An unusual case of intrapulmonary granulocytic sarcoma presenting as interstitial pneumonitis following allogeneic bone marrow transplantation for acute myeloid leukaemia and responding to donor lymphocyte infusion.

We report a 45-year-old female with AML who underwent a T cell-depleted sibling allograft and relapsed a year later with extramedullary disease involving the lung parenchyma and presenting with the clinical and radiological features of interstitial pneumonitis. The patient was treated with donor lymphocyte infusion (DLI) resulting in complete resolution of the radiological signs. The unusual presentation and the management options are discussed.     

A framework for the study of coping, illness behaviour and outcomes

This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio-economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self-efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho-social intervention.     

Periconceptional nutrient intake and risk for neural tube defect-affected pregnancies.

We investigated whether intakes of nutrients, including folate, by women in the periconceptional period were associated with risks of neural tube defect (NTD)-affected pregnancies. Data were part of a case-control study of fetuses and infants with NTDs among 1989-1991 California births. We conducted interviews with mothers of 409 NTD cases and 420 nonmal-formed controls. Nutrient intake for the 3 months before conception was derived from food frequency questionnaires and from questions to mothers about vitamin/mineral supplement use. We computed NTD risk for each nutrient controlling for the influence of all other studied nutrients and for maternal education, race/ethnicity, height, and prepregnancy weight. Most single nutrients reduced NTD risks when intakes were considered in quartiles and unadjusted for other nutrients. Some of the same nutrients, however, did not provide similar interpretations when we adjusted for other nutrients. Adjusted analyses revealed decreased NTD risks with increased intakes of methionine, lutein, magnesium, zinc, and thiamin for women who did not use vitamin supplements periconceptionally. We observed decreased NTD risks associated with increased intakes of linoleic acid, cysteine, calcium, and zinc for women who used supplements. We also observed increased NTD risks with increased intakes of oleic acid. For users as well as nonusers of vitamin supplements, we observed reduced risks with increased intakes of grains and dairy products. Chance was a likely alternative explanation for many of the observed risk patterns.     

A fatal poisoning from Nicotiana glauca

A young adult male was found dead in a field. No cause of death was apparent at autopsy, and the only positive toxicological finding was the presence of a nicotine-like alkaloid isolated from the liver. Anabasine, the major, highly toxic alkaloid of the shrub, Nicotiana glauca (tree tobacco) was subsequently identified in all body specimens examined using gas chromatography/mass spectrometry. Concentrations of anabasine in blood, urine and other body organs are reported.     

The effectiveness of differing dental health education programmes in improving the oral health of adults with mental handicaps attending Birmingham adult training centres.

There are few published data available relating to dental health in adults with handicaps, or to the effectiveness of dental health education in this group. The present study involved 382 people attending four different adult training centres in Birmingham, UK. Following baseline examinations all participants were given oral hygiene instruction and a scale and polish. Each of the centres was then randomly allocated to one of the four treatment regimens. No specific treatment was provided for the control group; daily supervised toothbrushing was carried out by the participants in the other three groups, with the addition of a three-monthly scale and polish and reinforcement of oral hygiene instruction in group 3 and one-monthly input in group 4. The participants were re-examined after three months and then at six-monthly intervals until 24 months after the baseline examination. The results showed that those people left to their own devices to carry out toothbrushing at home following instruction were not achieving an acceptable standard. Those who were reminded, encouraged and motivated by the adult training centre staff were obviously capable of better standards of oral care. The input of an experienced dental hygienist on a regular basis improved the periodontal condition considerably. Although there were significant differences between the groups throughout the study, particularly in the presence of calculus, the differences between the one-monthly and three-monthly hygienist input were not clinically very apparent after two years, and therefore a one-monthly input would be difficult to justify on a cost benefit basis.     

Superoxide dismutase in the erythrocytes of acute alcoholics during detoxification

The activity of erythrocyte superoxide dismutase in acute alcoholic patients on admission does not form a single population but clusters in two groups either above or below the normal range. The values in both groups revert towards the normal after a week of treatment. The divergent activities of this free radical scavenging enzyme between the two groups could not be explained by differences in age, haematology or liver function tests but are likely to be acute responses, possibly to diverse drinking patterns in the period immediately preceding admission.     

SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA: AUCKLAND EXPERIENCE 1979–87

Of 148 elective splenectomies performed in auckland during 1979-s7, 48 were performed as therapy for immune thrombocytopenic purpura (itp). In all cases medical therapy had either failed to maintain their platelet count (36 patients), or side-effects of medical treatment had made continuation unacceptable (12 patients). The mean age of the group was 31 years and there were 15 males and 33 females. Thirty-four of 48 patients (71%) had a favourable response to splenectomy: platelet count was maintained above 150 × 10⁹/1 and medical therapy was no longer required. There was no operative or inhospital mortality. Seven patienls experienced postoperative complications (mainly infections) of which none were life-threatening. There was no difference in response between males and females (67% and 73% response rate, respectively), and the response rates of europeans and non-europeans were similar (71% and 69%, respectively). By contrast, the average age of the responders ((29 years) was almost 10 years younger than the non-responders (38 years). It is concluded that the use of splenectomy as therapy for patienls with itp. Who have either failed to respond to medical management or for various reasons cannot tolerate the complications associated with steroid therapy, is a safe procedure which in the present series was associated with no operative mortality and an acceptably low rale of morbidity. Younger itp patients (< 30 years) have a better chance of responding favourably to splenectomy than do older patienls (> 40 years).