Fulminant cardiac tamponade: an exceedingly rare presentation of squamous carcinoma of the bronchus in a male patient

A 49 year old man presented with near-fatal, fulminant, haemorrhagic cardiac tamponade. He responded well to emergency pericardiocentesis and subsequent investigation revealed the cause to be an unknown squamous carcinoma of the bronchus with pericardial involvement. He died 13 weeks later. Such a dramatic presentation of this type of tumour in a male patient has not been previously described.     

Measurement of Carboxyhemoglobin and Methemoglobin by Pulse Oximetry: A Human Volunteer Study

Background: A new eight-wavelength pulse oximeter is designed to measure methemoglobin and carboxyhemoglobin, in addition to the usual measurements of hemoglobin oxygen saturation and pulse rate. This study examines this device's ability to measure dyshemoglobins in human volunteers in whom controlled levels of methemoglobin and carboxyhemoglobin are induced.

Methods: Ten volunteers breathed 500 ppm carbon monoxide until their carboxyhemoglobin levels reached 15%, and 10 different volunteers received intravenous sodium nitrite, 300 mg, to induce methemoglobin. All were instrumented with arterial cannulas and six Masimo Rad-57 (Masimo Inc., Irvine, CA) pulse oximeter sensors. Arterial blood was analyzed by three laboratory CO-oximeters, and the resulting carboxyhemoglobin and methemoglobin measurements were compared with the corresponding pulse oximeter readings.

Results: The Rad-57 measured carboxyhemoglobin with an uncertainty of +/-2% within the range of 0-15%, and it measured methemoglobin with an uncertainty of 0.5% within the range of 0-12%.     

A nursing approach to the management of type IIA hyperlipidemia: case study of a young adult

This case study illustrates the chronic nature of hyperlipidemia type IIa and the important contribution of the nurse in helping the client adjust life style, manage complex health regimes, and cope with the uncertainty of disease progression and its associated risks.     

A randomized placebo-controlled study of enalapril in the treatment of erythrocytosis after renal transplantation

BACKGROUND: Erythrocytosis is a common complication of renal transplantationwith an incidence of up to 17%. It is associated with an increasedrisk of complications due to thromboembolic events and has traditionallybeen treated by intermittent venesection. More recently, angiotensin-convertingenzyme inhibitors have been shown to cause a fall in haematocritin a number of groups of subjects and some uncontrolled studieshave shown these drugs to be of possible therapeutic benefitin post renal transplant erythrocytosis. METHODS: We performed a randomized double-blind placebo-controlled studyin 25 patients with post-transplant erythrocytosis. Subjectsreceived either 2.5 mg of enalapril daily or a placebo for 4months and all patients completed the study period without anyserious adverse effects. RESULTS: Haematocrit fell from 52.7 (±SEM 0.7) to 47.1 (±1.8) at 1 month and 46.1 (± 1.2) after 4 months in patientsreceiving enalapril, with no change in the placebo group (P=0.004).We did not demonstrate any change in serum erythropoietin ineither group. CONCLUSION: Angiotensin-converting enzyme inhibitors are a safe and effectiveform of treatment for erythrocytosis developing after renaltransplantation. The mechanism of action, however, is not mediatedby changes in erythropoietin production and remains uncertain.     

Immunoreactive p53 and metallothionein expression in duct carcinoma in situ of the breast

 Immunocytochemically detectable MT and p53 have been found more commonly in comedo DCIS of the breast with high-grade cytology. The aim of this study is to confirm these findings and to investigate the relationship between MT and p53 in a single large series of cases of DCIS of the breast. To this end, 127 cases of DCIS were classified histologically according to architecture, cytonuclear differentiation (grade), presence and extent of intraduct necrosis, and using the Van Nuys system. Sections were immunostained for p53 and MT (E9) using established techniques, and the extent and intensity of staining were assessed semi-quantitively. The results confirmed that there was generally more MT and p53 positivity in poorly differentiated (grade 3) DCIS with extensive necrosis and that MT expression was greater in grade 2 lesions than p53 expression. However, overall there was no statistically significant correlation between p53 and MT staining. The results indicate that MT and p53 overexpression may arise from independent mechanisms in early breast neoplasia. Received: 3 July 1996 / Accepted: 5 November 1996     

Regulation of CD59 expression on K562 cells: effects of phorbol myristate acetate, cross-linking antibody and non-lethal complement attack.

CD59 is the major membrane attack complex of complement (MAC) inhibiting protein on human cells. Its regulation is therefore an important factor in determining the fate of cells at sites of complement activation. We have chosen the K562 erythroleukaemia cell line as a model for studies of the regulation of CD59 expression, because it has previously been reported that phorbol 12-myristate 13-acetate (PMA) caused a 15-fold up-regulation of CD59 mRNA in these cells, implying a substantial capacity for CD59 synthesis. However, no assessment of CD59 protein expression was made in these studies. We show here that surface expression of CD59, as assessed by flow cytometry, was increased four-fold over a 16-hr incubation with PMA, whereas surface expression of decay-accelerating factor (DAF) (CD55) and membrane cofactor protein (MCP) (CD46) was not altered. The newly expressed CD59 was functionally active and anchored through glycosyl-phosphatidylinositol (GPI). Increased expression was dependent upon de novo protein synthesis. CD59 released into cell supernatant was also increased seven-fold by PMA, this 'secreted' CD59 retained its GPI anchor. Non-lethal complement attack did not alter CD59 expression but antibody cross-linking of CD59 caused a rapid loss of the CD59-antibody complexes. However, CD59 was quickly restored to pre-attack levels. This rapid restoration was not dependent upon protein synthesis, suggesting release from preformed stores.     

Citation patterns in the International Journal of Geriatric Psychiatry: Cultural ethnocentrism revisited?

The country/region of origin of all original papers appearing in the International Journal of Psychiatry (IJGP) during the first 9 years of its publication was recorded. A more detailed analysis of citation patterns was carried out on the 105 original articles published during 1992. The results indicated that 50–60% of the articles emanated from the United Kingdom but that in general authors cited a broad range of specialities from journals published around the world. North American authors tended to cite North American sources more frequently than did their counterparts from other countries. There was evidence that the impact of the IJGP is increasing despite its omission from some scientific reference databases.