Intrahospital transfer of critically ill patients; a prospective audit within Flinders Medical Centre.

A prospective observational audit of 32 intrahospital transfers of critically ill patients was undertaken within Flinders Medical Centre. The aim was to assess the adherence of recommended staffing and equipment required during intrahospital transfer according to the "Minimum standards for intrahospital transport of critically ill patients" (PS39) published in 2003 by the Joint Faculty of Intensive Care Medicine, the Australian and New Zealand College of Anaesthetists and Australasian College for Emergency Medicine. Incident monitoring was also performed during the audit. Findings showed adequate staffing for 75% of the transfers observed. Oxygen saturation and blood pressure monitoring were present in 97%, heart rate monitoring in 90.5%, electrocardiogram monitoring in 84.5% and capnometry monitoring in 75% of the intrahospital transfers observed. Overall, 44% of transfers resulted in incident occurrence, many of which were preventable with careful planning and increased communication between staff Intensive care units are encouraged to continually evaluate their intrahospital transportation of critically ill patients and to identify system problems contributing to failure of adherence to the current guidelines.

Solitary metastasis from cutaneous melanoma to the liver: resection by extended left hepatectomy (trisegmentectomy) with clearance of tumor from the portal vein.

A 61-year-old woman presented with low grade fever and an epigastric mass eight years following resection of a stage Clark IV infraclavicular cutaneous melanoma followed by axillary node dissection. Investigations revealed a tumor in segment II, III, IV and V of the liver and a thrombus involving the main portal vein. Liver resection with extended left hepatectomy (left trisegmentectomy) and portal vein thrombectomy is reported.

Peripheral T-cell lymphomas: histologic, immunohistologic, and clinical characterization.

A review of 40 cases of peripheral T-cell lymphoma identified at our institution between March 1983 and December 1985 revealed a clinically, histologically, and immunologically diverse group of neoplasms that were difficult to classify by conventional histomorphologic criteria for non-Hodgkin's lymphomas. These lymphomas were frequently extranodal at the time of initial manifestation (52%), and their clinical aggressiveness correlated with three major histologic categories--small lymphocytic, diffuse mixed, and large cell. Of the 40 lymphomas, 18 exhibited distinctive histologic features that allowed assignment of these cases into one of four subgroups: (1) angioimmunoblastic lymphadenopathy, (2) lymphomatoid granulomatosis, (3) Hodgkin's-like disease, and (4) Lennert's lymphoma (lymphoepithelioid lymphoma). Study of all our cases that fulfilled the morphologic criteria for lymphomatoid granulomatosis or angioimmunoblastic lymphadenopathy by using immunologic methods for identification of B-cell and T-cell antigens has shown these neoplasms to be peripheral T-cell lymphomas. Therefore, we now consider these earlier proposed entities to be distinct histologic variants of peripheral T-cell lymphoma.