Laparo-endoscopic single site hysterectomy in gynecologic surgery

Laparo-endoscopic single site (LESS) surgery has recently gained broader acceptance as a less-invasive approach to traditional multi-port laparoscopic procedures. LESS hysterectomy represents the gynecologic surgeon's progression toward this goal of performing minimally invasive hysterectomy procedures through increasingly fewer incisions. Although this procedure offers improved cosmesis and potentially decreased post-operative pain, there are also many challenges to adoption of this surgical procedure. LESS hysterectomy is associated with a steep learning curve and the need for the gynecologic surgeon to adopt new technologies and develop a new set of surgical skills. Following the basic principles of LESS surgery is essential for the gynecologic surgeon to safely and efficiently adopt this surgical procedure. Advances in surgical instrumentation will continue to allow surgeons to perform increasingly complex LESS surgical procedures in the future.

The FGFR4 Y367C mutant is a dominant oncogene in MDA-MB453 breast cancer cells

Mutational analysis of oncogenes is critical for our understanding of cancer development. Oncogenome screening has identified a fibroblast growth factor receptor 4 (FGFR4) Y367C mutation in the human breast cancer cell line MDA-MB453. Here, we investigate the consequence of this missense mutation in cancer cells. We show that MDA-MB453 cells harbouring the mutation are insensitive to FGFR4-specific ligand stimulation or inhibition with an antagonistic antibody. Furthermore, the FGFR4 mutant elicits constitutive phosphorylation leading to an activation of the mitogen-activated protein kinase cascade as shown by an enhanced Erk1/2 phosphorylation. Cloning and ectopic expression of the FGFR4 Y367C mutant in HEK293 cells revealed high pErk levels and enhanced cell proliferation. Based on these findings, we propose that FGFR4 may be a driver of tumour growth, particularly when highly expressed or stabilized and constitutively activated through genetic alterations. As such, FGFR4 presents an option for further mutational screening in tumours and is an attractive cancer target with the therapeutic potential.

Outcome for infants at high risk of major handicap

Perinatal intensive care had been introduced in University College Hospital, London, by 1966. In the succeeding 10 years, 28-day mortality rates fell among infants of birth weight 1500 g or less. Among the survivors, the incidence of major handicap was 10% or less and the mean IQ increased to within the range expected for a normal population. Of the children aged 8 years or more 76% had no handicaps and were attending normal schools; 18% had minor handicaps or problems for which they were receiving extra help in normal schools; and only 6% were attending special schools. Throughout the 10 years of the study, the overall prognosis for these infants of very low birth weight improved significantly. Results among other high-risk groups were equally encouraging. Analysis of variance of the data from the infants who weighed 1500 g or less at birth indicated that perinatal complications, particularly illnesses associated with abnormal neurological signs or acidaemia in the infants around the time of birth, were the principal factors determining the condition of the survivors at follow-up. Thus, it is likely that additional refinements in the management of the perinatal period may result in further improvements in the prognosis of these and other high-risk newborns.

Using an aseptic technique to reduce the risk of infection

It is essential that nurses recognise the consequences of patients acquiring a healthcare-associated infection (HCAI). This article outlines how handwashing continues to be the most important factor in reducing HCAI, but that the use of an aseptic technique will further cut the risk of infection. Because most aseptic techniques do not require a surgical aseptic technique, emphasis is placed on the use of an aseptic non-touch technique, which is required for many procedures in hospital and the community.

Ionising radiation: promoting safety for patients, visitors and staff

Diagnostic radiology and sealed and unsealed sources of radiotherapy are valuable in the treatment of cancer. However, unwanted consequences can result from excessive exposure to ionising radiation. Therefore, its administration requires great care not only to protect the patient but also the nurses involved in patient care. Nurses should be aware of the safety issues in the diagnostic and therapeutic use of ionising radiation so that they can work safely and confidently.

Gene therapy for children with cystic fibrosis--who has the right to choose?

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefit

Fluid intake, personality and behaviour in patients with eating disorders

OBJECTIVE

To examine psychological and behavioural variables associated with the disordered fluid intake of 112 eating disorder patients.

METHOD

Fluid intake history for previous seven days, and standardized psychological and behavioural measures of eating disorders, mood, personality and health, were completed on admission to hospital.

RESULTS

Only behaviours associated with eating disorders were associated with fluid intake. Greater amounts of total and energy-free fluids are consumed if patients report overeating, binge eating and dieting between overeating more frequently, drinking more caffeine-containing energy free drinks, vomiting and using laxatives. Energy-containing fluid intake is higher if patients feel their body weight is less important and if they binge eat. There is a significant difference in the amount of fluid drunk (ml or ml/kg) by patients with bulimia nervosa (BN) when compared to patients with no current diagnosis but not compared with anorexia nervosa (AN) or eating disorders not otherwise specified (EDNOS) patients.

