Self-inflicted burns in the Irish National Burns Unit.

We carried out a review of self-inflicted burns presenting to the National Burns Unit in the Republic of Ireland. 87 self-inflicted burns were identified over a 12-year period accounting for 4.2% of total Burns Unit admissions. Patient demographics were identified. The majority of patients had a history of mental illness and deliberate self harm. We also examined the motivation behind the self-immolation, the total body surface area involved and the mortality rates.

Creating environments that foster academic integrity.

A number of studies related to academic dishonesty within the nursing student population have been published; however, little has been written in the nursing literature regarding academic integrity and means of promoting this value. In addition to the many short-term solutions to prevent cheating and dissuade academic misconduct that are offered, solutions that promote long-term affective changes underlying the acquisition of academic integrity are needed. This article provides a context for discussions related to academic integrity, explores issues facing faculty when dealing with this challenge, and offers short-term and long-term strategies for creating environments that foster academic integrity.

An anatomical assessment of branch abscission and branch-base hydraulic architecture in the endangered Wollemia nobilis.

BACKGROUND AND AIMS: The branch-base xylem structure of the endangered Wollemia nobilis was anatomically investigated. Wollemia nobilis is probably the only extant tree species that produces only first-order branches and where all branches are cleanly abscised. An investigation was carried out to see if these unusual features might influence branch-base xylem structure and water supply to the foliage. METHODS: The xylem was sectioned at various distances along the branch bases of 6-year-old saplings. Huber values and relative theoretical hydraulic conductivities were calculated for various regions of the branch base. KEY RESULTS: The most proximal branch base featured a pronounced xylem constriction. The constriction had only 14-31 % (average 21 %) of the cross-sectional area and 20-42 % (average 28 %) of the theoretical hydraulic conductivity of the more distal branch xylem. Wollemia nobilis had extremely low Huber values for a conifer. CONCLUSIONS: The branch-base xylem constriction would appear to facilitate branch abscission, while the associated Huber values show that W. nobilis supplies a relatively large leaf area through a relatively small diameter 'pipe'. It is tempting to suggest that the pronounced decline of W. nobilis in the Tertiary is related to its unusual branch-base structure but physiological studies of whole plant conductance are still needed.

Axillary meristems and the development of epicormic buds in wollemi pine (Wollemia nobilis).

Intact trees of Wollemia nobilis Jones, Hill and Allen (Araucariaceae) routinely develop multiple coppice shoots as well as orthotropic epicormic shoots that become replacement or additional leaders. As these are unusual architectural features for the Araucariaceae, an investigation was made of the axillary meristems of the main stem and their role in the production of epicormic and possibly coppice shoots. Leaf axils, excised from the apex to the base of 2-m-high W. nobilis plants (seedling origin, ex situ grown), were examined anatomically. Small, endogenous, undifferentiated (no leaf primordia, no vascular or provascular connections) meristems were found in the axils from near the shoot apex. In the more proximal positions about half the meristems sampled did not differentiate further, but became tangentially elongated to compensate for increases in stem diameter. In the remaining axils the meristems slowly developed into bud primordia, although these buds usually developed few leaf primordia and their apical 'domes' were wide and flat. Associated vascular development was generally restricted to provascular dedifferentiation of the cortical parenchyma, with the procambium usually forming a 'closed loop' that did not extend back to the secondary vascular tissues. Development of the meristems was very uneven with adjacent axils often at widely differing stages of development into buds. The study shows that, unlike most conifers, W. nobilis possesses long-lived meristematic potential in most, if not all, leaf axils. Unlike other araucarias that have been investigated, many of the meristems in the orthotropic main stem will slowly develop into bud primordia beneath the bark in intact plants. It appears likely that this slow but continued development provides a ready source of additional or replacement leaders and thus new branches and leaves.

An unusual presentation of bilateral prominent ears.

