Community assessment: a church community and the parish nurse.

In central Massachusetts a large urban parish asked the University of Massachusetts, Amherst School of Nursing to conduct a community assessment for the church and newly employed parish nurse. The aims of the assessment were: to determine the health status of parishioners, identify their perceived health needs and perceived barriers in meeting those needs, and to assist the church and parish nurse in developing a health program for their faith community. Findings of the assessment are based on questionnaire and focus group data. Four hundred and twenty-one questionnaires were completed, and six focus groups were held to validate the data. Results showed most parishioners felt they were in good health (93%), believed faith and spiritual beliefs were important in maintaining health and well-being (91%), and thought that the church should play a role in helping parishioners meet their health needs (70%). In addition, focus group discussions revealed a need for respite care for primary caretakers of the ill and elderly, and health education programs for their teen and elderly populations. In conclusion, parishioners were positive and articulated support of the parish nurse and activities designed to address the physical, emotional, and spiritual needs of their community.

Arrhythmias and Guillain-Barre syndrome.

We report two patients with severe Guillain-Barre syndrome who had serious cardiac arrhythmias. One patient died of asystolic cardiac arrest; the other patient survived with conservative management. The association between the syndrome and arrhythmias, and the difficulties in the management of the latter, are reviewed.

The association of urothelial abnormalities with neoplasia: a 10-year followup.

More than 10 years ago we reported on the histological appearance and clinical significance of random biopsies of the intervening urothelium in 100 patients with transitional cell carcinoma of the bladder. Although the biopsied mucosa appeared normal cystoscopically a surprisingly large number of abnormalities were found: only 5 per cent of the patients had normal urothelium, 40 per cent had established carcinoma in situ and the remaining 55 per cent had changes described variously as cystitis glandularis, atypia and metaplasia. In the intervening decade these patients have been followed carefully and have been reviewed to determine their fate. Of the original 100 cases 92 were sufficiently well documented to make a meaningful analysis. The outstanding finding was that patients with carcinoma in situ had a significantly worse outcome statistically than those with normal mucosa or nonmalignant aberrations regardless of the characteristics of the primary tumor and its grade or stage (p less than 0.001). A detailed analysis is presented in relation to the clinical and experimental findings, suggesting that patients with carcinoma in situ associated with the primary tumor may require treatment to supplement the initial tumor resection.

Venacavography, corticosteroids and surgery in the management of idiopathic retroperitoneal fibrosis.

Four patients with idiopathic retroperitoneal fibrosis were found to have characteristic obstruction and anterior displacement of the lumbar vena cava. Varying degrees of venous collateral circulation were present, depending on the degree of vena caval compression. All 4 patients underwent ureterolysis to relieve the hydronephrosis and to confirm diagnosis by biopsy. Two patients were treated with corticosteroids postoperatively. Followup venacavography demonstrated improved filling and decrease in the collateral circulation in these 2 patients. Of the remaining 2 untreated patients 1 was lost to followup and the other revealed no change. Diagnosis of idiopathic retroperitoneal fibrosis can be made if characteristic changes are present on inferior venacavography and may provide an objective measure for following the basic disease process during medical treatment.

The assessment of histocompatibility by mixed lymphocyte reaction as measured by the macrophage electrophoretic mobility (MEM) test.

The mixed lymphocyte reaction (MLR) between donor and recipient lymphocytes has been measured by the macrophage electrophoretic mobility (MEM) test and the modified (MOD-MEM) test. Its value as a measure of compatibility has been assessed by comparison with conventional HL-A serotyping and with the outcome of renal transplantation. Thirty-six living donor/recipient pairs and 59 cadaver donor/recipient pairs for transplantation have been studied. Whilst uniovular twins gave lymphocyte interactions, measured as macrophage slowings of about 1%, the slowing produced by paired allogeneic lymphocytes ranged from 2% to 26% depending on the number of HL-A matches. The test measurement of lymphocytic interaction was significantly correlated with histocompatibility measured by HL-A serotyping, in both living and cadaver donors. One way MEM-MLR showed the dominant role of the second HL-A sublocus in mixed lymphocyte reactivity. The long term success of the renal graft correlated with the pre-transplant initial reaction between donor and recipient lymphocytes. The test has advantages in the field of human histocompatibility assessment since no particular reference to individual antigens is made and it may be performed in a matter of hours.

Effects of hyperthermia on bladder cancer.

A study of the effect of bladder lavage with isotonic fluid at 45 degrees C on proliferative transitional cell carcinoma has shown definite cancericidal changes. These early studies suggest that further investigation of hyperthermia on a larger scale would be worth while.