Alveolar soft part sarcoma of the uterus

A 14-year-old girl presented with menorrhagia. The curettage specimen was extensively necrotic but examination of the subsequent hysterotomy specimen established the diagnosis of alveolar soft part sarcoma of the uterus, a very rare site for this uncommon malignant tumour.     

Neurotoxicity of Methyl Chloride in Continuously versus Intermittently Exposed Female C57BL/6 Mice

Neurotoxicity of Methyl Chloride in Continuously versus IntermittentlyExposed Female C57BL/6 Mice. LANDRY, T. D., QUAST, J. F., GUSHOW,T. S., and MATTSSON, J. L. (1985). Fundam. Appl. Toxicol. 5,87–98. This study evaluated the relationship between methylchloride (MeCl) exposure duration and neurotoxicity. FemaleC57BL/6 mice were exposed to MeCl for 11 days, either continuously(22 hr/day) to 15, 50, 100, 150, or 200 ppm, or intermittently(5.5 hr/day) to 150, 400, 800, 1600, or 2400 ppm. This strainand sex of mouse was chosen because it is sensitive to MeClneurotoxicity and was a good candidate to allow the evaluationof morphological effects and the quantitation of functionaleffects. A simple quantitative relationship between neurotoxicityand continuous vs intermittent exposure was not observed. Althoughthe no-observable-effect levels for continuous and intermittentMeCl exposures were very nearly proportionate to exposure concentrationmultiplied by duration, the dose—response curve was muchsteeper for continuously exposed mice. Cerebellar granular celllayer degeneration was observed in mice exposed continuouslyto 100 ppm MeCl and in mice exposed intermittently to 400 ppm.This histopathologic effect was observed at lower concentrationsthan a decrement in rotating rod running performance. No effectswere observed in mice exposed to 50 ppm continuously or to 150ppm intermittently. Continuous exposure to MeCl produced thecerebellar lesion with less effect on other tissues than didintermittent exposure. In mice exposed to 2400 ppm intermittently,there were renal and hematopoietic effects in addition to relativelyslight cerebellar granular cell layer degeneration. These 2400-ppmexposed mice developed hemoglobinuria, apparently as a resultof intravascular hemolysis. Although the effect of exposureduration on MeCl toxicity was complex, this study indicatedthat careful judgment is necessary when extrapolating intermittentexposure data to a continuous exposure situation.     

Spot urinary creatinine excretion in pervasive developmental disorders

BACKGROUND: Excretion of creatinine in urine represents the end-point of endogenous energy transfer from stored adenosine triphosphate in skeletal and cardiac muscle. Measurement of urinary creatinine is commonly used to correct for total urine concentration. Various quantitative measures of compounds suspected to be either pathological to, or indicative of, possible therapeutic interventions for Pervasive Developmental Disorders (PDD) have relied extensively on spot creatinine as a ratio quantity, although this important metabolite has not been exclusively studied within this population. METHODS: Levels of urinary creatinine in spot urine samples were analyzed for a group of children diagnosed with PDD (n=24; median age, 75 months; range, 39-137 months) and a control group (n=50; median age, 109 months; range, 59-140 months). Diagnosis of PDD was confirmed using the Autism Diagnostic Interview-Revised. Samples were collected and analyzed blind for creatinine content using an improved Jaffe's reaction method. RESULTS: Controlling for sample pH and body mass index, a significant decrease in urinary creatinine concentration was found in the PDD group compared to controls using a Mann-Whitney two-tailed ranks test (P=0.001). CONCLUSION: Further studies of protein catabolism and renal function in autism are required to ascertain the relevance of decreased spot urinary creatinine excretion identified in this preliminary study. Issues regarding the use of single urine creatinine measurements and associated confounding variables are discussed in light of the findings, together with recommendations to use other internal or external standards for the quantification of urinary compounds in PDD research.     

Radiological services in a hospital Emergency Department — an evaluation of service delivery and radiograph interpretation

Abstract Radiological services to the Department of Ambulatory Paediatrics were audited over 1 month. Of a total of 782 separate radiographs, more than two-thirds were performed outside hours when radiologists are normally in the hospital. For only 171 of the 782 radiographs (22%) were there immediate reports by a radiologist.
To determine whether the absence of immediate radiologist reports affected clinical care, a process was introduced whereby radiologists reviewed interpretation of radiographs made by resident medical officers (RMO) when no report was available. Over a 5 month period 2888 patients had radiographs when there was no immediate radiologist's report. Comparisons were made between RMO interpretation and ultimate radiologist report in 1411 of these patients. In 232 cases (16.4%) there was a discrepancy between RMO interpretation and radiologist report; 70% of these were false positive (the RMO interpreting a normal film as abnormal) while 71 were false negative (the RMO interpreting an abnormal film as normal).
This study demonstrates the utility of a relatively simple quality assurance measure in situations where clinical decisions have to be made in the absence of an immediate radiologist report.     

