[Recurrent synovial chondromatosis of the tarsometatarsal joint. Case report and review of literature]. / Rezidivierende synoviale Chondromatose im Tarsometatarsalgelenk. Fallbericht und Literaturübersicht.

Primary synovial chondromatosis is a rare and usually monoarticular metaplasia of the synovia. It may recur, but the tendency to malignant transformation is very low. The radiological and histopathological differentiation from low grade chondrosarcoma can be difficult. We present a case report of a 32-year-old male with synovial chondromatosis in the tarsometatarsal joint area, which is an uncommon localization.

Credentialing and privileging of advanced practice nurses.

Credentialing and privileging are increasingly common administrative processes that advanced practice nurses must complete. With the intention of assuring the public of safe health care provided by qualified personnel, several federal and state organizations have developed criteria that licensed practitioners must meet. Managed care organizations are also creating credentialing and privileging guidelines for practitioners who are applying to their provider panels. Understanding the requirements of these processes is essential to advanced practice nurses establishing themselves in practice. This article explains the guidelines from federal, state, and institutional agencies and offers recommendations to practitioners as they prepare for the credentialing process. Also included are sample forms for establishing a practice agreement and a privilege-delineation request.

Phosphorylation of tau, Abeta-formation, and apoptosis after in vivo inhibition of PP-1 and PP-2A.

Chronic inhibition of protein phosphatases 1 and 2A in vivo was induced by infusion of okadaic acid into lateral ventricles of rat brain for up to 4 months. Cytoskeletal pathology, alterations of the amyloid precursor protein, and apoptotic cell death induced by this treatment followed a certain sequence and spatial distribution. Changes in the expression, phosphorylation, and subcellular distribution of neurofilament proteins and tau, as well as first signs of apoptotic cell death, occurred already after about 2 weeks. The distribution of apoptotic cells, however, was different from those revealing a high accumulation of hyperphosphorylated tau, indicating that those cytoskeletal pathology had no obvious sequelae for the viability of these neurones. A continuation of treatment for longer than 2 weeks induced diffuse deposits of both hyperphosphorylated tau and A beta-amyloid-immunoreactive material in white matter areas that increased in size and number over time. Because tau-phosphorylation is a regulator of the dynamic stability of microtubules, the pathology observed in the present experimental paradigm in the white matter might be viewed as an indication of a disturbed axonal transport. It is hypothesized that perturbations of the axonal transport might also be critically involved in the formation of paired helical filaments and amyloid deposits in Alzheimer's disease.

Paired helical filament-like phosphorylation of tau, deposition of beta/A4-amyloid and memory impairment in rat induced by chronic inhibition of phosphatase 1 and 2A.

Alzheimer's disease is histopathologically characterized by neurofibrillary tangles, formed by the abnormally high phosphorylated tau protein, and senile plaques which largely consist of the beta/A4-amyloid peptide. Metabolism of the amyloid precursor protein and its processing into beta/A4-amyloid is regulated by protein phosphorylation. Thus, an imbalance between protein phosphorylation and dephosphorylation might be crucial for the development of the molecular hallmarks of Alzheimer's disease. We report here that chronic infusion into rat brain ventricles of okadaic acid, a specific inhibitor of the serine/threonine protein phosphatases 1 and 2A, results in a severe memory impairment, accompanied by a paired helical filament-like phosphorylation of tau protein and the formation of beta/A4-amyloid containing plaque-like structures in gray and white matter areas.

Differential diagnosis of chest pain.

The differential diagnosis of chest pain is a challenging clinical experience requiring a perceptive and observant clinician. The patient is dependent on the clinician's skill in eliciting a meaningful and relevant history. The clinician must consider reasonable alternative diagnoses while providing immediate therapies to relieve the pain and maintain patient stability. Appropriate diagnostic procedures should be pursued quickly and efficiently to treat the patient effectively.

The unification model: a collaborative effort.

The Rush unification model unites clinical practice with nursing education. In this system, nursing faculty possess joint responsibilities to the college of nursing and to a specific unit in the medical center. Collaboration among managers, clinical specialists, educators, and researchers leads to achievement of unit, college, and departmental goals. The collaborative process among the leadership group members in the medical intensive care unit, consisting of the unit leader, the assistant unit leader, the clinical nurse specialists, and the practitioner-teachers, is described in detail to show how utilization of the skills and strengths of each team member increases the benefits to the unit and the patient.