Analysis of Ischemic Cholangiopathy After Treatment of Arterial Thrombosis in Liver Transplantation in Our Series

Liver transplantation offers patients with terminal liver disease an effective treatment accompanied by excellent quality of life, but it also has complications, such as hepatic artery thrombosis and development of ischemic cholangiopathy, described in 3%–17% of patients. It is a very important cause of morbidity and mortality. The objective of this report was to analyze the efficacy of the treatment they received in relation to the development of ischemic cholangiopathy and a comparative survival analysis and to propose prophylactic measures for high-risk patients.     

Emphysema induced by elastase enhances acute inflammatory pulmonary response to intraperitoneal LPS in rats

Abnormalities in lungs caused by emphysema might alter their response to sepsis and the occurrence of acute lung injury (ALI). This study compared the extension of ALI in response to intraperitoneal lipopolysaccharide (LPS) injection in Wistar rats with and without emphysema induced by elastase. Adult male Wistar rats were randomized into four groups: control, emphysema without sepsis, normal lung with sepsis and emphysema with sepsis. Sepsis was induced, and 24 h later the rats were euthanised. The following analysis was performed: blood gas measurements, bronchoalveolar lavage (BAL), lung permeability and histology. Animals that received LPS showed significant increase in a lung injury scoring system, inflammatory cells in bronchoalveolar lavage (BAL) and IL‐6, TNF‐α and CXCL2 mRNA expression in lung tissue. Animals with emphysema and sepsis showed increased alveolocapillary membrane permeability, demonstrated by higher BAL/serum albumin ratio. In conclusion, the presence of emphysema induced by elastase increases the inflammatory response in the lungs to a systemic stimulus, represented in this model by the intraperitoneal injection of LPS.     

Undertaking midwifery studies: Commencing students’ views

Objective

to explore the motivations and beliefs of commencing midwifery students against a background of high course demand and high student attrition.

Design

a qualitative analysis of student reflective essays.

Setting

Melbourne, Australia.

Participants

all commencing midwifery students, in 2008, were invited to participate (n=41).

Measurements and findings

three primary motivations for choosing midwifery were identified, including: notions of altruism (wanting to help), a fascination with pregnancy and birth, and a view of midwifery as a personally satisfying career.

Key conclusions and implications for practice

Bachelor of Midwifery programmes attract students with idealised views about midwifery practice. Such views may lead to student disillusionment, tensions with educators and clinicians, and higher rates of student attrition. Students need greater support to examine their views about midwifery practice. More meaningful support may assist the students' successful socialisation into clinical practice.