Use of greyscale and Doppler ultrasound in initial evaluation and follow-up of neurovascular malformations in children

Pediatric intracranial arteriovenous shunts are rare vascular malformations that can be diagnosed prenatally or postnatally, as an incidental finding or due to complications. We propose a review of cerebral vascular malformations in newborns and infants with special emphasis on neurosonography and Doppler ultrasound as the first diagnostic method. Sonography can thus contribute in the planning of further studies that are always necessary, and in post-therapy follow-up.

1q gain and CDT2 overexpression underlie an aggressive and highly proliferative form of Ewing sarcoma

Despite extensive characterization of the role of the EWS-ETS fusions, little is known about secondary genetic alterations and their clinical contribution to Ewing sarcoma (ES). It has been demonstrated that the molecular structure of EWS-ETS lacks prognostic value. Moreover, CDKN2A deletion and TP53 mutation, despite carrying a poor prognosis, are infrequent. In this scenario identifying secondary genetic alterations with a significant prevalence could contribute to understand the molecular mechanisms underlying the most aggressive forms of ES.We screened a 67 ES tumor set for copy number alterations by array comparative genomic hybridization. 1q gain (1qG), detected in 31% of tumor samples, was found markedly associated with relapse and poor overall and disease-free survival and demonstrated a prognostic value independent of classical clinical parameters. Reanalysis of an expression dataset belonging to an independent tumor set (n=37) not only validated this finding but also led us to identify a transcriptomic profile of severe cell cycle deregulation in 1qG ES tumors. Consistently, a higher proliferation rate was detected in this tumor subset by Ki-67 immunohistochemistry. CDT2, a 1q-located candidate gene encoding a protein involved in ubiquitin ligase activity and significantly overexpressed in 1qG ES tumors, was validated in vitro and in vivo proving its major contribution to this molecular and clinical phenotype. This integrative genomic study of 105 ES tumors in overall renders the potential value of 1qG and CDT2 overexpression as prognostic biomarkers and also affords a rationale for the application of already available new therapeutic compounds selectively targeting the protein-ubiquitin machinery.

Stable interference of EWS-FLI1 in an Ewing sarcoma cell line impairs IGF-1/IGF-1R signalling and reveals TOPK as a new target

BACKGROUND

Ewing sarcoma is a paradigm of solid tumour -bearing chromosomal translocations resulting in fusion proteins that act as deregulated transcription factors. Ewing sarcoma translocations fuse the EWS gene with an ETS transcription factor, mainly FLI1. Most of the EWS-FLI1 target genes still remain unknown and many have been identified in heterologous model systems.

METHODS

We have developed a stable RNA interference model knocking down EWS-FLI1 in the Ewing sarcoma cell line TC71. Gene expression analyses were performed to study the effect of RNA interference on the genetic signature of EWS-FLI1 and to identify genes that could contribute to tumourigenesis.

RESULTS

EWS-FLI1 inhibition induced apoptosis, reduced cell migratory and tumourigenic capacities, and caused reduction in tumour growth. IGF-1 was downregulated and the IGF-1/IGF-1R signalling pathway was impaired. PBK/TOPK (T-LAK cell-originated protein kinase) expression was decreased because of EWS-FLI1 inhibition. We showed that TOPK is a new target gene of EWS-FLI1. TOPK inhibition prompted a decrease in the proliferation rate and a dramatic change in the cell's ability to grow in coalescence.

CONCLUSION

This is the first report of TOPK activity in Ewing sarcoma and suggests a significant role of this MAPKK-like protein kinase in the Ewing sarcoma biology.

Primary primitive neuroectodermal tumour of the urinary bladder: a clinico-pathological study emphasising immunohistochemical, ultrastructural and molecular analyses

Primary primitive neuroectodermal tumours (PNETs) of the bladder are extremely rare and aggressive neoplasms, and only six examples have been reported in the literature. The case of a 21-year-old woman, who remains disease free 3 years after tumour resection, is reported here. Morphological features were found to correspond to a small round blue cell tumour without rosette formation and with extensive areas of necrosis. Strong expression of CD99, vimentin and CD117 (c-kit), and focal reactivity to cytokeratin and S-100 protein was observed in tumour cells. Ultrastructurally, sparse neurosecretory granules were observed. Diagnosis of PNET was supported by molecular genetic analysis, showing the EWS-FLI-1 fusion transcript type 2 by RT-PCR and EWS gene rearrangement by fluorescence in situ hybridisation. A normal genetically balanced genotype was shown by comparative genomic hybridisation, which, together with the expression of c-kit, a known therapeutic target for imatinib, may have prognostic and therapeutic implications.

