[Handover protocols in the emergency department]

Patient handovers are a vital juncture in the flow of medical information, and regardless of the mode of handover-oral, written, or combined-it often poses a risk of information loss. This could potentially jeopardize patient safety and influences subsequent treatment. The exchange of information in emergency care settings between paramedics and emergency personnel is particularly prone to errors due to situational specifics such as high ambient noise, the involvement of multiple disciplines, and the need for urgent decision-making in life-threatening situations. As handover training is not yet universally incorporated into education and ongoing training programs, there is a high degree of variability in how it is carried out in practice. However, strategies aimed at enhancing the handover process carry substantial potential for improving staff satisfaction, process quality, and possibly even having a positive prognostic impact.

[Intracranial manifestation of so-called "melanotic neuroectodermal tumor of infancy"--a choristoma with neural crest potentials]

A case is reported of so-called "melanotic neuroectodermal tumour of infancy" (= MNTI) in a female newborn. The tumour, whose localization was intracranial, but extracerebral, could be removed subtotally. A further 22 cases of the MNTI with neurocranial manifestations reported in the literature, but differing from our case in their extracranial growth, are listed for comparison. We believe that the neural crest is the histogenic origin of the MNTI and, therefore, our proposed definition is: "Christoma with neural crest potencies."

[So-called "ependymoma of the foramen of Monro" with differentiation of tissue toward the subfornical organ]

A tumour was found in the left ventricle of a 25 year-old woman. Histology of this "ependymoma of Monro's foramen" shows characteristic structures of the subfornical organ. Whereas tumours of the pituitary or the pineal gland, which are also part of the circumventricular organs, are quite frequent, a tumour with differentiation characteristic of the subfornical organ is a rarity.

Applicability of leukocyte esterase test strip in detection of canine pyuria

A commercially available leukocyte esterase assay was evaluated for application in analyzing canine urine for the detection of pyuria. In 229 urine samples, the leukocyte esterase activity was compared with leukocyte concentrations, as assessed by microscopic sediment analysis and chamber cell counts. The leukocyte esterase assay was specific (93.2%) for canine pyuria, but was poorly sensitive (46.0%) and did not appear to be applicable to analysis of canine urine samples.

Neurosarcoid reaction in association with a ruptured ACA-aneurysm

A case of neurosarcoid reaction presenting itself as a mass lesion associated with a ruptured ACA aneurysm is reported. Diagnosis was established by histological investigation of the resected "brain tumour". The pre-operative diagnostic problems, similar cases in the literature as well as the possible pathogenesis are discussed.

Subarachnoid metastases from a prolactinoma

A 37-year-old man developed a left frontal metastasis from a prolactin-secreting pituitary tumour, which had been operated on nine years before. The metastatic tumour was totally excised. One and a half years later he was found to have multiple left temporal and parietal subarachnoid metastases. Because treatment with bromocriptine for five months and subsequent radiation proved ineffective, the tumour nodules were removed surgically.

[Pathologic anatomy and mechanism of brain tissue damage in Mycoplasma infection based on a case report]

The following report deals with the pathological findings in severe brain tissue damage secondary to Mycoplasma infection with positive serological identification. The patient, a girl of 4 1/2 years, presented with the clinical signs of severe cerebral damage of acute onset and succumbed after an illness of 74 days. Autopsy revealed extensive cortical necrosis in one hemisphere with focal necrosis in the basal ganglia of the opposite hemisphere, together with demyelination and marked glial reaction. Although the changes suggest damage due to circulatory factors, the brain vessels appear normal. Disseminated intravascular coagulation appears to be the most likely pathogenesis.

