"A remarkable experience of god, shaping us as a family": parents' use of faith following child's rare disease diagnosis

A child's chronic illness can lead parents to utilize different types of coping, including religious beliefs and practices. Previous studies have generally focused on life-shortening diagnoses. The present study explored parental use of faith when the diagnosis was not life-shortening, using grounded-theory qualitative methodology. Data were collected using semi-structured telephone interviews with N = 12 parents of children diagnosed with Neuroendocrine Hyperplasia of Infancy (NEHI); approximately 50% of the diagnosed population in the United States at the time of the interview. Participants used faith to cope and make meaning in five ways: parents believed NEHI happened for a reason; beliefs provided resilience; parents were sustained by faith communities; beliefs affected parents' behavior; and beliefs developed over time. The results suggest that chaplains develop means for universal screening for spiritual struggle; educating congregational clergy how to support families in which a child has a chronic illness; and assisting parents construct meaning of their experience.

Left Ostial Stenosis Surgical Angioplasty

BACKGROUND

Left main coronary stenosis, including ostial lesions, is conventionally treated by coronary bypass surgery. This approach, however, restores a less physiological retrograde perfusion to part of the myocardium and may contribute to a competition of flows in non-occluded coronaries. Direct surgical reconstruction of the LMCA has been described and theoretically avoids these potential drawbacks.

METHODS

From May 1995 until December 2005, 25 patients with ostial left main stenosis underwent surgical angioplasty in our unit. Patients were all followed up clinically and with transesophageal echocardiography.

RESULTS

Mean age of the patients was 59.7 years (range, 33 - 73 years). The male to female ratio was 14 : 11. The left main coronary stem was approached anteriorly in all patients. The onlay patch consisted of saphenous vein and was extended across the aortotomy suture line. There were no early deaths or perioperative myocardial infarctions. All patients underwent follow-up clinical examination and transesophageal (TOE) echocardiography as well as other investigations when required. TOE demonstrated a wide open left main coronary artery normal flow pattern, and no aneurysmal dilatation or calcification of the onlay patch in 24 patients. After a mean follow-up of 8 years, the all-cause survival was 88 %, while event-free survival was 80 % with 21 pts remaining in CCS I.

CONCLUSION

Surgical reconstruction of the LMCA is a safe and effective treatment for left main stenosis. Re-institution of normal blood flow through the left main coronary artery possibly confers advantages over bypass surgery.

[Central serous chorioretinopathy. Studies of the site of the lesion with indocyanine green]

Indocyanine green angiographies of 33 patients with central serous chorioretinopathy (CSC) were examined in order to find out whether the location of ICG exudation was correlated with other findings. Areas of delayed choroidal filling at the site of the hot spot were found in 27 patients (82%). The hot spot was usually located at the margin of such areas. Furthermore, it seemed correlated to a larger ciliary artery in 19 patients (60.6%). A detachment of the pigment epithelium was detected in 18% and showed a characteristic early hypo- and late hyperfluorescence. There is evidence that the exudation of indocyanine green indicates a primary choroidal disorder as the cause of CSC. Many clinical features, for example pigment epithelial detachments, are easier to explain with this hypothesis. A correlation of the hot spot with variation of choroidal filling has to be interpreted with caution. Yet, it seems feasible that the border between areas of different speed of filling is especially vulnerable and might therefore decompensate in the case of diseased regulation of the choroidal vessels, as has been postulated for CSC.

[Exudation of indocyanine green from subretinal neovascularization and its significance]

Owing to its tight binding to protein, exudation of indocyanine green from subretinal new vessels would not normally be expected, but it has been demonstrated. We investigated 102 subretinal new vessels to find out how often exudation develops and to understand the reason for it. Exudation was found in 29 (28.4%) of the cases examined; 37 (36.6%) were stained, which means that these membranes became hyperfluorescent but not lighter than other, definitively non-exuding, structures on the fundus. In 26 (25.5%) no hyperfluorescence was seen in the late phase, and in 10, or 9.8%, neovascularization remained occult. The correlation of indocyanine green exudation with retinal blood or lipid deposits was significant (r = 0.77, p = 0.0001). Histological examinations showed a correlation of lipid deposits with a severe disintegration of retinal vessels. This finding, in combination with others, indicates that the exudation of indocyanine green reflects severe destruction of vessel walls, which does not seem to occur consistently in all neovascular membranes. The exudation of indocyanine green might be of prognostic value.

First human culture-proven Australian case of entomophthoromycosis caused by Basidiobolus ranarum

The first human case of entomophthoromycosis caused by Basidiobolus ranarum in Australia is described. Upon first presentation this rare disease was not recognized, but microscopy of biopsy sections and identification of the fungal isolate allowed this condition to be identified. Treatment with fluconazole was successful.