Segmental metacarpal replacement with bone cement and a silicone joint prosthesis: a case report.

The replacement of the distal half of the third metacarpal and the metacarpophalangeal joint with bone cement and a silicone implant is reported. Eight years after surgery, x-ray and clinical examination revealed no evidence of instability or material failure. The active and passive range of motion in the reconstructed metacarpophalangeal joint was 35 degrees, and the hand was free of pain.     

NORDTOX 1994: Interphase between Human Toxicology and Ecotoxicology: Skørping,Denmark — May 20-23, 1994

Abstract Endothelial damage, synovial oedema, fibrin deposition, polymorphonuclear cell (PMN) invasion, and mild lining cell hyperplasia characterize acute inflammatory arthritis. Later on, perivascular tissue is infiltrated by mononuclear cells. The early events are mediated by interactions between PMNs and endothelial cells. Both parts in the adhesion event are activated with multiple stimuli resulting in complex interactions of varying intensity and duration. Adhesion molecules present on the surface of PMNs (L-selectin) or induced by inflammatory stimuli (β₂-integrins) mediate PMN adhesion to activated endothelium, which has counter receptors (E-selectin for L-selectin and ICAM-1 and ICAM-2 for β₂-integrins). At the initial phase L-selectin initiates the rolling of PMNs on endothelial cells. Further stimuli result in a more prolonged adhesion between PMNs and endothelium. At the side of endothelium, induction of P-selectin and PAF by histamine, thrombin and LTC, contribute to the acute rolling of PMNs on endothelial surface. Tumor necrosis factor (TNF), interleukin-1 (IL-1) and lipopolysaccharide activate endothelial cells to synthesize interleukin-8 (IL-8), a potent chemotactic and proadhesive mediator for PMNs, and further adhesion molecule (E-selectin), a mediator of long-term adhesion between PMN and endothelium. After adhesion and migration to the focus of inflammation, PMNs induce inflammation by aggregating, releasing hydrolyzing enzymes, generating lipid peroxidation products such as prostaglandins and LTB₄, and oxygen derived free radicals. In studies on the pathogenesis of seronegative spondyloarthropathies, we have shown persistently aberrant PMN function evidenced by enhanced chemotaxis and high production of toxic oxygen derived free radicals by PMN. In the development of chronic inflammation, these aberrations may play a role. Lipopolysaccharide, shown to persist in such patients, could act as a priming factor. The triggering factor(s) and factors contributing to the chronic inflammation in rheumatoid arthritis are not known. In chronic diseases, synovial inflammation is characterized by monocyte/macrophage products such as IL-1, TNF, interleukin-6 (IL-6), IL-8, colony-stimulating factors, lysosomal enzymes, PGE₂, LTB₄, and oxygen derived free radicals. However, in the acute phase or during flare-up of chronic diseases, PMNs contribute to the inflammation by ingesting rheumatoid factors and immune complexes and by producing oxygen derived free radicals. During the first 1-2 years of rheumatoid arthritis, a low response to chemotactic stimuli and low production of oxygen radicals by peripheral blood PMNs seem to be associated with benign disease and a lack of early destruction of joints measured by the presence of radiological erosions.     

Secondary Cerebral Astrocytoma 3 Years After Diagnosis of Primary Osteogenic Sarcoma: A Case Report

A secondary astrocytoma appearing 3 years after diagnosis of osteosarcoma is reported in a boy 11 years old. The boy had been treated with cytostatics according to the T-10 protocol. Treatment had been discontinued 2 years before diagnosis of the astrocytoma.     

A theoretical argumentation on the consequences of moral stress

BACKGROUND: Intensive care units are characterized by heavy workloads, increasing work complexity and ethical concerns related to life-and-death decisions. In the present study, it is assumed that there is a relationship between moral stress, support and competence for nurses in intensive care units. AIM: To analyse and describe the theoretical relationship between moral stress and support on the one hand and competence on the other, in the context of intensive care. METHOD: A form of qualitative secondary analysis based on the findings from three original studies. In the analytic process a theory on professional competence was used. FINDINGS: The findings suggest that imbalance due to moral stress between different competences hinders the development of collectively shared caring competence. CONCLUSIONS: Moral stress cannot be totally eliminated in the intensive care unit. But moral stress is not only a problem. It can also become a driving force to stimulate competence.     

A formative evaluation to develop a school health nursing early intervention model for adolescent substance use

OBJECTIVE: To improve an early intervention (EI) triggered by the Adolescents' Substance Use Measurement (ADSUME) as a method to prevent substance abuse among adolescents. We assessed how ADSUME and EI work in practice and how EI could be improved. DESIGN AND SAMPLE: School health nurses (n=10) tested ADSUME and EI on 14- to 18-year-old adolescents (n=228). Six months later, these nurses and their professional partners were invited to assess EI in focus group interviews. METHODS: Four focus group interviews involving a total of 24 nurses and partners were implemented. Interview data were analyzed with qualitative content analysis. RESULTS: ADSUME concretized assessment, activated profound dialogue, and proved to be an important part of EI. It was important to assess the adolescent's resources in addition to the ADSUME score. EI worked well in confidential dialogues after the adolescent and the PHN reached a consensus on the level of concern about the adolescent's substance use. The recommended EI enabled individual brief intervention in all four stages of substance use, from abstinence or experimental use to hazardous use. CONCLUSIONS: EI was improved practically, and the contents of the intervention were reformulated. It is important to integrate EI with the preventive efforts of the school.     

