Regional water quality management for the Dong Nai River Basin, Vietnam.

A three-year study that started solely as an industrial pollution reduction effort in Dong Nai Province of Vietnam expanded into an ongoing regional river basin water quality management effort. The project was a cooperative effort between the United Nations (UNDP and UNIDO) and the Federal and Provincial governments in Vietnam. A comprehensive approach was used to assess the impacts and strategies for reducing industrial, municipal and agricultural pollution to the water, air and land. The strategy was based upon use of knowledge in four subject areas, economics, ecology, technology and institutions, integrated within a framework for regional environmental quality management, sometimes called Areawide Environmental Quality Management (AEQM). Dong Nal Province encompasses a major developing area immediately north of Ho Chi Minh City. The land area chosen for the AEQM study is the 1,400 square kilometre region in and around Bien Hoa that drains into the Dong Nai River. The Dong Nai River serves many purposes including navigation, fisheries and a water supply for both the Province and Ho Chi Minh City. Extensive industrial and residential development was underway and was projected to increase in the coming decade. A strategy for the control of pollution from liquid, gaseous and solid wastes for the period 1998 to 2010 in Dong Nai Province was developed.

Primary cardiac lymphoma: initial symptoms suggestive of gastrointestinal disease.

We report a case of primary cardiac lymphoma in a patient who was not infected with human immunodeficiency virus and had symptoms suggestive of upper gastrointestinal (GI) disease. Examination revealed no GI abnormalities. Echocardiography, prompted by sudden development of congestive heart failure, revealed a large right atrial mass. Cardiac biopsy followed by staging evaluation indicated primary cardiac non-Hodgkin's lymphoma. After chemotherapy was begun, the tumor shrunk and GI symptoms resolved, suggesting an etiologic relationship by a referred pain mechanism. Unusual features of our case include the initial predominance of GI symptoms and the circumstances that led to diagnosis antemortem. The case also underscores the importance of considering intrathoracic disease in patients with upper abdominal symptomatology.

Acute spontaneous tumor lysis syndrome.

An 83-year-old woman with no previous history of malignancy was admitted to our institution with weakness and anemia and subsequently developed acute tumor lysis syndrome secondary to newly diagnosed Burkitt's leukemia/lymphoma. This syndrome has been previously described in patients with hematologic malignancies; however, its development has been related to the administration of chemotherapy, steroids, or radiotherapy. The spontaneous occurrence of tumor lysis syndrome has not been previously reported; however, Cohen et al. [Am J Med 58:486-491, 1980] report 8 of 37 patients with "clinically insignificant pretreatment derangements" of serum potassium, phosphate, and calcium.

Amyloidosis. Part II. Implications for neuroscience nurses: Alzheimer's disease.

UNLABELLED: Amyloidosis describes a group of diseases characterized by deposition of abnormal fibrous proteins in body organs and soft tissues. This disease complex is classified under the broad headings primary and secondary based on whether or not chronic infections or inflammatory conditions coexist. In addition, localized versus systemic involvement and heredofamilial considerations are used to subclassify amyloidosis. Many primary and secondary amyloid diseases involve the central, peripheral and autonomic nervous systems. This paper will focus on the latest information concerning systemic and localized forms of amyloidosis involving the nervous system with special emphasis on Alzheimer's disease and amyloidosis secondary to spinal cord injury. The roles of the nurse related to diagnosis, patient care, patient and family education and identification of support systems in the community will be covered. Patient care will be discussed from the standpoint of process and outcome criteria for specific nursing diagnoses. OBJECTIVES: 1. Describe the pathophysiological processes of amyloidosis. 2. Relate four aspects of nursing care to nursing diagnoses. 3. List four critical elements to include in patient/family education.

Amyloidosis. Part I. Implications for neuroscience nurses: introduction and amyloidosis secondary to spinal cord injury.

Amyloidosis describes a group of diseases characterized by deposition of abnormal fibrous proteins in body organs and soft tissues. This disease complex is classified under the broad headings primary and secondary based on whether or not chronic infections or inflammatory conditions co-exist. In addition, localized versus systemic involvement and heredofamilial considerations are used to subclassify amyloidosis. Many primary and secondary amyloid diseases involved the central, peripheral and autonomic nervous systems. This paper will focus on the latest information concerning systemic and localized forms of amyloidosis involving the nervous system with special emphasis on Alzheimer's disease and amyloidosis secondary to spinal cord injury. The roles of the nurse related to diagnosis, patient care, patient and family education and identification of support systems in the community will be covered. Patient care will be discussed from the standpoint of process and outcome criteria for specific nursing diagnoses.

The prosthetic treatment of lower limb deficiency.

The prosthesis required for a child with a transverse deficiency whilst a simple version of that appropriate for the adult follows the same principles. The child with a longitudinal deficiency may require an extension, or orthoprosthesis and this may be combined with surgical reconstruction. The principles, technique of measurement and fabrication methods using both traditional and modern composites are described.

The ISO/ISPO classification of congenital limb deficiency.

This classification originally produced by the ISPO "Kay" Committee in 1973, has now with minor modifications, become an International Standard (ISO 8548-1: 1989). It is limited to those deficiencies which are failures of formation and describes them on anatomical and radiological bases only. All are divided into transverse and longitudinal, and use simple terms and descriptors.

Bleeding disorder associated with albumin-dependent partial deficiency in platelet thromboxane production. Effect of albumin on arachidonate metabolism in platelets.

