Thick malignant melanomas (> 3 mm Breslow) with good clinical outcome: a histological study and survival analysis

Thick malignant melanomas in general tend to have a poor prognosis, but exceptions occur where there may be no further recurrence. The reasons for this difference in clinical behaviour are not fully understood. We have looked at thick malignant melanomas (greater than 3.0 mm) in the East of Scotland that have no evidence of metastasis after a minimum of 6 years follow-up and compared the clinical and histological features with a similar group, associated with histological evidence of metastasis and/or death. Both groups received similar treatment regimes. We have identified 41 patients with thick melanomas in the former group. When compared with the control group, factors found to be significantly different between the two groups were: the nature of the lower margin of the tumour; vascular invasion; and anatomical location.     

Clinical leadership for high-quality care: developing future ward leaders

Aim This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. Background The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. Method An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Results Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. Conclusion The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Implications for nursing management Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention.     

PHARMACOKINETICS OF FENTANYL DURING CONSTANT RATE I.V. INFUSION FOR THE RELIEF OF PAIN AFTER SURGERY

Forty-five patients in four groups undergoing orthopaedic, upperabdominal, prolonged or cardiac surgery received a constantrate i.v. infusion of fentanyl 100 µg h^–1 for 24h starting 2 h before surgery. A single bolus dose was giveni.v. at the induction of anaesthesia. Plasma fentanyl concentrations,measured by radio-immunoassay were between 1 and 3 ng ml^–1until the infusions were discontinued. Clearance of fentanylwas decreased in the cardiac surgery group only. The eliminationhalf-life was 7.3–9.7 This simple regimen produced effectiveanalgesia.     

An histological and ultrastructural study of the 'dirty neck' appearance in atopic eczema

The‘dirty neck1 appearance is a characteristic disorder of pigmentation, which has previous!) been found to affect approximately 2% or adult atopies. This disorder results in a rippled pattern of hyper pigmentation similar to that seen in macular amyloidosis. Biopsy specimens from affected skin of three patients were examined by histological and electron microscopical techniques. In addition to eczematous changes, marked pigmetar incontinence was observed, Amyloid-like material was detected by electron microscopy bur not by light microscopy in all three specimens. Some deposition of amyloid occurs in this condition but the pigmentary changes arc attributable to melanin incontinence.     

Cutaneous malignant melanoma. Publicity, screening clinics and survival—the Edinburgh experience 1982–90

Summary The incidence of cutaneous malignant melanoma has increased considerably in south-east Scotland over recent years. In 1987 the Cancer Research Campaign launched a project to aid the early detection, diagnosis and treatment of malignant melanoma. Edinburgh, chosen as one of seven centres in the U.K. to participate in the study, was provided with funding for a direct access pigmented lesion clinic from 1987 to 1989. The changes in the pattern of cutaneous malignant melanoma before, during and after the publicity campaign have been examined; between 1982 and 1990. The incidence of malignant melanoma doubled from 5.7 to 11.4/100,000 per annum. The percentage of thin tumours (Breslow thickness ≤ 1.5 mm) increased steadily and significantly (from 43% in 1982 to 68% in 1990), but the number of thick tumours (Breslow thickness > 3.0 mm) remained constant over the same period (22 ±3.8), The influence of Publicity was assessed using a questionnaire. Those who were influenced by publicity were stgnificantly younger and had more thin tumours (Breslow ≤ 1.5 mm) than those who were uninfluenced by publicity. Five-year survival has significantly increased from 70% in the 1982–84 cohort to 84% in the 1987–89 cohort. The effect of the publicity campaign has been beneficial, but the impact on mortality cannot yet be assessed.     

THE ROLE OF IMMUNOPEROXIDASE TECHNIQUES ON PARAFFIN EMBEDDED TISSUE IN DETERMINING THE HISTOGENESIS OF UNDIFFERENTIATED THYROID NEOPLASMS

Twenty cases of undifferentiated thyroid tumours were reviewed histologically. In seven cases the histogenesis was difficult to determine using morphological criteria. Immunohistochemical staining with a panel of antibodies to lymphoid and epithelial cells, including monoclonal antibodies directed against the leucocyte common antigen, cytokeratin, and epithelial membrane antigen confirmed that four of these cases were lymphomas and that one was a medullary carcinoma. In the remaining two cases immunohistochemistry was unhelpful. In the thirteen histologically typical tumours, the immunohistochemical profile was in keeping with their histogenesis as determined by morphological criteria. Immunohistochemical staining with a panel of selected antibodies allows the reliable diagnosis of undifferentiated thyroid neoplasms, when this cannot be reached using routine histological techniques.