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AIDS: risk behaviors among rural Mexican women married to migrant workers in the United States.

International migration between Mexico and the United States has been acknowledged as a phenomenon that may contribute to the spread of AIDS in rural Mexico. The purpose of this study is to identify the information held by the participants regarding AIDS and to describe selected high-risk behaviors for AIDS transmission among a representative sample of rural women living in Mexico who are married to immigrant temporary workers to the United States. The women who participated in the study were married, of reproductive age, and had active sex lives with their spouses. Results revealed that most of the women interviewed had at least some knowledge about AIDS. Although some misconceptions were evident, most of the information they had was accurate. About one-third of the women felt at risk for AIDS, mostly because they doubted their husbands' fidelity, or because in the last five years they had donated blood, received a blood transfusion, or received an intramuscular or intravenous injection. The results of the study are discussed within the sociocultural context that surrounds the lives of the women interviewed.

Acquired Immunodeficiency Syndrome↗

Impact of immigration detention and temporary protection on the mental health of refugees.

BACKGROUND: Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. AIMS: To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. METHOD: Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection. RESULTS: A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. CONCLUSIONS: Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Adult↗

Stent migration necessitating surgical intervention.

BACKGROUND: Internal drainage with transhepatically or endoscopically placed endoprostheses has been used for many years as a temporary or definitive treatment for biliary tract obstruction. As a late complication, stent migration may occur. METHODS: We reviewed our records to identify patients who were operated on for a migrated endoprosthesis that was causing complications. In all, five such patients were identified. RESULTS: One patient had a large bowel perforation. Bowel penetration led to an interenteric fistula in one patient and to a biliocolic fistula formation in another. Small bowel distension was found in two patients. Surgical treatment consisted of local excision in three patients, segmental resection in one patient, and a bypass operation in the patient with biliocolic fistula. Postoperatively, four patients recovered without problems, but one patient died during a complicated postoperative course. CONCLUSION: If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications.

Adult↗

Emergent endovascular stent grafting for perforated acute type B dissections and ruptured thoracic aortic aneurysms.

BACKGROUND: The purpose of our study was to demonstrate the effectiveness of endovascular stent grafts in the treatment of acutely ruptured thoracic aortic aneurysms and type B dissections as an alternative to the conventional surgical approach in an emergency setting. METHODS: From January 2001 to October 2001, we deployed 11 emergent endovascular stent grafts into the thoracic aorta. We treated seven ruptured aortic aneurysms and four acutely perforated type B dissections. Aortic rupture was confirmed preoperatively by spiral computed tomography. In all cases, hemothorax was present. The average interval from onset of symptoms to treatment was 28.5 hours. We used nine Talent and two Excluder stent grafts. RESULTS: Deployment of the stent grafts was successful in nine cases. There were two cases of access failure due to small caliber of iliac arteries, and 1 of these patients died shortly after the procedure was abandoned, At 12 months of follow-up, there were no cases of paraplegia, stent migration, or endoleaks. There was, however, one temporary renal failure, and 2 patients required mechanical ventilation for more than 48 hours. CONCLUSIONS: Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in high-risk patients.

Adult↗

Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulation.

OBJECTIVE: To assess the long-term efficacy and safety of two-stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR). PATIENTS AND METHODS: The two-stage technique is used if patients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4-7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two-stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the thera-py and resolution. Residual urine was assessed by self-catheterization. The long-term voiding diary results were compared with baseline estimates and analysed statistically using the two-sided Student's t-test. RESULTS: Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44-66) underwent the two-stage technique; the mean (median, range) follow-up was 4.9 (5.2, 2.5-7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1-4) and these all failed in the subchronic phase. All patients underwent a first- and second-stage implant after a mean (range) screening period of 12.2 (2-29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow-up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention. CONCLUSION: The long-term results of the two-stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two-stage technique can offer a good and safe alternative of comparable efficacy in the long-term. If the two-stage technique had not been available to these 12 patients they would not have been offered neuromodulation.

Adult↗

John Turner's theory of intra-urban mobility and the African reality: examples from East and West Africa.

