Vesiculation of sickle erythrocytes during thermal stress

Since it is not known why sickle RBCs tend to undergo microvesiculation, we have investigated their susceptibility to thermal stress. While normal RBCs start to vesiculate at 49.0 +/- 0 degrees C (n = 14), sickle RBCs begin to vesiculate at 47.9 +/- 0.5 degrees C, with a range of 46.5 to 48.5 degrees C (n = 14). This abnormality is reproduced by treating normal RBCs with phenazine methosulfate (PMS), which stimulates the excess intracellular generation of superoxide characteristic of sickle RBCs. For PMS-treated RBCs, there is a strong correlation between membrane protein thiol oxidation and vesiculation temperature (r = .977, P less than .001). The abnormal vesiculation temperature of both unmanipulated sickle RBCs and PMS-treated RBCs is significantly improved by treatment of the RBCs with dithiothreitol. The most dense sickle RBCs are most prone to vesiculation during thermal stress, and they are the subpopulation having the greatest amount of thiol oxidation. We conclude that the tendency of sickle RBCs to vesiculate during thermal stress is further evidence for functional abnormality of the RBC cytoskeleton due to thiol oxidation.     

Cutaneous T-cell lymphoma

Cutaneous T-cell lymphoma (CTCL) is a neoplasm of helper T cells whose first manifestations usually appear in the skin. The various forms of CTCL are distinguished by both clinical features and histopathology. Early on, the diagnosis may be difficult to establish because of its numerous, and often non-specific, clinical presentations. Further, the pathological findings of early lesions may lack the diagnostic features observed in well-developed or advanced disease. The diagnosis of CTCL must be considered in any patient with a chronic, therapy-resistant condition of the skin. In patients with non-specific histological findings, a high index of suspicion and multiple biopsies may eventually lead to a diagnosis of CTCL. Once the diagnosis of CTCL is established, accurate staging is essential both for its effect on treatment decisions and for its prognostic value. In general, CTCL is a chronic, slowly progressive disease with a long evolution. The development of tumours is a poor prognostic sign, as is erythroderma. The Sezary syndrome is a distinct form of erythrodermic CTCL that is characterized by exfoliative erythroderma, lymphadenopathy, lymphocytosis, intense pruritus, and circulating large, abnormal lymphocytes (Sezary cells). When death does occur, it is most often due to septicemia. Treatment of CTCL must be tailored to the individual patient. The most commonly employed treatment options are photochemotherapy and topical chemotherapy.     

4－甲基－5－取代苯氧基－伯氨喹类似物的合成及抗疟活性的初步评价

以2-硝基-4-甲氧基-5-溴乙酰苯胺为原料，经6步反应，合成了7个4-甲基-5-取代苯氧基伯氨喹类似物(Ⅱ_2～8)。抗疟活性的初步评价结果表明，这类化合物对鼠疟 Plasmodium yoelii 的病因性预防作用明显优于伯氨喹．可达伯氨唪的4～8倍；同时，Ⅱ_2～8还有较强的杀血液裂殖体作用．Ⅱ_2,5,6,8在0.781 mg·kg^-1 的剂量对原虫的抑制率为100％。     

Health promotion in hospitals: the attitudes, beliefs and practices of hospital nurses

This research paper explores the attitudes, beliefs and health promotion practices of hospital nurses working on acute adult wards, as demonstrated through the use of semi-structured postal questionnaires Responses were compared with those from hospital-based occupational therapists, physiotherapists, dietitians and medical consultants, in order to examine issues of consistency and continuity between professional groups and their interaction with patients in relation to health promotion activity The nurses are considered both as a homogeneous group and also in relation to their seniority within the profession Results demonstrate the lack of a coherent health promotion strategy within acute care settings and highlight the differing educational needs of nurses according to their professional role within the hospital By addressing these issues, a strategy can be developed to enhance health promotion in hospital by building on the concerns and needs identified by the nurses themselves Research literature and analysis of this study demonstrate that whilst the current position of health promotion in hospital is generally poor, nurses are keen to integrate health promotion into their practice     