Decline in ribosomal fidelity contributes to the accumulation and stabilization of the master stress response regulator sigmaS upon carbon starvation

The sigma(S) subunit of RNA polymerase is a master regulator of Escherichia coli that retards cellular senescence and bestows cells with general stress protective functions during growth arrest. We show that mutations and drugs triggering translational errors elevate sigma(S) levels and stability. Furthermore, mutations enhancing translational fidelity attenuate induction of the rpoS regulon and prevent stabilization of sigma(S) upon carbon starvation. Destabilization of sigma(S) by increased proofreading requires the presence of the sigma(S) recognition factor SprE (RssB) and the ClpXP protease. The data further suggest that sigma(S) becomes stabilized upon starvation as a result of ClpP sequestration and this sequestration is enhanced by oxidative modifications of aberrant proteins produced by erroneous translation. ClpP overproduction counteracted starvation-induced stabilization of sigma(S), whereas overproduction of a ClpXP substrate (ssrA-tagged GFP) stabilized sigma(S) in exponentially growing cells. We present a model for the sequence of events leading to the accumulation and activation of sigma(S) upon carbon starvation, which are linked to alterations in both ribosomal fidelity and efficiency.     

EBNA1 expression in a lung transplant recipient with hypocomplementemic urticarial vasculitis syndrome

This article describes a transplant recipient with underlying hypocomplementemic urticarial vasculitis syndrome who expressed persistently Epstein-Barr virus nuclear antigen 1 (EBNA1) in peripheral blood. The patient received a bilateral lung transplant and was subsequently followed with monitoring of EBV expression in peripheral blood. Evaluation of viral expression in peripheral blood, serum, and graft tissue was performed with RT-PCR, Q-PCR, indirect immunofluorescence, anti-peptide assays, and in situ hybridization; samples were collected at various time-points up to 91 days post-transplantation. The patient expressed EBNA1 in 8/10 (80%) of the peripheral blood samples tested during the post-transplantation period, and interestingly, even including the day of transplantation. After analyses of indicative EBV mRNA, EBNA1 expression was found mainly to be Qp-initiated EBNA1, known to be important for EBV maintenance. Anti-EBNA1 epitope mapping showed significantly higher and broader antibody responses to EBNA1 epitopes pre-transplantation when compared to normal controls and a matched lung transplant control. Post-transplantation this response was largely diminished but there were still epitopes significantly higher than controls. Our results show the presence of EBV-positive proliferating cells before onset of intensive immunosuppressive treatment. Although no previous connection between EBV and hypocomplementemic urticarial vasculitis syndrome has been reported, it is tempting to speculate that the continuous EBNA1 expression is not caused by immunosuppression or post-transplant lymphoproliferative disease, but may be a factor involved in the etiology of the autoimmune disease.     

Antibody response to 7-valent conjugated pneumococcal vaccine in patients with chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) is a common adulthood mature B-cell neoplasm. Infections are the most important cause of mortality in this condition, and Streptococcus pneumoniae has been considered the most important single pathogen. We investigated the immunogenicity of 7-valent pneumococcal conjugate vaccine in patients with CLL. The study material comprised 52 patients with CLL and 25 age- and sex-matched controls. The subjects were vaccinated with Prevenar pneumococcal conjugate vaccine. Serum samples were taken for antibody determinations before and four weeks after vaccination. Antibody response rates to vaccine antigens were lower in patients with CLL compared to controls. However, if the vaccine had been administered at an early stage of the disease, i.e. before commencement of chemotherapy and the development of hypogammaglobulinaemia, a significant vaccination response to at least six antigens was obtained in almost 40% of the CLL patients. Our results indicate that early administration of conjugate vaccine may be beneficial in CLL.     

Oscillatory motor cortex-muscle coupling during painful laser and nonpainful tactile stimulation

Noxious stimulation activates-in addition to the brain structures related to sensory, emotional, and cognitive components of pain-also the brain's motor system. Effect of noxious input on the primary motor (MI) cortex remains, however, poorly understood. To characterize this effect in more detail, we quantified the ongoing oscillatory communication between the MI cortex and hand muscles during selectively noxious laser stimulation. The subjects maintained an isometric contraction of finger muscles while receiving the laser stimuli to the dorsum of the hand. Tactile stimuli with well-known effects on the MI cortex reactivity served as control stimuli. Cortex-muscle coherence was computed between magnetoencephalographic (MEG) signals from the contralateral MI and electromyographic (EMG) signals from the hand muscles. Statistically significant coherence at approximately 20 Hz was found in 6 out of 7 subjects. The coherence increased phasically after both types of stimuli but significantly later after laser than tactile stimuli (mean +/- SEM peak latencies 1.05 +/- 0.12 s vs. 0.58 +/- 0.06 s; P < 0.05), and the coherence increase lasted longer after laser than tactile stimuli (0.87 +/- 0.09 s vs. 0.50 +/- 0.06 s, P < 0.05). The observed coherence increase could be related to stabilization of the motor-cortex control after sensory input. Our findings add to the clinically interesting evidence about the cortical pain-motor system interaction.