Bacterial diseases of farmed deer and bison

The most important aerobic bacterial diseases of farmed deer and bison include bovine tuberculosis, Johne's disease (paratuberculosis), yersiniosis, leptospirosis, brucellosis, pasteurellosis, anthrax, salmonellosis and colibacillosis. Anaerobic bacterial infections affecting the same animals include necrobacillosis and a number of clostridial diseases such as tetanus, blackleg, malignant oedema and pulpy kidney. The relative importance of these diseases will vary throughout the world according to timing and circumstance, but bovine tuberculosis and Johne's disease are likely to present the most significant problems with respect to diagnosis, control, trade in live animals and the establishment of wildlife reservoirs of infection. The authors summarise the aetiology, the principal species of animal affected, geographical distribution, transmission, clinical signs, pathology, diagnosis, treatment and control of these diseases.

Viral, parasitic and prion diseases of farmed deer and bison

The most important viral disease of farmed deer and bison is malignant catarrhal fever. The other herpesviruses which have been isolated from these species are briefly described. Other viral agents that are recognised in these animals, including adenovirus, parapox, foot and mouth disease, bluetongue, epizootic haemorrhagic disease, bovine virus diarrhoea, rotavirus and coronavirus, are also discussed. Ectoparasites of importance in this group in various parts of the world include a variety of ticks, as well as lice, keds, Oestridae, mange mites and fire ants. Helminth parasites include liver flukes (Fascioloides and Fasciola), gastrointestinal nematodes of the family Trichostrongylidae, pulmonary lungworms of the genus Dictyocaulus and extra-pulmonary lungworms of the family Protostrongylidae. Chronic wasting disease is principally important in North America, where the disease occurs in wild cervids in a limited area and has been reported in farmed deer in a small number of states in the United States of America and one province in Canada. These diseases are summarised in terms of their classification, epidemiology, clinical signs, pathology, diagnosis, treatment and control.

Nurses' communication skills: an evaluation of the impact of solution-focused communication training

AIMS

This paper describes the evaluation of a short training course in solution-focused brief therapy (SFBT) skills. This evaluation examined the relevance of SFBT skills to nursing and the extent to which a short training course affected nurses' communication skills.

BACKGROUND

Nurses' communication skills have been criticized for many years, as has the training in communication skills that nurses receive. The absence of a coherent theoretical or practical framework for communication skills training led us to consider the utility of SFBT as a framework for a short training course for qualified nurses, the majority of them are registered nurses working with adults.

DESIGN AND METHODS

Quantitative and qualitative data were collected: the former using pre- and post-training scales, the latter using a focus group conducted 6 months after the training. Data were analysed using the Wilcoxon signed-rank test and content analysis.

RESULTS AND FINDINGS

Quantitative data indicated positive changes in nurses' practice following the training on four dimensions, and changes in nurses' willingness to communicate with people who are troubled reached levels of significance. Qualitative data uncovered changes to practice, centred on the rejection of problem-orientated discourses and reduced feelings of inadequacy and emotional stress in the nurses.

CONCLUSIONS

There are indications that SFBT techniques may be relevant to nursing and a useful, cost-effective approach to the training of communication skills. Solution focused brief therapy provides a framework and easily understood tool-kit that are harmonious with nursing values.

A phenomenological study of pain following fractured shaft of femur

There is very little work that discusses the pain experience following fractured shaft of femur. Therefore, an exploratory phenomenological study of the individual experience of pain following a traumatic fracture of the shaft of femur was conducted. Two key themes emerged: the injury experience and the pain experience, both linked to the need to maintain physical integrity. The findings underline the highly complex nature of the pain experience and illustrate the range of experiences that individuals with traumatic fractures are exposed to. The findings have implications for the nursing and medical management of patients following long bone fracture.

"Is there a place for "care" within nursing?"

This paper explores the assumption that care and nursing are both interchangeable and symbiotic concepts, and argues through exploration of the literature on the nature of care, its relationship to nursing, the socialisation process, and the personal human difficulties nurses experience when carrying out their daily role, that this assumption needs serious reconsideration. This has major implications for the nursing profession when attempting to define its roles and boundaries, as current views appear inconsistent with each other and in conflict with the actual process of nursing, and need to be resolved to reflect the actual practice of nursing and work of the nurse.

