Comparison of peanut agglutinin and S100 stains in the paraffin tissue diagnosis of Langerhans cell histiocytosis

We compared peanut agglutinin and S100 stains on paraffin embedded material from a variety of sites involved in Langerhans cell histiocytosis (LCH). The two techniques were comparable in terms of ease of performance, time taken and cost. Peanut agglutinin produced dense cell surface and paranuclear staining of the characteristic LCH cells seen in lesions, which was easier to distinguish than the more diffuse cytoplasmic staining produced by the S100 technique. This characteristic staining pattern is more specific than that for the S100 protein which is present in a variety of different cells, including some malignant histiocytes. We recommend that peanut agglutinin be used as a routine diagnostic test for all samples suspected of being LCH.     

Meeting changing service need through role development: a case study for Band 4 assistant practitioners

thurgate c., macgregor j. & o'keefe h. (2010) Journal of Nursing Management  18, 654–661
Meeting changing service need through role development: a case study for Band 4 assistant practitioners Aim To debate the evolution of the Assistant Practitioner (AP) role and its impact on workforce development and Higher Education provision. Background The Band 4, AP, has been identified in England as a means for supporting Registered Nurses and enhancing patient care. However, the education and training of Band 4 AP requires new ways of partnership working between Trusts and Higher Education Institutions (HIEs) to ensure that programmes reflect employers needs and that the AP is fit for purpose. Method(s) This case study focuses on the first cohort of 13 students who were supported by a local NHS Trust to undertake a Foundation Degree (FD) in Health and Social Care (Adult Care). Results Issues include: supporting the clinical development for new roles, role boundaries, regulation of APs and supervision in training/education. Conclusion(s) There is a need for regulation and understanding of role boundaries, shared learning and development of new ways of working which HEIs need to consider in the next decade. Implications for nursing management Nurse managers need to consider skill mix and challenge established clinical roles. There is a need for FD students to be supernumerary and provided with effective support while undertaking work-based learning.     

INTRAVENOUS, INTRAMUSCULAR, SUBCUTANEOUS AND INTRANASAL ADMINISTRATION OF LH/FSH-RH: THE DURATION OF EFFECT AND OCCURRENCE OF ASYNCHRONOUS PULSATILE RELEASE OF LH AND FSH

The duration of action of 100 μg of the synthetic gonadotrophin releasing hormone, the decapeptide LH/FSH-RH, was compared in three subjects after intravenous, intramuscular and subcutaneous administration, given in random order at 7–10 day intervals. The levels of serum LH and FSH were followed over 9 hr. Each route of administration was equally effective in promoting LH and FSH release, and the magnitude of the responses and their time course were the same in each case. Two of these subjects then received 2 mg of the pure material dissolved in 0±5 or 1 ml of 0±9% NaCl by intranasal application. Although definite LH and FSH responses were seen, this route was less effective in promoting gonadotrophin release despite the higher dose used. In three further subjects blood sampling was carried out at 10 min intervals for 4 hr, following i.v., i.m. or s.c. injection of LH/FSH-RH; pulsatile release of LH and FSH was observed in each subject but the fluctuations in LH and FSH were asynchronous. The therapeutic implications of subcutaneous and intranasal administration of the material are discussed.     

Diminished Cardiac Fibrosis in Heart Failure is Associated with Altered Ventricular Arrhythmia Phenotype

