Vascular Access for Therapeutic Plasma Exchange

Abstract: Adequate venous access is an essential component of therapeutic plasma exchange (TPEX). The simplest kind of venous access is venipuncture of antecubital veins, but this technique may be limited by venous size or scarring following the procedure, requiring the placement of a specialized vascular access device (VAD). VADs provide reliable central venous access and may remain in place for several weeks or months, depending on the VAD and the venous site chosen. Their use, however, is potentially limited by the risk of complications. We discuss indications for insertion, choice of catheter and access site, and complications of VAD placement for TPEX.     

Pituitary macroadenomas associated with hyperprolactinaemia: immunocytochemical and in-situ hybridization studies

OBJECTIVE: We have assessed whether in-situ hybridization for prolactin messenger RNA (mRNA) provides additional information for the classification of pituitary macroadenomas associated with hyperprolactinaemia. DESIGN: In-situ hybridization for PRL mRNA was performed on surgical biopsies of pituitary adenomas and the results correlated with serum PRL levels and PRL immunoreactivity. PATIENTS: Twenty-one patients (11 men, 10 women) were included; five had normal serum PRL levels, 11 mild hyperprolactinaemia (less than 3000 mU/l) and five marked hyperprolactinaemia (greater than 3000 mU/l). MEASUREMENTS: Immunocytochemistry for PRL and in-situ hybridization for PRL mRNA were performed on surgical biopsies. RESULTS: Immunoreactivity for PRL was detected in tumours from all patients with serum PRL greater than 3000 mU/l and in one of 11 patients with mild hyperprolactinaemia. Positive signal for PRL mRNA was detected in four of five immunopositive cases studied, in a further two cases with mild hyperprolactinaemia, and in one tumour associated with normal serum PRL level. CONCLUSIONS: In-situ hybridization provides evidence of PRL gene activation in the absence of immunoreactivity for prolactin. This may reflect low levels of hormone storage or defective translation of the mRNA.     

Accidental Occupational Farm Fatalities in North Carolina: 1984 to 1988

Development of interventions to prevent accidental occupational fatalities requires the prior identification of those at risk and the circumstances surrounding the injuries. A survey of unintentional farm fatalities was conducted using medical examiner reports (RIME) and death certificates (MECD) to identify deaths due to agricultural occupational injuries in North Carolina from 1984 through 1988. Of 393 cases, 123 met the criteria "farmer" listed as occupation on the RIME/MECD and/or "victim" in a rural area performing a farming task when injured. A second aim of this study was to use an existing data base to achieve maximum accuracy in identifying true cases of work-related farm fatalities.
A fatality rate of 41/100,000 agricultural workers was found; the National Institutes of Occupational Safety and Health's National Traumatic Occupational Fatality study criteria would have identified only 57 percent of these. Victims were characterized as middle age (53 years), white (76%), male (100%), full-time farmers (65%). Injury occurred during harvest season on Monday or Tuesday (47%) between 2 and 6 p.m. (54%). Death was pronounced at the scene (74%), with probable cause listed as tractor (62%). Injury location and land elevation were also related, with the mountain region having twice the fatality rate as the coastal plains region.     

Validity in hermeneutic phenomenological inquiry: towards an ethics of evaluation.

This article explores the relationship of ethics to validity in hermeneutic phenomenological inquiry. First, the authors present a brief overview of the various discourses on validity in qualitative research that have been variously applied to hermeneutic phenomenological inquiry. Next, they examine how relational ethics is a presence to bear within this form of inquiry. Finally, they offer a set of ethical reflections to help the researcher engage in a process of ethical questioning during each step of the research process.     

Mood Matters: Negative Mood Induction Activates Dysfunctional Attitudes in Women Vulnerable to Depression

Cognitive theory holds that dysfunctionalattitudes are important risk factors for depression.Critics have questioned this view, noting that, althoughdysfunctional attitudes are elevated in depression, they are not evident in vulnerable individualswho are asymptomatic. To deal with this criticism,Miranda and Persons (1988) have advanced the mood-statedependent hypothesis, which suggests that cognitive vulnerability factors are indeed present invulnerable individuals, but remain dormant untilactivated by negative mood. To test this hypothesis, 33women with and 67 women without histories of depression reported dysfunctional attitudes before andafter a film negative mood induction. As predicted,vulnerable subjects who reported increased negative moodreported increased dysfunctional attitudes.Unexpectedly, nonvulnerable subjects who reported increasednegative mood reported decreased dysfunctionalattitudes. These findings support the mood-statedependent hypothesis, and suggest that a deficit in theability to regulate negative emotions may be animportant feature of vulnerability todepression.