Assessment and learning in post-registration nurse education

Assessment in nurse education concentrates too much on academic abilities and fails to measure the practical nursing abilities of students. This article argues for a change in emphasis, so that assessment is seen as a part of learning, rather than a series of arbitrary hurdles to be negotiated.

The effect of an acute pain service on nurses' knowledge and beliefs about post-operative pain

The management of post-operative pain has been an area of concern for many years, with many studies focusing on the knowledge and beliefs of nurses working in this area. Following the report of the Royal College of Surgeons & College of Anaesthetists (1990) in the UK, there has been a rapid expansion in the development of Acute Pain Services (APS) in an attempt to counter these concerns. This descriptive study considers the possible impact the introduction of an APS had on the knowledge and beliefs of nurses working in the surgical area. A closed-answer questionnaire was used to replicate an earlier study (Mackintosh, 1994) which took place before the introduction of the APS. Findings demonstrate a consistent but mainly statistically non-significant trend in all areas towards an improved knowledge base and more appropriate beliefs about pain.

Effect of field capture on the measurement of cellular immune responses in wild ferrets (Mustela furo), vectors of bovine tuberculosis in New Zealand

Ferrets are recognised as significant wildlife vectors of bovine tuberculosis (Tb) in New Zealand. Disease management strategies, such as the development of a protective wildlife vaccine, could be assisted by the ability to measure pertinent cellular immune responses among wild animals. In the present study, we investigated whether it is possible to measure in vitro lymphocyte reactivity in wild-caught ferrets, and also determined levels of physiological stress in these animals, and we compared these responses to those observed in laboratory-maintained domesticated ferrets. Over a 12-month period, 80 ferrets were live-captured from a Tb-endemic region (Otago, southern New Zealand); cardiac blood was withdrawn on-site, and mononuclear cell cultures were successfully established from 75 of these animals. Lymphocyte transformation (LT) responses to T cell and T/B cell mitogens (Concanavalin A [Con A] and pokeweed mitogen) were measured via uridine incorporation assay. The magnitude of these responses did not differ significantly between animals that had been captured in wire-framed cage traps and those captured using soft-jawed leg-hold traps. Levels of serum cortisol and glucose (as indicators of physiological and oxidative stress, respectively) were highest in animals captured using leg-hold traps. In comparison to domesticated ferrets, wild-caught ferrets had lower overall LT responses to Con A, but significantly higher levels of serum cortisol. Finally, 10/80 animals captured from the wild were severely diseased (Tb+), as evidenced by gross tuberculous lesions at autopsy. Successful mononuclear cell cultures were established from nine of these animals; LT responses to Con A were significantly lower in Tb+ ferrets than in either wild-caught/non-diseased (Tb-) or domesticated ferrets. These results demonstrate that it is possible to measure cellular immune responses from the blood of wild-caught ferrets, but that field capture and disease status may have detrimental effects on in vitro T cell function, possibly due to the influence of physiological stress.

Infection control--evidence into practice

This paper arises out of two workshop sessions held at the fourth meeting of the Federation of Infection Societies, Manchester, 1997. The aims of the workshops were, first, to identify the factors which impede the process of translating research findings into infection control practice and second, to suggest how these barriers may be overcome. Key points from the workshops are presented within an idealized framework of creating, implementing and maintaining evidence-based infection control practice. This lends structure to our exploration of the evidence underlying infection control guidance and the reasons why such guidance often does not result in appropriate action by healthcare workers. The strengths and weaknesses of each stage of the process are examined, using examples provided by participants at the workshop.

