The complication of pulmonary vein stenosis is potentially life-threatening, and the application of radiofrequency current within the pulmonary veins with standard catheter technology should be avoided. This complication can be treated with balloon dilation, although the long-term course is unknown.

Epoprostenol has markedly improved the treatment of pulmonary arterial hypertension, although predictors of outcome with epoprostenol are not well characterized. From June 1995 through August 2001, 91 patients with pulmonary arterial hypertension were treated with epoprostenol at our institution. We analyzed the effects of long-term epoprostenol treatment to determine features associated with outcome. Predictors of worse outcome included older age of disease onset (hazard ratio 3.2, 95% confidence interval 1.32-7.76 for patients above the median age of 44 years), World Health Organization functional Class IV, either at baseline or follow-up, (3.07, 1.42-6.62 compared with functional Class I, II, and III), and scleroderma spectrum of disease (2.32, 1.08-4.99). There were no baseline or follow-up hemodynamic factors predictive of outcome. Our results indicate that treatment with epoprostenol improves survival in patients with Primary Pulmonary Hypertension compared with that predicted by the National Institutes of Health Primary Pulmonary Hypertension Registry's survival equation and that their survival is significantly better than that of patients with scleroderma spectrum of disease (p = 0.001). Older patients treated with epoprostenol have significantly shorter survival, regardless of etiology.

Background Fibrosing Mediastinitis (FM) is a rare complication of infection with Histoplasma capsulatum, which can lead to obstruction of pulmonary and systemic vasculature and large airways, often resulting in significant morbidity and mortality. Medical therapy is ineffective and surgical intervention is often not feasible. Stent implantation offers a potential treatment for vascular obstruction due to FM, but this has not been well studied. Methods and Results We conducted a retrospective review of all patients undergoing cardiac catheterization for FM. Anatomic site of stenosis and hemodynamic information before and after intervention, as well as clinical presentation and follow-up data were recorded. From 1996 to 2008, 58 patients underwent cardiac catheterization for FM, with intervention performed in 40 (69%). A total of 77 stents were used to relieve 59 lesions (pulmonary artery = 26, pulmonary vein = 21, superior vena cava = 12). Significant reduction in pressure gradients (p<0.001) and increase in vessel caliber (p<0.001) was seen at all locations. Symptomatic recurrent stenosis requiring further intervention occurred in 11 (28%) patients. Median time to recurrence was 115 months. Thirty-two (87%) of 37 patients for whom follow-up was available reported symptomatic improvement following stent placement. Procedure-related complications occurred in 14 patients (24%). Overall mortality was 19%, with the majority of deaths in patients with bilateral disease. Among patients with bilateral disease, intervention was associated with improved survival at 5 years. Conclusions Percutaneous vascular stent implantation is an effective therapy for central vascular obstruction due to FM, providing significant relief of anatomic obstruction and sustained clinical improvement.

Most of the published literature on clergy abuse of children has addressed the emotional and psychological effects of sexual abuse common to all victims. The literature published by Church-related sources has consistently addressed the impact of clergy abuse on the Church as an institution as well as the problems and treatment needs of the clergy abusers. Little has been written or even explored about the spiritual trauma suffered by clergy victims. This article examines some of the symptoms and possible recovery from the spiritual dimension of post abuse trauma.

1. Developmental changes in free tissue catecholamine levels were studied using Nafion‐coated, carbon fibre electrodes placed in rat carotid bodies, in vitro. Simultaneously, single fibre chemoreceptor afferent activity was recorded from the sinus nerve. Five age groups were examined: 1, 2, 6, 10 and 20‐30 days of age. 2. Using fast‐scan voltammetry, similar current peaks were observed during exposure to exogenous dopamine and during superfusion with hypoxic saline. This suggests that changes in carbon fibre electrode current are due to an increase in free tissue catecholamines. 3. Baseline catecholamine levels were significantly less in the 1‐6 day age groups compared to 10 day and 20‐30 day rats. 4. During 1 min of hypoxia the peak concentration of tissue catecholamine was significantly less in the 1 day compared to the 2 day age groups, and these were less than in 10 day and 20‐30 day rats. 5. Peak nerve response during hypoxia increased with age from 4.5 +/‐ 0.6 Hz in the 1 day to 10.5 +/‐ 1.6 Hz in the 6 day and to 15.5 +/‐ 2.2 Hz in the 20‐30 day rats. 6. We conclude that (1) resting free tissue catecholamine levels increase with age in the newborn period, (2) hypoxia causes enhanced catecholamine release, and (3) the magnitude of the release increases in the postnatal period as does the nerve activity.

