The Clinical Spectrum of Acute Glomerulonephritis and Lung Haemorrhage (Goodpasture's Syndrome)

The aetiology, clinical features and outcome of 40 patientspresenting with Goodpasture's syndrome (glomerulonephritis withhaemoptysis and pulmonary infiltrates) are reviewed. The diseasesof the patients studied could be divided into three groups:antiglomerular basement membrane (anti-GBM) antibody-induceddisease (7/40); systemic vasculitis (22/40) and idio-pathicGoodpasture's syndrome (i.e. no systemic disease or anti-GBMantibody detected) (11/40). Overall mortality was 57.5 per cent(anti-GBM disease 4/7; systemic vasculitis 15/22; and idiopathicGoodpasture's syndrome 4/11). Most patients died of diseaseprogression or infection. End-stage renal failure developedin 26 patients (anti-GBM (7), vasculitis (14) and idiopathicGoodpasture's syndrome (5). End-stage renal failure developedin 23 of 24 patients presenting with a creatinine of > 600µM/Iregardless of the aetiology of Goodpasture's syndrome or treatmentused. Review of renal histology showed that all had proliferativenephritis, with 80 per cent of patients having more than 30per cent crescents. Thus Goodpasture's syndrome was associatedwith a wide variety of underlying disease. It had a poor prognosis,with the degree of renal impairment at presentation, the extentof crescent formation and the nature of the underlying diseasebeing the major determinants of outcome.     

Circulating and tissue guanylin immunoreactivity in intestinal secretory diarrhoea*

Abstract. Guanylin is a recently discovered peptide hormone that activates intestinal guanylate cyclase (GC-C) and thereby stimulates intestinal chloride secretion. Immunohistochemistry showed its presence in enterochromaffin (EC) cells of the gut. In vitro studies suggested that guanylin plays an important role in the endogenous modulation of intestinal salt and water secretion. In the present study the concentration of circulating immunoreactive (1R)— guanylin in plasma of patients with intestinal diarrhoea due to chronic bowel inflammation and patients with carcinoid tumours were measured with a specific radioimmunoassay. In 22 patients with Crohn's disease and eight patients with ulcerative colitis, plasma concentrations of IR-guanylin were 44 ± 3 and 42± 4 fmol mL^-1, respectively. Levels were not different from that in 44 healthy volunteers suggesting that the circulating hormone is not involved in diarrhoea of these patients. In 17 patients with symptomatic carcinoid tumors the median concentration of circulating IR-guanylin was significantly enhanced (94±16 fmol mL^-1, range 37–312 fmol mL^-1). Immunohistochemistry revealed the presence of immunoreactive guanylin in carcinoid tissues, suggesting that these tumours co-release guanylin along with their usual resident hormone, serotonin. Enhanced local secretion of guanylin may play a causal role in diarrhoea of these patients and its elevation in plasma may be of diagnostic value in this type of endocrine tumours.     

Registered Nurses' views on their professional role

Aim The aim is to study Registered Nurses’ opinions and reflections about their work tasks, competence and organization in acute hospital care. Background The definition of the role of nurses has changed over time and it is often discussed whether Registered Nurses have a professional status or not. Method A qualitative research design was used. Data were derived from written reflections on diaries and from focus group interviews. Results All respondents had difficulties in identifying the essence of their work. It can be argued that being ‘a spider in the web’ is an important aspect of the nursing profession. Conclusion Registered Nurses tend to regard their professional role as vague. Managers must be considered key persons in defining the professional role of Registered Nurses. Implications for nursing management This study contributes to an understanding of the managers’ and the importance of nursing education in Registered Nurses professional development.     

Nurses' everyday activities in hospital care

Aim  This study aims at examining nurses' work in somatic and psychiatric wards in a hospital in Sweden.
Background  It is asked whether the humanistic ideology, emphasizing holistic care and human interaction more than practical skills, which has become widespread in the Swedish nursing education programmes, fits with the actual work that nurses carry out.
Method  In this study, diaries on work activities were written during 5 days by 30 nurses.
Results  It turned out that the nurses generally spend 38% of their working time with patients (nursing) and the remaining time on other activities.
Discussion  There are certain differences between clinics and they can to some extent be explained by differences in work organization.
Conclusion  The results in this piece of research indicate that a relatively small proportion of nurses' working time is used for general and specific nursing. It should be asked whether or to what extent the humanistic and holistic perspective taught in nursing education will be utilized in practical nursing.     

Effect of specific immunotherapy in Dermatophagoides pteronyssinus allergic children

The effect of immunotherapy on 21 Dermatophagoides pteronyssinus (Dpt)-sensitive patients (15 children with extrinsic asthma and six children with extrinsic asthma plus allergic rhinitis) aged 8.9±0.71 years was studied. Their subjective and objective respiratory symptom score was recorded before beginning and after the first year of immunotherapy. The respiratory subjective symptoms, such as cough day/night, running nose, sputum production, sneezing, shortness of breath at night and asthma attacks, decreased significantly from pretreatment level (P < 0.05). The objective symptoms, such as wheezing, dyspnea with prolonged expiration, sibilant rales and retractions score, gradually decreased during treatment (P < 0.01). Total eosinophil count decreased in 76.2% of patients after immunotherapy (P < 0.01). While total immunoglobulin E (IgE) decreased in 81% of patients and specific IgE for Dpt decreased in 90.5% of patients, specific IgG for Dpt increased in 76% of patient (P < 0.001). Our results suggested that rising IgG and falling IgE values do not always coexist in the patients who benefit from immunotherapy.     

OUTCOME AFTER GENRAL ANAESTHESIA FOR REPAIR OF FRACTURED NECK OF FEMUR: A Randomized Trial of Spontaneous V. Controlled Ventilation

One hundred and fifty-two patients undergoing surgery for fracturedneck of femur were randomly allocated to receive either generalanaesthesia with spontanoeous ventilation with nitrous oxideand halothane in oxygen or general anaesthesia with controlledventilation with fentanyl, nitrous oxide and halothane in oxygen.Atracurium was used to provide muscle paralysis in 65% of thelatter group, the remained receiving no neuromuscular blockingagent other than suxamethonium for intubation. Patients werefollowed up for 6 months. Mortality and outcome were not significantlydifferent between the groups. Overall mortality at 4 weeks was5.2% and at 6 months was 15.1%—figures which are considerablylower than in some other comparable studies. This study doesnot support the suggestion that general anaesthesia with controlledventilation is associated with increased postoperative mortality. ^*Department of Anaesthetics, Royal Devon & Exeter (Wonford),Exeter. Acting District Medical Officer, Northampton Health Authority.     

Cardiac hydatid cyst in a child: Diagnostic value of echocardiography and magnetic resonance imaging

Cardiac hydatid cyst is extremely rare in children. We report a case of a cardiac echinococcal cyst in an 11 year old boy, diagnosed by two-dimensional echocardiography and magnetic resonance imaging (MRI). The cyst was located in the posterior wall of the left ventricle and was excised surgically. Echocardiographic and MRI findings are discussed.