Dissociation of bone turnover in anorexia nervosa

Biochemical markers were measured to assess bone turnover in a cross-sectional study of 43 patients with anorexia nervosa; 28 were at their first assessment (untreated) with a body mass index (BMI) (median interquartile range) of 13.3 (2) kg/m2. A second group of 15 patients undergoing treatment (treated) had a median BMI of 17.6 (2.8) kg/m2. The median, interquartile range of urinary deoxypyridinoline (DPyd), a bone resorption marker, was raised in both groups compared with an age-matched control population [DPyd = 17.8 (15.2), 17.5 (16.4) and 9.2 (4.0) nmol/mmol creatinine, respectively]. Serum type 1 collagen carboxyterminal propeptide (P1CP), a marker of bone formation, was similar to controls in the untreated patients [112 (29) and 112 (78.5) ng/ml, respectively], but was significantly raised in the treated patients [163 (219) ng/ml, P < 0.05]. A second group of 21 patients was followed prospectively, on admission and during 8 weeks of intensive inpatient care (BMI on admission and after 8 weeks was 13.0 (2) and 16.7 (3) kg/m2, respectively). The resorption marker, serum type 1 collagen carboxyterminal telopeptide (1CTP) was raised on admission and remained high during treatment. P1CP and osteocalcin levels were similar to control levels on admission but increased with treatment, and after 8 weeks were 40% and 63% higher respectively than on admission. These findings suggest that in untreated anorexia nervosa there was uncoupling of bone turnover as bone resorption markers were raised without a concomitant increase in bone formation markers. As the condition was treated and patients gained weight, the formation markers also increased, leading to a more balanced, although higher, bone turnover.

Reflection: a flawed strategy for the nursing profession

The meaning and process of reflection and reflective practice appear to be currently accepted and institutionalized within the nursing profession. This paper, through use of a literature review, attempts to question the value that is consequently placed on this strategy and argues that on closer examination, reflection has no clear or universal definition, an uncertain framework for implementation, and is of unproven benefit to the professional practice of nurses. Given this evidence, the author concludes that reflection is a fundamentally flawed strategy that must be of limited benefit to the nursing profession.

Serum ferritin and anemia in trained female athletes

The aim of this study was to establish whether extremely low serum ferritin values in female athletes were associated with indications of iron deficiency anemia and whether serum ferritin values were influenced by the type of training or participants' body size. Hematological data collected during 6 years at the Australian Institute of Sport were reviewed to quantify changes in serum ferritin concentration associated with training and to establish whether decrements in serum ferritin were associated with any change in hemoglobin concentration, mean corpuscular volume, or mean corpuscular hemoglobin concentration. Mean serum ferritin concentrations of 7.5 microg x L(-1) were not associated with any indication of iron-deficiency anemia. Serum ferritin declined by approximately 25% with the onset of rigorous daily training (p < .01) whether training was predominantly weight-bearing or non-weight-bearing. Rowers had significantly higher ferritin concentrations than basketball players of similar stature (p=.02). We conclude that considerable background information such as the stage of training, specific sport, and previous blood results should be sought when interpreting serum ferritin concentrations in female athletes.

Audit of postoperative pain following day case surgery

Day case surgery is an expanding area within the NHS. However, pain following day case procedures remains a constant concern for healthcare professionals. An audit of postoperative pain following a range of day case procedures over a 2-year period at a general hospital in the north of England found that 17-20% of patients experienced unacceptable levels of pain. However, very few of these patients were worried about the pain they experienced and none contacted their GP. This implies that healthcare professionals overestimate the significance of postoperative pain for the patients concerned.

Effects of inflammation and treatment on bone turnover and bone mass in polymyalgia rheumatica

OBJECTIVE

Polymyalgia rheumatica (PMR) has an abrupt onset of inflammatory symptoms, making it a useful model for studying the effects of inflammation in bone. PMR requires corticosteroid treatment, which may itself have a detrimental effect on bone. This study used serially measured biochemical markers of bone turnover and bone density to address the relative contributions of systemic inflammation and corticosteroid therapy to bone loss.

METHODS

Fifty untreated patients with PMR were randomized to receive oral prednisolone or intramuscular methylprednisolone. Biochemical bone markers (pyridinoline [PYR], deoxypyridinoline [DPYR], procollagen type I carboxy-terminal peptide [PICP]) and bone mineral density (BMD) were measured at baseline and at 6, 12, and 24 months.

RESULTS

The median disease duration at presentation was 12 weeks (range 5-32 weeks). Levels of urinary crosslinks were increased in patients with untreated PMR compared with controls (PYR 74.9 +/- 30.0 nmoles/mmole creatinine, DPYR 14.6 +/- 6.4 nmoles/mmole creatinine [mean +/- SD]; P = 0.0001); the PICP level was normal (115.0 +/- 39.0 microg/liter). With treatment, the crosslinks levels fell and PICP levels rose within 6 months (P = 0.01). Bone resorption (PYR) correlated with untreated disease activity (erythrocyte sedimentation rate [ESR]) (r = 0.5, P = 0.003) and with interleukin-6 levels (r = 0.48, P = 0.05). There was a significant reduction in BMD of both the hip and the spine after 12 months of treatment (P = 0.0002), with no difference between treatment groups. As the steroid dosage was reduced, bone mass improved. Initial ESR influenced the percent change in BMD at 1 year (r = 0.35, P = 0.05), while cumulative steroid dose, mean ESR, and type of steroid used did not.

