Parsing dimensions of family violence exposure in early childhood: Shared and specific contributions to emergent psychopathology and impairment

Early childhood exposure to family violence predicts increased risk for psychopathology. However, violence between partners and towards children often co-occur. This complicates efforts to determine how experiences of family violence contribute to early mental health problems. Utilizing mother-report data on harsh parenting and intimate partner violence (IPV) from two large community-based, socioeconomically and ethnically diverse samples of 3-5-year-old children, we illustrate the value of a bifactor method for characterizing a family climate in which verbal and physical violence are more chronic and pervasive among family members. In our Calibration sample (N = 1,179), we demonstrate the fit of a bifactor model with a shared violence factor reflecting violence among partners and towards children and orthogonal factors for physically harsh parenting and IPV. Examination of item distributions along quartiles on the identified factors reveals that violent behaviors are most frequent/chronic in families with high scores on the shared violence factor. Next, we apply this model in Validation (N = 1,316) and lab-visit samples (N = 369). Children's symptoms and impairment showed relatively strong and consistent associations with the shared factor. Some unique associations with IPV and harsh parenting were also observed. Overall, patterns suggest particularly negative impact when verbal and physical violence are more chronic and pervasive among family members. Finally, evidence supporting the bifactor model's validity relative to multi-method data from coded interviews about child abuse and IPV and observed parenting is presented. Findings illustrate the value of a bifactor approach for the meaningful characterization of shared and specific features of family violence.

Safety and efficacy of intravenous diltiazem in atrial fibrillation or atrial flutter

This study examines the efficacy of various doses of intravenous diltiazem to control the ventricular response during atrial fibrillation or atrial flutter. Control of the ventricular response of patients with atrial fibrillation and a rapid ventricular response can provide patients with relief of symptoms and improve hemodynamics. Eighty-four consecutive patients with atrial fibrillation or atrial flutter, or both, received an intravenous bolus dose of diltiazem followed by a continuous infusion of diltiazem at 5, 10, and 15 mg/hour. The mean ventricular response and blood pressure were monitored. Overall, 94% of patients (79 of 84) responded to the bolus dose with a > 20% reduction in heart rate from baseline, a conversion to sinus rhythm, or a heart rate < 100 beats/min. Seventy-eight patients received the continuous infusion. After 10 hours of infusion, 47% of patients (confidence interval [CI]: 36%, 59%) had maintained response with the 5 mg/hour infusion, 68% (CI: 57%, 79%) maintained response after the infusion was titrated to 10 mg/hour, and 76% (CI: 66%, 85%) after titration from the 5 and 10 mg/hour infusion to the 15 mg/hour dose. For the 3 diltiazem infusions studied, mean (+/- SD) heart rate was reduced from a baseline value of 144 +/- 14 beats/min to 98 +/- 19, 107 +/- 25, 107 +/- 22, 101 +/- 22, 91 +/- 17, and 88 +/- 18 beats/min at infusion times 0, 1, 2, 4, 8, and 10 hours, respectively. By the end of the infusion, 18% of patients (14 of 78) had conversion to sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative identification of a radiofrequency lesion allowing validation of catheter mapping of ventricular tachycardia with a computerized balloon mapping system

Radiofrequency current was utilized to mark the anatomic location of earliest endocardial activation during catheter mapping of ventricular tachycardia. Intraoperative identification of the radiofrequency lesion allowed validation that the site of earliest endocardial activation determined by a catheter mapping study was the same as assessed by a computerized balloon mapping system. Radiofrequency current may be a useful method of marking areas of endocardium thought to be potential sites for ablative surgery as well as allowing correlation between different mapping techniques.

Lack of association between keratoconus, mitral valve prolapse, and joint hypermobility

The authors enrolled 95 patients with keratoconus and 96 matched controls in a cross-sectional study to determine if mitral valve prolapse and hypermobile joints occur with greater frequency in individuals with keratoconus than in individuals without keratoconus. The hypothesis that keratoconus may not be a distinct eye disease, but a nonspecific sign representing a more generalized systemic disorder, possibly a mild collagen tissue abnormality, was considered. M-mode and two dimensional echocardiography and cardiac auscultation detected no statistically significant difference in the prevalence of mitral valve prolapse in patients with keratoconus compared with controls. Formal, systematic examination of five joints also failed to detect a statistically significant difference in the prevalence of hypermobile joints in keratoconus patients and controls. However, as an ancillary finding, a significantly higher proportion of patients with keratoconus was found to have a history of hay fever than was the case with controls.

