Strategies for engaging with future radiation protection professionals: a public outreach case study.

It is evident that there is a nuclear skills shortage within the UK, and logically it can be assumed that the shortfall extends to the radiation protection arena. Plans for nuclear new-build and the decommissioning of existing nuclear sites will require many more people with radiological knowledge and practical competencies. This converts to a nuclear industry requirement in the order of 1000 new recruits per year over at least the next ten years, mainly as new apprentices and graduates. At the same time, the strong demand for persons with radiation protection know-how in the non-nuclear and health care sectors is unlikely to diminish. The task of filling this skills gap is a significant one and it will require a determined effort from many UK stakeholders. The Society for Radiological Protection (SRP) has adopted a strategy in recent years to help address this skills gap. The aim is to engage the interest of secondary school students in the science of radiation and inspire them to follow a career in radiation protection. This paper presents the reasoning behind this strategy and, in an 'outreach case study', describes the establishment of the annual SRP Schools Event. This event is becoming an important addition to the national efforts aimed at increasing the numbers of skilled UK radiation protection professionals over the forthcoming decades.

CT of calcified liver metastases in colorectal carcinoma.

PURPOSE: To assess the incidence, characteristics and prognostic significance of calcification within colorectal hepatic metastases. MATERIALS AND METHODS: A retrospective analysis of CT in 265 patients with locally advanced or metastatic cancer was performed. Four groups were defined: (a) calcification within liver metastases prior to therapy, (b) noncalcified liver metastases with development of calcification on therapy, (c) noncalcified liver metastases, and (d) advanced local tumour without liver metastases. The number of calcified deposits in each patient was documented. A marker lesion was analysed for character, distribution and percentage of calcification. Survival between the four groups was compared. RESULTS: Twenty-nine (11%) patients had calcified liver metastases at presentation and 10 (4%) developed calcification during chemotherapy. Analysis of a marker lesion showed that the most frequent characteristic was fine calcification with a variable distribution. The most frequent change on treatment was alteration in the extent of calcification. Calcification developing on treatment was usually central. There was no difference in survival between groups 1, 2 and 3, but groups 1, 2 and 3 had a shorter survival than group 4. CONCLUSION: Calcification of liver metastases shows a variable pattern and may develop or change during therapy. Liver metastatic calcification may not carry any prognostic significance in colorectal cancer.

Mediastinal venous anomalies: potential pitfalls in cancer diagnosis.

Mediastinal venous anomalies encountered during CT assessments of cancer patients are often unsuspected and may be misinterpreted, particularly in the presence of intrathoracic disease. Errors in diagnosis result from a lack of intravenous contrast, concomitant mediastinal lymphadenopathy and primary intrathoracic tumour. The small calibre of vessels, previous mediastinal surgery and poor mediastinal planes are other confounding factors. An awareness of the anatomical features and optimal scanning technique are required to avoid misinterpretation.

Management of malignant oesophageal obstruction with self-expanding metallic stents.

BACKGROUND: The use of self-expanding metal stents for palliation of malignant dysphagia is increasing. Experience in 70 patients was reviewed with respect to the value of stenting and management of the complications encountered. METHODS: Oesophageal stents were inserted in 70 patients (42 men) of mean age 73 years with malignant oesophageal obstruction. Data regarding stent insertion and degree of dysphagia were gathered prospectively. RESULTS: Seventy-six stents were placed in 70 patients. By the end of the study 57 patients had died and 13 were still alive. Three patients died within 3 days of stent insertion and dysphagia was relieved in 64 of the 67 patients remaining. Stent migration, tumour ingrowth and overgrowth, and food impaction were encountered during follow-up in eight patients. CONCLUSION: Insertion of self-expanding metal stents for the palliation of malignant oesophageal obstruction is a successful therapy which can be carried out with relative ease. Palliation of dysphagia with an appropriate stent can be expected in up to 95 per cent of patients.

Lichen planopilaris: clinical and pathologic study of forty-five patients.

BACKGROUND: We review the findings in a large series of patients with lichen planopilaris. OBJECTIVE: Clinical, histologic, and direct immunofluorescence findings were reviewed in 45 patients. METHODS: Scalp biopsy specimens for routine histologic examination and direct immunofluorescence were reviewed. Clinical data and follow-up were obtained. RESULTS: Women were affected more commonly and had patchy hair loss, with perifollicular erythema, perifollicular spines, and scarring. Half had or developed glabrous skin, mucous membrane, or nail changes typical of lichen planus. Follicular involvement was limited to the infundibulum and isthmus and included lichenoid inflammation and cytoid formation, with few or no changes in interfollicular epidermis. Direct immunofluorescence showed cytoid body staining with anti-IgM and anti-IgA and patchy or linear fibrinogen deposition along the basement membrane zone. The various therapeutic options used were usually unsuccessful. CONCLUSION: To make the correct diagnosis, patients with scarring alopecia should be evaluated histologically and with direct immunofluorescence. They should also be followed up to assess whether lichen planus develops elsewhere.

