Langerhans cells in human warts

Seventy-six warts (15 plantar, 38 hand, 16 miscellaneous and seven anogenital lesions) taken from 55 patients, were studied by indirect immunofluorescence with monoclonal antibodies specific for T-cell subsets, Langerhans cells (LC) and HLA-DR antigen. The results were related to the presence of viral antigen. Approximately 80% of the lesions showed an infiltrate. Only 19 lesions contained helper/inducer or suppressor/cytotoxic T cells. The distribution of LC was abnormal in 65% of biopsies which contained LC in the dermis, and 29% were devoid of LC in the epidermis. Many lesions had reduced numbers of LC in the epidermis. The disappearance of LC from the epidermis was related to the presence of viral antigen, but not to the presence of particular T-cell subsets. Infiltrating cells were sometimes HLA-DR-positive, whereas basal cells did not express HLA-DR antigen, irrespective of the density of the infiltrate.     

Attitudes of Physicians and Nurses Towards the Role of Social Workers in Primary Health Care: What Promotes Collaboration?

Many writers have indicated that the future of social work inprimary health care is dependent on the attitudes of physiciansand nurses. This article reviews the literature in the fieldand describes the results of a study of 95 physicians and 78nurses in Israel which found that physicians have a more positiveattitude towards social work intervention than nurses and exploresthe differences in these attitudes in relation to particularpersonal characteristics. Physicians who were young, had recently received their MD degreeand had been educated in Israel had by far the most positiveattitudes towards social workers. Those aged over 60 years old,who had received their MD degree in Western countries more than25 years ago were more positively inclined towards social workin the clinics than middle-aged physicians educated in EasternEuropean countries. The personal characteristics of the nursesmade little difference to their generally poor attitude towardssocial work in the clinics. Those who received their nursingeducation more recently were more positive than other nurses.     

Adult Acute Rheumatic Fever: A Rare Case Presenting with Left Bundle Branch Block

In contrast to the more common electrocardiographic patterns seen in acute rheumatic fever, such as first-degree heart block, the appearance of left bundle branch block is rare. An adult patient with acute rheumatic fever presented with left bundle branch block on admission, subsequently had sudden cardiac arrest. She was resuscitated successfully and required temporary pacing. An echocardiogram and radionuclide ventriculography were compatible with interventricular septal involvement in the rheumatic carditis. After 20 days of steroid therapy, the left bundle branch block pattern of the electrocardiogram disappeared. A possible mechanism for the development of complete heart block in acute rheumatic fever is discussed. It is suggested that patients with acute rheumatic carditis who have electrocardiographic manifestations of prolonged P-R interval and left bundle branch block should be managed with prophylactic pacing.     

Soil Moisture and the Distribution of Two Eucalypts

Although narrow leaved peppermint (Eucalyptus robertsonii Blakely) is obviously better adapted than brown barrel (E. fastigata Deane and Maiden) to shallow soils and exposed aspects within the Australian Commonwealth Territory, the two species may also form a mosaic pattern on apparently similar soils within more sheltered habitats. Here, E. fastigata may be sensitively delimited by small variations in soil properties influencing root movement and penetration of light summer rains.     

Mothers'' Perceptions of Their Neonates'' In-hospital Transfers from a Neonatal Intensive-Care Unit

This study explored mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit. A convenience sample of 15 mothers was selected, and the researchers interviewed each mother once within a week after her neonate's transfer. Three themes emerged from the data: (1) the mothers expressed feelings of relief accompanied by concern, fear of the unknown, and feelings of alienation; (2) the mothers depended on familiar things and people; and (3) the mothers experienced feelings of helplessness. The mothers' perceptions of their preparation for transfer and continuity of care were mainly negative.     

