Immunoreactive cytokeratins in plasmacytomas

Fourteen plasma cell tumours, including examples of solitary plasmacytoma and multiple myeloma, were studied with a panel of antibodies reactive in formalin-fixed, paraffin wax-embedded tissue. Each case showed immunoglobulin light chain restriction. Five tumours were reactive with antibodies to cytokeratin. Of these five cases, four were negative with antibodies to leucocyte common antigen and only one was weakly positive. Anti-cytokeratin reactivity by plasma cell tumours is more common than was originally anticipated and represents an important diagnostic pitfall.     

Behavior and quality of life measures after anesthesia for tonsillectomy or ear tube insertion in children

Background: Past research examining the psychosocial impact of general anesthesia and day case surgery on children has been hampered by a lack of valid and reliable assessment tools. Aim: The purpose of the current study was to assess the feasibility of using a well‐validated scale (i.e. the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0, PedsQL) in the perioperative setting and to establish changes seen in a sample of children having day case surgery when using this scale. Method: Eighty‐nine children (aged 3–12 years) scheduled for general anesthesia for day case tonsillectomy or ear tube insertions were recruited into a prospective study in Melbourne, Australia. Parents completed the PedsQL and the Post Hospitalization Behavioral Questionnaire (PHBQ), and children completed the PedsQL (child self‐report) at baseline (preanesthesia), 7 days following anesthesia and 30 days following anesthesia. Results: The response rate at day 7 and day 30 was modest but when returned the PedsQL and PHBQ had minimal missing data. On the PedsQL, parents rated children’s physical functioning as worse at day 7 than at baseline but psychosocial functioning did not differ significantly from baseline. At 30 days, both physical and psychosocial functioning was rated by parents to be better than baseline levels. From children’s perspective, there was little evidence of a change in their physical or psychosocial functioning on the self‐report PedsQL at day 7, but by day 30 both physical and psychosocial functioning was above baseline levels. A similar pattern was observed on the PHBQ, with little difference in ratings of behavioral problems between baseline and day 7, but less behavioral problems reported at day 30 compared with baseline. Conclusions: The PedsQL is feasible for use in the perioperative setting. Future studies should take into account the possibility that deterioration of psychosocial functioning is uncommon at 1 ‐month postsurgery compared to the preoperative baseline.     

Epidermal damage in skin of allogeneic marrow recipients: relative importance of chemotherapy, conditioning and graft v. host disease

The relative importance of previous chemotherapy, conditioning and graft v. host disease in producing the epidermal damage associated with allogeneic bone marrow transplantation was investigated by enumerating individually necrotic cells. A small number was seen in many pre-transplant biopsies and was related to the time interval between biopsy and the last dose of chemotherapy. Their presence did not predispose patients to develop graft v. host disease in the post-transplant period. In post-transplant patients without rashes the degree of epidermal damage at 14 days was similar to that seen in the pre-transplant period indicating that the effects of the conditioning regime were insignificant. In patients with rashes clinically classical of graft v. host disease, necrotic cells were increased above the pre-transplant levels even in the absence of a lymphocytic infiltrate. Lymphocytic infiltration was seen more frequently in biopsies taken later after transplantation and after the onset of the rash and was associated with the maximal amount of epidermal damage. Comparison of the degree of epidermal damage in pre- and post-transplantation specimens lacking a lymphocytic infiltrate resulted in the correct identification of the majority of patients with clinical evidence of graft v. host disease. This approach may, thus, be useful in diagnosing early graft v. host disease especially if combined with keratinocyte HLA-DR staining.     

Research in general practice for smokers and excessive drinkers in Australia and the UK. I. Interpretation of results

This review examines the role of the general practitioner in assisting patients to stop smoking and in reducing levels of excessive drinking. After over a decade of clinical trials, vie discuss what interventions work in general practice and interpret the results of clinical trials conducted predominantly in Australia and the UK. Studies have generally found a superiority of GPs’ brief advice over non-intervention groups. Very brief GP advice results in smoking abstinence rates from 5% to 10%, reduction in alcohol consumption of around 25–35% and reduction in proportions of excessive drinkers of around 45%. The greater investment of GPs’ time and the more comprehensive interventions which include follow up usually resulted in higher abstinence rates among smokers from between 20% to 36%, and reduction in proportions of excessive drinkers of up to 60–70%. The contributions of the adjuncts nicotine chewing gum, follow up visits and the personalisation of health effects are discussed. It is difficult to make comparisons between studies and toe examine some of the reasons. The predictors of successful outcome are presented as they are of particular interest to GPs in terms of targeting health promotion activities.     