"The purpose of this paper is to discover whether Turner's Latin American model of intra-urban mobility also applies to Sub-Saharan Africa. Because of the scarcity of literature on mobility within African cities, it is not entirely possible to arrive at definitive conclusions. Nevertheless, the often temporary nature of rural-to-urban migration, the operation of ethnic networks in the city, the role of the extended family in the integration of migrants and the specific patterns of landownership in the peripheral zones around African cities strongly suggest that the Latin American model is of little value for explaining the African reality."

Africa↗

Migration, population growth, and development.

In the 30 years between 1950 and 1980, the population of the developing world almost doubled--from 1.7 to 3.3 billion. Among the most conspicuous signs of this increase are the growth of cities and, in some areas, international labor migration. Since 1950 the cities in Africa, Asia, and Latin America have been growing more than twice as fast as those in North America and Europe. Some of the biggest cities are growing fastest--by as much as 8 percent each year. At this rate they will double in less than a decade. About 40 percent of this growth is due to migration and 60 percent to the children born in the cities to natives and the newly arrived migrants. Altogether, about one billion people (1,000 million) now live in developing-country cities, where fewer than 300 million lived in 1950. About 15 to 20 million workers, mostly from developing countries, are now international migrants. About half travel to Europe and the US, the rest to other developing countries. Many of the migrants, especially to the US, Europe, or the Middle East, want to bring their families eventually and settle permanently. Migration to African destinations is more likely to be temporary or seasonal, while Latin American and Asian patterns are mixed. Policy makers in developing countries are voicing concern about the highly visible social, economic, and political problems created by rapid urbanization and by large-scale international labor migration. While governments have tried a variety of policies to influence population distribution, most have been limited in scope and had little success. As long as birth rates remain high in some areas and large differences in wages exist between jobs in different places, most of these policies have little hope of stopping or reversing long-term trends. Family planning programs, although they do not create immediate jobs or higher wages in rural areas, can help to reduce the high birth rates that produce an ever-increasing supply of potential migrants. They also directly address the source of 60 percent of urban growth: natural increase. The main reasons for both rural-to-urban and international migration are economic. Except in the case of refugees (not covered in this report), most migrants move because they expect to find better jobs and higher wages in the new location. Often the decision to migrate may be made by the family because the money that migrants send home adds to and diversifies family income.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

[Criteria for utilization and indications for use of permanent and short- and medium term temporary endocaval filters. Personal experience and review of the literature].

Screening and prophylaxis of the population at risk is the most correct approach to thromboembolic disease. Caval filters play a major role in the prevention of pulmonary embolism, but their use remains widely controversial, even if they are an alternative or additional method to medical therapy and not antithetical to it. July, 1990, to September, 1995, seventy-seven permanent vena cava filters (59 LGM, 13 Filcard and 5 titanium-Greenfield), 22 short-duration temporary vena cava filters (11 LGT, 6 Filcard, 3 Filcard-Emanuelli and 2 Lysofilter) and 10 mid-duration temporary vena cava filters (Tempofilter) were inserted in 109 patients (55 men and 54 women) aged 17-88 years. An inferior vena cavogram was always made before filter insertion to "map" the inferior vena cava and its tributaries (renal veins) and to assess caval size. This is a mandatory step to exclude or confirm the presence of endocaval thrombi. Sixty-eight filters were inserted percutaneously via a right internal transjugular approach, 40 via a common transfemoral approach (34 right and 6 left) using the same route as inferior cavography and digital pneumoangiography. One temporary filter was inserted via a right transhumeral approach. Sixty-three patients (57.8%) (44 with a permanent filter, 14 with a temporary filter and 5 with a Tempofilter) had medical diseases, 7 patients (6.4%) (4 with a permanent filter, one with a temporary filter and 2 with a Tempofilter) had surgical conditions; 10 patients (9.2%) (7 with a permanent filter and 3 with a Tempofilter) were surgical-orthopedic patients. Twenty-seven patients (24.8%) (22 with a permanent and 5 with a temporary filter) had cancer. Two patients (1.8%) with a temporary filter were breast feeding. All the patients had deep venous thrombosis of the lower limbs, including the inferior vena cava and the right renal vein in two patients. A proximal floating thrombus and a pulmonary thromboembolism was diagnosed in 41 (37.6%) and 34 (31.2%) cases, respectively. The temporary filters remained in situ 1-4 days and the Tempofilters 3-5 weeks. A pelvic hematoma developed (because of heparin?) after the insertion of a temporary filter and a Tempofilter branch detached and migrated into a lower branch of the left pulmonary artery were reported as immediate and short-term consequences. There were no early or late consequences for the patients. An axillary hemorrhage was observed in the site of previous surgery, during fibrinolysis with a Lysofilter, as well as the incomplete opening of a titanium-Greenfield filter and of two permanent LGM filters, partly trapped within endocaval thrombi. No further consequences to the patients due to permanent filters were observed, nor any case of symptomatic pulmonary thromboembolism, in patients with permanent or temporary filters. With reference to the relative literature and to their own experience, the Authors propose a detailed and rational synthesis of the diagnostic-instrumental approach protocol to thromboembolic disease.

