Myofibroblastic infiltration of the bowel: A case report and literature review.

INTRODUCTION: Inflammatory myofibroblastic tumours (IMTs), are uncommon tumours which can act with malignant potential. The management of these tumours can be extremely problematic but are often referred to surgical multi-disciplinary team meetings with the intention of surgical and oncological management (Chaudhary [1]). CASE REPORT: A 69-year-old gentleman was admitted with a 2-day history of abdominal pain and vomiting, and a 4-day history of absolute constipation. CT Abdomen Pelvis demonstrated distended loops of small bowel with pronounced fluid levels but no transition point. Intra-operative findings showed a right ileocolic mass adherent to the pelvic side wall and omental caking. Biopsies showed a florid myofibroblastic reaction, not a malignant process. CONCLUSION: IMTS are aggressive lesions but metastases is rare. Abdominal IMTS are difficult to diagnose and manage as they are often initially mistaken for lymphoma or peritoneal metastases. The therapy of choice is surgical resection of the tumour (Firat et al. [3]).

Unintentional weight loss in long-term care: predictor of mortality in the elderly.

We retrospectively reviewed the medical records of 153 long-term care residents. Of these, 24 had lost at least 5% of their body weight during a 1-month interval. An unmatched control group of 51 patients was randomly selected from the remaining patients. Subjects who lost at least 5% body weight in 1 month were 4.6 times more likely to die within 1 year. Using multiple logistic regression, the odds ratio for weight loss and mortality was 5.1 (95% confidence interval 1.5 to 17.1) after adjustment for potential confounding by age and sex. The relatively simple anthropometric measure of body weight could be used by a multidisciplinary team in long-term care settings to identify patients at increased risk of dying. Further work is needed to clarify the role that nutrition could play in decreasing mortality in long-term care facilities.

Cardiopulmonary resuscitation. Paper 2: A survey of basic life support training for medical students.

This paper presents the results of a survey of Basic Life Support (BLS) training, based on experience gained by undergraduate medical students who had just completed their first clinical year (third year) at the University of Glasgow. Data were collected on the amount and quality of BLS training received, along with students' own perceptions of their confidence in providing BLS in a cardiac arrest resuscitation attempt. The results made interesting, but not surprising, reading with only 15% of students appearing to have been adequately taught BLS at any point during their third year. Students want more training and 98% see resuscitation as an important topic in the curriculum. Self-perceived confidence in performing BLS in an acute resuscitation situation is low. With no evidence to suggest that the situation is any different elsewhere in the UK, it is recommended that undergraduate resuscitation training is improved to reflect the importance that medical students attach to it.

Cardiopulmonary resuscitation. Paper 1: A survey of undergraduate training in UK medical schools.

This paper presents the results of a UK national survey of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training for undergraduate medical students. In all responding medical schools, undergraduates are taught BLS at least once during their course but the assessment and refresher aspects of BLS training are not uniformly covered. There are inconsistencies in ACLS teaching, with some schools providing formal courses, some teaching specific techniques and others providing no ACLS teaching. Most interestingly, of those completing the questionnaire, only 52% considered present undergraduate training adequate to enable junior house officers to provide an effective resuscitation service. We recommend that all aspects of BLS and ACLS training for medical undergraduates be improved and standardized throughout the UK.

Ontogeny of shortening velocity in porcine trachealis.

We examined the effect of maturation on force-velocity (F-V) parameters in porcine tracheal smooth muscle (TSM) to determine the relationship between maximal isometric contractile force (Po) and maximal velocity of shortening (Vmax). Strips of TSM excised from 1-day-old neonatal swine (neo; n = 8), 2-wk-old swine (2ws; n = 7), and 10-wk-old swine (10ws; n = 7) were tethered to an electromagnetic lever system for F-V analysis of contractility. TSM strips were activated by electrical field stimulation at optimal resting tension, voltage, and length (Lo) so that maximal reproducible contractile force (Po) was elicited. Velocities were measured at the early phase of isometric contraction (3.1 +/- 0.1 s for neo, 2.9 +/- 0.1 s for 2ws, and 3.1 +/- 0.1 s for 10ws; P = NS). Shortening velocity increased progressively with maturation; Vmax was 0.164 +/- 0.011 Lo/s for neo, 0.194 +/- 0.013 Lo/s for 2ws (P less than 0.05 vs. neo), and 0.260 +/- 0.024 Lo/s for 10ws (P less than 0.01 vs. neo; P less than 0.05 vs. 2ws). Maximal isometric force generation increased substantially during the first 2 wk of postnatal life and thereafter returned to neonatal levels; Po was 71.5 +/- 2.1 mN/mm2 for neo, 95.4 +/- 7.0 mN/mm2 for 2ws, and 74.7 +/- 6.2 mN/mm2 for 10ws (P less than 0.05, 2ws vs. neo and 10ws). In separate studies, we also determined whether differences in Vmax occurred during the normal cycling phase of the cross bridge (3 s) or during the slowly cycling phase of the latch bridge (8 s) in tissue from 12 additional animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental poisoning in childhood: a multicentre survey. 1. General epidemiology.

As background to a study of the effectiveness of packaging in preventing childhood poisoning, the National Poisons Information Service coordinated a prospective survey, in which 9 Accident and Emergency (A & E) departments and 5 paediatric departments, between July 1982 and February 1984, recorded 2043 cases of suspected accidental poisoning in children aged 0-60 months. The products implicated were drugs (59%), household products (37%) and plants (3%). The drugs most frequently implicated were analgesics, anxiolytics, cough medicines, oral contraceptives and drugs to supplement diet or treat dietary disorders. The most frequently implicated household products were cleaners such as bleach, detergent and disinfectant, and petroleum distillate. Seventy-five per cent of the children were 2 and 3-year-olds. Fifty-six per cent were male. Only 22% of the children had signs or symptoms on admission. In only 2 cases were these serious. Treatment other than ipecacuanha and/or oral fluids was seldom required. Of the cases where outcome was recorded, 56% were discharged from A & E. The rest were admitted to a ward; only 7 children were admitted to intensive care units. No child died. Comparison with HASS and other epidemiological surveys shows that these results are representative of national trends.

