Atypical carcinoid tumour of the thymus: a study of eight cases

Atypical carcinoids of the thymus are rare neoplasms of uncertain prognosis. We have studied eight cases (six male, two female; age range 48–60 years, mean 55 years), none with evidence of a paraneoplastic neuroendocrine syndrome. Tumour size was large and ranged from 7.5 to 10 cm. Microscopically, all had a nesting/insular or trabecular pattern, eosinophilic cytoplasm, round nuclei with fine chromatin and small nucleoli. No small cell features were evident. Mitotic activity ranged from 2 to 21 per 1.52 mm². Focal necrosis was seen in all cases. All were positive for cytokeratin (AE1/AE3, CAM 5.2) and the neuroendocrine markers NSE, synaptophysin and chromogranin; five cases were positive for calcitonin. On electronmicroscopy all contained dense core granules, often numerous. Three cases were stage I and five stage III (infiltrating lung or chest wall). Follow-up information was available in four cases (one stage I and three stage III): the stage I tumour had local recurrence and metastasis to the lung within a year whilst the three patients with stage III tumours died of liver, bone and brain metastases within 3 years.     

LH AND FSH SECRETION AND RESPONSES TO GnRH AND TRH IN PATIENTS WITH CLINICALLY FUNCTIONLESS PITUITARY ADENOMAS

Serum concentrations of LH and FSH and their response to the separate administration of GnRH (100 micrograms i.v.) and TRH (200 micrograms i.v.) have been studied preoperatively in 12 patients with a clinically functionless pituitary adenoma, of whom nine (3F: 6M) were found to secrete gonadotrophins in vitro. In three patients with a gonadotrophin-secreting adenoma (GSA) the pulsatile release of LH and FSH was also assessed preoperatively. An elevated serum FSH was recorded in six of nine patients with a GSA, and was subnormal in one, whilst an elevated LH was recorded in only two and was subnormal in six. A doubling of LH occurred in only four of the nine patients after GnRH and in three of six after TRH. None of the three patients with a non-GSA was shown to have an aberrant response to GnRH or TRH. In patients with a GSA, pulsatile release of LH and FSH was usually asynchronous and neither hormone demonstrated any regular harmonic pattern. These data show that in patients with a GSA the serum FSH level is usually elevated but this is not invariable, and the LH may well be low. Pathological responses of LH are frequently found following the administration of either GnRH or TRH and these stimulation tests should be performed separately in patients presenting with a clinically 'non-functioning' pituitary tumour to assist in the preoperative diagnosis. The absence of normal LH and FSH pulsing also appears to be a feature of GS adenomas, and suggests that tumorous gonadotrophin secretion is not under physiological control by hypothalamic GnRH.     

Pain and the administration of analgesia: what nurses say

? Pain of moderate to severe intensity continues to be an important problem for many hospitalized patients. ? Nurses spend more time with patients than any other health professional group and have a key role to play in the management of patients' pain. ? This paper reports the findings from a series of focus group interviews which were undertaken to explore nurses' perceptions regarding pain and the administration of narcotic analgesia. ? Themes identified from participants' comments related to (1) the pivotal role of nurses in pain management; (2) nursing assessment and pain management decisions (3) individual factors influencing nurses' pain management decisions and (4) the influence of others on nurses' pain management decisions. ? These findings have implications for further research and the development of innovative educational strategies.     

Structure-activity Relationships of Some Novel Coronary Dilator Derivatives of Palmitoyl Carnitine in the Rat Isolated Heart

The structure-activity relationships of some novel coronary dilator derivatives of palmitoyl carnitine in the rat isolated perfused heart are described. It has been shown previously that esterification of palmitoyl carnitine changes the activity of the compound from a coronary constrictor to a coronary dilator. In this study, it was found that the ester group is not a necessary requirement for coronary dilator activity, but only the absence of the negatively charged carboxylic acid group of palmitoyl carnitine, as compounds containing an ethyl group in place of the ester group were also active coronary dilators. Furthermore, substituting the methyl groups attached to the nitrogen atom of the molecule profoundly altered coronary dilator activity. A quaternary ammonium group was a necessary requirement for potent coronary dilator activity.     

Cell Membrane Receptors in a Case of Human Acute Monocytic Leukaemia

A study of membrane receptors on peripheral blood mononuclear cells from a patient with acute monocytic leukaemia is presented. Fc and (C) receptors which are found on normal monocytes were strongly expressed on the leukaemic cells. Electron microscopy and the cultural characteristics of these cells are also described.     

Primary Ciliary Dyskinesia: Cytological and Clinical Features

SUMMARY Thirty patients with functional and/or morphological abnormalitiesof respiratory tract cilia were identified. The diagnosis ofprimary ciliary dyskinesia was based on observed abnormalitiesof ciliary ultrastnicture or beating in vitro (beat pattern,beat frequency or percentage of motile cilia). Beat frequencyand motility indices approached the normal range in some casesand suggests that the term ‘immotile cilia syndrome’is not appropriate. Morphological abnormalities were most commonlydue to deficiency of dynein arms, affecting the outer arms (n=7),inner arms (n=3) or both (n=10). Examples of radial spoke andmicrotubular defects were also identified but in seven subjectsciliary ultrastructure was normal. In six patients paired samplesof nasal and bronchial cilia were obtained and showed consistentabnormalities of motility and ultrastnicture. Adenosine triphosphateand adenosine triphosphatase did not restore in vitro motilitywhen added to dynein deficient cilia. The clinical picture wasof life-long sinusitis and recurrent bronchial infection butthe spectrum was broader than that encompassed by Kar-tagener'striad (dextrocardia, sinusitis and bronchiectasis). Fourteenpatients had normal cardiac situs and definite or highly suggestiveevidence of bronchiectasis was present in only 17 patients.Radiological evidence of sinusitis was common but absence offrontal sinuses was not universal. Chronic serous otitis mediawas a frequent finding but deafness was rarely profound. Fertilityproblems were common but were not universal in female subjects.Lung function testing revealed evidence of airflow obstructionbut this was mild in most cases.