Cardiac evaluation of women distance runners by echocardiographic color Doppler flow mapping

Echocardiographic color Doppler flow mapping was performed in 46 normal women to determine the normal flow phenomena across each of the four heart valves. Three groups were studied: Group I consisted of 15 highly trained long distance runners, mean age 27 years, running an average of 105 km/week, with a mean rest heart rate of 45 beats/min; Group II consisted of 14 moderately trained long distance runners, mean age 28, running an average of 60 km/week, with a mean rest heart rate of 53 beats/min; Group III consisted of 17 sedentary control subjects, mean age 28, with a mean rest heart rate of 77 beats/min. Color Doppler flow mapping showed that the ventricular inflow and outflow patterns were the same for each of the groups and identified a regurgitant flow pattern across each of the valves. A tricuspid regurgitant flow pattern was present in 14 subjects (93%) in Group I, 8 (57%) in Group II and 4 (24%) in Group III. A pulmonary regurgitant flow pattern was present in 13 subjects (87%) in Group I, 8 (57%) in Group II and 3 (18%) in Group III. A mitral regurgitant flow pattern was present in 4 subjects (20%) in Group I, 5 (35%) in Group II and 1 (17%) in Group III and an aortic regurgitant flow pattern was present in 1 subject (6%) in Group I. Patients in Group I had significantly more tricuspid and pulmonary regurgitant flow patterns than did patients in Group III (p less than 0.001). Heart rate and distance training in women appear to correlate with the frequency of tricuspid and pulmonary regurgitant flow patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic identification of an aortic valve ring abscess

A valve ring abscess was diagnosed in four patients with a prosthetic aortic valve by identifying an echo-free space on two-dimensional echocardiography. Three of the patients presented with severe aortic regurgitation and congestive heart failure after an episode of endocarditis, but two of them did not have evidence of active endocarditis. The fourth patient had endocarditis, but no evidence of aortic regurgitation or heart failure. All four patients required valve replacement. Similar findings in all 11 previously reported cases suggest that a valve ring abscess can be diagnosed by two-dimensional echocardiography. It may be found without clinical evidence of endocarditis, in the absence of aortic regurgitation, without echocardiographically identifiable vegetations or during resolution of endocarditis.

Influence of left ventricular function on signal averaged late potentials in patients with coronary artery disease with and without ventricular tachycardia

Left ventricular dysfunction has been suggested as a cause of late potentials on the signal averaged ECG of patients with coronary artery disease. We compared the averaged surface ECG with angiographic findings in 57 patients with coronary artery disease and left ventricular dysfunction. Sixteen patients had sustained ventricular tachycardia and 41 had no documented arrhythmia. These two patient groups were comparable with respect to age, mean ejection fraction, and wall motion score. Late potentials, defined as voltage less than 25 microV in the last 40 msec of the filtered QRS complex, were found in 10 of 16 patients with ventricular tachycardia and in 6 of 41 patients without arrhythmia (p less than 0.005). However, late potentials were independent of ejection fraction, wall motion score, or presence of dyskinesis in both groups. There was no correlation between the total filtered QRS duration and ejection fraction or wall motion score in either patient group. In patients with coronary artery disease, late potentials are associated with ventricular tachycardia but are independent of global or regional left ventricular function. This finding has important implications for studies of the prognostic value of late potentials following myocardial infarction.

Vibrio vulnificus septicemia. Isolation of organism from stool and demonstration of antibodies by indirect immunofluorescence

Vibrio vulnificus was isolated from blood and stool cultures from a 65-year-old man who had underlying alcoholic liver disease. The patient had eaten raw oysters the day before he became ill. To our knowledge, this is the first published report of isolation of the organism from stool in a patient with primary septicemia, and it provides support for epidemiologic studies suggesting that the infection is acquired through the gastrointestinal tract by eating raw seafood containing the organism. It was also possible, in this case, to demonstrate the presence of high antibody titers to the blood isolate by indirect immunofluorescence but not by agglutinating or vibriocidal tests.