The authors describe a patient with a longstanding bleeding disorder associated with impaired platelet aggregation and secretion despite normal granule contents. Thrombin-induced platelet thromboxane A2 production, measured using a radioimmunoassay for thromboxane B2, was markedly decreased or undetectable in platelet-rich plasma and whole blood serum. However, significant amounts of thromboxane B2 were detected on thrombin stimulation of platelets suspended in albumin-free salt medium. Malondialdehyde and 14C-hydroxyheptadecatrienoic acid production was undetectable in the patient's platelets. Liberation of free 14C-arachidonic acid from phospholipids during stimulation of prelabeled platelets was normal, indicating normal phospholipase activity. These observations indicate an albumin-dependent partial deficiency in thromboxane production resulting from a defect either in cyclooxygenase or thromboxane synthetase. Further, the authors studied the effect of albumin on arachidonic acid metabolism in normal platelets. These studies indicate that albumin enhances liberation of arachidonic acid from phospholipids but has an overall inhibitory effect on thromboxane synthesis.

Platelet secretion defect associated with impaired liberation of arachidonic acid and normal myosin light chain phosphorylation.

We describe four patients with impaired platelet aggregation and 14C-serotonin secretion during stimulation with adenosine diphosphate (ADP), epinephrine, collagen, and platelet-activating factor. The response to arachidonic acid was normal in all patients with regard to aggregation and in three of the four with regard to 14C-serotonin secretion. The total platelet adenosine triphosphate (ATP) and ADP content and the ATP to ADP ratio was normal in all patients, thereby excluding storage pool deficiency as the cause of the secretion defect. Studies with 3H-arachidonic acid-labeled platelets revealed that the thrombin-induced liberation of arachidonic acid from membrane-bound phospholipids was impaired in these patients. Further, platelet thromboxane B2 production, measured using a radioimmunoassay, was diminished during stimulation with ADP and thrombin, but was normal with arachidonic acid, indicating that the oxygenation of arachidonic acid was normal and that the diminished thromboxane production was due to a defect in the liberation of arachidonic acid. Release of arachidonic acid is mediated by phospholipases that are Ca++ dependent. To examine whether these patients may have a defect in making intracellular Ca++ available, another Ca++-dependent process, myosin light chain phosphorylation, was studied during thrombin stimulation. Platelets from three of the patients were found to behave the same as normal ones, suggesting that the deficiency in phospholipase activity may not be due to impaired Ca++ mobilization. Our studies demonstrate a novel group of patients with platelet secretion defects associated with impaired liberation of arachidonic acid from phospholipids. These patients exemplify a congenital defect, other than deficiencies of cyclooxygenase and thromboxane synthetase, by which thromboxane production may be impaired in platelets.

The assessment and description of amputee activity.

The activity achieved by a lower limb amputee is usually assessed by clinical judgement or physiological tests. The former is seldom absolute, being affected by factors such as patient age, and is expressed in categories which may not be equivalent to those used by other observers. Physiological testing provides a measure of the patient's capabilities, but not his activity which may be dependent more on social requirements than physical state. This paper describes a method of questioning the patient using multiple choice answers attracting positive and negative scores, which summate to provide an overall "Activity Score". The procedure takes about 15 minutes and uses the minimum of observer judgement. The technique has been developed over six years and 2400 patients have been investigated. Validation procedures are described, including the use of step counters which show a substantially linear relationship between annual step rate and "Activity Score".

Metabolic aspects of the secretion of stored compounds from blood platelets. The effect of NaF at different pH on nucleotide metabolism and function of washed platelets.

The purpose of this study was to investigate the response of human blood platelets to fluoride at different pH. The results were as follows. (1) Fluoride induced secretion faster and at a lower concentration when pH was lowered. (2) Platelets exposed to 2 mM-fluoride at 0 degrees C at pH 5.3 underwent secretion when first pH and then temperature was raised, although no secretion was seen at 2 mM-fluoride concentration in the absence of the preincubation at low pH. (3) The concentration of [14C]ATP in platelets decreased steeply in response to fluoride before induction of secretion. Addition of antimycin blocked or partly inhibited secretion. Fluoride thus exerts an inhibitory effect on platelet glycolysis before induction of secretion. (4) Fluoride accumulated in the platelet pellet by a time course that preceded secretion. The accumulation was faster and greater at pH 6 than at 7.4. These four points are taken as indirect evidence that fluoride has to penetrate to the interior of the platelet to induce secretion. The activation takes place over a wide range of acid pH in contrast with induction of platelet function via the outside of the plasma membrane. In addition evidence is presented that the salvage pathway may under special circumstances play an important role in the re-synthesis of platelet adenine nucleotides.

An evaluation of a whole-blood platelet counter.

The performance of the platelet count in the hematology laboratory remains a laborious, time-consuming technic requiring separation of platelet-rich plasma, correction for leukocyte counts, lysis of erythrocytes, etc. The availability of an instrument that would count platelets in whole blood would appear to be a distinct advantage. One such instrument has been recently evaluated. The Ultra-Flo 100 Whole Blood Platelet Counter was found to be a reliable instrument for performing platelet counts on microspecimens of untreated whole blood. Counts were both accurate and precise, with no carry-over from specimen to specimen. The major advantage of the system is the speed with which platelet counts may be performed (25 sec) and results produced, a distinct advantage in those laboratories serving large outpatient hematology/oncology clinics. Six months of day-to-day experience in the laboratory has shown a favorable frequency-of-repair record, with little downtime.

The stump and the prosthesis.

In performing amputations the surgeon must bear in mind the biomechanical and other constraints of the prosthesis likely to be fitted and, so far as possible, should fashion the stump accordingly. The various types of prosthesis and their features are discussed in relation to amputations of the lower and upper limbs at all levels.