DISCUSSION

Fluid intake is associated with eating disorder behaviour rather than personality and psychological variables. Patients eating more drink more.

Post-Cesarean Delivery Analgesia

Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. Pain and anxiety may also reduce the ability of a mother to breast-feed effectively. It is necessary that pain relief be safe and effective, that it not interfere with the mother's ability to move around and care for her infant, and that it result in no adverse neonatal effects in breast-feeding women. The most commonly used modalities are systemic administration of opioids, either by intramuscular injection or i.v. by patient-controlled analgesia, and neuraxial injection of opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific advantages and disadvantages which will be discussed in this review. In addition, there are new drug applications of potential benefit for the treatment of post-cesarean delivery pain.

Use of hormone replacement therapy (HRT) and survival following breast cancer diagnosis

Although hormone replacement therapy (HRT) use has been associated with breast cancers that have better prognostic features, it is not clear whether this leads to improved survival. We studied a cohort of 4022 postmenopausal women diagnosed with breast cancer between 1993 and 2000, who attended a mammographic screening program, among whom 312 deaths subsequently occurred. Proportional hazards models were used to examine survival from breast cancer and all-causes among HRT users and non-users. The multivariate hazard ratio for HRT use was 0.64 (95% CI: 0.41-1.00) for breast cancer deaths and 0.69 (95% CI: 0.49-0.96) for all-cause mortality. This was attenuated by grade (HR 0.71; 95% CI: 0.45-1.10). HRT use at diagnosis was associated with modestly improved survival from breast cancer that appeared in part to be explained by the influence of HRT on tumour grade, although we cannot exclude the possibility of confounding by factors associated with the choice to use HRT.

Localised extranodal lymphoma of the head and neck: the Sheffield Lymphoma Group experience (1971-2000)

AIMS

Over the 30-year period from 1971-2000, 3750 cases of lymphoma were referred to the Sheffield Lymphoma Group for investigation and treatment. Of these, 580 were extranodal presentations and, of these, 190 (33%) were localised to the head and neck region. The aim of this lymphoma database review was to evaluate the patient characteristics and survival rates for these patients.

MATERIALS AND METHODS

The sample included 98 women and 92 men, with a median age at presentation of 65 years.

RESULTS

The most common site affected was tonsil (34%), followed by salivary glands (16%). Other common sites were the thyroid, orbit and nasopharynx. The most frequent presenting feature was a swelling or mass, with pain, dysphagia and nasal obstruction also comprising large groups. All cases were non-Hodgkin's lymphoma. Fifty-five cases were histological grade 1; 132 were grade 2. Diffuse large B cell was the most common histological subtype. The overall 5- and 10-year survival rates were 55% (95% CI 47-62) and 44%, (95% CI 36-53), respectively, with a median survival of 92 months (95% CI 56-128). Stage and grade were both found to influence survival.

CONCLUSION

This data concords with and extends information available from previous studies. More detail is now required on specific head and neck sites.

EGFR signal transactivation in cancer cells

The EGFR (epidermal growth factor receptor) plays a key role in the regulation of essential normal cellular processes and in the pathophysiology of hyperproliferative diseases such as cancer. Recent investigations have demonstrated that GPCRs (G-protein-coupled receptors) are able to utilize the EGFR as a downstream signalling partner in the generation of mitogenic signals. This cross-talk mechanism combines the broad diversity of GPCRs with the signalling capacities of the EGFR and has emerged as a general concept in a multitude of cell types. The molecular mechanisms of EGFR signal transactivation involve processing of transmembrane growth factor precursors by metalloproteases which have been recently identified as members of the ADAM (a disintegrin and metalloprotease) family of zinc-dependent proteases. Subsequently, the EGFR transmits signals to prominent downstream pathways, such as mitogen-activated protein kinases, the phosphoinositide 3-kinase/Akt pathway and modulation of ion channels. Analysis of GPCR-induced EGFR activation in more than 60 human carcinoma cell lines derived from different tissues has demonstrated the broad relevance of this signalling mechanism in cancer. Moreover, EGFR signal transactivation was linked to diverse biological processes in human cancer cells, such as cell proliferation, migration and anti-apoptosis. Together with investigations revealing the importance of this GPCR-EGFR cross-talk mechanism in cardiac hypertrophy, Helicobacter pylori -induced pathophysiological processes and cystic fibrosis, these findings support an important role for GPCR ligand-dependent EGFR signal transactivation in diverse pathophysiological disorders.