Diminished Ventricular Fibrosis and Tachyarrhythmias. Objectives: We sought to define the role of interstitial fibrosis in the proarrhythmic phenotype of failing ventricular myocardium. Background: Multiple cellular events that occur during pathological remodeling of the failing ventricle are implicated in the genesis of ventricular tachycardia (VT), including interstitial fibrosis. Recent studies suggest that ventricular fibrosis is reversible, and current anti‐remodeling therapies attenuate ventricular fibrosis. However, the role of interstitial fibrosis in the proarrhythmic phenotype of failing ventricular myocardium is currently not well defined. Methods: Class II histone deacetylases (HDACs) have been implicated in promoting collagen biosynthesis. As these enzymes are inhibited by protein kinase D1 (PKD1), we studied mice with cardiomyocyte‐specific transgenic over‐expression of a constitutively active mutant of PKD1 (caPKD). caPKD mice were compared with animals in which cardiomyopathy was induced by severe thoracic aortic banding (sTAB). Hearts were analyzed by echocardiographic and electrocardiographic means. Interstitial fibrosis was assessed by histology and quantified biochemically. Ventricular arrhythmias were induced by closed‐chest, intracardiac pacing. Results: Similar degrees of hypertrophic growth, systolic dysfunction and mortality were observed in the two models. In sTAB mice, robust ventricular fibrosis was readily detected, but myocardial collagen content was significantly reduced in caPKD mice. As expected, VT was readily inducible by programmed stimulation in sTAB mice and VT was less inducible in caPKD mice. Surprisingly, episodes of VT manifested longer cycle lengths and longer duration in caPKD mice. Conclusion: Attenuated ventricular fibrosis is associated with reduced VT inducibility, increased VT duration, and significantly longer arrhythmia cycle length. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1031‐1037, September 2010)     

Clinical Experience with Dofetilide in the Treatment of Patients with Atrial Fibrillation

Introduction: Dofetilide is the newest drug approved by the United States Food and Drug Administration for the treatment of patients with atrial fibrillation (AF). Few data on the efficacy and safety of dofetilide in a diverse group of patients are available. The aim of this study was to evaluate the results of dofetilide in a consecutive series of 69 patients with AF.
Methods and Results: Sixty-nine patients with persistent (n = 53) or paroxysmal (n = 16) AF were administered dofetilide in-hospital. Prior to starting dofetilide, all patients had been adequately anticoagulated, and concomitant agents contraindicated in the presence of dofetilide were discontinued. Heart rhythms were monitored continuously by telemetry in all patients. The initial dose, which was determined using the Cockroft-Gault calculated creatinine clearance, was 500 μg bid, 250 μg bid, and 125 μg bid in 51, 13, and 5 patients, respectively. Reductions in subsequent dosage occurred in 12 patients, 4 for QT prolongation. Dofetilide was discontinued in-hospital in 7 patients, 2 for adverse arrhythmic events and 3 for unacceptable QT prolongation. Twenty-seven (63%) of 43 patients in AF converted spontaneously to sinus rhythm. Fifty-eight patients were discharged receiving dofetilide treatment and were followed as outpatients for 21 ± 7 months. One third of patients continued to take dofetilide at 1 year. One patient had a cardiac arrest 1 day after hospital discharge.
Conclusion: Dofetilide is a well-tolerated antiarrhythmic drug with a high conversion rate of AF to sinus rhythm. One third of patients maintained sinus rhythm at 1 year. Proarrhythmia can occur and initiation of therapy must be performed in-hospital. (J Cardiovasc Electrophysiol, Vol. 14, pp. S287-S290, December 2003, Suppl.)     

Cigarette smoking cessation and alcohol treatment

Cigarette smoking is common among problem drinkers and recovering alcoholics but most cessation research has not addressed this special population of smokers. Confidential survey data were collected from over 700 alcoholism counselors and medical personnel in residential and outpatient chemical dependency units (CDUs) in Nebraska to identify the quit smoking methods these experts recommend and to assess their personal experiences with smoking cessation. A total of 334 respondents (45% of the group) self-identified as a recovering alcoholic, 51 (7%) as a problem drinker, and 350 (48%) as having no history of alcohol problems. Over 63% of all respondents were former or current smokers. The most frequently recommended quitting methods for people still in treatment for alcohol problems were relying on a support group (69%), adhering to Alcoholics Anonymous (AA) principles (64%), and quitting “cold turkey” (45%). In an adjusted logistic regression model, quitting “cold turkey” and relying on the principles of AA significantly increased a respondent's odds of personally becoming a successful tobacco quitter. We conclude that many recovering alcoholics and problem drinkers can successfully quit smoking and should be encouraged to use abstinence coping skills learned in alcohol treatment.