Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient

We report a case of preclinical variant Creutzfeldt-Jakob disease (vCJD) in a patient who died from a non-neurological disorder 5 years after receiving a blood transfusion from a donor who subsequently developed vCJD. Protease-resistant prion protein (PrP(res)) was detected by western blot, paraffin-embedded tissue blot, and immunohistochemistry in the spleen, but not in the brain. Immunohistochemistry for prion protein was also positive in a cervical lymph node. The patient was a heterozygote at codon 129 of PRNP, suggesting that susceptibility to vCJD infection is not confined to the methionine homozygous PRNP genotype. These findings have major implications for future estimates and surveillance of vCJD in the UK.     

Piloting cross-boundary training to develop cancer care nursing

Flexible approaches to lifelong learning have the potential to increase motivation and influence recruitment and retention. This paper explores how the introduction of a collaborative rotational placement programme between the NHS and the voluntary sector helped qualified staff to develop their practice in caring for patients with cancer from diagnosis through to bereavement. Staff experienced an increase in their personal motivation, confidence and enthusiasm.     

Gene therapy progress and prospects: cancer gene therapy using tumour suppressor genes

Targeting tumour suppressor gene pathways is an attractive therapeutic strategy in cancer. Since the first clinical trial took place in 1996, at least 20 other trials have investigated the possibility of restoring p53 function, either alone or in combination with chemotherapy, but with limited success. Other recent clinical trials have sought to harness abnormalities in the p53 pathway to permit tumour-selective replication of adenoviral vectors such as dl1520 (Onyx-015). Other tumour suppressor genes, such as retinoblastoma (Rb) and PTEN (phosphatase, tensin homologue, deleted on chromosome 10), are the targets for imminent clinical trials, while microarray technologies are revealing multiple new genes that are potential targets for future gene therapy.     

Handover of responsibility for the anaesthetised patient - opinion and practice

Anaesthesia is a critical and complex process that extends from the pre-operative assessment through to the postoperative management of patients. Handover of responsibility for logistical as opposed to patient-orientated reasons may compromise that process of care. If such handover becomes inevitable with shift-based patterns of working, the implications need to be considered and procedures developed in order to minimise adverse consequences. This survey of national practice reveals little formalisation of procedure and a spectrum of opinion on the relevance of the key considerations. There is, however, a majority view amongst respondents that national guidelines would be of value and that professional defensibility would be aided by standardisation and documentation of any handover.     

Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylene implants

BACKGROUND: Infection is one of the most devastating complications following implantation of a prosthetic material. The aim of this study was to compare the behaviour of two biomaterials contaminated with Staphylococcus aureus or Staphylococcus epidermidis, used to repair abdominal wall defects. METHODS: Defects (7 x 5 cm) were created in the anterior abdominal wall of 60 white New Zealand rabbits and repaired using polypropylene or expanded polytetrafluoroethylene (ePTFE) prostheses. The site of repair had been previously inoculated with 10(6) colony-forming units/ml S. aureus or S. epidermidis. Seven and 30 days after implantation, prosthetic specimens were examined by light and scanning electron microscopy, and immunohistochemical and biomechanical analysis. RESULTS: No significant differences with respect to controls were observed in the S. epidermidis groups. Two animals inoculated with S. aureus died. S. aureus induced the appearance of denuded areas exposing the filaments in the polypropylene prostheses, whereas the ePTFE prostheses showed zones of erosion, disorganized tissue, haemorrhage and necrosis. The biomechanical strength of the contaminated implants was unaltered. CONCLUSION: Integration within host tissue was affected in the setting of S. aureus infection but the tensile strength of contaminated prostheses was not significantly reduced.     

Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta

We performed limb lengthening and correction of deformity of nine long bones of the lower limb in six children (mean age, 14.7 years) with osteogenesis imperfecta (OI). All had femoral lengthening and three also had ipsilateral tibial lengthening. Angular deformities were corrected simultaneously. Five limb segments were treated using a monolateral external fixator and four with the Ilizarov frame. In three children, lengthening was done over previously inserted femoral intramedullary rods. The mean lengthening achieved was 6.26 cm (mean healing index, 33.25 days/cm). Significant complications included one deep infection, one fracture of the femur and one anterior angulation deformity of the tibia. The abnormal bone of OI tolerated the external fixators throughout the period of lengthening without any episodes of migration of wires or pins through the soft bone. The regenerate bone formed within the time which is normally expected in limb-lengthening procedures performed for other conditions. We conclude that despite the abnormal bone characteristics, distraction osteogenesis to correct limb-length discrepancy and angular deformity can be performed safely in children with OI.