Functional intestinal obstruction due to deficiency of argyrophil neurones in the myenteric plexus. Familial syndrome presenting with short small bowel, malrotation, and pyloric hypertrophy

In 3 infants functional intestinal obstruction, associated with a short small intestine, malrotation, and pyloric hypertrophy, was shown to be due to failure of development of the argyrophil myenteric plexus, with the absence of ongoing peristalsis. 4 infants with similar clinical features have been described previously, and there is evidence for an autosomal recessive mode of inheritance of this syndrome.     

Pet sensitivities in asthmatic children

A history of pet contact and/or apparent clinical sensitivity was obtained in 65 (55%) of 118 unselected asthmatic children. These 65 children were skin tested and their sera examined for specific IgE using the radioallergosorbent test. Those children who had apparent clinical sensitivities had larger skin test reactions and were more likely to have positive specific IgE results than those without apparent sensitivities. Positive skin tests were very common (80%), but the larger the skin test reaction (weal diameter greater than 4 mm diameter) the more likely was there to be a positive history or a positive specific IgE result. Hence a large skin test reaction can provide a helpful pointer to animal allergy of clinical importance. Commercially available animal extracts have limitations for diagnostic tests. A questionnaire survey of 150 day schools emphasized the potential opportunities for contact with animal allergens at school.     

Knowledge of Cardiovascular Risk Factors in West African Refugee Women Living in Western Australia

As obesity and cardiovascular disease are elevated in refugees who have migrated recently to Western countries, barriers to healthy eating and exercise were investigated in West African women who had entered Australia recently as refugees. Questionnaires on diet and exercise were administered to convenience samples of 51 West African women and 100 Australian women. Eighty percent of the West African women were overweight or obese compared with 49% of Australian women. The West African women were less clear about nutritional guidelines and had more misconceptions about exercise than the Australian women. BMI increased with age in both groups, and increased with fewer years at school and the number of internal barriers to exercise in Australian women. Dietary changes, limited nutritional knowledge of Western foods, a sedentary lifestyle, and barriers to participating in physical activity programmes may increase vulnerability to obesity and cardiovascular disease in West African women who have entered Australia recently as refugees.     

Thoracic wall involvement by Hodgkin disease and non-Hodgkin lymphoma: CT evaluation

Thoracic computed tomographic (CT) scans of 250 patients with newly diagnosed or recurrent lymphoma revealed thoracic wall involvement in 24 patients (11 with Hodgkin disease, 13 with non-Hodgkin lymphoma). Thoracic wall involvement occurred without contiguous mediastinal or parenchymal involvement in 17 patients. Of these, 13 patients had masses beneath the pectoralis muscles or within the breast, and four had masses arising from the ribs. Five additional patients had mediastinal masses with thymic involvement and parasternal extension through the thoracic wall. Pulmonary parenchymal lymphoma with thoracic wall invasion was noted in the remaining two patients. In five of nine patients receiving radiation therapy, treatment plans were modified by CT demonstration of thoracic wall lymphoma.     

Fatty infiltration of the liver: evaluation by proton spectroscopic imaging

The reliability of proton spectroscopic imaging in evaluating fatty infiltration of the liver was investigated in 35 subjects (12 healthy volunteers and 23 patients with fatty livers). With this modified spin-echo technique, fatty liver could be separated from normal liver both visually and quantitatively. On the opposed image, normal liver had an intermediate signal intensity, greater than that of muscle, whereas fatty liver had a lower signal intensity, equal to or less than that of muscle. In normal livers, the lipid signal fraction was less than 10%, while in fatty livers it was greater than 10% and usually exceeded 20%. With this technique, nonuniform fatty infiltration of the liver can be differentiated from hepatic metastases, and the technique may prove useful in the differentiation of some hepatic disorders.     

The use of therapeutic interchange for biologic therapies

Therapeutic interchange is the practice of switching or dispensing drugs that are chemically distinct but therapeutically similar in terms of their efficacy, safety, and tolerability profiles. The stated goal of therapeutic interchange is to achieve an improved or neutral outcome with the new agent while reducing overall treatment costs. Until recently, most interchange programs have been limited to switches within drug classes, such as angiotensin-converting enzyme (ACE) inhibitors, proton pump inhibitors (PPIs), HMG-CoA reductase inhibitors (statins), and selective serotonin reuptake inhibitors (SSRIs), and generally to drugs that use the same routes of administration. Therapeutic interchange now is being applied to some biologic agents, such as those used to treat psoriasis and rheumatoid arthritis (RA). In some cases, these agents differ in structure and mode of administration. Patients who require a biologic agent are often difficult to manage, and the comorbidities that are prevalent in these patients further complicate management and agent selection. Population-based outcomes among various agents may not appear notably different, but because there is no a priori means to determine the effects of a given biologic agent on any individual patient, therapeutic interchange is inadvisable once a patient receiving RA or psoriasis therapy has been stabilized. However, if a biologic agent has been designated as preferred on a formulary, it is reasonable to initiate treatment with that agent in a patient who is naive to biologic therapy if that agent is not contraindicated. Respectful, two-way communication between health care professionals and managed care organizations (MCOs) will help ensure that a patient receives the appropriate therapy at the right time.     

Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging

Two sports-related knee injuries resulted in small fractures at the posteromedial corner of the tibial plateau. Magnetic resonance imaging demonstrated findings consistent with an avulsion injury at the semimembranosus insertion, as well as a similar pattern of internal derangement in both cases.     

Sequential appearance of cytoskeletal components during the early stages of neurite outgrowth from cerebellar granule cells in vitro

Cerebellar granule cells derived from one-week-old rat pups have been placed into culture to examine the expression of microfilament, microtubular and neurofilament proteins in developing neurites up to 2 days in vitro. Immunofluorescence and rhodamine-phalloidin studies have shown that the first cytoskeletal element to appear in the developing neurite was the microfilament network which was present in cell processes and expansions from at least 8 minutes in vitro. Rhodamine-phalloidin fluorescence was maintained in the developing neurite over 2 days and was enriched in some growth cones. At between 30 and 60 min in culture microtubules (reacting with anti alpha-tubulin antibodies) appeared in the neurites but did not ramify throughout the growth cone at this or later time points. The expression of tyrosylated alpha-tubulin in microtubules of the developing neurite appeared to precede that of acetylated alpha-tubulin. Only one of the neurofilament subunits, the 200 kDa subunit, could be positively identified in granule cell processes in these cultures. The developmental pattern of cytoskeletal protein expression in granule cell neurites in vitro may reflect a process of stabilisation of the growing neurite behind an active, motile growth cone.     

A wind of change for entrenched behaviour. Getting the nursing process to work in ICU

As the emphasis on individualised patient care increased in a large ICU, it was decided to apply the nursing process. This article describes how the process was adapted to suit the unit's special needs.