Haemostasis, anticoagulants and fibrinolysis

Anticoagulant and fibrinolytic drugs are being used with increasing frequency in acute and community settings. Nurses need to maintain an up-to-date understanding of these drugs to provide effective patient care and education.     

Nutritional support in wound healing

Wounds place increased metabolic and hence nutritional demands on patients, which may not always be met, especially in older patients in the community. Patients may be deficient in carbohydrates, protein and amino acids, fatty acids and certain micronutrients. Nutritional support may be needed to promote wound healing. Nurses should be able to assess the risk of poor nutrition in patients with wounds and have a role in ensuring adequate nutrition through the normal diet or supplementation where necessary.     

Modelling hospital and social care bed occupancy and use by elderly people in an English health district

The paper confirms that exponential equations can be used to model the total system and sub-systems of institutional health and social care for elderly people using bed occupancy census data for 6068 elderly aged 65 and over. Two streams of flow were present in NHS acute hospitals, Local Authority residential homes and independent sector nursing homes. Three streams of flow were present in the overall data set and in the NHS geriatric hospital beds, NHS psychiatry beds and independent sector residential care homes. In total 22% of patients/residents stayed an average of 24 days (short stay), 69% for 825 days (medium stay) and 9% for 3384 days (long stay). In both sexes, the older a patient/resident, the longer the time they occupied short stay beds and the shorter the time they occupied long stay beds.     

Transurethral implantation of macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency

OBJECTIVE: To assess the results of transurethral implantation of Macroplastique in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures. METHODS: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0-7) previous episodes of continence surgery. Up to three treatment episodes were used, if necessary. The outcome was assessed by telephone interview (56 patients, mean follow-up period 19 months) and videocystometry (41 patients, mean follow-up period 16 months). Transurethral ultrasound scanning was performed in a further 9 patients. RESULTS: Symptomatically, 19.6% of the women interviewed by telephone considered themselves cured of their incontinence or were no longer using pads. A further 41.1% said their symptoms had significantly improved. Pad usage was reduced from a median of five to three pads per day (p < 0.001). Videocystometry in 41 women (mean follow-up period 16 months) was normal in 16 patients (39%) and showed genuine stress incontinence in 18 (43.9%) and detrusor instability in 12 patients (29.3%). Overall, 71.4% stated that they would undergo the procedure again under the same circumstances, and 80.4% would recommend this form of treatment to a friend with the same condition. Transurethral ultrasound scanning was performed in 9 patients (5 subjectively improved or cured, 1 patient with persistent symptoms but normal cystometry, and 3 patients with persistent genuine stress incontinence). Hyperechoic foci were seen surrounding the proximal urethra, consistent with implanted Macroplastique boluses. When completely encircling the urethra, the outcome was generally good. A total of 10 patients have undergone or are awaiting open surgery, and 3 are awaiting repeat implantation. CONCLUSION: Sustained improvement or cure of genuine stress incontinence has been achieved using Macroplastique in a large proportion of women with intrinsic sphincter deficiency, often following previous unsuccessful continence surgery. Transurethral ultrasound may prove to be a clinically useful imaging technique for the assessment and subsequent management of treatment failure following Macroplastique implantation.     

Infected midurethral tape presenting as an ischiorectal abscess

This is the first reported case of an ischiorectal abscess after a midurethral intravaginal slingplasty (IVS). The patient presented with recurrent ischiorectal abscess which was initially thought to be an unusual presentation of a fistula in ano. Subsequent examination under anaesthesia, however, revealed a fistulous tract extending from the right postero-lateral perianal opening to the vagina where the tape was noted to be eroded and infected. The abscess healed only after removal of the source of infection i.e. the IVS tape. In this report, we also discuss the two main types of meshes used as midurethral slings, the ways in which they differ and the arguments for and against using them.     