Sogn and Fjordane county community-based injury prevention: evaluation design.

The Sogn and Fjordane Injury Prevention Programme is a community-based research and demonstration project located in the Sogn and Fjordane county (S&F county) in Western Norway. The aim of the project is: (i) to further effective intervention; (ii) to be cost-effective; (iii) to provide information about local community based injury intervention. Liaison groups on injury prevention will be organised in 24 communities participating in the project. Starting 1 April 1993 they will be supplied with local specific injury rates obtained from the all-injury registration of the National Injury Surveillance System. The intervention design includes feedback of three types of information: (1) home and traffic injury rates; (2) sports, occupational, school, and outdoor injury rates; (3) both (1) + (2). The liaison groups will be asked to concentrate their activities only on the information-related injury areas. The hypothesis is that the results will be information-related. The intervention protocol will last for two years, until 1 April 1995. Evaluation will be based on a hypothetical causal intervention model. The model includes three groups of independent influences, two groups of mediator attributes, and desired end-result. A variety of data sources will be used including national and local data sources, two cross-sectional surveys on awareness, knowledge, behaviour and attitudes, interviews, observations, and self-reports from individuals. A mixed-model ANOVA will be used to test the main information-related effects. A combination of multivariate analytical methods will be used to test the hypothesised causal intervention model.

Immunopathology of oral mucosal inflammatory diseases.

Many inflammatory conditions of oral mucous membranes are the end result of altered immune reactivity. Lesions from these disorders, as well as a wide variety of infectious, irritant, and idiopathic conditions, appear clinically similar in the mouth and are difficult to differentiate. New and improved immunologic laboratory techniques have helped to further our understanding of the pathogenesis of many of these disorders and have proved to be valuable in clarifying the diagnosis underlying many of these difficult dermatoses.

Henoch-Schönlein vasculitis: direct immunofluorescence study of uninvolved skin.

Henoch-Schönlein purpura is a multisystem disease believed to be a consequence of entrapment of circulating IgA-containing immune complexes in blood vessel walls throughout the skin, kidney, and gastrointestinal tract. In this direct immunofluorescence study, twenty-five skin biopsy specimens from twenty patients with Henoch-Schönlein purpura were examined (9 from uninvolved, normal-appearing skin). A distinct stippled pattern of vascular fluorescence was found in 87% of lesion biopsies; 75% of these contained deposits of IgA. In uninvolved skin, seven (78%) showed immunoglobulin in vessel walls and six (67%) contained IgA, suggesting that immune complexes are deposited with equal frequency in normal-appearing and lesional skin of patients with Henoch-Schönlein purpura. Biopsy of uninvolved, rather than of purpuric, skin for direct immunofluorescence studies may be more helpful in confirming the diagnosis of Henoch-Schönlein purpura because tissue morphology is usually of better quality.

Direct immunofluorescence for the study of cutaneous drug eruptions.

Forty-one patients with drug eruptions were retrospectively evaluated to correlate clinical, direct immunofluorescence, and dermatopathologic findings. Forty-six biopsy specimens were obtained for immunofluorescence in addition to specimens for dermatopathologic study. Eighteen patients had blood vessel fluorescence. Fourteen patients had basement membrane zone fluorescence. Eleven patients had dermatopathologic evidence of lichenoid changes; 8 of these had basement membrane zone fluorescence. Triamterene-hydrochlorothiazide caused the most eruptions (six patients). Positive direct immunofluorescence findings may aid the diagnosis of drug eruptions, especially in the presence of a nonspecific clinical picture or histopathologic findings.

Nodular lymphoid disease of the head and neck: lymphocytoma cutis, benign lymphocytic infiltrate of Jessner, and their distinction from malignant lymphoma.

Skin biopsy specimens from six patients with nodular lymphoid disease of the head and neck were studied by routine histology, direct immunofluorescence microscopy, and leukocyte monoclonal antibodies to T and B cell subsets and monocytes. Initially, these lesions were clinically considered to be benign lymphocytic infiltrates of Jessner, lymphocytoma, or lymphoma. Direct immunofluorescence was negative or showed nonspecific staining in all four patients in whom it was performed. Leukocyte monoclonal antibody stains revealed two distinct patterns of lymphocytes. Lymphocytoma was represented by nodular masses of B lymphocytes with peripheral and intervening zones of T cells. The second pattern consisted of solid nodular masses of T lymphocytes occupying the dermis and subcutaneous tissue. In the specimens interpreted as benign lymphocytic infiltration, the T cells were composed equally of helper and suppressor cells.

Clinical and histopathologic spectrum of necrotizing vasculitis. Report of findings in 101 cases.

