The treatment of chilblains with nifedipine: the results of a pilot study, a double-blind placebo-controlled randomized study and a long-term open trial

A pilot study, a double-blind placebo-controlled randomised study and a long term open trial have indicated that nifedipine is effective in the treatment of perniosis. At a dose of 20 mg to 60 mg daily, nifedipine significantly reduced the time to clearance of existing lesions and prevented the development of new chilblains. Nifedipine also reduced the pain, soreness and irritation of the lesions. A comparison of the pre- and post-treatment skin biopsies showed resolution of the dermal oedema and diminution of the perivascular infiltrate. An increase in cutaneous blood flow following administration of nifedipine suggests that the vasodilator action of this drug may be important in its action.     

A retrospective review of cervical cytology in women developing invasive squamous cell carcinoma

Summary. The records of 93 women who presented with invasive squamous cell carcinoma were searched for evidence of cervical cytology during the years preceding this diagnosis; a search was also made through the files of local laboratories and contact was made with general practitioners and relevant hospital departments. Only 26 (28%) of these 93 women had had a cervical smear at any time before the diagnosis of invasive cancer, and only 11 (12%) had had regular cytological surveillance. Fifteen (60%) had had a smear taken and reported as negative within the previous 5 years, six (6%) within the previous year. Eleven of these 15 slides were obtained for review: three were regarded as positive and three more were re-classed as too scanty for conclusive assessment. In nine of the 67 women who had never had a smear, a gynaecological or obstetric examination was known to have been performed or indicated within the previous 5 years, thereby representing a missed opportunity for screening. In three patients cytological abnormalities had been reported within the previous 3 years but no action had been taken.     

Self-Nonself Discrimination due to Immunological Nonlinearities: the Analysis of a Series of Models by Numerical Methods

In a set of models incorporating a varying amount of immunologicalcomplexity, we investigate processes by which T lymphocytes‘learn’ to discriminate self from nonself. The modelsall incorporate the following immunological data: (1) T lymphocytesproduce their own growth factor (IL2), (2) T lymphocyte effectorsproliferate in response to IL2 and antigen, and (3) T lymphocyteeffectors become memory cells whenever antigenic restimulationis poor. The first two facts are sufficient to generate a proliferationthreshold: the (self-reinforeing) proliferation process onlystarts when LL2 concentrations are sufficiently high. We first analyse a fairly simple model i.e. an immune systemin which cytotoxic effectors (CTL) and helper T cells (HTL,the cells that produce IL2) are assumed to be identical. Thissimple model accounts for self–nonself discriminationin the absence of any down-regulatory interactions (i.e. suppressions).Clones with high affinity to a self antigen remain below theproliferation threshold, whereas T lymphocytes with low selfaffinity accumulate memory cells and cross the proliferationthreshold whenever a (high-affinity) foreign antigen entersthe immune system. Secondly, we analyse this tolerance process in various morecomplex models that incorporate CTL and HTL as separate populations.Such an extension of the model adds interesting new features,because the populations now compete for andtigen and IL2. Competitionfor IL2 markedly influences tolerance: enlarged CTL populations(due, for example, to memory accumulation) raise the proliferationthreshold by intensive IL2 absorption. We investigate here howsuch complex models can regain the tolerance behaviour of theprevious (simple) model. This is achieved by incorporating theadditional complexity of antigen presentation and a lymphoidfactor that regulates the expression of the IL2 receptor. Itthus appaears that results obtained in a simple model, whichis attractive from a theoretical point of view, do require modificationbefore their extrapolations to more complex systems is justified. Self-nonself discrimination develops in the models as a resultof nonlinearities in the T lymphocyte proliferation and activationprocess. The parameter setting of the models was fixed; sincethe models incorporate the same immunological processes, theparameters should also be identical. The models were analysedby numerical methods: numerical integration and the numericalgeneratrion of zero-isoclines. We think that, by combining thesemethods, we can investigate a fairly large set of complex modelsconcomitantly. The analysis of such a diverse set of modelsis markedly facilitated when the complex models are projectedinto 2-D or 3-D state spaces by quasi-steady-state assumptions:zero-isoclines in such reduced state spaces indicate the similaritiesand discrepancies between the various models.     

