Heat shock proteins (hsp) represent a group of chaperones which protects the cells against a diversity of stresses. It has been demonstrated that hsp27 is constitutively present in cells where it plays an important role in different cytoprotective processes which ultimately inhibit cell death. We investigated the response of the isolated perfused mouse heart over expressing hsp27 to the ischaemia/reperfusion injury using infarct size as an end point. Our results show for the first time that mice over expressing hsp27 (verified by Western blotting analysis) were found to be protected from lethal ischaemia/reperfusion injury compared to their negative littermates.
Malignant pleural effusions in the presence of trapped lung remain notoriously difficult to treat. Various methods exist ranging from minimally invasive procedures including repeated needle thoracocentesis to the need for a formal surgical procedure such as placement of a pleuroperitoneal shunt and even thoracotomy and decortication. Controversy exists as to what is the optimum treatment for this condition. Any planned treatment should balance the therapeutic benefit provided against convalesce for a disease with a limited life expectancy. Patients should not spend a significant proportion of their remaining life span recovering from palliative procedures. In a series of patients with malignant pleural effusion the medial survival time was 20 weeks, with 30 days and 1 year mortality rates of 12.8% and 83.6%, respectively. We describe our five-year experience with the use of indwelling PleurX catheters in patients with malignant pleural effusions in the presence of confirmed trapped lung on radiological or VATS investigation. Patient health related quality of life was investigated by telephone questionnaire. The parameters analysed were symptomatic relief, mobility and ease of management following insertion. One hundred and sixteen patients underwent PleurX catheter insertion by a single operator, 48 questionnaires were completed. Of the 48 cases analysed, improvement in all three quality of life indices was recorded following catheter insertion. Ease of mobility was recorded as moderately satisfied and very satisfied in 50% and 15% of patients, respectively. Symptomatic improvement was found to have been increased with 42% and 6% of patients responding to moderately satisfied and very satisfied, respectively. Ease of management was recorded as 'slightly satisfied' and moderately satisfied in 50% and 33% of patients, respectively, demonstrating a high satisfaction index in patients with chronic progressively debilitating malignancies. Complications were either transient or readily correctable. Pain was the predominant complication occurring in 35% of patients lasting <3 days. No patient required catheter removal for resolution of discomfort. Our findings support the use of PleurX catheters for palliative patients with malignant pleural effusions in the presence of trapped lung. The catheters are not only easy to insert and discrete but they can be managed effectively by patients and community nurse practitioners and prevent repeated admissions to hospital in palliative patients with compromised life expectancy.
In terms of economic impact, the occurrence of an anastomotic leakage has a large negative influence on medical resource utilization, so that, despite the complication-related increase of DRG-reimbursement, every complicated case represents a financial burden for the hospital.
Economic implications favouring early discharge have led to an ever increasing demand to send patients home for recuperation. Patients are now routinely released on their fourth postoperative day, thereby making postdischarge complications harder to record and audit. We set about the use of a structured questionnaire to evaluate the incidence of all postdischarge complications requiring therapy within the first six weeks of convalescence. Over a 24-month period, 382 patients were questioned following cardiac surgery. Of these patients, 72% had an uneventful postoperative recovery, however, 17% needed treatment from their general practitioner, 6% were readmitted, 5% required district nurse treatment and 1% called the National Health Service advice line (NHS direct). Furthermore, despite the fact that 28% of discharges required further medical intervention in the majority of cases, cardiothoracic clinicians were not aware of complications requiring treatment. The auditing of these complications has resulted in changes in our surgical practice leading to a reduction in postoperative complications. Structured questionnaires are a useful tool in allowing improvement in surgical technique. They can be used by all members of the cardiothoracic team regardless of their grade and enable a methodical and reproducible assessment of all discharged patients.
A case of malignant transformation in an extra-ovarian site, 13 years after total abdominal hysterectomy and bilateral salpingooophorectomy, is discussed in a patient on long-term oestrogen implants, which highlights the potential risks surrounding the use of long-term oestrogen replacement therapy.
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