Guinea pig MSEL-neurophysin. Sequence comparison of eight mammalian MSEL-neurophysins

The amino acid sequence of guinea pig MSEL-neurophysin has been determined using tryptic peptides derived from the performic acid-oxidized protein and staphylococcal proteinase peptides obtained from the reduced-carboxamidomethylated neur-ophysin. Guinea pig MSEL-neurophysin consists of a 93-residue polypeptide chain that shows 12 substitutions and 2 deletions when compared to bovine MSEL-neurophysin. It displays the highest number of variations among known mammalian MSEL-neurophysins. These variations are mainly found in the C-terminal region (residues 88–93). Moreover guinea pig MSEL-neurophysin, like rat homologous protein, exhibits substitutions in positions 2, 5, 29 and 81 and lacks an arginine in the penultimate position. Comparison between eight mammalian MSEL-neurophysins reveals a highly conserved region (residues 1 to 88) and a hypervariable region (residues 89 to 93/95). On the other hand the eight species examined are endowed with arginine vasopressin except pig, which has a lysine vasopressin. In the vasopressin-MSEL-neurophysin precursor, the hormonal moiety and the MSEL region of neurophysin (residues 1–9) are encoded by a common exon in ox, rat and man; it can be concluded that this exon is evolutionarily conservative in contrast to the one encoding the C-terminal region of MSEL-neurophysin.     

Changing patterns in interventional bronchoscopy

Background and objective:   Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach.
Methods:   A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted. Patients were categorized into two groups according to the procedure used, that is, RB (251 patients), and FB (161 patients) groups. Patients with malignancies were included as a separate subgroup, comprising 178 RB and 117 FB patients. For every procedure, the location of the lesion, patient survival from the first interventional procedure performed, and in patients with malignancy, additional treatments received such as chemotherapy and radiation were recorded.
Results:   Ninety per cent of RB procedures were performed in patients with tracheal or main stem lesions, while over half the patients undergoing FB had more distal lesions. A trend towards increasing use of FB for interventional procedures in recent years was noted.
Conclusions:   FB is a valuable alternative to RB for treating less advanced malignant disease or distal airway lesions.     

SERUM FREE 1,25-DIHYDROXYVITAMIN D AND THE FREE 1,25-DIHYDROXYVITAMIN D INDEX DURING A LONGITUDINAL STUDY OF HUMAN PREGNANCY AND LACTATION

The changes in three different indices of 1,25-dihydroxyvitamin D (1,25(OH)2D) biological activity were studied longitudinally in 35 women during late pregnancy and lactation and in 26 control women. Measurements were made of maternal serum total 1,25(OH)2D and free 1,25(OH)2D concentration (by centrifugal ultrafiltration) and the free 1,25(OH)2D index (the molar ratio of total 1,25(OH)2D and vitamin D binding protein (DBP]. During late pregnancy total 1,25(OH)2D concentrations were significantly elevated when compared to controls, as were free 1,25(OH)2D and DBP concentrations and the free 1,25(OH)2D index. Serum total 1,25(OH)2D, free 1,25(OH)2D and DBP concentrations all fell dramatically during the first 2 weeks of lactation with total 1,25(OH)2D and free 1,25(OH)2D concentrations falling to levels below those of controls. During the course of lactation both total 1,25(OH)2D and free 1,25(OH)2D levels rose significantly although they were not different from controls at 18 weeks of lactation. In contrast, the free 1,25(OH)2D index fell during the first 2 weeks of lactation, but remained at this level, significantly lower than controls. Neither urinary calcium excretion nor dietary calcium intake correlated with total or free 1,25(OH)2D, DBP, or the free 1,25(OH)2D index. The disagreement in the results of free 1,25(OH)2D concentration and free 1,25(OH)2D index demonstrates that these two approaches to measuring biologically active 1,25(OH)2D are not equivalent. In attempting to account for the increased calcium requirements of human reproduction we conclude that in pregnancy any of the 1,25(OH)2D measurements may be appropriate. In lactation, however, either 1,25(OH)2D is not a major factor or 1,25(OH)2D biological activity is inadequately represented by any of the currently available methods.