Clinical and histopathologic features of 101 cases of necrotizing vasculitis were selected on the basis of the following histopathologic criteria: fibrinoid necrosis of blood vessel walls, endothelial cell hyperplasia, and an infiltrate within and around the blood vessel walls predominantly of polymorphonuclear leukocytes. There were three clinical patterns of vasculitis: (1) associated with other coexistent disease, (2) associated with known precipitating events, and (3) idiopathic. Two histologic features were particularly notable in view of the clinical findings. First, vasculitis extending deep into the reticular dermis or subcutaneous tissue seemed to be associated more often with systemic disease such as malignancy or connective tissue disease. Second, in biopsy specimens from patients with hypocomplementemia, the inflammatory infiltrate was composed almost exclusively of neutrophils, as compared with the mixed infiltrate seen in normocomplementemic vasculitis.

Pacemaker contact sensitivity.

In a patient who had 4 cardiac pacemakers implanted and removed, pruritus, redness, and swelling of the skin overlying the pacemaker developed at intervals of 6 weeks to 17 months after insertion. Patch testing showed a 2+ reaction to titanium. The positive result of this test, the titanium case of the generator, and the history of multiple local reactions around the generator site pointed toward contact sensitivity to the pacemaker. Although a review of the literature indicates that this problem is rare, it is of extreme importance to the patient with pacemaker contact dermatitis.

Dermal ultrastructure in leprosy.

We studied the ultrastructure of the dermal inflammatory response in 18 patients with leprosy. Biopsy specimens from 14 lepromatous patients, including four with Lucio's phenomenon and four with erythema nodosum leprosum, were compared with biopsy specimens from one borderline lepromatous and three borderline tuberculoid patients. In all, the dermal infiltrate consisted of macrophages, lymphocytes, and mast cells. This infiltrate was predominantly perivascular, and chronic reactive changes were found in the small dermal vessels. The macrophages contained phagocytized organisms within membrane-bound vacuoles and a wide variety of lysosomal residual dense bodies. Intraendothelial organisms were occasionally seen, especially in biopsy specimens from the patients with Lucio's phenomenon. The greatest number of mast cells were also seen in the infiltrate in those cases. The frequent close association of macrophages with lymphocytes and mast cells suggests an interrelationship between these cells that appears typical of the host response to leprosy.

Ultrastructure of the dermal microvasculature in leprosy.

Infection with M. leprae may lead to the presence of the organism within the dermal vascular endothelium, a phenomenon most pronounced in lepromatous leprosy. In order to study the ultrastructural features of the dermal microvasculature in leprosy, biopsies from 18 patients with lepromatous (14), borderline lepromatous (1) and borderline tuberculoid (3) leprosy were examined. Four patients with Lucio's phenomenon and four with erythema nodosum leprosum were included. The ultrastructural changes in the dermal microvasculature included endothelial swelling and hypertrophy, increased endothelial and pericytic cytoplasmic processes, and pronounced basal lamina reduplication. Occasional large, pale, endothelial cells with widely dispersed organelles were encountered. Phagocytized, membrane-bound intraendothelial organisms were found, similar in appearance to those within dermal macrophages. The predominantly perivascular dermal inflammatory infiltrate consisted of lymphocytes, macrophages and mast cells. The observed ultrastructural changes in the dermal microvasculature are similar to those previously described in the endoneurial vessels. While reflecting nonspecific responses of the dermal microvasculature in chronic inflammation, the findings support a possible role of the small dermal vessels in the chronic nature of the host's response to infection with M. leprae.

Malignant fibrous histiocytoma, myxoid variant metastatic to the oral cavity. Report of a case and review of the literature.

Primary and metastatic malignant fibrous histiocytoma (MFH) of the oral cavity is exceedingly rare. A review of the literature yielded only nine cases of primary MFH and no reports of MFH metastatic to this area. We report a case of recurrent malignant fibrous histiocytoma of the myxoid type arising in the soft tissue of the lower extremity and metastasizing to the gingiva as the typical storiform fibrous variant.

Neuroblastoma and adrenal morphologic features in anencephalic infants.

At autopsy, an incidental congenital neuroblastoma was found in the adrenal gland of an 8-day-old full-term anencephalic baby. This previously unreported coincidence of neuroblastoma and anencephaly prompted a retrospective study of adrenal morphologic features in 20 anencephalic patients and 20 matched controls. Anencephalic adrenal glands were smaller and the fasciculoreticular zone was thinner (average 32%) than in the normal controls (average 76%). The neural crest-derived cells represented an average of 2% of the total gland area in anencephalic patients and 0.5% in the controls. These findings, statistically significant and compatible with previous studies, verify the deficient development of the fetal cortex in anencephalic patients. Furthermore, the neural component in anencephalic patients may be delayed in its maturation by the abnormal cortex, and thus may be prone to undergo malignant transformation and become a neuroblastoma.