CONCLUSION

Inflammation in PMR increases bone resorption and appears to have a more detrimental effect on bone than does low-dose corticosteroid. If corticosteroids can be tapered and discontinued, bone loss in PMR can be a transient phenomenon.

A historical study of men in nursing

This study outlines a brief history of men as nurses in the United Kingdom. It uses a variety of historical sources, primary archival, oral history and secondary sources to retell the history of nursing with emphasis on the frequently neglected place of men within it. History appears to indicate that men have had a place in nursing for as long as records are available, but their contribution has been perceived as negligible, largely because of the dominant influence that the 19th century female nursing movement has had on the occupation's historical ideology. The study indicates that men have an equally valid historical role within nursing, and that this should be acknowledged when considering male nurses' position within the nursing profession.

Reduced bone density in patients with inflammatory bowel disease

BACKGROUND

Reduced bone mineral density in patients with inflammatory bowel disease is thought to be due to disturbances in calcium homeostasis or the effects of corticosteroid treatment.

AIMS

To assess the prevalence and mechanism of reduced bone mineral density in 79 patients with inflammatory bowel disease (44 with Crohn's disease, 35 with ulcerative colitis) who did not have significant risk factors for low bone densities.

METHODS

Dual x ray absorptiometry was used to measure bone mineral density and serum and urinary markers of osteoblast (alkaline phosphatase, procollagen 1 carboxy terminal peptide and osteocalcin) and osteoclast (pyridinoline, deoxypyridinoline, and type 1 collagen carboxy terminal peptide) activities to assess bone turnover.

RESULTS

There was a high prevalence of low bone mineral density (prevalence of T scores < -1.0 from 51%-77%; T scores < -2.5 (osteoporosis) from 17%-28%) with hips being more often affected than vertebrae (p < 0.001). Reduced bone mineral density did not relate to concurrent or past corticosteroid intake, or type, site, or severity of disease. Whereas calcium homeostasis was normal, bone markers showed increased bone resorption without a compensatory increase in bone formation.

CONCLUSIONS

The greater prevalence of reduced hip bone mineral density, as opposed to vertebral, mineral density and the pattern of a selective increase in bone resorption contrasts with that found in other known causes of metabolic bone disease.

Evaluation of a nurse-led acute pain service. Can clinical nurse specialists make a difference?

This paper attempts to identify the impact of a nurse-led in-patient acute pain service (APS) on three areas of concern; pre-operative information, patients self-reported levels of pain, and analgesics prescribed. It considers the results of a baseline survey carried out in 1992 and its replication in 1995, in an attempt to assess the impact this service may have had. Results appear to indicate some changes in all areas of concern, with significant reductions in reported levels of pain and patterns of analgesic prescribing between the two surveys. It therefore appears within the constraints of this type of study, that the work of the nurse-led APS has had a significant impact on changing outcomes and improving quality of patient care.

Activation of an interleukin-4 mRNA-producing population of peripheral blood mononuclear cells after infection with Mycobacterium bovis or vaccination with killed, but not live, BCG

This study examines the expression of mRNA for the Th2 cytokine, interleukin-4 (IL-4). Peripheral blood mononuclear cells from deer infected with Mycobacterium bovis or vaccinated with live or killed M. bovis bacillus Calmette-Guérin (BCG) were cultured with mycobacterial antigens. IL-4 mRNA production was assayed using the polymerase chain reaction. Elevated levels of IL-4 mRNA were detected in response to at least one antigen preparation in all animals infected with M. bovis as compared with none of the non-infected control animals. After a primary immunization, elevated levels of IL-4 mRNA were detected in only a proportion of vaccinated animals and this did not correlate with whether the vaccine was live BCG or killed BCG in oil. After boosting, all the animals vaccinated with killed BCG in oil exhibited elevated IL-4 mRNA production whereas none of the animals vaccinated with live BCG showed elevated levels. The data suggest that IL-4 is turned off during the immune response to live BCG, that boosting of low-dose live BCG vaccine may be required to 'imprint' this signal and that this may be important in the development of protective immunity to tuberculosis. Killed BCG in adjuvant is not protective and as with experimental infection with virulent M. bovis it failed to switch off the IL-4 response. IL-4 may be useful as a diagnostic tool and as an in vitro marker of vaccine efficacy.