Adolescent↗

Loa loa infection in temporary residents of endemic regions: recognition of a hyperresponsive syndrome with characteristic clinical manifestations.

Loiasis in residents of endemic areas is generally manifested by microfilaremia, episodic angioedema, periocular migration of adult worms, modest eosinophilia, and variable antibody levels. In 20 temporary residents who acquired loiasis in West Africa, however, the clinical presentations were markedly different. Only three of the 20 had detectable microfilaremia. Furthermore, these patients often showed a state of marked immunological hyperresponsiveness manifested by very high titers of antibody to filariae, increased levels of serum IgE, and profound hypereosinophilia--to levels greater than 3,000/mm3 in 18 of the 20. These patients were also notable for the increased severity, frequency, and pruritic nature of their angioedema. Also, significant complications occurred in seven of the 20; one patient developed endomyocardial fibrosis and six, renal disease after treatment with diethylcarbamazine. Thirteen of the 20 developed subcutaneous nodules; adult parasites were recovered from three of five of these patients who underwent biopsy. All of the patients responded to therapy with diminution of their clinical symptoms and decreases in levels of eosinophils, IgE, and antibody to filariae.

Adult↗

Integrating stress physiology, environmental change, and behavior in free-living sparrows.

As weather deteriorates, breeding animals have a diverse array of options to ensure survival. Because of their mobility, birds can easily abandon territories to seek out benign conditions away from the breeding site. The timing of abandonment, however, may have repercussions for territory size, mate quality, reproductive success, and survival. There is a large body of evidence indicating that the adrenocortical response to stress plays a role in mediating the onset and maintenance of this behavioral switch. Here we develop a model describing the interactions of weather, food availability, body condition, and stress physiology in initiating departure from the breeding site. We tested the model using a population of white-crowned sparrows breeding at high elevation in the Sierra Nevada, where severe weather at the beginning of the breeding season often induces temporary abandonment of breeding territories and facultative altitudinal migration to lower elevation refugia. The data show that (1). during inclement weather, exogenous corticosterone delays return to the breeding site after territory abandonment; (2). during good weather, exogenous corticosterone alone does not induce territory abandonment, but does increase activity range around the breeding site; and (3). the magnitude of the corticosteroid response to stress is inversely related to body condition of the sparrow.

Adipose Tissue↗

The biopsy diagnosis of gastroesophageal reflux disease, "carditis," and Barrett's esophagus, and sequelae of therapy.