赛庚啶对离体犬心肌肌质网Ca~(2+),Mg~(2+)—ATP酶活性和~(45)Ca~(2+)摄取功能的影响

当赛庚啶浓度在8×10~(-6)mol/L～2×10~(-4)mol/L之间时,该药对正常犬心肌肌质网Ca~(2+),Mg~(2+)—ATP酶活性几乎没有影响,仅在10~(-3)mol/L时对该酶活性才有一定的抑制作用(抑制率为39.85%,P<0.01)。正常犬心肌肌质网的~(45)Ca~(2+)摄取过程有明显的时间依赖性,至第30 min,其~(45)Ca~(2+)摄取量可达312.79±22.25 nmol/mg protein.赛庚啶对心肌肌质网的~(45)Ca~(2+)摄取有一定的抑制作用,其IC_(50)为1.94×10~(-4)mol/L。     

Inadvertent tracheobronchial placement of feeding tubes

Seventeen adult patients in whom small-diameter, flexible-tipped feeding tubes had been inadvertently placed in the lung were identified during a 22-month period. In nine patients pneumothorax developed, all cases due to transpleural passage of small-diameter (2.7-mm) feeding tubes. In one of these patients, hydropneumothorax and subsequent empyema developed. Placement of larger diameter (4.3-mm) feeding tubes did not lead to pneumothorax, but pneumonitis developed in one patient after intrapulmonary instillation of antacid solution. Of the 17 patients, 15 had impaired mental status or diminished gag, cough, or swallowing reflexes; the remaining two were pharmacologically sedated during the procedure. Radiographic confirmation of feeding tube placement is essential to avoid these complications, with particular attention paid to the course of the tube.     

Thoracic empyema: management with image-guided catheter drainage

Forty-three patients with thoracic empyema were treated by means of image-guided catheter drainage. In 40 patients, image-guided catheter drainage was the primary treatment method; in three it was used after conventional, surgical chest tube placement failed. Drainage was performed with ultrasound guidance in 30 patients (69.8%), computed tomography in eight (18.6%), and fluoroscopy in five (11.6%). A combination of guidance modalities was used in six patients. Image-guided catheter drainage alone was successful in 31 of 43 patients (72.1%). In three patients (7%), empyemas were initially drained, but a thoracotomy was ultimately required because of a persistent pleural peel. In eight patients (18.6%), the procedure failed, predominantly due to tube clogging, persistent pneumothorax, or progressive development of a pleural peel. In one patient, drainage was successful but he died 10 days later of complications of renal failure. No major complications were encountered. Treatment of these patients requires a thorough understanding of the pathogenesis of pleural space infection, principles of empyema drainage, techniques of abscess drainage under image guidance, and the use of a pleural drainage system.     

COMBINED SPINAL AND EPIDURAL ANAESTHESIA FOR ABDOMINAL SURGERY: A NEW TECHNIQUE

Combined spinal and epidural anaesthesia was used in 50 patients undergoing abdominal surgery. A fixed dose of 1.0 mL of 5 per cent lignocaine was injected intrathecally in all cases followed by 10 mL of 0.5 per cent bupivacaine epidurally, using “needle through needle” technique in the same lumbar intervertebral space. Subsequently epidural catheter was passed for top-up doses and postoperative analgesia. The advantages of this technique observed were immediate onset of intense block of prolonged, controllable duration and no incidence of post-spinal headache. Five cases developed intraoperative hypotension which required correction. No patient developed any complications of spinal and epidural anaesthesia.KEY WORDS: Anaesthesia epidural, Anaesthesia spinal     

Medical management of interstitial ectopic pregnancy: a case report and literature review

Recent reports describe successful treatment of interstitial ectopic pregnancies using methotrexate. While the number of reported cases is increasing, no consensus exists regarding the management of this complication of pregnancy. We present the successful use of combined systemic and direct intrasac injection of methotrexate for an interstitial pregnancy with the highest yet reported initial beta-human chorionic gonadotrophin concentration (102,000 mIU/ml). We also describe the use of Doppler ultrasound for monitoring treatment progression. Through a review of the current literature, we propose to facilitate management decisions and increase outcome success by summarizing previously reported treatment regimens and by describing enhanced parameters for patient selection and monitoring.