Inflammatory endobronchial polyposis with bronchiectasis in cystic fibrosis.

An unusual case of endobronchial polyposis associated with extensive bronchiectasis in the context of cystic fibrosis (CF) has been described. A 15-yr-old female patient with CF underwent partial pneumonectomy for extensive bronchiectasis and frequent infective pulmonary exacerbations. Cylindrical bronchiectasis with associated purulent bronchitis and bronchiolitis, together with inflammatory polyposis, was noted in the resected lung. To the best of the authors' knowledge, this is the first report of multiple endobronchial polyposis and may represent a rare complication of bronchiectasis in a patient with cystic fibrosis. On-going infection and the cellular composition of the polyps are discussed in relation to their possible aetiological relevance and relationship to upper respiratory tract polyps.     

A description of clients nursed by community psychiatric nurses whilst attending English National Board Clinical Course No. 811: clarification of current role?

The English National Board Clinical Course No. 811 is a 36-week preparation for community psychiatric nurses (CPNs). Unlike health visiting or district nursing the course is not yet a mandatory prerequisite for practice and it has been estimated that, nationally, 23% of all CPNs have been awarded the certificate to date. There are currently 24 course centres in England, offering 420 places annually. The completion of a care study by the course student is a curriculum requirement. The present study aimed to establish the characteristics of clients chosen by course students for such work whilst attending the course in an attempt to obtain a 'proxy' measure of the current CPN role nationally. A stratified random sample of eight course centres was selected--four based in schools of nursing, and a further four located in establishments of higher education. Then within each course centre a stratified random sample of students was selected, who each completed a postal questionnaire. A 79% response was obtained. The results are described and discussed within the context of the CPN's developing role. The findings suggest that many CPNs conceptualize their role and function, to use Caplan's terminology, at the primary prevention level, and see their work as being located firmly in primary health care settings. The desirability of this orientation to CPN intervention is examined, acknowledging both mental health service developments and the wider educational implications.     

Quantitation of CD62, soluble CD62, and lysosome-associated membrane proteins 1 and 2 for evaluation of the quality of stored platelet concentrates

BACKGROUND: Platelets become activated during storage, which results in secretion of granules, vesiculation of microparticles, secretion of protein, and a number of other biochemical and morphologic processes that decrease the utility of platelet concentrates stored for transfusion. STUDY DESIGN AND METHODS: To evaluate the quality of stored platelet concentrates, the cell surface expression of specific activation-dependent antigens (CD62 and lysosome-associated membrane proteins 1 and 2 [LAMP-1, LAMP-2]) on platelets stored in a hospital blood bank over a 7-day period was examined. Relative microparticle counts and the expression of CD62 by microparticles, as well as platelet concentrate supernatant levels of soluble CD62, were determined. RESULTS: The percentage of platelets expressing CD62 increased significantly from Day 1 to Day 5 (p < 0.05) of storage; the mean fluorescence values for CD62 did not. In contrast, the mean fluorescence values of LAMP-1 and LAMP-2 rose significantly (p < 0.01 and p < 0.05, respectively) between Days 1 and 5. Significant declines in CD62, LAMP-1, and LAMP-2 percent expression and mean fluorescence were seen on Day 6 of storage (p < 0.001). Microparticle numbers increased significantly during storage and correlated with levels of CD62 protein (free and membrane-bound) (r = 0.95 vs. Day 2, p < 0.05; r = 0.88 vs. Day 5, p < 0.05). CONCLUSION: Flow cytometric evaluations of the expression of cell surface CD62, LAMP-1, and LAMP-2 are complementary tests that, especially when used in conjunction with the quantitation of CD62 protein, provided a simple and effective means of evaluating the quality of platelet concentrates stored for transfusion.     

Abdominal wall reconstruction following removal of a chronically infected mid-urethral tape

We report a rare postoperative complication of a mid-urethral tape. The patient presented with a chronic infection resistant to treatment with several weeks of antibiotics, with eventual surgical removal, and the resulting complications of an infected incisional hernia and vesico-cutaneous fistula required reconstruction of the abdominal wall with Permacol™ and excision of the vesico-cutaneous fistula. We also look briefly at the impact of health tourism on the National Health Service.