Histologic changes indicative of gastroesophageal reflux disease (GERD) are found on both sides of the squamocolumnar junction (Z-line). In the gastric cardia, inflammation is found as part of GERD in the absence of Helicobacter pylori or other causes of gastritis (carditis). The squamous mucosa is the location most likely to show inflammatory changes, such as neutrophils or eosinophils, close to the Z-line, whereas traditional reactive changes in the squamous mucosa are found only in biopsies taken at least 3 cm above the Z-line. Endoscopic criteria for GERD have a morphologic counterpart in capillary congestion and hemorrhage into the papillae, which have largely been ignored by pathologists as secondary to biopsy trauma. A biopsy protocol that maximizes the chances of detecting changes of GERD is suggested. The traditional definition of Barrett's esophagus as requiring 3 cm of glandular mucosa extending into the esophagus is no longer tenable. However, even the concept of short-segment Barrett's esophagus, in which less than 3 cm of intestinalized mucosa is present, often as tongues, is being challenged because random biopsies immediately distal to the Z-line may also show intestinal metaplasia when Barrett's esophagus is unsuspected endoscopically. Moreover, it is difficult or impossible to determine whether these changes indicate the earliest lesion of Barrett's esophagus or intestinal metaplasia in native cardiac mucosa. It is suggested that Barrett's esophagus be redefined as intestinal metaplasia in the lower esophagus. It is presently unclear whether patients with such minimal Barrett's epithelium are at increased risk for adenocarcinoma or require surveillance. Successful therapy for GERD results in healing of disease in squamous mucosa and may result in regression of Barrett's epithelium. In the stomach it may be associated with temporary regression of H. pylori and associated inflammation, migration of H. pylori into the oxyntic mucosa, hypertrophy and hyperplasia of parietal cells, and a variant of fundic gland polyps. Some patients may be at risk for accelerated atrophic gastritis if inflammation is present before therapy.

Adult↗

Healing characteristics of expanded autografts on wounds covered with homograft and Biobrane temporary wound dressing.

This study compared the healing characteristics of expanded autografts on wounds with interstices that were closed with cryopreserved cadaver homograft split-thickness skin and wounds with interstices that were closed with the synthetic skin substitute, Biobrane temporary wound dressing. Nine paired wounds in four patients with large burns were used in this study. When Biobrane temporary wound dressing adhered to a wound, epithelial migration did not proceed until it was removed. Although wounds covered with homograft immediately had the appearance of healed wounds, biopsy specimens showed evidence of a delay in epithelial migration. Although these results indicate impaired epithelial migration with the use of both materials, we concluded that homograft offered an advantage because the wounds that were covered with it remained closed during the entire reepithelialization process.

Adult↗

Intermittence of blood flow in liver sinusoids, studied by high-resolution in vivo microscopy.

Kupffer cell migration and leukocyte-vessel wall interactions cause temporary slowing and/or stoppage of blood flow through individual liver sinusoids. Such temporal heterogeneity of flow was quantified in anesthetized mice and rats. Video recordings of red blood cell flow in 44 networks containing 8-16 sinusoids each were analyzed for 5- to 10-min periods. Flow was graded "fast," "slow," "stopped," or "reversed" based on red blood cell velocity. The mean numbers of flow changes (between grades) per minute in zone 1 vs. zone 3 were 1.39 vs. 0.78 (mouse) and 1.25 vs. 0.09 (rat). The mean percentage of time for each flow grade differed significantly between zones 1 and 3 and between species. For example, fast flow was present in zone 1 sinusoids for 51% of the time in mice and for 74% in rats; in zone 3 the corresponding numbers were 76 and 95%. Flow stasis was present in zone 1 sinusoids for 19% of the time in mice and for 7% in rats; in zone 3 the corresponding numbers were 2 and 0%. Thus considerable intermittence of perfusion exists, and the flow conditions create very different microenvironments for hepatocytes in zone 1 vs. zone 3.

Animals↗

Fibrin enhances the expression of IL-1 beta by human peripheral blood mononuclear cells. Implications in pulmonary inflammation.

Tissue injury is accompanied by increased vascular permeability and influx of plasma proteins including fibrinogen. Fibrinogen is converted into a fibrin matrix by procoagulants activated at the site of tissue injury and inflammation. This fibrin matrix is thought to participate early in the inflammatory response by providing a temporary protein "scaffold" for inflammatory cell adhesion and migration, and subsequent remodeling of the tissue with permanent extracellular matrix proteins such as collagen. Collagen and fibronectin have been shown to regulate the expression of inflammatory cytokines, but whether fibrin can regulate cytokine expression is not known. We hypothesized that fibrin induces the expression of the proinflammatory cytokine IL-1 beta and sought to explore mechanisms responsible for this induction. In this report, we demonstrate that fibrin stimulates human PBMCs to express IL-1 beta message and protein. We show that induction of IL-1 beta by fibrin is mediated partly by the integrin receptor CD11b/CD18 and modulated by cytoskeletal rearrangement. Fibrin also suppresses production of IL-1 receptor antagonist (IL-1ra) a non-bioactive competitor of IL-1 for IL-1Rs. We propose that injured tissues where the conditions favor coagulation and fibrin accumulation, the interaction between mononuclear cells and the newly formed fibrin matrices may elicit the production of the proinflammatory cytokine IL-1 beta. This proposal is supported by immunohistochemical studies which show the co-distribution of fibrin and IL-1 beta in granulomas in lung sections from patients with the systemic granulomatous disease, sarcoidosis.

