Measuring anxiety in surgical patients using a visual analogue scale.

Since the early days of surgery patients have been anxious about undergoing operations. This feeling remains common today despite advances in medicine and surgical techniques. Numerous studies have shown the effect anxiety has on the human body.

Medullary sponge kidney: causes and treatments.

Medullary sponge kidney is a little known and little understood disease. A patient with a medullary sponge kidney may undergo decades of suffering in the form of infections and pain before any diagnosis is even made. When a diagnosis is made, it is more than likely to be an incidental finding from a test for another problem.

Infective endocarditis: changing aetiology of disease.

Infective endocarditis (IE) is an evolving disease resulting in high morbidity and mortality. Despite medical and diagnostic advances, the incidence of the disease has remained unchanged, reflecting the changing epidemiological and microbiological profile of IE. Classical risk factors such as rheumatic heart disease have now been overtaken by new risk factors including an ageing population, degenerative valve disease and intravenous drug use.

Cyclical vomiting syndrome: diagnosis, causes and treatment.

Cyclical vomiting syndrome (CVS) is a disorder of unknown cause. Patients experience episodes of sudden violent vomiting that last from a few hours to a few days, which can occur several times a year. CVS affects children and adults yet despite numerous studies the cause of the condition is unknown.

Airway management of an elective surgical patient.

Airway management is a skill that all healthcare professionals need to learn. This skill is used in two specific areas. First, in emergency situations such as cardiac arrest or respiratory arrest.

Identifying and assessing anxiety in pre-operative patients.

Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients.

Managing anxiety in the elective surgical patient.

Patients coming into hospital can suffer a great deal of anxiety--Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period. These fears manifest themselves as uncertainty, loss of control and decreased self-esteem, anticipation of postoperative pain, and fear of separation from family (Egan et al, 1992; Asilioglu and Celik, 2004). As technical advances and improved anaesthetic techniques become available to the NHS, the ability to offer day surgery to a wider patient population is increasing.

Reversible hyponatraemia with venlafaxine in a young patient.

A 28-year-old woman with a depressive episode developed hyponatraemia (126 mmol/l), in the absence of hypovolaemia, oedema, or diuretic use, 2 weeks after starting treatment with the antidepressant venlafaxine. Full blood count, potassium, urea, creatinine, thyroid function test, liver function test, amylase, serum cortisol, and glucose were all normal. A repeat blood test 3 days later revealed a further reduction in the sodium concentration to 123 mmol/l.

Selective serotonin reuptake inhibitor use in primary care: a 5-year naturalistic study.

Objective: To investigate prescribing trends of selective serotonin reuptake inhibitors (SSRIs) during the course of the Defeat Depression Campaign (1992 to 1996).

Methods: This study utilised cross-sectional data on the prescribing of SSRIs for the treatment of depression from a large primary care database for the 5 consecutive years of the Defeat Depression Campaign, producing the largest study of SSRI use to date.

Results: A total of 93 600 prescriptions were issued for fluoxetine, paroxetine and sertraline, in 27 210 treatment episodes.

Association of oestrogen receptor beta 2 (ER beta 2/ER beta cx) with outcome of adjuvant endocrine treatment for primary breast cancer--a retrospective study.

Background: Oestrogen receptor beta (ERbeta) modulates ERalpha activity; wild type ERbeta (ERbeta1) and its splice variants may therefore impact on hormone responsiveness of breast cancer. ERbeta2/ERbetacx acts as a dominant negative inhibitor of ERalpha and expression of ERbeta2 mRNA has been proposed as a candidate marker for outcome in primary breast cancer following adjuvant endocrine therapy. We therefore now assess ERbeta2 protein by immunostaining and mRNA by quantitative RT-PCR in relation to treatment outcome.

Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural mesothelioma.

Background: Malignant pleural mesothelioma (MPM) is a highly aggressive malignancy whose incidence is expected to increase in the United Kingdom, Western Europe, and Australia over the next 20 years as a result of occupational exposure to asbestos fibres. Surgery is feasible in only a small proportion of cases, and radiotherapy and cytotoxic chemotherapy are used in palliation. Pemetrexed is the first and only chemotherapy agent that has been granted a marketing approval for use in combination with cisplatin for the treatment of chemo-naïve patients with unresectable MPM.

Expression of cellular adhesion molecule 'OPCML' is down-regulated in gliomas and other brain tumours.

The four GPI-anchored cell adhesion molecules that exemplify the IgLON family are most highly expressed in the nervous system and associate to form up to six different heterodimeric 'Diglons' that can modify cell adhesion and inhibit axon migration. Recently, two members, OPCML and LSAMP, were identified as putative tumour suppressor genes in ovarian and renal carcinomas respectively. In this study, we investigated OPCML expression in nonneoplastic brain tissue and 35 brain tumours (18 glioblastoma multiformes, five anaplastic gliomas, five meningiomas, six metastases and one medulloblastoma) and four glioma cell lines using quantitative reverse transcriptase polymerase chain reaction (RT-PCR).

Parvovirus B19 infection presenting as 'bathing trunk' erythema with pustules.

A 7-year-old girl presented with acute vulval erythema and pustules, associated with a petechial eruption in her flexures and over her feet. There was a mild prodromal illness and the patient was afebrile. There were minimal symptoms associated with the rash.

Genetic and metabolic predictors of chemosensitivity in oligodendroglial neoplasms.