Patients with bilateral prominent ears commonly present for surgical correction. The cause of this condition is probably multifactorial and, whilst there is certainly a strong familial component, pathological causes are few. We present a case of bilateral postauricular dermoid cysts giving rise to this condition.

Biomechanical characterization of tissues in Dupuytren's disease.

The aim of this study was to characterize mechanical properties of tissues of Dupuytren's disease and to attempt to identify changes due to cellular activity. Tensile tests confirmed the heterogeneity of Dupuytren's disease tissue with distinct stress-strain curves for the three tissue types normally present, namely, cord, transition zone and nodule. The tensile strength for cord tissue was nearly twice that of nodule tissue, but the latter was nearly twice as stretchable as cord. In contrast, the transition tissue had the tensile strength of cord with the stretchability of nodule. It was found that tensile loading stimulated a cellular response as demonstrated by an increase in the creep strain rate of the tissue at 37 degrees C compared with that at 4 degrees C using Dupuytren's tissue in an in vitro culture test. The creep strain rate for nodule at 37 degrees C was more than seven times that for cord at a nominal creep stress of 0.75 MPa.

Mechanical stress in vitro induces increased expression of MMPs 2 and 9 in excised Dupuytren's disease tissue.

We have previously shown that the ability to mechanically extend Dupuytren's contractures in vivo by the Continuous Elongation Technique before surgery resulted in increased metalloproteinase activity. However, under these conditions it was not possible to show whether the response was proportional to the mechanical stimulus or was inflammatory cell mediated. Using an in vitro system of controlled extensions in which inflammatory involvement is absent, we have now shown that there is a clear correlation between the load applied to the tissue and the release of matrix metalloproteinase-2. The subsequent degradation of the collagen results in a loss of mechanical strength reported in the preceding paper.

Eye injuries caused by elasticated "octopus" straps.

"Octopus" elasticated straps are a common cause of severe accidental eye injuries, which we believe are largely preventable. In a retrospective study (January 1990 to August 1996), we identified 42 patients with such injuries severe enough to warrant admission to hospital. The injuries included hyphaema, vitreous haemorrhage, retinal detachment, and choroid and globe rupture, with 28% (12/42) of the injuries resulting in permanent visual loss. We believe octopus straps should not be available for sale in their current form.

An audit of hypertensive care in general practice.

This mainly urban based study of hypertensive care in general practice consisted of 5,400 patients of these 287 individuals were diagnosed as being hypertensive, a practice prevalence of 5.31%. Among those between 30-80 years (2456 patients) there were 265 hypertensives, a prevalence of 10.8%. The overall male: female ration was 1:1.8. Hospitals were involved in the management of 53.9% of the hypertensives. The use of WHO criteria to make the diagnosis had increased from 38.6% to 59% over the past five years. The completence of history taking and relevant investigations was suboptimal, 78.9% of the hypertensives had their BP checked in the previous year. Management of hypertension is similar to other practices who have performed audits. There is room for improving standards in all clinical activities relating to hypertension.

Aortic and mitral valve replacement in a patient with severe haemophilia A.

A forty-nine year old man with severe Haemophilia A developed left ventricular failure as a complication of valvular heart disease. On November 26th, 1979, open heart surgery was performed and both the aortic and mitral valves were replaced with porcine heterografts. Replacement therapy in the form of Factor VIII concentrates maintained the Factor VIII coagulant level at 100% until ten days post-operatively and a total dose of 116,600 units were given. The patient described is the first haemophiliac to undergo open heart surgery in Australia and the first reported case in the world to have had a successful double valve graft. With the current availability of factor VIII concentrates, elective surgical procedures are being performed more frequently. Such procedures require careful pre-operative planning and post-operative monitoring of replacement therapy to ensure satisfactory haemostasis. Although haemostatic defects may occur after open heart surgery, this case report illustrates that the haemostatic problems of open heart surgery and haemophilia can be prevented by pre-operative planning and meticulous post-operative monitoring of replacement therapy.