CD18 Antigens↗

Extravasation of polymorphonuclear leukocytes from the cerebral microvasculature. Inflammatory response induced by alpha-bungarotoxin.

Postcapillary venules represent the segment of the microvasculature most vulnerable to inflammatory processes. While there is a considerable body of data on the peripheral vasculature, little is known about the primary events occurring during inflammatory reactions in cerebral blood vessels. We introduce here a model by which the migration of polymorphonuclear leukocytes through the CNS endothelial barrier can be studied. Alpha-bungarotoxin is used as a chemotactic agent and is shown, for the first time, to act by activating the complement cascade. Leukocytes migrate through the endothelium transcellularly. Two modes of migration are described: a direct mode whereby the cells use temporary pores in the vessel wall as portals, and an indirect mode whereby the leukocytes leave the vascular compartment after being enveloped by and incorporated into endothelial cells. The functional implications of these findings lead us to conclude that the direct mode of migration is a causal agent in the massive breakdown of the blood-brain barrier under acute inflammatory conditions.

Animals↗

Silicone punctal plug migration resulting in dacryocystitis and canaliculitis.

PURPOSE: One of the modalities of treating dry eyes is punctal plugs. They are usually used for temporary occlusion of the lacrimal drainage system. Among the complications associated with silicone punctal plugs are extrusion, downward migration, irritation, and epiphora. To our knowledge, this is the first report of dacryocystitis and canaliculitis as a result of spontaneous migration of punctal plugs into the lacrimal drainage system. METHODS: We describe the sequelae of spontaneous migration of silicone punctal plugs into the lacrimal drainage system in two patients with dry eyes. RESULTS: In two patients, spontaneous migration of silicone punctal plugs into the canaliculus or the lacrimal sac, respectively, resulted in canaliculitis or dacryocystitis. CONCLUSION: Smaller sized newer generation punctal plugs were designed to facilitate insertion; however, this design also increases the likelihood of proximal migration within the lacrimal drainage system. The importance of monitoring patients after punctal-plug placement cannot be over-emphasized.

Adult↗

Clinical outcomes of metallic stent insertion for obstructive colorectal cancer.

BACKGROUND/AIMS: As the treatment of acute malignant obstruction of the left colon, self-expandable metallic stent insertion has been clinically used with good results. The aim of this study is to analyze the outcome of planned operation after stent insertion for obstructive colorectal cancer. METHODOLOGY: From 2000 to 2003, among 37 patients treated for obstructive colorectal cancer, we compared hospital days and complications between Group A (n=18) and Group B (n=19). Group A included the patients who underwent planned operation after stent insertion and Group B included the patients who underwent planned operation after emergency temporary colostomy formation. RESULTS: In Group A, complications after stent insertion were perforation with abscess formation (n=1) and stent migration (n=2). Complications after definitive operation were not observed. In Group B, complications after temporary colostomy involed stoma site wound infection (n=2). Complications after definitive surgery were as follows: anastomotic leakage (n=1), pneumonia with acute renal failure (n= 1), wound infection (n=2). In group A and group B, hospital day after decompressive procedure was 5+/-4.0 days (range, 1-16 days) vs. 14+/-4.7 days (range, 7-27 days) (P=0.000). Hospital day after definitive operation was 11+/-4.0 days (range 8-22 days) vs. 16+/-9.2 days (range 10-41 days) (P=0.002). CONCLUSIONS: Because preoperative self-expandable metallic stent insertion for obstructive colorectal cancer had better postoperative results and shorter hospital days than emergent diverting colostomy, this procedure is a good "bridge to surgery".

Adult↗