A mobile retroclavicular lymph node of some clinical significance

The only clinically enlarged peripheral lymph node in three patients wasone lying hidden deep behind the medial end of the clavicle. Its presencewas established by instructing the patient to cough and strain; this dislocatedthe node up into the supraclavicular fossa, thus allowing biopsy.

Submitted on September 11, 1958 Accepted on November 22, 1958     

Immunodepression and the course of infection of a chronic Trypanosoma brucei infection in mice

The relationships between course of infection, antigenic variation, and immunodepression of antibody responses to heterologous antigens have been investigated in mice chronically infected with Trypanosoma brucei. T. brucei Brunel University Trypanosomiasis (BUT) 64 produces a fluctuating parasitaemia lasting about 80 days and ending fatally. It is demonstrated that recurring peaks of parasitaemia are associated with the appearance of new variant antigenic types. At 21 and 31 days of infection, IgG responses to the heterologous antigen, sheep red blood cells (SRBC), are absent and IgM responses are less than 5% of normal. When a single dose of cyclophosphamide (300 mg/Kg) was injected into mice on day 31 of infection, the parasitaemia rose sharply in an uncontrolled fashion and the treated mice died in about 10 days. Cyclophosphamide, given in this way, is known to ablate antibody production completely but temporarily. It is therefore concluded that even though infected mice make extremely poor antibody responses to heterologous antigens, they are still capable of producing sufficient antibody to control peaks of parasitaemia associated with the emergence of new variant antigenic types. The significance of these findings is discussed in relation to recurrent hypotheses of trypanosome-associated immunodepression.     

On Establishing Primary Cultures of Neonatal Rat Ventricular Myocytes for Analysis Over Long Periods

Neonatal Rat Ventricular Myocyte Cultures. Introduction: Primary cultures of neonatal rat ventricular myocytes include a population of rapidly dividing nonmyocardial cells that can alter the properties of myocytes and complicate experimental interpretations. Without any intervention, nonmyocyte proliferation restricts the utility of primary cultures in biochemical and electrophysiologic studies to 4–5 days. However, with the recent interest in regulation of cardiac gene expression and the effects of growth factors on cardiac function, long-term studies with stable heart cultures are warranted. Methods and Results: In the present study an immunohistochemical staining strategy was developed that allowed for reliable quantitation of myocytes and nonmyocytes in cultures maintained for extended periods under different culture conditions. Density gradient purification of myocytes was found valuable in limiting nonmyocyte levels to < 20% at early times. Further treatment of cultures with a mitotic inhibitor, 0.1 mM bromodeoxyuridine, or 3500 rads of γ-irradiation effectively blocked the proliferation of nonmyocardial cells, while it had no effect on cardiocyte levels. However, bromodeoxyuridine displayed side effects on the myocytes; the spontaneous beating rate and intracellular glycogen content were markedly depressed. In contrast, a systematic investigation of the properties of the irradiated myocytes, including spontaneous beating rates, dihydropyridinc receptors, glycogen content, sarcoplasmic reticulum function, and phosphoinositide signaling, revealed that irradiation did not alter cardiac cell function. Although ionizing radiation can stimulate gene expression in some cell types, γ-irradiation did not evoke c-fos expression or cause sarcomere formation, responses seen in cardiac cells to several trophic factors. Conclusion: This study establishes a system of stable, functional, primary cultured cardiac cells that can be used in long-term molecular and electrophysiologic studies of at least 2 weeks.     

Helping ‘new carers' of the frail elderly patient: the challenge for nurses in acute care settings

• ? The present policy of community care for frail elderly individuals relies primarily on the provision of support by informal carers. Such carers are usually close family members, most often spouses or children.
• ? Whilst most carers take on their role willingly they often do so at a time of crisis, such as following a period of hospitalization. As a consequence many individuals are ill-prepared for their new responsibilities. For a minority of others the role of carer is adopted reluctantly.
• ? This paper argues that nurses in acute care settings are in the best position to try and ensure that individuals become carers following an informed decision-making process.
• ? Suggestions are provided as to how current nursing practice can be improved in order better to achieve this aim.

     

A model for maintaining ward-based goal planning

Castle Priory College, the staff training centre of the Spastics Society, is increasingly taking courses out to hospitals, schools and centres. One such course is a workshop on goal planning, taught by Paul Williams, based on the work of Peter Houts and Robert Scott in Pennsylvania. Over two days, using lectures and practical exercises, a framework is taught to help direct-care staff to set realistic short-term goals for individual mentally handicapped people and to keep simple written records. One of the main problems with any short course is maintaining enthusiasm, interest and action after its completion. This article describes an attempt to ensure this at Northgate Hospital.