Pediatric thoracic organ transplants: challenges in primary care

Pediatric nurse practitioners (PNP) confront numerous challenges when delivering care to infants, children, and adolescents who receive thoracic organ transplants. Today, thoracic organ transplantation is an acceptable and viable option for infants, children, and adolescents with end stage cardiac and pulmonary disease. Despite the plateau in the actual numbers of thoracic organ transplants performed annually in the United States, they are still being performed in a significant number. The care of children who receive transplants includes long-term use of immunosuppressants, dealing with infectious diseases, and utilizing principles of well child and family care. PNPs play a vital role in providing holistic care to infants, children, and adolescents who receive a thoracic organ transplant.     

Uterine artery embolization: the role in obstetrics and gynecology

OBJECTIVE: Evaluation of the studies for the use of uterine artery embolization in various conditions in both obstetrics and gynecology. DESIGN: Literature review. RESULTS: Uterine artery embolization was successful in controlling postpartum hemorrhage in 94.9% of the cases. It was effective in controlling the bleeding in 96% of cases with uterine arteriovenous malformations and in 100% of the cases with abdominal and cervical pregnancies. Recently, it has been introduced as a line of treatment for uterine fibroids. It controlled bleeding in 82-92% of cases, and lead to 20-64% reduction in size of fibroids. CONCLUSIONS: Uterine artery embolization is of significant value in treating certain hemorrhagic conditions in obstetrics and gynecology including postpartum hemorrhage, ectopic pregnancy, and arteriovenous malformations. Its use in treatment of uterine fibroids is new and needs more collaborative studies by gynecologists and intervention radiologists to evaluate issues related to necrosis of the tumor, sepsis, and the long-term effect on size and recurrence rate.     

Evidence-based guidelines for family presence in the resuscitation room: a step-by-step approach

The benefits of family presence (FP) during resuscitation have been well documented in the literature for the past 20 years. However, many hospitals lack written guidelines to direct staff members during a resuscitation event. A structured approach affords staff a uniform and organized way to offering FP, avoiding any interference with patient care. The purpose of this paper is to provide evidence-based practice guidelines to offering FP during resuscitation in the emergency department. The guidelines illustrate a practical step-by-step approach that staff members can follow every time a patient is being evaluated and/or treated in the resuscitation room.     

Prospective,randomized study of diagnosis and outcome in acute upper-gastrointestinal bleeding: Endoscopy versus conventional radiography

Sixty patients with mild to moderate upper-gastrointestinal bleeding were admitted to a prospective, controlled study of diagnosis and management, and were randomized to endoscopy or upper-gastrointestinal (UGI) barium series as the initial study. Definitive localization of the source of bleeding was made initially in 69% of the endoscopy group and 21% of the UGI group (P<0.0005). Of 54 patients undergoing both studies, endoscopy was definitive in 67% and UGI series in 22%. Thus, endoscopy also made more diagnoses when used as the second study (P<.01). The use of endoscopy as the initial procedure led to significantly more rapid diagnosis than with UGI series. However, there were no significant differences between the two groups in clinical outcome. Endoscopy is the initial diagnostic procedure of choice in patients with mild to moderate upper-gastrointestinal bleeding because it enables detection of superficial bleeding lesions and has significantly increased the speed of diagnosis.     

Expression of HBxAg in human chronic hepatitis,cirrhosis and primary hepatic carcinoma and its significance

The specimens of this study were obtained from 110 cases of chronic hepatitis,108cirrhosis and 110 primary hepatic carcinoma(PHC).Formalin-fixed and paraffin-embedded seetions were stained by ABC method forHBxAg,and by PAP method for HRsAg and HBcAgOf the 110 cases of chronic hepatitis,72(65.5％)were positive HBxAg in the liver cells,66(60％)were postitive in HBsAg and 35(31.8％)in HBcAg.Among the 108 eases of drrhosis,84(77.8％)revealed to be HBxAg positive in the liver cells,73(67.6％)were demonstrated to beHBsAg-positive and 18(16.7％)were shown to be HBcAg-positive.Among the 110 eases of pri-mary hepatic carcinoma,64(58.2％)showed HBxAg-positive reaction in cancerous tissues.Therates of positive HRsAg and HBcAg in tumor tissues were 15.5％ and 10.9％,respectively.Six-ty-three(78.8％)of 80 cases of the non-cancerous hepatic tissues displayed HBxAg positivenessand the rates of positive HRsAg and HBcAg in the non-tumor tissues were 47(58.8％)and 21(2.6.3％),respectively.The above-mentioned results sugared that the detection rote of HBxAg inchronic hepatitis,cirrhosis and PHC was higher than that of HBsAg and HBcAg.This studydemonstrates a dose relationship between chronic hepatitis,cirrhosis,PHC and chronic persistentinfection of hepatitis B virus(HBV).Persistent chronic HBV infection plays an important role inthe pathogenesis of chronic hepatitis, cirrhosis and PHC.It is possible that the detection ofHBxAg with anti-HBx could be an additional new diagnostic marker for HBV infection.Howev-er,the role of HBxAg in the pathogenesis of chronic liver diseases needs to be furtherinvestigated.