Infection of left ventricular thrombus in a patient with silent myocardial infarction -- a unique complication

A 72-year-old male was admitted to hospital with exertionaldyspnoea of recent onset. Echocardiography showed a left ventriclewhich was severely hypokinetic on the anteroseptal and anteriorwall with an akinetic inferior wall and apex. A string of globularmasses was seen to be floating in the left ventricle, attachedto the septum near the apex. Coronary arteriography showed severetwo-vessel disease. Urgent surgery revealed degenerated thrombusin the left ventricle containing green pus. The infected thrombuswas attached to an area of septal infarction. The pus-filledthrombus was removed and by-pass grafting was effected. No infectiveorganism was identfled.     

Neuropeptides and general neuronal marker in psoriasis an immunohistochemical study

Nerve fibres immunoreactive to antibodies to vasoactive intestinal polypeptide (VIP) and substance P (SP) were increased in lesional psoriatic skin when assessed semi-quantitatively. Biopsies from psoriatic plaques on the arm were studied in 13 patients and compared with biopsies from non-lesional areas (in three of the same psoriatic subjects) and from normal skin in seven non-psomtic controls. Immunohistochemical methods were used on cryocut skin sections to demonstrate the neuropeptides SP, VIP, calcitonin gene-related peptide and neuropeptide Y, and the general neuronal marker protein gene product (PGP) 9.5. The immunofluorescence was examined by semiquantitative and, for PGP 9.5, by quantitative methods. VIP reactive nerve fibres were increased at areas of eccrine sweat glands throughout the dermis, at the dermo-epidermal junction, and in the epidermis, in psoriasis lesional skin. SP reactive nerve fibres were increased at the dermo-epidermal junction, where the nerves ran parallel with and perpendicularly through the junction. PGP 9.5 reactive nerve fibres showed an increase at the dermo-epidermal junction, in the papillary dermis, and at the eccrine sweat glands in lesional psoriatic skin but not in non-lesional, or in control skin. These findings support the hypothesis that neuropeptides may be involved in the pathogenesis of psoriasis.     

Development of nursing documentation for use in the outpatient oncology setting

In response to the particular demands upon patients and nursing staff in the outpatient setting, and the identification of a need for nursing orientated documentation, a new nursing documentation system has been developed and implemented within an oncology day unit. The documentation is used by the nursing team engaged in the care of patients receiving outpatient chemotherapy treatment. The system consists of documents for the initial and ongoing assessment, planning, implementation and evaluation of nursing care. These include pretreatment patient self-assessment forms, flowsheets for the documentation of chemotherapy treatment and administration and a record for information and teaching given to patients and significant others. Referrals to other services and health care professionals are also documented. This tool is designed to ensure a high standard of nursing intervention and maximize quality of life in this group of patients. An audit is planned to evaluate the effectiveness of this tool and highlight any areas requiring improvement or modification. There are also plans to further develop this system for use in the inpatient and community setting.