CLINICAL ASSESSMENT OF ANKYLOSING SPONDYLITIS: A STUDY OF OBSERVER VARIATION IN SPINAL MEASUREMENTS

Twenty-two measurements repeated non-sequentially on each of10 patients by five observers were undertaken to determine theirreliability for routine clinical use. Measurements without significantinter-observer variation or with a coefficient of reliabilitygreater than 0.70 were cervical rotation, cervical lateral flexion,tragus to wall distance, fingertip to floor distance on sagittaland lateral flexion, C₇ to iliac crest line distraction andmodified Schober index. It is concluded that many of the currentlyused measurements are either statistically unreliable or clinicallyunhelpful in mild or moderate ankylosing spondylitis. The mostclinically useful were cervical rotation using a protractor,cervical lateral flexion using a goniometer, thoracolumbar flexionas the C₇ to iliac crest line distraction, thoracolumbar lateralflexion as the fingertip to floor distance and the modifiedSchober index. KEY WORDS: Reliability, Inter-observer, Intra-observer, Ankylosing spondylitis, Assessment Present address: Department of Rheumatology, Royal North ShoreHospital, Sydney, Australia.     

Atrial and Ventricular Stimulation Threshold Development: A Comparative Study in Patients with a DDD Pacemaker and Two Identical Carbon-Tip Leads

The atrial and ventricular pacing threshold development during the first postoperative year was studied in a group of patients receiving DDD pacemakers. Identical carbon-tip endocardial leads were implanted in atrium and ventricle. Atrial and ventricular voltage stimulation thresholds were measured at implantation, and noninvasively at 1 and 12 months thereafter. The atrial amplifier sensitivity required for adequate P wave sensing during follow-up was also determined. The possible influence of a number of factors upon atrial and ventricular threshold evolution was statistically assessed. The threshold data were complete in 57 patients (mean age +/- SD, 65.2 +/- 12.4 years). Thirteen patients had a diagnosis of sinus node disease, whereas 44 had not. Patient age and diagnosis did not significantly influence atrial or ventricular stimulation threshold development. Atrial sensing thresholds were not related to atrial stimulation thresholds during follow-up. Atrial pacing thresholds were higher than ventricular thresholds at pacemaker implantation (P less than 0.00005), but the postoperative threshold rise and thresholds at 1 and 12 months postoperatively did not differ significantly between the atrium and ventricle. The ratio of chronic to acute stimulation thresholds was higher on the ventricular than on the atrial level (0.001 greater than P greater than 0.0005). The chronic atrial threshold showed a logarithmic relation to the threshold at implantation (P = 0.0006); postoperative threshold rise was not a significant determinant of the chronic atrial threshold (P = NS). On the ventricular level, the reverse was seen: The chronic threshold was related to the postoperative threshold rise (P = 0.0015, logarithmic relation), but not to the implantation threshold (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Long‐term posttraumatic effects of intraoperative awareness in children

Background: The consequences of intraoperative awareness in children have received little empirical attention to date. Previous studies suggest that children are less likely to be distressed than adults in the short term, but long‐term consequences have only been studied retrospectively. Aim: The aim of this study was to investigate posttraumatic stress symptoms in children who have experienced an awareness event. Methods: In this prospective cohort study, children who were found to have experienced intraoperative awareness in our previous study were approached for assessment for posttraumatic stress symptoms using the Trauma Symptom Checklist for Children (Alternate version; TSCC‐A). Results: Seven children were aware in the original cohort. Only four families agreed to participate and were interviewed via telephone. Only one child recalled the awareness event. No children exhibited trauma related symptoms in the clinically significant range. Conclusions: Although no children had clinically significant symptoms, the small numbers and failure to follow‐up all children limit any conclusions with respect to true incidence of posttraumatic stress disorder in children who have had an awareness event.     

Cushing's syndrome in childhood and adolescence

Objective: To review the diagnosis, management and outcome of Cushing's syndrome in children and adolescents.
Methods: We conducted a retrospective review of nine cases treated between 1976 and 1996 at the Royal Children's Hospital, Melbourne, Australia.
Results: Six children with Cushing's disease and three with primary adrenal disease were identified. Mean age at diagnosis in the Cushing's disease patients was 11.3 years and in the children with primary adrenal disease 9.5 years. The most common presenting symptoms were weight gain and delayed growth. Two children had the unusual presenting symptoms of an eating disorder and hemihypertrophy, respectively. Laboratory diagnosis of Cushing's syndrome was established by demonstration of elevated urine free cortisol, loss of normal diurnal variation of serum cortisol, and loss of suppressibility of cortisol secretion by low dose dexamethasone. Investigations used to determine the aetiology of hypercortisolism included serum adrenocorticotropic hormone (ACTH) levels, high dose dexamethasone suppression tests, imaging studies, and inferior petrosal sinus sampling. Four patients with Cushing's disease had successful transphenoidal adenomectomies. Two patients with bilateral primary pigmented nodular adrenocortical dysplasia underwent bilateral adrenalectomies. One child with an adrenal adenoma was treated by left adrenalectomy.
Conclusions: Cushing's syndrome in children and adolescents remains a diagnostic challenge. Successful treatment often requires the use of multiple tests to achieve the correct diagnosis, appropriate surgery and a good long-term outcome.     

Primary Glomerulonephritis and Pregnancy

SUMMARY Three hundred and ninety-five pregnancies undertaken by 238women with primary glomerulonephritis between 1962 and 1987were analysed to record fetal and maternal outcome and identifyrisk factors for a poor outcome. Of 398 fetuses, 26 per centwere lost (including therapeutic abortion), 24 per cent survivinginfants were premature(