Death,portry, psychotherapy and clinical supervision (the contribution of psychodynamic psychotherapy to palliative care nursing)*

This paper explores one facet of a therapeutic relationship with a woman suffering from inoperable cervical cancer. The psychotherapy sessions were conducted in both hospital and the family home and continued on a weekly basis until final termaination immediately prior to the woman's death. Through a ‘suspense structure’ case study narrative, the writer, a nurse psychotherapist, describes the way in which the humanities art and poetry can provide a means through which to understand seemingly incomprehensible feelings related to reviewing past events as a preparation for death. While no explict critique is made of the twin psychoanalytical concept of transference and countertransference, the occurrence is woven into the text. The essential nature of clinical supervision is illustrated in context. The author proposes that engagement in a therapeutic relationship with a dying person presents the worker with parallel struggles manifesting in elementary feelings which require discernment. The central recommendation of this paper is that the rich symbolic language and metaphors, redolent in art and poetry, be harnessed as a potent therapeutic and metaphors, redolent in art and poetry, be harnessed as a potent therapeutic tool. Throughout the discussion, the terms counseling and psychotherapy are used interchangeably.     

Simulating realistic zero loop pedigrees using a bipartite Prufer code and graphical modelling.

Graph algorithms previously developed by the authors are adapted to simulate pedigrees similar to those used in genetic linkage studies which associate disease phenotypes with specific genomic locations. Pedigrees are chosen uniformly at random from the set of those with specified numbers of individuals and matings and which contain no loops. Summary statistics from pedigrees generated in this way can be used to check real pedigrees for anomalies due to biased sampling or phenotypic effects on the pedigree structure.     

Prion protein accumulation and neuroprotection in hypoxic brain damage

The function of the normal conformational isoform of prion protein, PrP(C), remains unclear although lines of research have suggested a role in the cellular response to oxidative stress. Here we investigate the expression of PrP(C) in hypoxic brain tissues to examine whether PrP(C) is in part regulated by neuronal stress. Cases of adult cerebral ischemia and perinatal hypoxic-ischemic injury in humans were compared with control tissues. PrP(C) immunoreactivity accumulates within neuronal processes in the penumbra of hypoxic damage in adult brain, and within neuronal soma in cases of perinatal hypoxic-ischemic injury, and in situ hybridization analysis suggests an up-regulation of PrP mRNA during hypoxia. Rodents also showed an accumulation of PrP(C) in neuronal soma within the penumbra of ischemic lesions. Furthermore, the infarct size in PrP-null mice was significantly greater than in the wild type, supporting the proposed role for PrP(C) in the neuroprotective adaptive cellular response to hypoxic injury.     

The matrix metalloproteinase-3 (MMP-3) 5A/6A promoter polymorphism is not associated with ischaemic heart disease: analysis employing a family based approach

Matrix metalloproteinase-3 (MMP-3) has been proposed as an important mediator of the atherosclerotic process. The possible role of the functional -1612 5A/6A polymorphism of the MMP-3 gene in the susceptibility to ischaemic heart disease (IHD) was investigated in a well-defined Irish population using two recently described family based tests of association. One thousand and twelve individuals from 386 families with at least one member prematurely affected with IHD were genotyped. Using the combined transmission disequilibrium test (TDT)/sib-TDT and the pedigree disequilibrium test (PDT), no association between the MMP-3 -1612 5A/6A polymorphism and IHD was found. Our data demonstrate that, in an Irish population, the MMP-3 -1612 5A/6A polymorphism is not associated with IHD.     

Action of ryanodine on neurogenic responses in rat isolated mesenteric small arteries

1. Rat mesenteric arteries (∼250 μm) were set up in a single-channel isometric myograph designed to allow fluorescence measurements concurrent with field stimulation of intramural nerves. Vessels were loaded with 6 μM fura-2AM for 2 h and simultaneous recordings of neurogenic contraction (force) and intracellular calcium [Ca²⁺]_i were obtained. In other experiments, arteries were loaded with 1 μCi ml⁻¹ [³H]-noradrenaline (NA) for 30 min in order to measure release of [³H]-NA in response to field stimulation to examine whether ryanodine directly inhibited neuronal release of NA.
2. Arteries were activated by single intermittent field stimulation or continuously to excite intrinsic sympathetic nerves, or by cumulative addition of noradrenaline (1 nM–10 μM) to the bathing solution.
3. Pre-incubation with ryanodine markedly inhibited the contraction and [Ca²⁺]_i release in response to single-pulse nerve stimulation. Ryanodine also inhibited an early phasic component of the response to continuous field stimulation and reduced the rate of rise in force in response to continuous field stimulation. However, stable maximal contraction and [Ca²⁺]_i in response to continuous field stimulation as well as maximal responses to exogenous NA were unaffected. Release of [³H]-NA in response to single intermittent field stimulation was not affected by ryanodine when compared to vehicle.
4. Our results suggest that brief intermittent activation of intramural sympathetic nerves increases [Ca²⁺]_i and contracts small arteries primarily by releasing Ca²⁺ from a ryanodine-sensitive intracellular store. In contrast, the stable rise in tone and [Ca²⁺]_i resulting from continuous nerve stimulation may largely depend on sources of Ca²⁺ other than the ryanodine-sensitive intracellular store.

     

Internal maxillary artery ligation for idiopathic intractable epistaxis

Epistaxis though common, is rarely life threatening. Routinely nose pinching, anterior find posterior nasal packing and endoscopic cauterization of bleeding points is sufficient to control epistaxis in 99% of the cases. It is mandatory to rule out local and systemic causes before labeling a case as idiopathic by using a battery of investigative modalities. Here are two interesting cases of epistaxis which did not respond to conventional therapeutic modalities in which transantral internal maxillary artery ligation was attempted leading to complete cure.