The effect of dietary advice on nutrient intakes: evidence from the diet and reinfarction trial (DART)

The effect of dietary advice on nutrient intakes was examined in a random subsample of 459 men who were taking part in a randomized controlled trial of secondary prevention of myocardial infarction. The trial is of factorial design, to examine the effect of three dieteary aims, alone and in combination:

• (1) 

  A reduction in total fat to 30% of energy, together with an increase in polyunsaturated/saturated fat ratio (P/S) to 1.0.
• (2) 

  An increase in fatty fish consumption to at least 300 g/week (3 g eicosapentaenoic acid (EPA)).
• (3) 

  An increase in cereal fibre intake to 18 g/day (total fibre 30 g/day). Men were randomly allocated to one of the eight regimens (fat, fish, fibre, fat plus fish, fat plus fibre, fish plus fibre, fat plus fish plus fibre, or none of these) and are being followed up for at least two years. Six months after the advice was given, nutrient intakes were assessed from 7-d weighed intake records. Of those advised to reduce fat intake and increase P/S ratio, mean intakes were 31% of energy and 0.85, respectively. This compared with 35% of energy and 0.45 for those not given this advice. Mean EPA intake was 2.5 g/week for the fish advice group and 0.79 g/week for the no fish advice group. Mean cereal fibre intake of the fibre advice group was 15 g/d (26 g/d total fibre) compared with 9 g/d (20 g/d total fibre) for the no fibre advice group. Thus for each of the dietary aims, the advice had a substantial effect on intakes.

     

A study of 5′-nucleotidase activity in subcellular fractions of rat cerebellum after the administration of the convulsant 3-mercaptopropionic acid

The activity of 5′-nucleotidase in cerebellum subcellular fractions after the administration of the convulsant 3-mercaptopropionic acid was studied. This membrane enzyme presented an increase in its activity in certain fractions containing nerve endings and microsomes (Mic₂₀, Mic₁₀₀) in seizure and postseizure periods. 5′-nucleotidase activity in nuclear and myelin fractions did not show differences between the control and treated fractions. On the other hand, a decreased activity in the crude mitochondrial fraction and in a nuclear subfraction was found. It is suggested that the changes in the enzyme activity in some cerebellum fractions might be related to structural alterations previously observed in this laboratory and with the anticonvulsant actions of adenosine.     

Thinner inhalation effects on oxidative stress and DNA repair in a rat model of abuse

Humans can come into contact with thinner by occupational exposure or by intentional inhalation abuse. Numerous studies of workers for genotoxic effects of thinner exposure have yielded conflicting results, perhaps because co‐exposure to variable other compounds cannot be avoided in workplace exposure studies. In contrast, there is no data concerning the genotoxic effects of intentional inhalation abuse. The aim of this project was to examine the genotoxic effects of thinner inhalation in an animal model of thinner abuse (rats exposed to 3000 ppm toluene, a high solvent concentration over a very short, 15 min time period, twice a day for 6 weeks). The data presented here provides evidence that thinner inhalation in our experimental conditions is able to induce weight loss, lung abnormalities and oxidative stress. This oxidative stress induces oxidative DNA damage that is not a characteristic feature of genotoxic damage. No significant difference in DNA damage and DNA repair (biomarkers of genotoxicity) in lymphocytes from thinner‐treated and control rats was found. Lead treatment was used as a positive control in these assays. Finally, bone marrow was evaluated as a biomarker of cellular alteration associated with thinner inhalation. The observed absence of hemopoietic and genetic toxicity could be explained in part by the absence of benzene, the only carcinogenic component of thinner; however, benzene is no longer a common component of thinner. In conclusion, thinner did not cause genotoxic effects in an experimental model of intentional abuse despite the fact that thinner inhalation induces oxidative stress. Copyright © 2009 John Wiley & Sons, Ltd.     

Primary Breast Lymphoma After Mastectomy With Reconstruction

Primary breast lymphoma accounts for only 0.05%–1.1% of all breast malignancies, and less than 1% of all cases of non-Hodgkin lymphoma. Although primary breast lymphoma may present clinical similarities to breast carcinoma, the majority of cases lack the typical features of breast malignancy or lymphoma. We describe a case of primary breast lymphoma in a reconstructed breast, 8 years after a mastectomy for breast cancer. To the best of our knowledge, this is the first reported case in the worldwide literature of primary breast lymphoma in a reconstructed breast. We will discuss the diagnostic and treatment strategies involved in the management of primary breast lymphoma, and the effect of breast reconstruction on the detection of recurrent breast cancer.