THROAT AND NOSE SURGERY IN PATIENTS WITH CONSTITUTIONAL HAEMOSTATIC DEFECTS.
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Christmas seals, i. e., special stamps used to decorate or seal Christmas and New Year's mail, were created by the Danish post office clerk E. Holboell. The proceeds from the sale of the stickers were meant to alleviate the suffering of children sick with tuberculosis. The first Christmas seal, showing a portrait of Queen Louise of Denmark, was issued on December 10, 1904. The demand at the post office was enormous. The funds raised exceeded all expectations and made it possible to finance the construction of a sanatorium for tuberculosis children. The idea of Christmas seals spread quickly around the world and ended up being copied in 130 countries. At the beginning of the 20 (th) century, the small stamp with the red double-barred cross became a banner for the crusade against tuberculosis. For many patients, it also represented a symbol of hope for recovery even though this hope, given the cure rates of a sanatorium treatment, only became a reality for a few. Worldwide, Christmas seals were and are colourful and imaginatively designed, mostly with Christmas symbols or motives relating to the fight against tuberculosis. The funds raised through the sale of the seals initially helped to build hospitals and were later also used to screen persons at risk for tuberculosis, to improve housing conditions of patients and for other measures of support. With the decrease of tuberculosis, some organisations discontinued fundraising through Christmas seals while others widened their intended purpose and supported, for example, the prevention of and research on lung diseases. In Germany, Christmas seals are closely connected with the German Central Committee against Tuberculosis. Today the "Kuratorium Tuberkulose in der Welt" is the only organisation in this country that still raises funds by this means. The funds are mostly used to assist developing countries with a high burden of tuberculosis.
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The use of powered instrumentation in functional endoscopic sinus surgery has been a revolutionary development in the surgical treatment of chronic sinusitis. Several studies have demonstrated the safety, efficacy, and ease of use of this new technique. To provide support and coordinate the surgical process in powered functional endoscopic sinus surgery procedures, perioperative nurses must have an appreciation for its specific equipment handling and for appropriate patient care. This article describes a specific protocol that perioperative nurses can use to facilitate efficient and safe surgical environments for patients who undergo powered endoscopic sinus surgery procedures.
Chemokines are important mediators of leucocyte chemoattraction to inflammatory sites. Previous work has shown that the expression of some chemokines is upregulated during renal transplant rejection. The objectives of the present study were to determine whether chemokine expression is increased during renal transplant rejection. Immunohistochemistry was used to localize the C-X-C (alpha) chemokine interleukin-8 (IL-8) and the C-C (beta) chemokines monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1beta (MIP-1beta) in 30 needle biopsies of human kidney transplants taken for diagnosis of renal dysfunction. Urine samples from transplant patients taken immediately prior to biopsy were assayed for chemokine content using enzyme-linked immunosorbent assays (ELISAs). Results from groups of patients having different clinicopathological diagnoses were then compared. All three chemokines were detected in most renal transplant biopsies showing acute cellular rejection but, although infiltrating leucocytes were often positive, staining was predominantly localized to renal tubular epithelium. Staining for MCP-1 was generally weaker than for the other chemokines, and collecting tubules were usually stained more strongly than proximal convoluted tubules. Tubular epithelial staining was also found in biopsies from patients without signs of acute cellular rejection. There were significantly higher amounts of IL-8 in the urine of patients with acute cellular rejection, even when patients with urinary tract infections were excluded, but mean titres of urinary MIP-1beta did not differ between patient groups. This was also found when titres were normalized for urine volume and creatinine levels. Production of IL-8, MCP-1 and MIP-1beta is not confined to kidney transplants showing acute cellular rejection, and may be a relatively nonspecific response of tubular epithelial cells to renal damage.
Alloreactive T cell populations can show skewing of T-cell antigen receptor (TCR) Vbeta gene usage. The aims of the experiments were to compare in vivo and in vitro T cell alloresponses against donor alloantigens for TCR Vbeta gene usage. T-cell cultures from renal biopsies taken during acute rejection and pretransplant mixed lymphocyte cultures (MLC) were established from five renal transplant patients. TCR Vbeta gene usage, assessed with Vbeta family specific antibodies, showed that up to five different Vbeta families were significantly expanded. In four of five cases, there was close concordance between Vbeta families expanded from the biopsy and in MLC. T-cell clones from one renal biopsy were specific for the mismatched donor alloantigen and showed similar TCR Vbeta gene usage to the original T-cell line. The results show very similar patterns of TCR Vbeta gene usage in alloreactive T cells generated ex vivo or in vitro.
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Two cases of acute streptococcal necrotising fasciitis are reported. Both patients were taking nonsteroidal antiinflammatory drugs when they developed this infection. Urgent surgical debridement was undertaken and resulted in a successful outcome in both patients. The clinical and histopathological features of this condition are reviewed.
Ten patients with Parkinson's disease and urinary symptoms underwent urodynamic assessments before and after subcutaneous administration of the dopamine receptor agonist apomorphine. Voiding efficiency improved after apomorphine injection, with an increase in mean and maximum flow rates in nine patients and reduction in post-micturition residual volume in six. Although the effect on detrusor behaviour was variable, subcutaneous apomorphine may be of use in both the assessment and treatment of voiding dysfunction in patients with Parkinson's disease.