Accidental poisoning in childhood: a multicentre survey. 2. The role of packaging in accidents involving medications.

To assess the effectiveness of child-resistant closures (CRCs) and unit dose packaging in preventing childhood poisoning with medications, a survey by 14 hospitals of accidental suspected poisoning in children under 5-years-old, was compared with a survey of a representative sample of households with children under 5 living in the catchment areas of the hospitals. Nine hundred and thirty-eight medications thought to have been ingested by 877 children were compared with 5827 medications found in households with children. The relationship between availability of packs or medications in the home and their involvement in accidents was quantified by means of an Accident Association Index (AAI). A low AAI indicated that the involvement of a pack or medication was less than expected from availability and therefore safe. A high AAI indicated that involvement was greater than expected and therefore unsafe. Medications involved in suspected poisoning were most frequently packed in containers without CRCs (63%) or transparent blisters (20%); both had high AAIs. CRCs, strips, sachets and opaque blisters had low AAIs. Analgesics, expectorants and gastrointestinal medications, had low AAIs, while oral contraceptives, hypnotics, sedative/tranquillizers, antidepressants, anticonvulsants, anti-emetics, and anti-infectives had high AAIs. Prescription medications were more frequently involved in accidents than over-the-counter (OTC) medications and had a higher AAI. Comparison of the AAIs of different kinds of medication in each of their various pack types showed that safe packaging reduced the risk from medications which had a high average AAI. Only 40% of medications were in their normal storage place at the time of the accident. Medicine and bathroom cabinets, and kitchen cupboards and drawers were the safest places to store medications. Handbags, fridges, and shelves or ledges in the bathroom were the most unsafe places. No pack had a low AAI when stored on open shelves indicating that safe packaging cannot compensate for unsafe storage. Other factors which influenced the involvement of medications in accidents were the intended user and the duration of storage. The results of the study have important implications for design of packaging for medications and for education of the public.

Varying Photoperiod, Ribulose 1,5-Bisphosphate Carboxylase/Oxygenase and CO(2) Uptake in Thalassiosira fluviatilis (Bacillariophyceae).

The purpose of this research was to test the hypothesis that acclimation of the unicellular marine alga, Thalassiosira fluviatilis Hustedt, to short photoperiods results in decreased cellular concentrations of ribulose 1,5-bisphosphate carboxylase/oxygenase and decreased rates of light-saturated CO(2) uptake. Cells were acclimated to photoperiods of 6:18, 12:12, and 18:6 h:h light:dark, and concentrations of the large subunit of the enzyme and responses of CO(2) uptake to varying irradiance were measured. Concentrations of the large subunit, which weighed approximately 50 kilodaltons, were conserved while rates of CO(2) uptake under light saturation and limitation, and cellular contents of chlorophyll a increased as photoperiod decreased. Apparently, these cells acclimate to short photoperiods by increasing rates of CO(2) uptake under saturating irradiances by increasing in vivo activation of ribulose 1,5-bisphosphate carboxylase/oxygenase. Also, chlorophyll-specific concentrations and specific activities of the enzyme appear to be lower and higher, respectively, in diatomaceous algae than in higher plants.

Effect of varying freezing and thawing rates in experimental cryosurgery.

Six different freezing/thawing programs, which varied freezing rate, duration of freezing, and thawing rates, were used to investigate the effect of these factors on cell destruction in dog skin. The range of tissue temperatures produced was from -15 to -50 degrees C. The extent of destruction was evaluated by skin biopsies 3 days after cold injury. In single, short freezing/thawing cycles, the temperature reached in the tissue was the prime factor in cell death. Longer freezing time and slow thawing were also important lethal factors which increased destruction of cells. Cooling rate, whether slow or fast, made little difference in the outcome. The experiments suggested that present-day, commonly employed cryosurgical techniques, which feature fast cooling, slow thawing, and repetition of the freeze/thaw cycle, should be modified by the use of maintenance of the tissue in the frozen state for several minutes and slow thawing. Thawing should be complete before freezing is repeated. These modifications in technique will maximize tissue destruction, an important consideration in cancer cryosurgery.

Regional concentrations of insulin in the rat brain.

Recent evidence that insulin receptors are concentrated in the hypothalamus and olfactory bulb suggests that insulin may have an important regulatory function in these regions. This hypothesis would be supported by finding that insulin itself is concentrated in the hypothalamus and olfactory bulb. Therefore, we extracted the hypothalamus and olfactory bulb, as well as the amygdala, hippocampus, cerebral cortex, hindbrain, midbrain, and whole brains, of fasted male Wistar rats and measured immunoreactive insulin (IRI). Recovery of insulin added to extraction volumes of 500-1000 microliters was 90-100%, whereas recovery of insulin from tissue extracts was 63%. Mean IRI concentrations were relatively uniform throughout the brain (0.19 ng/g wet wt; uncorrected for recovery) and were significantly lower than plasma levels (1.03 ng/ml). Nevertheless, IRI concentrations were significantly higher in hypothalamus (0.39 +/- 0.02 ng/g; P less than 0.01) and olfactory bulb (0.37 +/- 0.02 ng/g; P less than 0.05) compared to those in other brain regions sampled.