Surgical treatment of Boerhaave syndrome in the past, present and future: updated results of a specialised surgical unit.

INTRODUCTION: Boerhaave syndrome is a rare clinical entity associated with high rates of morbidity and mortality. Early recognition of the symptoms, and identification of the site and extension of the injury are key in improving the prognosis. METHODS: This study presents data on the mortality, morbidity and length of hospital stay in patients diagnosed with Boerhaave syndrome. The data were retrieved from a prospectively collected database in a single surgical unit between 2012 and 2022. The study makes a comparison with the surgical outcomes of the previous decade. RESULTS: Some 33 patients were diagnosed with Boerhaave syndrome and were treated surgically between 2012 and 2022 in a specialist upper gastrointestinal surgical unit. All patients underwent standard surgical repair (in-theatre diagnostic endoscopy, T-tube placement through thoracotomy and feeding jejunostomy through laparotomy). The mean size of the defects in the oesophageal lumen was 3.3cm. Delayed presentation was noted for 13 patients (39%); 8 patients (24%) died in hospital, and 19 patients (58%) developed postoperative complications. Mortality was similar to the rate recorded for the 20 patients from the previous decade (24% vs 20%, respectively). The mean length of hospital stay was 41 days, and was comparable to the 35.7 days reported between 1997 and 2011. CONCLUSIONS: Early and aggressive management of spontaneous oesophageal rupture ameliorates the postoperative recovery and prognosis. The surgical results of our unit were found comparable to the previous decade in the population of patients who were treated surgically.

Development of a method for treating lower-eyelid carcinomas using superficial high dose rate brachytherapy.

In this study, a method was developed for delivering high dose rate (HDR) brachytherapy treatments to basal cell carcinomas (BCCs) as well as squamous cell carcinomas (SCCs) of the lower eyelid via superficial catheters. Clinically-realistic BCC/SCC treatment areas were marked in the lower-eyelid region on a head phantom and several arrangements of catheters and bolus were trialled for treating those areas. The use of one or two catheters of different types was evaluated, and sources of dosimetric uncertainty (including air gaps) were evaluated and mitigated. Test treatments were planned for delivery with an iridium-192 source, using the Oncentra Brachy treatment planning system (Elekta AB, Stockholm, Sweden). Dose distributions were evaluated using radiochromic film. The proposed method was shown to be clinically viable, for using superficial HDR brachytherapy to overcome anatomical difficulties and create non-surgical treatments for BCC and SCC of the lower eyelid.

Nutrition as a neglected factor in insect herbivore susceptibility to Bt toxins.

The widespread global adoption of Bt crops elevates concerns about the evolution of Bt resistance in insect pest species. Current insecticide resistance management (IRM) strategies focus solely on genetic variation as a causal factor in the evolution of resistance, but ignore the role that environmental factors, such as nutrition, may play. In this opinion paper, we discuss the benefits that insect herbivores gain from consuming foods with protein-carbohydrate content that matches their self-selected protein-carbohydrate intake, and show that even within monocultures there is amply opportunity for insect herbivores to regulate their macronutrient intake. Next we review new data that show that dietary protein and carbohydrates can: firstly, have predictably strong effects on the survival and performance of caterpillars challenged with Bt toxins, and secondly, mediate plasticity in susceptibility to Cry1Ac, which can account for large differences in LC50 values. Nutrition-Bt interactions such as these have important implications for IRM, particularly given that diet-incorporated Bt bioassays commonly use artificial diets that vary substantially from their self-selected optimal diets, which likely results in underestimates of resistance in the field. Failing to bioassay larvae on ecologically-relevant diets can seriously confound the results of Bt resistance monitoring bioassays and undermine our ability to detect resistance in the field.

Glutathione supplementation to University of Wisconsin solution causes endothelial dysfunction.