Identification of a Protein That Inhibits the Phosphorylated Form of Nitrate Reductase from Spinach (Spinacia oleracea) Leaves

The low-activity, phosphorylated form of nitrate reductase (NR) became activated during purification from spinach (Spinacia oleracea) leaves harvested in the dark. This activation resulted from its separation from an approximately 110-kd nitrate reductase inhibitor protein (NIP). Readdition of NIP inactivated the purified phosphorylated NR, but not the active dephosphorylated form of NR, indicating that the inactivation of NR requires its interaction with NIP as well as phosphorylation. Consistent with this hypothesis, NR that had been inactivated in vitro in the presence of NR kinase, ATP-Mg, and NIP could be reactivated either by dephosphorylation with protein phosphatase 2A or by dissociation of NIP from NR.

Do nurses provide adequate postoperative pain relief?

The inadequate educational background of nurses fails to prepare them to assess and control postoperative pain effectively. Ineffective pain control occurs because of the confusion over the complex nature of pain, a reluctance to accept patients' verbal reports of pain, ignorance of the relationship of pain to tissue damage, and the lack of a coherent framework for assessing pain. Nurses need improved formal training in methods of pain control at all educational levels. Nurses must recognize their own knowledge limitations and seek to improve their awareness of current research and improvements in pain control so that these can be implemented in clinical practice.

Non-reporting of cardiac pain

A study of 55 patients over a three-month period who were admitted to the coronary care unit of a large university teaching hospital indicated that, despite the well-documented importance of recognising and treating cardiac chest pain, of the 80% of patients who experienced pain or discomfort, 19% delayed in reporting 'chest pain' for more than 20 minutes and 4% failed to report their 'chest pain' at all. Non-reporting of symptoms was felt to be caused by lack of nursing and medical awareness that this problem existed, lack of patient awareness of the need to report all symptoms and difficulties in communication between nursing staff and patients.

Protein phosphatase 2A and its [3H]cantharidin/[3H]endothall thioanhydride binding site. Inhibitor specificity of cantharidin and ATP analogues

The target site for cantharidin (CA) and its analogues was isolated recently from mouse liver and identified as protein phosphatase (PP2A) in the heterodimeric form known as PP2A2. The most toxic CA analogue, endothall thioanhydride (ETA) (mouse i.p. LD50 0.3 mg/kg), appears to have the same binding site in mouse liver and brain based on studies comparing [3H]ETA and [3H]CA. ATP and its nonhydrolyzable analogues and pyrophosphate and related compounds including phosphonoformic acid inhibited both [3H]CA and [3H]ETA binding with IC50 values ranging from 2 to 81 microM. As with CA itself, the most potent inhibitors have two negatively charged groups in close proximity to each other. Inhibition of [3H]CA binding by 5,5'-dithiobis(2-nitrobenzoic acid) and stimulation by N-ethylmaleimide indicated the involvement of a thiol site in the CA-binding domain. CA and three analogues (cantharidic acid, palasonin and endothall) inhibited PP2A and protein phosphatase 1 (PP1) but not PP2B or PP2C. The catalytic subunit of PP2A was 5- to 12-fold more sensitive to these CA analogues than the catalytic subunit of PP1. CA and the herbicide endothall also inhibited spinach leaf PP1 and PP2A and, at 50 microM, decreased the PP2A-mediated light-induced activation of nitrate reductase in intact spinach leaves by 62 and 56%, respectively. This is consistent with PP2A as their site of action in plants, and indicates the potential use of CA analogues as pharmacological probes to investigate cellular processes that are regulated by reversible protein phosphorylation in vivo.

Antibiotic resistance monitoring, with particular reference to methicillin-resistant Staphylococcus aureus

Two surveys of antibiotic resistance in hospital pathogens are described. The first is a long-term, multi-center, laboratory based investigation in which antibiotic resistance data from laboratories with computerized reporting is collected. The difficulties of this type of investigation are discussed and some solutions suggested. In the second investigation reports of the isolation of methicillin-resistant Staphylococcus aureus (MRSA) were collected from microbiological laboratories on a nation-wide basis. The results were useful in monitoring the spread of the organism and in its control.

Carcinoma of the duodenum

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