Oxidative stress as a mediator of cardiovascular disease.

During physiological processes molecules undergo chemical changes involving reducing and oxidizing reactions. A molecule with an unpaired electron can combine with a molecule capable of donating an electron. The donation of an electron is termed as oxidation whereas the gaining of an electron is called reduction.

Should the cardiotomy suction blood be cell-saver processed before retransfusion? A clinico-pathologic mystery.

The use of cardiotomy suction (CS) in cardiopulmonary bypass (CPB) surgery is associated with a pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. However, CS is yet been employed to preserve autologous blood during on-pump surgery. Though processing CS blood with a cell saving device is considered paramount in significantly reducing the inflammatory effects, yet this might also have potential harmful effects on the outcome of the patient.

Tracing the origins of postoperative atrial fibrillation: the concept of oxidative stress-mediated myocardial injury phenomenon.

Background: Atrial fibrillation (AF) is the most common arrhythmia associated with coronary artery surgery and is an important factor contributing to postoperative morbidity and mortality. Recently, there is growing evidence that dysregulation of the oxidant-antioxidant balance, inflammatory factors and discordant alteration of energy metabolites may play a significant role in its pathogenesis.

Design: We evaluated the link between postoperative atrial fibrillation with inflammatory factors and oxidative stress.

Ethnicity and adverse operative outcomes among Australian patients undergoing first-time isolated coronary artery bypass graft surgery.

The study compared cardiovascular risks factors, morbidity and in-hospital mortality following coronary artery bypass graft (CABG) surgery in Australian patients of different ethnic backgrounds including Aboriginal (AB), Italian (IT), Indian (IA), British Caucasians (BC), and Chinese (CH). These groups AB (n = 20), CH (n = 12), IT (n = 104), BC (n = 493), and IA (n = 16) all had first-time isolated CABG surgery at St. Vincent's Hospital, Melbourne from March 2001 to March 2007.

Functional adaptation to oxidative stress by memory T cells: an analysis of the role in the cardiovascular disease process.

T cells participate in combating infection and critically determine the outcomes in any given disease process. Impaired immune response occurs in a number disease processes such as in cancer and atherosclerosis although the underlying mechanisms are still not fully understood. This article gives an up-to-date review of T cells development and functional adaptation to pathophysiological stimuli and participation in the cardiovascular disease process.

Memory loss resulting from fornix and septal damage: impaired supra-span recall but preserved recognition over a 24-hour delay.

Despite increasing evidence that the fornix is important for memory, uncertainty remains about the exact nature of subsequent impairments arising from damage to this tract. This uncertainty is often created by pathology in additional brain structures. The present study involved a young man, DN, who had almost complete bilateral loss of the rostral columns of the fornix and much of the surrounding septum in the left hemisphere following the surgical removal of a cavernous angioma.

Monozygotic triplet pregnancy following egg donation and transfer of single frozen-thawed embryo.

Objective: To describe a case of monozygotic triplet pregnancy following egg donation and the transfer of a single frozen-thawed embryo.

Design: Case report.

Setting: District general hospital and regional department of fetal medicine in northeast England.

The right choice of prosthesis for patients undergoing aortic valve surgery: searching the truth.

Aortic valve surgery is suggested when native aortic valve is diseased and complications outweigh the risks. Choice of prosthesis for aortic valve surgery is vastly undetermined, in part due to the varied options (bioprosthetic, mechanical prosthesis, homografts and allografts) available. The technical issues during valve surgery and the anticoagulation concerns along with the patient type with respect to age, ethnicity, sex and quality of life do contribute to the challenge for deciding the type of valve prosthesis best substituted to the diseased native valve.

Hemodilution during cardiopulmonary bypass: optimal hematocrit for safe outcome.

Studies have implicated hemodilution during cardiopulmonary bypass (CPB) as an independent risk factor for perioperative morbidity and mortality, however, it is plausible that the variability in results so far quoted are species-specific or blood product covariate dependent. Nevertheless, obvious debate regarding the optimal degree of hemodilution during CPB with regard to patients' outcome still prevails in the modern cardiac surgery era. We agree from the reported arguments that the range of absolute differences in the perioperative hematocrit (HCT) seem more reasonable to use than individual values yet we present a new avatar of evidence in this letter regarding the optimal HCT to be used during normo/hypothermic CPB.

Adolescents in the perioperative environment.

The following paper discusses the experiences of the author with adolescents in the perioperative environment and explores issues of consent and ethics, including competency, treatment in Accident and Emergency, and terminations.

Rupture of the quadriceps tendon: an association with a patellar spur.

We reviewed the records of 107 consecutive patients who had undergone surgery for disruption of the knee extensor mechanism to test whether an association existed between rupture of the quadriceps tendon and the presence of a patellar spur. The available standard pre-operative lateral radiographs were examined to see if a patellar spur was an indicator for rupture of the quadriceps tendon in this group of patients. Of the 107 patients, 12 underwent repair of a ruptured patellar tendon, 59 had an open reduction and internal fixation of a patellar fracture and 36 repair of a ruptured quadriceps tendon.

Case Report: grandmother, mother and another -- an intergenerational surrogacy using anonymous donated embryos.

Surrogacy and embryo donation remain beneficial but controversial infertility therapies. This is the first report of a pregnancy and subsequent birth of healthy twins following a surrogacy involving a female patient's biological mother as surrogate, but using anonymously donated embryos. Due to the novelty of combining intergenerational surrogacy with embryo donation, the legal side of adoption has taken over 3 years to complete.

Healthcare assistants. To scrub or not to scrub?

The appropriateness of healthcare assistants expanding their role into the domain of scrubbing has been a contentious issue for a long time. Whenever the shortage of theatre staff becomes a major concern, expanding the role of the healthcare assistant into scrubbing is discussed and decided against. Although allowing healthcare assistants to scrub is not the sole answer for all theatre's problems, Hazel Smith argues that it would ease a difficult situation.

Observations on a consecutive series of patients who have had Trilucent breast implants removed as recommended by the MDA Hazard Notice (May 2000).

A prospective study of 25 female cosmetic-surgery patients who had a total of 50 Trilucent breast implants forms the basis of this paper. All but one patient elected to have new implants, of which all but three patients had silicone implants (the others selected glucose saline implants). The Trilucent implants were more difficult to remove than expected because of a 'Velcro-like' attachment to the internal surface of their capsules.

Male patients with lower urinary tract symptoms. 2: Treatment.

The first part of this article (Dorey, 2000) described the subjective and objective assessment of men with lower urinary tract symptoms (LUTS). This article will examine treatment protocols for stress incontinence, urge incontinence, post-prostatectomy incontinence, post-micturition dribble, overflow incontinence, reflex incontinence and functional incontinence. Pelvic floor muscle exercises, biofeedback, electrical stimulation, urge suppression techniques, and fluid intake are discussed.

An analysis of perioperative care.

Perioperative nursing requires an appreciation of patients' needs throughout the episode of care. This article presents a critical analysis and examination of the perioperative care of a patient undergoing total abdominal hysterectomy. In addition to analysing the efficacy of care delivery in the perioperative setting, we will explore the application of nursing theory and research to everyday practice and the degree to which a hospital's infrastructure facilitates quality care.

Adult hypoxaemia in the perioperative period: a review of the literature.

As a group of academic skills, learning to search for, obtain, read and critically review literature represents a considerable achievement. For the many perioperative nurses who may never be able to pursue their own research project, reading literature reviews is an excellent alternative which enables individuals to become better and more critically informed. A review of the available literature may provide answers to questions or indicate where a subject is in need of further research.