Religious duress is a unique kind of threat and constraint involuntarily experienced by some members of the Roman Catholic Church as a result of religious indoctrination and training. Fear, awe and respect for the clergy foster the development and actualization of religious duress. This phenomenon can seriously impede a person's capacity to accurately perceive and evaluate abusive actions perpetrated on them by clergy. This constraint poses an impediment to emotional and spiritual development. Internalized religious duress confuses and psychologically overwhelms such individuals and renders them incapable of absorbing their sexual trauma. The consequent feelings of numbness and immobility distort the perception of reality. It then becomes impossible for the individual to act in a manner that would protect and promote emotional growth and spiritual well being.

ObjectivesTo assess safety, efficacy, and intermediate term outcomes of percutaneous interventions in Mustard patients.BackgroundBaffle leaks and obstruction are present in 20% of Mustard survivors. Surgical reintervention is associated with high mortality.MethodsRetrospective review of percutaneous interventions performed at three adult congenital catheterization programs.ResultsOverall, 26 catheterizations and 29 interventions were performed in 22 patients (mean age 32.4 ± 8.3 years). Previous laser pacemaker lead extraction was successful in seven of seven procedures where the lead was at risk. Stent placement was successful in all 18 patients with systemic venous baffle (SVB) obstruction (mean gradient: 6.2 ± 3.4–0.6 ± 1.0 mm Hg; P < 0.01, narrowest diameter 4.5 ± 4.5–17.1 ± 3.9 mm; P < 0.01). Balloon angioplasty was performed in two patients for pulmonary venous baffle (PVB) obstruction with mixed results. Baffle leak interventions included device occlusion (n = 6), coil occlusion (n = 1), and covered stent occlusion (n = 3). Postprocedural residual leaks were demonstrated in three of eight. In two of the three the residual leak was not appreciable at 1‐year follow‐up. No patient experienced leak or obstruction related symptom recurrence (mean follow‐up: 33.4 ± 29.5 months). Complications included one death secondary to ventricular arrhythmia 2 days after PVB angioplasty and device related inferior SVB obstruction with resolution following stent placement.ConclusionsStent placement for SVB obstruction following Mustard repair is effective and likely safer than surgical intervention. Baffle leak occlusion can be safely accomplished but residual leaks are common in the short term. © 2012 Wiley Periodicals Inc.

Sexual abuse by Catholic clergy and religious has become the greatest challenge facing Catholicism since the Reformation. Violations of clerical celibacy have occurred throughout history. The institutional church remains defensive while scholars in the behavioral and social sciences probe deeply into the nature of institutional Catholicism, searching for meaningful explanations for the dysfunctional sexual behavior. Clericalism which has traditionally led to deep-seated societal attitudes about the role of the clergy in religious and secular society, explains in part why widespread abuse has apparently been allowed. Clericalism has a profound emotional and psychological influence on victims, church leadership, and secular society. It has enabled the psychological duress experienced by victims which explains why many have remained silent for years. It has also inspired societal denial which has impeded many from accepting clergy sexual abuse as a serious and even horrific crime. KEY WORDS: clericalism; Roman Catholic Church; clergy sexual abuse; narcissism.To fully understand both the origins and the complex impact of the contemporary clergy sexual abuse scandal, one must understand some of the more subtle yet powerful inner workings of institutionalized Catholicism. Above all, one must appreciate the nature of clericalism and the impact it has had on Catholic life in general but especially on the victims of clergy sexual abuse.Catholicism is a spiritual force, a way of life, and a religious movement. It is also a complex socio-cultural reality and a world-wide political entity. It has the power to touch the spiritual, moral, emotional, psychic, and economic lives of members and non-members alike. It has had more impact on world history than any other religious body. The world-wide Catholic Church, with a membership 1 Thomas P. Doyle is a Canon Lawyer and Certified Addictions Specialist. 2 Address correspondence to Thomas P. Doyle, Certified Addictions Specialist, 7514 Cayuga Ave.,