steps-for-autologous-ex-vivo-perfused-porcine-liver-kidney

Steps for the Autologous <em>Ex vivo</em> Perfused Porcine Liver-kidney Experiment

The use of ex vivo perfused models can mimic the physiological conditions of the liver for short periods, but to maintain normal homeostasis for an ...

University Hospitals of Leicester

We present the case of a near fatal aspiration of a foreign body requiring extracorporeal membrane oxygenation (ECMO) support. The use of ECMO to support treatment for a foreign body in the distal trachea is rare and there are only two cases reported in the literature. A 13-year-old male presented with a three-weeks' history of a cough and swinging fevers. Subsequent investigation revealed a foreign body causing collapse of the right middle and lower lobe with abscess formation. On attempted bronchoscopic removal, copious amounts of pus were aspirated, soiling both lungs. The patient became severely hypoxic and hypotensive. He was unstable on ventilation and inotropes and ECMO was used to stabilise him and facilitate removal of the foreign body and infected lung. He made excellent recovery and suffered no neurological sequalae. This is the first reported use of ECMO support for an acute presentation of a chronic problem. If the patient is too unstable for bronchoscopy, ECMO can be used to temporarily stabilise the patient allowing safe removal of the object. If the patient is acutely unwell and septic, ECMO should be more readily considered.

Late presentation of foreign body aspiration requiring extracorporeal membrane oxygenation support for surgical management.

Background: Pancreatic cancer has an extremely poor clinical outcome. Surrogate biomarkers for outcome are scarce. There is mixed evidence for the association of high mannose-binding lectin (MBL) complement activity with cancer outcomes, including reduced survival and increased infectious complications. ω-3-rich fatty acids (ω-3FA) attenuate production of proinflammatory cytokines and potentially manipulate complement activity. Materials and Methods: As part of a single-arm phase II trial in a university hospital, patients with advanced pancreatic adenocarcinoma were treated with weekly ω-3FA-rich intravenous infusion (Lipidem [B. Braun Melsungen AG, Melsungen, Germany]: up to 100 g/wk) plus gemcitabine chemotherapy until withdrawal or tumor progression. Primary outcome measure was objective response rate. Changes in complement activity, which were a secondary outcome measure, were analyzed and relation to clinical outcome determined. Results: Twenty-three patients were assessable for time to progression (TTP), overall survival (OS), and complement activity. No hypoactivity in alternative and classical pathways was demonstrated. Baseline MBL was low in 10 of 23 patients (43.5%). There was no difference in OS or TTP between low- and high-baseline MBL patients. Of these 10 patients, 5 were classified as MBL responders. MBL responders had a tendency toward improved OS over nonresponders (8.9 vs 4.4 months, P = .07). MBL responders had significantly improved TTP over nonresponders (10.6 vs 5.3 months, P = .03). Conclusion: MBL restoration had an association with improved outcome in the cohort of patients with low MBL activity at baseline. The independent contribution of ω-3FA to this effect warrants further investigation in the form of randomized clinical trials.

Restoration of Mannose-Binding Lectin Complement Activity Is Associated With Improved Outcome in Patients With Advanced Pancreatic Cancer Treated With Gemcitabine and Intravenous ω-3 Fish Oil.

Digital rectal examination (DRE) is an important skill in the investigation of rectal symptoms. This frequently performed examination is poorly taught and while students agree it is an important skill, their experience is often limited. Studies have suggested that structured teaching can improve confidence, knowledge, and ability of DRE.

Article	Year
Late presentation of foreign body aspiration requiring extracorporeal membrane oxygenation support for surgical management. Interactive cardiovascular and thoracic surgery\| PubMed ID: 21252207	2011
Restoration of Mannose-Binding Lectin Complement Activity Is Associated With Improved Outcome in Patients With Advanced Pancreatic Cancer Treated With Gemcitabine and Intravenous ω-3 Fish Oi... JPEN. Journal of parenteral and enteral nutrition\| PubMed ID: 23423329	2013
Teaching digital rectal examination to medical students using a structured workshop-a point in the right direction? Journal of surgical education\| PubMed ID: 23427973	2013

John Isherwood

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