Resection of the tracheal bifurcation through a left thoracotomy

The surgical management of tumors of the left main bronchus with involvement of the lower trachea is one of the most difficult problems of tracheobronchial surgery. Two cases of adenocystic carcinoma in this location are presented, where resection of the tumor and reconstruction of the airway were performed through a left thoracotomy. In one case reconstruction of the tracheobronchial tree could be accomplished without loss of lung parenchyma; in the second case the left lung had to be removed since the lobar bronchi were infiltrated by the tumor. Such extensive left tracheobronchial resections have so far not been reported in the literature.     

Food, nutrition, physical activity and the prevention of cancer: a global perspective – the WCRF/AICR second report

Summary   The 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report, Food, Nutrition and the Prevention of Cancer: a global perspective, has become the most authoritative statement on the topic. Since then, new evidence has emerged, and more sophisticated methods of reviewing and assessing the literature have been developed. As a result, WCRF/AICR has invited a new expert panel of scientists, with observers from the United Nations and other international agencies, to work on the production of a second report, due to be published in 2006. In addition, a special methodology task force, commissioned by WCRF, has established a methodology to systematically review the evidence. No such methodology has, up to now, been used for assessing mainly observational data on causation of disease. A portfolio approach to the evidence is used, in which all types of study, with their advantages and disadvantages, contribute to the inference of causation. Seven academic centres from the UK, the USA and continental Europe are using this new methodology to comprehensively review evidence in systematic literature reviews. In a separate process, an expert panel will make conclusions from the systematic literature reviews. Together with other relevant evidence, the panel will use these conclusions as the basis for formulating recommendations. Set against this backdrop, the new report will act as the most authoritative global report ever to be published on the subject of food, nutrition, physical activity and the prevention of cancer. It will form the basis for coherent strategies for cancer prevention and control and will set the scientific agenda for years to come.     

Unusual approaches for insertion of the greenfield vena cava filter: the value of its approach through the jugulosubclavian junction

During the last four years, we have attempted 249 insertions of the Greenfield inferior vena cava filter using the right internal jugular vein. This approach was impossible in 31 patients (12.5%). Our first alternative was the insertion of the filter through the venous junction between the right internal jugular and right subclavian veins. If this latter technique was not possible we attempted the insertion of the Greenfield filter through the left internal jugular vein before using the retrograde femoral route which is associated with high morbidity. By these techniques we have been able to reduce the number of patients in whom it is impossible to achieve mechanical endocaval partial interruption to 2.4%.     

Craniofacial resection for anterior skull base tumours

Summary This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity.8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath.There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively.The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed.     

Antibodies to cardiolipin and intermediate filaments: A study of autoimmunity in rheumatoid arthritis

Summary Autoantibodies to cardiolipin and intermediate filaments have both been reported with increased frequency in rheumatoid arthritis. We evaluated the frequency, pathological significance, and diagnostic relevance of these autoantibodies in a series of 124 patients and controls. We studied 81 patients with rheumatoid arthritis, 23 with osteoarthritis, and 20 normals. Antibodies to cardiolipin were measured by an ELISA method and antibodies to intermediate filaments were measured by indirect immunofluorescence using HEp2 cells. Antibodies to cardiolipin were present in 58% of rheumatoid patients and antibodies to intermediate filaments were present in 55% rheumatoid patients. They were both predominantly of IgM class, and were more frequent than in normal or osteoarthritic controls. Correlating levels of both these auto-antibodies to clinical and laboratory measures of disease activity such as Ritchie articular index and C-reactive protein level showed that no consistent relationships existed. They were not related to other auto-antibodies such as rheumatoid factors and antinuclear antibodies, nor to each other. These results show that antibodies to cardiolipin and intermediate filaments in rheumatoid arthritis are of no diagnostic value, they are not related to disease activity, and have no relationship to other autoimmune disturbances. We suggest that several pathological mechanisms must be involved in the development of auto-antibodies in rheumatoid arthritis.     

A Novel, Intensive Home-Visiting Intervention for Runaway, Sexually Exploited Girls

PURPOSE.  Few studies have examined interventions that help adolescents who run away. This study both describes a home-visiting intervention program for young, sexually assaulted runaways (10–14 years old) and provides preliminary outcomes from the first 20 female participants.
DESIGN AND METHODS.  Using a strengths-based approach, advanced practice nurses provided frequent home and school visits and case management, and assisted girls to access an empowerment group over a 1-year period.
RESULTS.  Teens' risk behaviors decreased, including truancy, runaway episodes, sexually transmitted infections, and substance use.
CONCLUSIONS.  Preliminary results suggest that this is an effective intervention for reducing risk behaviors and helping younger runaways reconnect to school and family.
PRACTICE IMPLICATIONS.  Client-centered interventions in community settings can address the complex health needs of vulnerable young runaways.     

Posterior approach for simultaneous access to the popliteal and anterior tibial arteries applications to distal arterial bypass

Abstract Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a peroperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interosseous fascia, which was divided over 10 cm. Medial rotation of the limb by 30° exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.     

ACD/Log P method description

This study describes the development of the ACD/Log P calculation method. Analysis of 14 calculation methods revealed that the most accurate calculations are obtained when correction factors are used. We evaluated the correction factors used by Hansch and Leo in CLOGP in order to simplify their method. Most of the CLOGP structural factors are included in our fragmental increments. Aliphatic and aromatic factors are replaced with additive interfragmental increments. Missing increments are estimated by two empirical equations with simple physical interpretation. The final method uses three simple equations with several types of parameters. The training set included 3601 compounds and the correlation between experimental and calculated Log P values gave R = 0.992, S = 0.21. The method was validated by comparing it with 17 other methods on various data sets of independently selected drugs and other compounds. In all cases, our method produced the best results. The weakness of this method is that it uses a large number of individual increments for aromatic interactions. Each increment represents a combination of several effects which presently cannot be separated. This revised version was published online in August 2006 with corrections to the Cover Date.     

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

cutter j. & jordan s. (2012) Journal of Nursing Management
The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre Aim To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Background Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The ‘systems approach’ to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. Methods A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. Results The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Conclusions Injuries are frequently under-reported, possibly compromising safety in operating theatres. Implications for nursing management A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.