Assessment of upper‐limb capacity,performance, and developmental disregard in children with cerebral palsy: validity and reliability of the revised Video‐Observation Aarts and Aarts module: Determine Developmental Disregard (VOAA‐DDD‐R)

Aim To investigate the validity and reliability of the revised Video‐Observation Aarts and Aarts module: Determine Developmental Disregard (VOAA‐DDD‐R). Method Upper‐limb capacity and performance were assessed in children with unilateral spastic cerebral palsy (CP) by measuring overall duration of affected upper‐limb use and the frequency of specific behaviours during a task in which bimanual activity was demanded (‘stringing beads’) and stimulated (‘decorating a muffin’). Developmental disregard was defined as the difference in duration of affected upper‐limb use between both tasks. Raters were two occupational and one physical therapist who received 3 hours of training. Construct validity was determined by comparing children with CP with typically developing children. Intrarater, interrater, and test–retest reliability were determined using the intraclass correlation coefficient. Standard errors of measurement and smallest detectable differences were also calculated. Results Twenty‐five children with CP (15 females, 10 males; mean age 4y 9mo [SD 1y 7mo], range 2y 9mo–8y; Manual Ability Classification System levels I–III) scored lower on capacity (p=0.052) and performance (p<0.001), and higher on developmental disregard (p<0.001) than 46 age‐ and sex‐matched typically developing children (23 males; mean age 5y 3mo [SD 1y 5mo], range 2y 6mo–8y). The intraclass correlation coefficients (0.79–1.00) indicated good reliability. Absolute agreement was high, standard errors of measurement ranged from 4.5 to 6.8%, and smallest detectable differences ranged from 12.5 to 19.0%. Interpretation The VOAA‐DDD‐R can be reliably and validly used by occupational and physical therapists to assess upper‐limb capacity, performance, and developmental disregard in children (2y 6mo–8y) with CP.     

Coronary Sinus Lead Extraction

TYERS, G.F.O., et al .: Coronary Sinus Lead Extraction. Complications are reported more frequently with the implantation of coronary sinus (CS) than other types of leads, and attempts to extract CS leads may also be associated with increased risks. The authors have performed nonthoracotomy lead extraction (LE) since 1981 and maintained a detailed database. By November 2001, 796 leads had been removed from 401 patients. We undertook review of our CS-LE experience to evaluate prevalence, safety, and efficacy. Of 14 patients referred for CS-LE, 7 were treated in the last year. In six the lead had been placed in the CS intentionally, and in eight inadvertently. One recent patient treated with biventricular pacing was septic and died before LE was undertaken. In nine men and four women (mean age 66 years) had one each CS lead and a total of 34 LEs (2.6/patient). Four CS leads had been in place for <6 months (mean 1.5 month), whereas nine had been in place for between 6 months and 27 years. Several LE methods were used, from simple traction to the use of intraluminal locking stylets and powered sheaths. Complete removal of all leads was achieved in all patients. CS-LE required a mean of 13 minutes, including 1.8 minutes of fluoroscopy. There were no serious complications during the procedures, and the mean hospital stay was 4 days. (PACE 2003; 26[Pt. II]:524–526)     

Effects of Separation From Spouse on Pregnancy, Labor and Delivery, and the Postpartum Period

The absence of her husband during woman's pregnancy, labor, and delivery, especially during first pregnancy, can result in additional stress for the woman. The couples'temporary separation produces practical and logistical problems, and may have significant psychologic effects. It is the nurse's responsibility to be aware of these problems, to provide emotional support, and to help the woman plan for her delivery and postpartum period.