Erythrocyte volume distribution analysis and hematologic changes in two horses with immune-mediated hemolytic anemia

Immune-mediated hemolytic anemia was diagnosed in two horses on the basis of regenerative anemia, increased erythrocyte fragility in hypotonic saline, autoagglutination, and a positive direct antiglobulin (Coomb's) test. During steroid therapy partial resolution of the anemia was indicated by rising packed cell volume, macrocytosis, and bone marrow erythroid hyperplasia. Using erythrocyte volume distribution histograms (erythrograms), the regenerative response was characterized by analysis of macrocytic and normocytic erythrocyte subpopulations. In both horses, a gradual net increase of about 2 X 10(6) macrocytes/microliter occurred over a four- to five-week period. Over the same interval there was a gradual decrease in the number of normocytes. We suggest that the macrocytes remained large through this period rather than contributing to normocyte population growth. Erythrograms may provide an additional means of evaluating erythrocyte regeneration in horses.

Erythrocyte volume distribution analysis and hematologic changes in dogs with iron deficiency anemia

Hematologic features were characterized in 12 dogs with iron deficiency anemia attributable to chronic external blood loss. Consistent abnormalities in hemograms included moderate to marked reticulocytosis, decreased mean corpuscular volume, and decreased mean corpuscular hemoglobin concentration. Hypoproteinemia occurred in only four of 12 dogs. Consistent blood film findings included hypochromic cells, leptocytosis, and erythrocyte fragmentation. These dogs had significantly decreased serum iron values (p less than 0.001) and percent transferrin saturation values (p less than 0.001) compared with 33 clinically healthy adult dogs. The total iron binding capacity values of these dogs were not significantly different (p greater than 0.5) than those of the healthy dogs. Using erythrocyte volume distribution curves, the percentages of microcytic cells (less than or equal to 45 fl) were determined to range from 20% to 82%. Sequential changes in erythrocyte subpopulations were evaluated in four dogs which received iron therapy. The hematologic response consisted of fairly rapid restoration of packed cell volume by production of normocytes followed by a more gradual replacement of residual microcytes by new normocytes.

[Density distribution of human lymphocytes. II. Distribution patterns of malignant lymphocytes and their prognostic significance in patients with non-Hodgkin's lymphoma]

The aim of this study was to investigate the prognostic significance of density distribution profiles in non-Hodgkin lymphomas. Density profiles were evaluated by equilibrium centrifugation on linear polysucrose-metrizoat gradients. Biopsy cells from 44 untreated non-Hodgkin lymphomas in advanced stages according to their density patterns could be classified into one of two distinct groups: Group A lymphomas exhibited high to intermediate densities and resembled normal resting B or T lymphocytes; they showed low spontaneous proliferation and favourable histologies. Group B lymphomas exhibited light densities, resembling activated lymphocytes and frequently revealed high spontaneous proliferation and unfavourable histology. Within a minimal time of observation of 40 months only 28% of the group A but 75% of the Group B lymphomas died. Simultaneously performed surface marker studies excluded the possibility that variable proportions of normal lymphocytes contaminating the lymphoma suspensions are responsible for the two density groups. They rather suggested that these patterns reflect the individual capacity of a lymphoma to differentiate into denser tumour clones with low spontaneous proliferation. We therefore conclude that analyses of density profiles from non-Hodgkin lymphomas represenmts a promising method for the prognostic classification of this disease.

Prognostic significance of lymphocyte density distribution profiles in adult non-Hodgkin lymphomas

Biopsy material from 24 adults with advanced stages of non-Hodgkin lymphomas (NHL) were examined for the distribution profiles of infiltrating cells following centrifugation to equilibrium on linear density gradients. Seven of these biopsies were predominantly composed of cells with high buoyant densities and 9 further biopsies predominantly of cells with intermediate buoyant densities. Both patterns were associated with favorable histologic features and with low proliferation of lymphoma cells. Intensive polychemotherapy was rarely required to achieve long-lasting disease control; in both groups, only 28% of patients died within a minimal observation period of 40 mo. In 8 biopsies, a predominance of light lymphoma cells was observed. This pattern was frequently associated with unfavorable histology and with high spontaneous tumor cell proliferation. Despite intensive polychemotherapy, rapid disease progression occurred in all cases, leading to death in 75% of the patients within a minimal observation period of 40 mo. Surface marker studies excluded the hypothesis that only the variable proportions of normal lymphocytes contaminating the lymphoma suspensions were responsible for the differences in the density distribution patterns described above; they rather suggested that these patterns reflect the individual capacity of a lymphoma to differentiate into dense tumor clones with low spontaneous proliferation.

