Background: The treatment of vascular malformations with sirolimus is increasingly reported in the literature with variable results. We report a case of vascular malformation successfully treated with sirolimus in our institution. Case presentation: A full-term neonate born after a well monitored pregnancy was diagnosed prenatally with a slow-flow vascular malformation on the right chest wall and right axillary region. Postnatal physical examination, ultrasound, and MRI confirmed the diagnosis. We initiated our standard treatment protocol which consisted in systemic corticosteroid therapy at 1-2 mg/kg/day for 5 days, combined with propranolol at 2-3 mg/kg/day for 1 month. There was not a favorable response to this treatment. After a multidisciplinary discussion, we decided to treat the patient with sirolimus, initially administered orally at a dose of 0.8 mg per m2 per 12 hours, and gradually increasing it to a maximum dose of 2 mg per m2 per day. We observed a favorable response to this treatment. The treatment duration was 9 months, after which the treatment was interrupted without a taper. Functional and aesthetic results remain acceptable at 3 years of follow-up. Conclusion: Sirolimus seems to be a safe and effective alternative to surgery for vascular slow-flow malformations refractory to other medical therapies.
In our opinion, academic research into why young Canadians choose a military career in times of war remains very peripheral. Nevertheless, during Canada’s mission in Afghanistan, many young people joined the Canadian Armed Forces, including as infantry soldiers. We address this phenomenon as a way of reflecting on the sociological, cultural, and existential factors that lead young people to make such a career choice – one that, in the contemporary context, remains unconventional and can prove fatal. The notion of risk taking and the role it plays in the lives and career choices of certain young people serves as both the starting point and common thread for our analysis.
(Int J Gynecol Obstet. 2020;148:198–204) Cesarean delivery involves a longer length of hospital stay, higher rates of morbidity, and greater costs and need for care compared with vaginal delivery. Misgav Ladach cesarean (MLC) is a widely used cesarean procedure, though it may impede future fertility. French Ambulatory Cesarean Section (FAUCS) appears to shorten recovery time. This study aimed to assess the results of FAUCS for maternal and neonatal safety in a unit that introduced FAUCS in January 2018.
Today's health care journalists work in a very different environment than those of yesterday. The demand for stories and broadcasts has grown exponentially, and the resources available have shrunk dramatically. While it may therefore be difficult to see how improvements in health care journalism are possible, let alone a way to improve health care literacy, there is an important connection that, if illuminated, could help both fields. To understand the literature on the quality of health care journalism, it is critical to understand the backgrounds of today's health care journalists and the challenges they face. That literature also goes hand in hand with studies of the effects that news coverage has on the public's understanding of health care issues. There are training and educational programs designed to help health care journalists do their jobs better, and this chapter concludes with a discussion of how cooperation between health journalists, physicians, and other stakeholders can lift all boats.
