Pulmonary tumour embolism complicating a case of leiomyosarcoma

Patient. A case of peripheral leiomyosarcoma presenting with features of pulmonary thromboembolism is described.

Discussion. Persistence of the embolus despite triple-armed thrombolytic therapy and the presence of intravascular tumour invasion suggest the rare entity of pulmonary tumour embolism from a leiomyosarcoma.

An investigation of the pharmacokinetics of topical Lamisil® 1% cream

Twenty volunteers were entered into a study to investigate the pharmacokinetics of Lamisil® 1% cream. The subjects were randomized to receive Lamisil® 1% cream applied to the skin on the back on 1 day, or on 3, 5 or 7 consecutive days. Up to five biopsies were taken at a site on the upper back at various time-points both during treatment and after treatment. Lamisil® levels in the biopsies were analyzed using HPLC. The study showed that increasing the number of applications from one to seven did not significantly increase the peak concentration (Cmax) in the stratum corneum. However, there was an increase in the total amount of Lamisil® found in the stratum corneum resulting in Lamisil® being detected for longer periods after cessation of therapy. Treatment for 7 days resulted in Lamisil® still being detectable 7 days after cessation of therapy, and the drug concentration was significantly higher than the concentration killing the common causative organisms of superficial dermatomycoses. This study indicates a significant potential for short-term treatment with Lamisil® 1% cream in superficial dermatomycoses.

Asymmetric Berry-phase interference patterns in a single-molecule magnet

A Mn(4) single-molecule magnet displays asymmetric Berry-phase interference patterns in the transverse-field (H(T)) dependence of the magnetization tunneling probability when a longitudinal field (H(L)) is present, contrary to symmetric patterns observed for H(L)=0. Reversal of H(L) results in a reflection of the transverse-field asymmetry about H(T)=0, as expected on the basis of the time-reversal invariance of the spin-orbit Hamiltonian which is responsible for the tunneling oscillations. A fascinating motion of Berry-phase minima within the transverse-field magnitude-direction phase space results from a competition between noncollinear magnetoanisotropy tensors at the two distinct Mn sites.

Short range ordering in the modified honeycomb lattice compound SrHo(2)O(4)

The low temperature behaviour of single crystalline SrHo(2)O(4) has been characterized by dc magnetic susceptibility, heat capacity, and neutron scattering experiments. Our results show that despite the lack of magnetic long-ranged ordering in the presence of strong antiferromagnetic correlations, SrHo(2)O(4) does not order down to 1.8 K. Elastic neutron scattering experiments show prominent magnetic diffuse scattering correlated with a broad feature in the dc susceptibility at T = 4 K, indicative of magnetic short-ranged ordering of the Ho(3) spins. Inelastic neutron scattering shows the presence of five crystal field levels up to 80 K in energy, in agreement with the integration of the magnetic specific heat component yielding Rln5 entropy release. The magnetic short-ranged ordering is fitted to a nearest neighbour interaction model with good agreement.

A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder

In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.

A collection of rare anomalies: multiple digital glomuvenous malformations, epidermal naevus, temporal alopecia, heterochromia and abdominal lipoblastoma

Glomuvenous malformations are a subtype of venous malformations, which present in infancy or childhood. We describe a teenage girl who presented with multiple digital glomuvenous malformations from birth. In addition, she had an epidermal naevus on the upper lip, an area of congenital alopecia of the scalp, heterochromia irides and an abdominal lipoblastoma. We are unaware of any reports of the association of multiple glomuvenous malformations with the other uncommon developmental anomalies seen in our patient, and a common link eludes us.

Intrauterine growth retardation associated with precocious puberty and sertoli cell hyperplasia

The original description of patients with Russell-Silver syndrome included precocious puberty, the mechanism of which was unclear. We describe a child with a Russell-Silver syndrome-like phenotype who presented with precocious puberty that was associated with hyperplasia of the Sertoli cells. The patient was found to have an immature cryptorchid testicle; hyperplastic Sertoli cells were also aneuploid carrying trisomy 8. This chromosomal abnormality was present in Sertoli cells only and could not be detected in peripheral lymphocytes, tunica vaginalis, or other, normal, testicular tissue. Sertoli cells in culture showed excess aromatization providing an explanation for the rapid advancement of the patient's bone age. We conclude that in a patient with a Russell-Silver syndrome-like phenotype, Sertoli cell hyperplasia was associated with somatic trisomy 8, increased aromatization, and gonadotropin-independent precocious puberty.

