falling was also related to the number of these identified risk factors. These findings suggest that a simple screening protocol, taking about 5 min to complete, can assist in the identification of patients at risk of falls whilst in hospital.

A comparison of caregivers for elderly stroke and dementia victims

OBJECTIVE

To compare elderly co-resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity.

DESIGN

Cohort study.

SETTING

Caregivers interviewed at home.

SUBJECTS

Convenience sample, 99 co-resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over.

MAIN OUTCOME MEASURES

Caregiver burden as measured by self-administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ).

RESULTS

Forty-six percent of caregivers had significant psychological morbidity (GHQ greater than 4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P less than 0.01; stroke caregivers r = 0.30, P less than 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P, 0.0001).

CONCLUSION

Elderly co-resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.

Aorto-iliac aneurysms following umbilical artery catheterization

Aneurysms of the aorta and its major branches are rare in the pediatric population and are usually associated with cardiovascular malformations. Recently, however, a number of children have emerged with aneurysms following umbilical artery catheterization (UAC). In the last 8 years, two such patients have presented at the Medical College of Virginia. These are reported in detail and compared with 18 others found in the literature (12 thoracic, 4 abdominal, 2 iliac). Several conclusions follow from the study of this group of 20 children: The history of umbilical artery catheterization in the presence of bacteremia, especially staphylococcal, is a prime risk factor in the development of aneurysms (90%, P less than .01). In addition, there was a concordance between the location of the catheter tip and the site of future aneurysm formation (P less than .05). UAC associated aneurysms are difficult to diagnose because of their rarity and have often been mistaken for tumors. The diagnosis should be suspected in the workup of a tumor in a child with an appropriate history. Though these aneurysms are probably mycotic, pus has not been encountered at surgery and there have been no reported graft infections. Patients with S aureus bacteremia complicating UAC should be followed closely to detect aneurysm formation.

Brown recluse spider bites

The brown recluse spider (Loxosceles reclusa), found in many areas of the United States, is capable of producing significant medical problems and potentially life-threatening systemic manifestations. This paper reviews the clinical presentation, diagnostic workup, pathophysiology, and management of the brown spider bite. Emphasis is placed on the potential for error in establishing this diagnosis. The need for a simplified management program is discussed along with current concepts on how to achieve this management program. Attention is also directed to the more serious complications.

Late results of ureteroureterostomy in puppies

Experimental resection of a segment of ureter in the puppy with end-to-end ureteroureterostomy led to severe anastomotic stricture, obstructive atrophy, and 100% ipsilateral renal loss at one year. This may have been the result of unrecognized anastomotic tension. Transureteroureterostomy was followed by normally functioning upper urinary tracts at the end of one year, without evidence of damage to the recipient ureter. These experimental findings in the growing animal suggest that transureteroureterostomy in the immature nondilated ureter is a safe and reliable procedure in the management of surgically acquired unilateral segmental ureteral defects.