INTRODUCTION: Glutathione (GSH) is added to University of Wisconsin (UW) organ preservation solution to protect against oxidative stress. This study assesses the effect of GSH-supplementation on endothelial function in tissues subjected to cold ischaemia and compares its effects to a mono-ethyl ester equivalent (GSH-MEE) and S-nitrosated GSH (GSNO). METHODS: Rat aortic rings were stored for 1 h or 48 h in cold, hypoxic UW solution with or without GSH (3 mM), GSH-MEE (3 mM) or GSNO (100 mciroM) supplementation. Aortic rings were reoxygenated in warm Krebs solution; smooth muscle function was assessed by responses to phenylephrine (PE), and endothelial function by vasodilatation to the endothelium-dependent dilator, acetylcholine (ACh). The protective effects against oxidant-induced endothelial cell death were assessed in cultured human umbilical vein endothelial cells (HUVEC). RESULTS: Supplementation of UW with either GSH or GSH-MEE had no effect on vascular responses to PE, but smooth muscle contraction was significantly attenuated in rings incubated for 48 h with GSNO. Endothelium-dependent relaxation was significantly impaired in tissues stored under hypoxic conditions in GSH, GSH-MEE and GSNO supplemented UW solution for 1 h. However, impairment at 48 h was significantly more pronounced in GSH-treated vessels. Cultured HUVEC death was exacerbated by GSH and GSH-MEE in unstressed cells and in those stressed with a superoxide anion generator. CONCLUSIONS: GSH supplementation of UW solution exacerbates cold-ischaemia induced endothelial dysfunction. GSNO did not share the detrimental effects of GSH and promoted NO-mediated vasodilatation.

Prediction of survival from carcinoma of oesophagus and oesophago-gastric junction following surgical resection using an artificial neural network.

AIM: The aim of this study was to assess the ability of artificial neural network (ANN) in predicting survival in patients undergoing surgical resection for carcinoma of oesophagus and oesophago-gastric junction. METHODS: From January 1995 to August 2004 patients who underwent surgery for oesophageal and gastric carcinoma were identified. Biographical data, body mass index and pathological minimal cancer dataset were used to design an ANN. Post-operative survival was assessed at 1 and 3 years. Sixty percent of data was used to train and validate the ANN and 40% was used to evaluate the accuracy of trained ANN in predicting survival. This was compared with Union Internacional Contra la Cancrum UICC TNM classification system. RESULTS: Two hundred and sixteen patients underwent resectional surgery for oesophageal and OGJ carcinoma. The accuracy of the ANN in predicting survival at 1 and 3 years was 88% (sensitivity: 92.3%, specificity: 84.5%, DP = 2.3) and 91.5% (sensitivity of 94.61%, specificity: 88%, DP = 2.72), respectively. These figures were significantly better than 1- and 3-year survival predictions using the UICC TNM classification system 71.6% (sensitivity of 66.4%, specificity: 75.5%, and DP < 1) and 74.7% (sensitivity of 70.5%, specificity: 74.9%, DP < 1), respectively (P < 0.01) (P < 0.05). CONCLUSION: ANNs are superior to the UICC TNM classification system in correlating with survival following resection of carcinoma of oesophagus and OG junction and can become valuable tools in the management of patients with oesophageal carcinoma.

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals.

This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service.

Nurse education in Australian universities in a period of change: expectations of nurse academics for the year 2005.

In Australia, the education of nurses in the academic arena now has a decade of history which arguably represents advancement of the nursing discipline. Until the conduct of the study which is the subject of this report, however, expectations for the next decade were unknown. In order to provide information concerning the future of nursing education and related professional and social factors, and entire population of nurse academics in Australia was surveyed. Findings indicate that although advances have been made, there are a number of concerns regarding the rate of disciplinary development. These include parity of status with other academic areas, resource issues, the workload of nurse academics and the perception that there is lack of cohesiveness amongst nurses as a professional group.

Nursing research 'down under'.

1. The major constraints preventing psychiatric nurses from conducting research are lack of time and knowledge. 2. Nurses can be motivated to explore the possibility of conducting research without having necessary skills or knowledge to start. 3. The nursing profession must face its responsibility to support and nurture nurses' interests in conducting and using research.

A phenomenological study of families and psychoeducation support groups.

1. An essential characteristic for nurses is hope, which much be passed on to caregivers of people diagnosed with schizophrenia. 2. The sharing of experiences by families contributes to the development of a common human bond that facilitates understanding and acceptance of mental illness by significant others. 3. Empowerment of family caregivers increases their ability to deal with the illness and enhances the family's chance of living a normal life.

A brief mental fatigue questionnaire.

A brief mental fatigue questionnaire was administered to normal subjects and muscle-diseased, Chronic Fatigue Syndrome (CFS), recovered CFS and depressed patients. The questionnaire was found to have excellent internal consistency and discriminated effectively between CFS and depressed patients on the one hand and recovered CFS, normal and muscle-diseased patients on the other. However, the scale failed to discriminate between CFS and depressed subjects, who were found to experience qualitatively and quantitatively similar mental fatigue symptoms.

