Venous thrombosis is a very rare occurrence in patients with haemophilia A. We report the case of a haemophiliac in whom initially a calf haematoma was suspected, but neither this nor deep venous thrombosis (DVT) could be confirmed on ultrasound scanning. Subsequently, a high segment venous thrombosis was diagnosed by venography in a portion of a duplicated superficial femoral vein. Treatment with factor VIII (FVIII) and low molecular weight heparin led to a successful resolution. The only other case we have been able to find in the literature occurred during FVIII replacement therapy, which was not the situation with our patient.
is an elderly Navajo man suffering from Parkinson's disease. B.H. lives with his wife of 40 years in a one-room earth-covered hogan without electricity or running water. B.H.'s wife suffers from severe arthritis in her legs and cannot walk even with the aid of a walker. A wheelchair would be of no use to her as the sand and mud (during the rainy season) surrounding her hogan would not support the narrow gauge wheels of a wheelchair. B.H. also has great difficulty getting around. He usually spends most of the day sitting in .a very worn easy chair, alert except for short periods following the administration of his medication. Tremors and weakness in his extremities make it very difficult for him to accomplish even the most simple chores, e.g., carrying drinking water inside from barrels stored outside the hogan. B.H. and his wife could not care for themselves were it not for three important factors. A Tribal Home Care Program pays their daughterin-law minimum wage to spend 4 hours a day with them, helping with cooking, washing, and other chores. The daughter-in-law, even though she lives 2 miles away, would probably provide these services free. However, the income she earns from this program is critical in keeping her family's pickup running. Her husband, B.H. 's son, has worked only 4 months during the last year. His sporadic wage income, his wife's meager salary, and contributions from his parents (whose combined income is about $500/month) help support him, his wife, and their four children. In return, the son's services are critical to the support of his parents. He h~mls wood for fuel and water for drinking, cooking, and bathing. He contributes meat from his wife's small herd to his parent's diet (prohibitively expensive otherwise). He also provides critical transportation to a hospital some 45 miles from their residence. At least once a week he takes his parents on an outing to the Trading Post where they socialize and purchase necessities. Both of his parents' degenerative illnesses are monitored by a Community Health Representative (CHR) who takes vital signs, delivers medicine, and tries to anticipate any acute episode.
Until recently, American Indian tribes lacked procedures for the commitment of mentally ill reservation residents. The Red Dog decision (White v. Califano) highlighted the difficult issues inherent in this situation. This article reports the experiences of IHS and tribal service providers who struggle with these issues and describes the commitment procedures developed by five different reservation communities. Similarities and differences in these models are discussed, with special emphasis on implementation.
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