Anaphylactic shock: mechanisms and treatment

This paper reviews the mechanisms of anaphylactic shock in terms of the immunoglobulin and non-immunoglobulin triggering events; and the cellular events based on the rise in intracellular cyclic AMP and calcium that release preformed granule associated mediators and the rapidly formed, newly synthesised mediators predominantly based on arachidonic acid metabolism. These primary mediators recruit other cells with the release of secondary mediators that either potentiate or ultimately curtail the anaphylactic reaction. The roles of these mediators in the various causes of cardiovascular collapse are examined. The treatment of anaphylactic shock involves oxygen, adrenaline and fluids. The importance and safety of intravenous adrenaline are discussed. Combined H₁ and H₂ blocking antihistamines and steroids have a limited role. Glucagon and other adrenergic drugs are occasionally used, and there are several new experimental drugs.     

Diverticulosis in total colonic aganglionosis

Two infants with total colonic aganglionosis (TCA) extending into the distal part of the ileum are described. Considerable diagnostic delay occurred with the correct diagnosis established first at 3 and 8 months, respectively. Radiologic findings compatible with TCA such as prolonged barium retention, reflux into ileum following barium enema, and foreshortening of colon were not clearly evident initially. Both patients demonstrated multiple acquired colon diverticula which increased both in number and size during the period of observation. These diverticula are probably a late manifestation of the spastic state of the anganglionic colon. Thus demonstration of diverticula supplies a strong evidence of TCA in infants with intestinal obstruction.     

Subsequent reproduction and obstetric outcome after methotrexate treatment of cervical pregnancy: a review of original literature and international collaborative follow-up

The case reports of 22 patients with cervical pregnancies treated by methotrexate (MTX) administration and published in English literature between 1983 and 1995 were reviewed, by either original paper review or follow-up under international collaboration, to determine the subsequent reproductive performance and obstetric outcomes. Out of 22 cases, 18 (78%) MTX chemotherapy attempts succeeded with complete remission and four (22%) failed. Of the 13 women who wished to conceive and could be followed for at least 3 years, nine succeeded in having live births without congenital malformations, one spontaneously aborted and three suffered infertility. In general, MTX chemotherapy alone or combined with adjuvant methods such as subsequent cervical curettage or cervical tamponade, or intracervical potassium chloride injection, appears to be a convenient and effective method for the treatment of the majority of cervical pregnancies before 12 weeks gestation, and has not been shown to have detrimental effects on subsequent reproductive capacities, obstetric outcomes and progeny health for those cases with successful preservation of the uteri.      

Effectiveness of an experiential workshop for enhancing helping professionals’ self‐competence in death work in Hong Kong: a randomised controlled trial

Helping professionals require self‐competence in coping with the existential and emotional challenges of death work. Previous training often focused on knowledge and skills rather than on this competence. This study aimed to examine the effectiveness of a 3‐day workshop in Hong Kong to enhance helping professionals’ self‐competence in death work. A randomised controlled trial was conducted to examine the effects of the training between January and May 2014. Targeted participants were helping professionals who had been doing death work for at least 6 months. The 112 participants were openly recruited from hospitals and NGOs and were assigned to an intervention group or a waitlist control group. Data were collected at pre‐intervention and post‐intervention. Primary outcome was self‐competence in death work. All participants were grouped for analysing the changes in outcomes at pre‐intervention, post‐intervention and 3‐month follow‐up. Participants in the intervention group experienced a significant increase in the total score of the Self‐competence in Death Work Scale (SC‐DWS) and in scores of the Existential and Emotional subscales of SC‐DWS. The positive effects of training on self‐competence in death work were maintained at the 3‐month follow‐up. This study provides evidence of the effectiveness of training in enhancing helping professionals’ self‐competence in death work. Further research is required to examine the long‐term effects of training.