Subcorneal accumulation of Langerhans cells in erythema gyratum repens

Erythema gyratum repens (EGR) is a cutaneous manifestation of malignant disease. We report an unusual accumulation of activated epidermal Langerhans cells in the upper layer of the epidermis and propose that these cells play an important immunopathological role.     

Liposomal 1,25 (OH)2 vitamin D3 compounds block proliferation and induce differentiation in myelomonocytic leukaemia cells

The vitamin D₃ derived hormone 1,25 (OH)₂ vitamin D₃ (1,25 D₃) is able to induce growth arrest and differentiation in myelomonocytic leukaemia cells. In order to allow for specific delivery to leukaemic cells the lipophilic compound was incorporated into the lipid membranes of liposomes. Liposomal 1,25 D₃ reduced proliferation as measured by ³H-thymidine incorporation in HL60 leukaemia cells by up to 60%. When liposomes were prepared at different concentrations of 1,25 D₃ 65% inhibition was achieved at 48 n M . The MC 1288 stereoisomer of 1,25 D₃ was more potent and had the same activity at 48 n M .
The effect of the liposomal compounds was specific to myeloid cells as they reduced proliferation in myelomonocytic HL60, monoblastic U937 and monocytic Mono Mac 6 cells but not in the T-cell lines Jurkat and Molt 4.
The antiproliferative effect of liposomal 1,25 D₃ was associated with an induction of differentiation since treated HL60 cells showed a monocytic morphology, increased expression of CD14 and decreased expression of CD33.
When peripheral blood leukaemic cells from M4 and M5 acute myeloid leukaemia (AML) patients were admixed with liposomal compounds an antiproliferative effect was seen in all five cases, including the two cases where free compounds led to enhanced growth. Liposomal delivery of 1,25 (OH)₂ vitamin D₃ may offer a novel approach to treatment of myelomonocytic leukaemia.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.     

The use of distraction and imagery with children during painful procedures

The effectiveness of a paediatric pain management programme was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents'anxiety and behavioural stress. Fourteen people were videotaped while receiving lumbar punctures during an 8–12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behaviour and child pain ratings were obtained at all three visits. The children's behavioural responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.     

The aetiology of preterm labour

Summary. Factors associated with spontaneous preterm birth were analysed in 254 primigravidae who gave birth to singleton infants between 28 and 36 completed weeks gestation in Aberdeen City District between 1978 and 1982. In 144 women labour followed premature rupture of the membranes and in 110 the membranes were intact and labour began with contractions. Among those with intact membranes, unmarried women and teenagers were over represented to a significant extent compared with all primigravidae. Among those with premature rupture of the membranes, the distribution of age and marital state was similar to that in all primigravidae, but the birthweight centile distribution showed a significant shift towards light-for-dates babies. It is argued that there may be two distinct categories of pregnancies that end in spontaneous preterm labour.     

Review of 59 patients with hypergonadotrophic amenorrhoea

Summary. Fifty-nine patients presented with elevated concentrations of gonadotrophins and secondary amenorrhoea before the age of 35 years. Fifty-three underwent laparoscopic examination and primordial follicles were observed in 16. Two others had follicles as they later became pregnant and a third showed biochemical evidence of spontaneous ovulation. There were streak ovaries in 12, two with follicles and three others with chromosomal abnormalities, two being 47XXX and one XO/XX. Two other patients had only one ovary each but no follicles. Chromosomal abnormalities were detected in two further patients one being XO/XX and the other a recombinant. Six patients became pregnant, two of them twice, resulting in four term deliveries and four spontaneous abortions. Three other patients showed biochemical evidence of ovulation; one spontaneously, one after oestrogen therapy and the third after treatment with gonadotrophin releasing hormone analogue.     

Aphysiologic performance on dynamic posturography

The remarkable ability of the body to maintain balance is the result of central nervous system integration of sophisticated inputs from the vestibular, visual, and somatosensory systems. Strategies by patients with balance dysfunction are aphysiologic when their performance is relatively better on more difficult conditions of sensory conflict than on easier ones. Twenty-two aphysiologic patterns on computerized dynamic posturography were compared with age-matched normal and vestibular patterns. The aphysiologic group performed significantly better than the patients in the vestibular dysfunction group on the most difficult subtests of computerized dynamic posturography, conditions 5 and 6, yet significantly poorer on the easier subtests, conditions 1 through 4. In addition, patients in the aphysiologic group tended to show greater intertrial variability compared with patients in both normal and vestibular system dysfunction groups. A stepwise linear discriminant analysis was used to determine a set of conditions that had significant value in discriminating between the three patient groups. Case studies are presented to further illustrate the clinical usefulness of computerized dynamic posturography testing in the evaluation of patients suspected of having a functional component to their on-feet balance problems. (OTOLARYNGOL HEAD NECK SURG 1995;112:676-88.)     

Concomitant and repeated happenings of complications of the third stage of labour

Summary. Complications of the third stage of vaginal delivery have been studied among 36312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless. only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.     

Strengthening communities: changing roles for community health nurses

Future nursing roles in the community will be influenced bycurrent initiatives to achieve Health For All by strengtheningcommunity health. During a national consultation process onstrengthening community health services, informal workshopsinvolving community members were held in several rural and urbancommunities in Manitoba (Canada). Data obtained during thisprocess were analysed using the framework of caring communities(First National Community Health Action Conference, Bradford,United Kingdom, 1986). Two major issues with implications forfuture roles of Community Health Nurses emerged from the dataThese were: (i) who will determine the nature of community healthnursing practice? and (ii) to whom will community health nursesbe accountable? Implications for the practice of community healthnursing the education of community health nurses, and the futuredirection of research in the area of community health are identified.The authors conclude that successful resolution of these issueswould advance community health nursing's role in strengtheningcommunities.     

A Microassay Method for Neurotoxic Esterase Determinations

A microtiter plate reader with an associated computer to averagetriplicate samples and subtract blanks was used for readingand calculating neurotoxic esterase (NTE, also known as neuropathytarget esterase) activities in spinal cord regions of hens 4hr after administration of diisopropylphosphorofluoridate (DFP,0.5 mg/kg sc). Although NTE inhibition is an early indicatorof organophosphorus ester-induced delayed neuropathy, DFP-inducedinhibition was not greater in regions of the spinal cord wherepathological changes are most notable. Acetylcholinesterase(AChE) activities and protein determinations were also doneon these tissues using microassay methods. DFP-induced AChEinhibition was similar to NTE inhibition. In addition to thecapability to be used for small regional esterase activity measurements,the microassay was advantageous because the number of samplesincorporated into a single assay was increased and the timeneeded for the NTE assay was reduced by 50%. Total volume ofincubate in each well was 0.3 ml; the incubate contained 1/20quantities of sample and reagents necessary in more conventionalassays. Validation of the microassay was performed by comparisonwith more conventional assays when measuring inhibition of NTEand AChE in brains of control and experimental hens of two differentgenetic strains (B13B13 and B21B21 white leghorns). Experimentalbirds were given DFP, 0.5 mg/kg sc, 24 hr before samples werecollected. NTE activities in brains of control hens were similarusing both types of NTE analytical procedures. Percentage inhibitionof NTE caused by DFP was within 4% using both assay proceduresin both strains of hens. The microassay was sensitive enoughto detect NTE activity in 42 µg of hen brain after 15min of incubation. Hen lymphocytes could also be examined foreffects of organophosphorus esters on NTE activity, with 14.1±2.2 and 8.3 ±2.2 /xmol/15 min/mg protein in 1x10⁶cells measured in samples taken before and 4 hr after administrationof 0.5 mg/kg SC DFP.