Best practices: the consultation-liaison in primary-care psychiatry program: a structured approach to long-term collaboration

This column presents the Consultation-Liaison in Primary-Care Psychiatry model, which was developed in Australia. This model is a structured approach to collaborative care of people with mental illnesses between primary care services and specialist mental health services. The first component of the model is a consultation, liaison, and education service provided by psychiatric consultants at participating general practices. The second component involves transferring selected patients from community mental health services into general practitioner-based collaborative care. In the final component a clinical case-register and reminder system managed by the specialist services is used to actively promote follow-up for transferred clients. The column also offers some evidentiary support for this care model that suggests a best-practices model for maintaining adequacy of care for patients.     

Exclusive Y graft operation for multivessel coronary revascularization

BACKGROUND: The pedicled (in-situ) left internal mammary artery grafted to the left anterior descending artery has a very high late patency and reduces late mortality following coronary artery bypass surgery. A technique is described which achieves total arterial revascularization in patients with multivessel coronary disease and which is also entirely pedicled. METHODS: Using the left internal mammary artery and radial artery joined as a composite Y graft, all coronary territories may be grafted. RESULTS: One in-hospital death from 464 patients (0.2%) occurred. Age (mean +/- standard error) was 64.7 +/- 0.5 years and number of distal anastomoses 3.4 +/- 0.04. Of 1,681 patients from Royal Melbourne Hospital, 346 had this operation. Comparison found no preoperative selection bias and no postoperative differences in complications. Actuarial survival was 0.98 +/- 0.01 at 36.1 +/- 0.3 months. CONCLUSIONS: Total arterial revascularization may be performed using the left internal mammary artery and radial artery as a composite Y graft. There was no increase in complications. This technique preserves the left internal mammary artery to left anterior descending artery graft.     

Role of chemokines in tumor growth

Chemokines play a paramount role in the tumor progression. Chronic inflammation promotes tumor formation. Both tumor cells and stromal cells elaborate chemokines and cytokines. These act either by autocrine or paracrine mechanisms to sustain tumor cell growth, induce angiogenesis and facilitate evasion of immune surveillance through immunoediting. The chemokine receptor CXCR2 and its ligands promote tumor angiogenesis and leukocyte infiltration into the tumor microenvironment. In harsh acidic and hypoxic microenvironmental conditions tumor cells up-regulate their expression of CXCR4, which equips them to migrate up a gradient of CXCL12 elaborated by carcinoma-associated fibroblasts (CAFs) to a normoxic microenvironment. The CXCL12-CXCR4 axis facilitates metastasis to distant organs and the CCL21-CCR7 chemokine ligand-receptor pair favors metastasis to lymph nodes. These two chemokine ligand-receptor systems are common key mediators of tumor cell metastasis for several malignancies and as such provide key targets for chemotherapy. In this paper, the role of specific chemokines/chemokine receptor interactions in tumor progression, growth and metastasis and the role of chemokine/chemokine receptor interactions in the stromal compartment as related to angiogenesis, metastasis, and immune response to the tumor are reviewed.     

Primary Colonic Liposarcoma Causing Colo-colic Intusussception: A Case Report and Review of Literature

Introduction

Liposarcomas are most common soft tissue sarcomas usually seen in deep soft tissues of extremities and retroperitoneum. Although secondary involvement of gastrointestinal system can occur in cases of retroperitoneal tumours, liposarcomas primarily involving the gastrointestinal tract are extremely uncommon. Intusussception refers to telescoping of contiguous segments of intestine causing obstruction. Colo-colic intusussception is rare in adults and usually associated with a malignant etiology, usually epithelial malignancies (adenocarcinomas).

Discussion

Colonic liposarcomas leading to colo-colic intussusception are extremely rare, with only six cases reported in the literature.

Conclusion

In this report, we describe this rare occurrence in a 66-year-old lady and highlight the diagnostic difficulties such cases can pose along with a review of relevant literature.