An analysis of a performance feedback system: the effects of timing and feedback, public posting, and praise upon academic performance and peer interaction

In the first experiment, after establishing baseline composition rates in each classroom, timing (announcing time limits) and feedback (student self-scoring) were introduced followed by the introduction, removal, and reintroduction of public posting of highest scores. Timing and feedback improved story writing performance and public posting of highest scores improved performance even further in both classrooms. Teacher praise produced further improvement in one classroom but had no effect on performance in the other. Changes in on-task behavior paralleled changes in writing rate. Comments made by children concerning their own work or work of their peers were recorded throughout the experiment. Although the baseline rate of performance comments was almost zero, the introduction of each variable markedly increased the rate of performance comments. In the second experiment, baseline rates on reading and language exercises were established in a fifth-grade classroom. The entire performance feedback system was introduced on a multiple baseline across the two behaviors and then removed during the final phase of the experiment. Introducing the system improved performance on both tasks. These results further increased the generality of some of the findings of the previous experiment and of previous research on the efficacy of the experimental package of timing, feedback, public posting, and praise.

Telepsychiatry and carer education for schizophrenia

OBJECTIVE

Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ.

METHOD

We delivered the carer education course for schizophrenia simultaneously to a carers group in rural north west Ireland (remote) via three ISDN lines and live to a carers group in a city (host). We compared knowledge gains using the Knowledge Questionnaire before and after each course.

RESULTS

Fifty-six carers of people with schizophrenia participated in the trial. At baseline, participants at the remote and host centers did not differ in terms of knowledge about schizophrenia. After the course, carers at both centers improved significantly and the knowledge gains between groups were equivalent at 6 weeks.

CONCLUSION

Telepsychiatry can deliver effective carer education programmes about schizophrenia and may provide one solution to bridging the chasm between scientific evidence and clinical reality.

Library-dependent and library-independent microbial source tracking to identify spatial variation in faecal contamination sources along a Lake Ontario beach (Ontario, Canada)

Multiple microbial source tracking methods were applied to investigate spatial variation in faecal pollution sources impacting a 1.7 km freshwater beach on Lake Ontario (Canada). The highest E. coli concentrations measured in the study area were from interstitial sand pore water at Sunnyside Beach, reaching 2.6 x 10(6) CFU/100 ml. These E. coli concentrations exceeded those in the nearby Humber River and Black Creek, which are impacted by combined sewer overflows containing municipal wastewater and by stormwater conveying washoff from the urban area. Library-independent Bacteroidales HF183 analyses identified the more frequent occurrence of municipal wastewater contamination in the Humber River and at a Sunnyside Beach location closest to the mouth of the river. Library-dependent E. coli antibiotic resistance and rep-PCR DNA fingerprinting analyses identified the more frequent occurrence of bird faecal contamination at Sunnyside Beach locations away from the river mouth. These microbial source tracking results raise caution about managing beaches with multiple sources of contamination as a single entity without considering spatial variability in faecal pollution sources and the need for more localized beach management practices.

Surgical excision of skin cancer: the importance of training

Background Skin cancers are the most common malignancy in New Zealand and their treatment imparts a huge burden on the healthcare system both in terms of the cost of surgical intervention and in treatment delivery (estimates are in excess of NZ$33 million per annum for the year 2000). Currently in New Zealand, skin cancers are excised by dermatologists, general practitioners (GPs), GPs with a special interest in skin surgery (GPSIs) and specialist surgeons with diverse training backgrounds including ear, nose and throat, ophthalmic and general surgeons. To date there is scant literature evaluating complete excision rates following surgical treatment of skin cancer between these vocational groups. Objectives To review retrospectively pathology reports from all skin excisions sent to one private pathology laboratory over three consecutive months. The aim was to investigate the margins of excision and completeness of skin cancer surgery performed by each vocational group. Methods A retrospective analysis of skin pathology reports was undertaken for a 3-month period between April and June 2007. Raw data obtained from the pathology reports included diagnosis, completeness of excision, size of specimens, body site and vocational group of the medical practitioner performing the surgery. Results In total, 1532 lesions were excised: 432 benign and 1100 malignant. Six hundred and seven were from the head and neck. Dermatologists excised 276 lesions of which 93% were malignant, 55% were from the head and neck, and 0% were incompletely excised. GPs excised 633 lesions: 63% malignant, 30% head and neck, 23% incomplete excision of malignant lesions. GPSIs excised 368 lesions: 71% malignant, 35% head and neck, 21.5% incomplete malignant excision. Specialist surgeons excised 255 lesions: 72% malignant, 53% head and neck, 20% incomplete malignant excision. Conclusion GPs and GPSIs excised more benign lesions and had higher incomplete excision rates of skin cancer surgery than dermatologists. Incomplete excision rates for the vocational groups ranged from 0% to 45% depending on site and pathology.

Evolution of light trapped by a soliton in a microstructured fiber

We observe the dynamics of pulse trapping in a microstructured fiber. Few-cycle pulses create a system of two pulses: a Raman shifting soliton traps a pulse in the normal dispersion regime. When the soliton approaches a wavelength of zero group velocity dispersion the Raman shifting abruptly terminates and the trapped pulse is released. In particular, the trap is less than 4 ps long and contains a 1 ps pulse. After being released, this pulse asymmetrically expands to more than 10 ps. Additionally, there is no disturbance of the trapping dynamics at high input pulse energies as the supercontinuum develops further.