The -1p/-19q genotype predicts chemosensitivity in oligodendroglial neoplasms, but some with intact 1p/19q also respond and not all with 1p/19q loss derive durable benefit from chemotherapy. We have evaluated the predictive and prognostic significance of pretherapy (201)Tl and (18)F-FDG SPECT and genotype in 38 primary and 10 recurrent oligodendroglial neoplasms following PCV chemotherapy. 1p/19q loss was seen in 8/15 OII, 6/15 OAII, 7/7 OIII, 3/11 OAIII and was associated with response (Fisher-Exact: P=0.

Clinical use of genotype to predict chemosensitivity in oligodendroglial tumors.

Background: The -1p/-19q genotype has been associated with prolonged survival and chemosensitivity in oligodendroglial neoplasms, but the predictive and prognostic significance of genotype in the routine clinic is not established.

Methods: The authors investigated allelic imbalance in 1p36, 19q13, 17p13, 10p12-15, and 10q22-26 and p53 mutation in a cohort representative of clinical practice at their center (50 primary, 26 recurrent cases) given PCV chemotherapy between 2000 and 2003 and compared with response and outcome following PCV.

Results: 1p/19q loss was found in 12/19 OII, 10/23 OAII, 11/13 OIII, and 6/21 OAIII.

Use of calcipotriene cream (Dovonex cream) following acute treatment of psoriasis vulgaris with the calcipotriene/betamethasone dipropionate two-compound product (Taclonex): a randomized, parallel-group clinical trial.

Introduction: A calcipotriene/betamethasone dipropionate two-compound product (Taclonex ointment) has been shown to be safe and effective in the treatment of psoriasis over 4 weeks. Since treatment of psoriasis is generally long-term, the objective of this study was to investigate the efficacy and safety of transferring patients to maintenance treatment with calcipotriene cream (Dovonex cream) following a 4-week treatment period with the two-compound product.

Methods: Patients with psoriasis were randomized to one of the following three treatment groups: 4 weeks of the two-compound product followed by 8 weeks of calcipotriene cream (calcipotriene cream group); 4 weeks of the two-compound product followed by 8 weeks of calcipotriene cream on weekdays and the two-compound product on weekends (alternating group); 4 weeks of the two-compound product followed by 8 weeks of vehicle of calcipotriene cream (vehicle group).

Successful treatment of type I adult-onset pityriasis rubra pilaris with infliximab.

A 59-year-old woman presented with a painful, pruritic eruption that had commenced as an erythematous, dry patch on the upper back but progressed to erythroderma. Examination revealed orange-tinged erythroderma, scalp scaling, ectropion, palmoplantar keratoderma and nail changes. A diagnosis of type I adult-onset pityriasis rubra pilaris was made, and a subsequent skin biopsy was consistent with this.

Significance of the metastasis-inducing protein AGR2 for outcome in hormonally treated breast cancer patients.

The anterior gradient protein-2 (AGR2) is inducible by oestrogen and itself can induce metastasis in a rat model for breast cancer. Here, a rabbit antibody to recombinant human AGR2 was used to assess its prognostic significance in a retrospective cohort of 351 breast cancer patients treated by adjuvant hormonal therapy. The antibody stains 66% of breast carcinomas to varying degrees.

Expression of ADAMTS-8, a secreted protease with antiangiogenic properties, is downregulated in brain tumours.

Angiogenesis and extracellular matrix degradation are key events in tumour progression, and factors regulating stromal-epithelial interactions and matrix composition are potential targets for the development of novel anti-invasive/antiangiogenic therapies. Here, we examine the expression of ADAMTS-8, a secreted protease with antiangiogenic properties, in brain tissues. Using quantitative RT-polymerase chain reaction (PCR), high, equivalent expression of ADAMTS-8 was found in normal whole brain, cerebral cortex, frontal lobe, cerebellum and meninges.

Making effective clinical decisions: a framework for nurse practitioners.

Much has been written and researched about the decision-making process. Many agree it is one of the most difficult processes a health professional has to undertake. It is also one of the most important parts of nursing practice.

Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix.

Background: The National Cancer Institute (USA) alert in February 1999 stated that concomitant chemoradiotherapy should be considered for all patients with cervical cancer, based on evidence from five randomised controlled trials (RCTs).

Objectives: To review all known RCTs comparing concomitant chemotherapy and radiation therapy with radiotherapy for locally advanced cervical cancer.

Search Strategy: We searched electronic databases, trials registers and reference lists of published trial reports and review articles were also searched.

Implementing nurse-led discharge from day surgery.

The demands now placed upon the NHS to reduce waiting lists and cut costs mean that day surgery is being seen not only as a way forward for elective surgery, but also as a key factor for assisting in the bed management of acute services. This article focuses on the practical steps that health and social care professionals can take to improve discharge processes in their care settings.

Hypersensitive K303R oestrogen receptor-alpha variant not found in invasive carcinomas.

Introduction: Genetic abnormalities or mutations in premalignant breast lesions may have a role in progression toward malignancy or influence the behaviour of subsequent disease. The A908G (Lys303-->Arg) change in the gene encoding oestrogen receptor-alpha (ER-alpha) creates a hypersensitivity to oestradiol and would have significant consequences if present in breast carcinoma, especially those treated with endocrine therapy. We have therefore examined a panel of endocrine-treated invasive carcinomas for the presence of this mutation.