Lymphomatoid granulomatosis with primary manifestation in the skeletal muscular system

Lymphomatoid granulomatosis (LYG) has been recognized as a peculiar disease which primarily affects the lungs and occasionally the upper respiratory tract. Typical histopathologic lesions present features of a nonneoplastic lymphoproliferative disorder associated with necroses of the infiltrated tissues and with angiodestructive processes. The authors observed a peculiar case in which lesions typical for LYG first developed in the striated muscles. In this case multiple tumorous muscular infiltrates and affections of the pharynx, larynx, paranasal sinuses, and orbita preceded the infiltration of the lung, which was first recognized 6 months after the first muscular infiltrate and 2 months before death. Because primary muscular manifestation of LYG has never been reported, this case is remarkable both for its unusual manifestation and for its striking irresponseveness towards therapy. Clinical and experimental data suggest impairment of T-cell functions.

Cryolesions of bone. An experimental study. part I: Examinations in technique of controlled cryolesion on bone

Three different approaches of freezing rabbit tibia bones are demonstrated. Intramedullary freezing seems to be the safest method to avoid soft tissue necrosis. Bone specimens removed immediately after the freezing-thawing process showed electron optically evidence of irreversible damage of bone cells in all cases.

Cryolesions of bone. An experimental study. part II: Results of cryosurgery on bone

After freezing-devitalisation of rabbit tibia bone, a slow resorption and substitution by new bone within a period of 6 months could be demonstrated. Intramedullary freezing combined with internal fixation of an osteotomy in the frozen area was followed by a delayed healing. Angiographic studies showed an almost normal circulation after freezing of the main vessels.

[Granular cell tumor and the phagocytozing form of Schwann cells. Electron microscopic examinations of 3 cases (author's transl)]

In granular cell tumors, the granule-containing tumor cells and their processes form rounded complexes surrounded by a common bounding membrane. In the tumor, these complexes are closely related to the peripheral nerves and are seen in the perineurium and in the endoneurium. In addition, there are mixed complexes composed both of Schwann cells and granular tumor cells: the two types of cells are in close contact with each other and are also surrounded by a common bounding membrane. Furthermore, there one contacts between granular tumor cells and axons. These observations strongly suggest the existence of a relationship between Schwann cells and the cells of granular cell tumors. A comparison between the granular tumor cells and the phagocytic forms of Schwann cells reveals striking similarities: the granular cell tumor complexes are comparable with the Büngner bands of phagocytozing Schwann cells. A relationship between granular cell tumors and the phagocytozing form of Schwann cells is therefore assumed.

[Neurofibroma and Perineurial cell. Electron microscopic examinations of 9 neurofibromas (author's transl)]

In neurofibromas type I (plexiform) and type II (diffuse) the Schwann cell is the predominant cell in the neoplastic proliferation. Electron microscopic investigation of a neurofibroma with structures resembling tactile corpuscles (type III) revealed neoplastic proliferation of perineurial in stead of Schwann cells. The tactile-like (pseudo-Meissnerian) corpuscles (corpuscles neurofibromateux) are formed by neoplastic perineurial cells. These cells have a tendency to wrap themselves around longitudinal structures, such as collagen fibres or axons, and to come into direct contact with the latter. The close relationship between the axon and the neoplastic perineurial cell, analogous to that between axon and Schwann cell, points to a neuroectodermal origin origin of the perineurial cell. The electron microscopic appearances suggest that either the Schwann cell or the perineurial cell is the essential neoplastic component of neurofibromas, the fibroblastic proliferation being a secondary phenomenon.