Manchester Memorial Hospital

This case report outlines the first reported case of bilateral paramedian thalamic infarct, likely stemming from a rare artery of Percheron (AOP) variant, secondary to uncontrolled atrial fibrillation with rapid ventricular response. We underscore the importance of considering hypoperfusion due to decreased cerebral perfusion as a potential mechanism in cryptogenic AOP infarcts, challenging the conventional association with embolic etiology. This report contributes to the limited literature on AOP infarctions, emphasizing the need for heightened awareness among healthcare providers for diverse clinical presentations and potential etiologies to improve diagnosis and management, ultimately enhancing patient outcomes.

Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

Exercise training is considered a necessary component of comprehensive pulmonary rehabilitation. However, to date, there is no consensus on an exercise training strategy for pulmonary rehabilitation, and this has resulted in varied approaches to this intervention in its literature. As in healthy individuals, the effect of exercise training on patients with chronic lung disease is dose dependent, with higher intensities resulting in greater physiological adaptations than lower intensities. It is not clear from our review of the literature that these enhanced physiological effects from higher levels of exercise training translate into a reduced burden of symptoms, hence a better quality of life. Indeed, there is some evidence that pulmonary rehabilitation approaches incorporating lower intensities of exercise training are at least as good in improving questionnaire rated symptoms of health status. This provides food for thought, since the prominent goal of pulmonary rehabilitation should be to reduce bothersome symptoms or enhance health status, not simply increase endurance time on a cycle ergometer.

Deep venous thrombosis (DVT) and its complications, pulmonary embolism (PE), and postphlebitic syndrome (PPS) affect millions of Americans. The risk is especially high in surgical patients in general, and orthopaedic patients in particular. Virchow's triad describes the three factors that affect coagulation within a blood vessel: stasis, vessel injury, and coagulation factors. Risk factors, which relate to these factors, can predict which patients will be most likely to develop DVT. Prophylactic regimens should be tailored to patient risk. Nursing care is the key to implementation, maintenance, and compliance with any prophylactic program and its ultimate success.

Searching the literature is easier than ever with the advent of CD-ROM. Cost effective and simple to use, this technology is being used for clinical patient management as well as health care administration. For the materiel manager, literature searches can provide additional information, and access to research and other data to assist in making objective, informed, defensible purchasing decisions.