In vivo interactions of NAN-190, a putative selective 5-HT1A antagonist, with ipsapirone.

The actions of NAN-190, a putative 5-HT1A antagonist, were assessed in rats. The selective 5-HT1A agent ipsapirone suppressed operant responding, but this effect was not antagonised by NAN-190, which suppressed responding itself in a dose-related manner, and had additive effects when administered with ipsapirone. These data do not support suggestions that NAN-190 is a 5-HT1A antagonist. NAN-190 may be a 5-HT1A partial agonist which can antagonise effects of full 5-HT1A agonists.

Tolerance to the behavioural effects of the selective 5-HT(1A) agent, ipsapirone.

Effects of ipsaprione on rats were studied in procedures in which tolerance was assessed with operant responding and in feeding tests. Initially, the suppressant effect of ipsapirone on Fixed Ratio 20 behaviour was studied. During 33 days treatment (7.5mg/kg daily) no tolerance developed. Subsequently, the same rats received ipsapirone (7.5mg/kg) three times daily, at intervals of 2.5h, the first injection preceding operant sessions. Over 10 further days of treatment, there was still no evidence of tolerance. In a second study, ipsapirone was again administered at 7.5mg/kg before operant sessions, followed by 2 daily injections of 20mg/kg, at at 2.5h intervals after operant sessions. Under these conditions, some tolerance developed although it was incomplete and rapidly lost. The effects of ipsapirone on operant responding were found to be short-lasting. The suppressant action of 7.5mg/kg of ipsapirone (to 50% of baseline) was abolished if the drug was injected 4h before sessions. In other studies, we confirmed that tolerance develops very rapidly to hyperphagic actions of ipsapirone (see Kennett et al., 1987). We conclude that: 1) tolerance develops at differing rates to various effects of ipsapirone; 2) only those effects of ipsapirone (and related agents) which involve activation of presynaptic autoreceptors show rapid tolerance; 3) tolerance develops to effects on operant responding only if high doses are administered frequently. Since ipsapirone is short-acting, tolerance to such effects develops only when drug is continuously present in body tissue. The tolerance observed (to effects on operant behaviour) was probably of a pharmacodynamic nature and did not involve learning processes.

Inhibition of arm regeneration by Ophioderma brevispina (Echinodermata, Ophiuroidea) by tributyltin oxide and triphenyltin oxide.

Effects of water-bourne toxicants on regeneration of arms by the brittle star, Ophioderma brevispina, are described. Regeneration was inhibited by 0.1 micrograms liter-1 bis(tri-n-butyltin)oxide and bis(triphenyltin)oxide. Both substances are known to act upon the nervous system, and it is suggested that inhibition was caused by neurotoxicological action of the tin compounds or by their direct effect upon tissue at the breakage point. The former is most likely because regeneration is mediated by the radial nerves of brittle stars.

Effects of 1,2,4-trichlorobenzene on estuarine macrobenthic communities exposed via water and sediment.

Macrobenthic animal communities that colonized sand-filled aquaria were exposed to 1,2,4-trichlorobenzene (TCB), a recent replacement for polycholorinated biphenyls in the electrical industry. In one test, communities established by planktonic larvae entrained in continuously supplied unfiltered seawater for 50 days were exposed to waterborne TCB for 6 days; in the second test, the toxicant was added to the sediment before 8 weeks of colonization. Concentrations that affected community structure were usually two orders of magnitude lower for waterborne TCB than for sediment-bound TCB, but the same types of organisms were affected by each route of exposure. The lowest TCB concentrations (measured) that affected average numbers of individuals exposed via the water were 0.04 mg/liter for mollusks, 0.4 mg/liter for arthropods, and 4 mg/liter for annelids. Average number of species was significantly lower than the control at 4 mg/liter. For TCB exposures via the sediment, the lowest concentrations (nominal) that affected average numbers of individuals were 100 micrograms/g for mollusks and echinoderms, and 1000 micrograms/g for arthropods and annelids. Average number of species in experimental aquaria was significantly lower than the control at greater than or equal to 100 micrograms/g. TCB persisted in sediments, but some leached into water throughout the 8-week exposure via sediment.