Rhabdomyosarcoma is an uncommon tumour that may present at a wide variety of different sites. We report a 4-year-old girl who developed an embryonal rhabdomyosarcoma arising in the left pinna which was clinically indistinguishable from a lymphangioma. The case illustrates that this neoplasm can be easily misdiagnosed because of its variable morphology. Early recognition is important as successful treatment is now possible with a combination of chemotherapy, surgery and/or radiotherapy.
Five commercially available cytokeratin antibodies (lu-5, AE1/AE3, CAM 5.2, MFN116 and anti-cytokeratin 18) were used to stain a wide range of normal and neoplastic epithelial and non-epithelial tissues to assess their potential value in diagnostic histopathology. All five showed good specificity, with some cross-reactivity in smooth muscle cells. The wider reactivity of AE1/AE3, lu-5, and MFN 116, which includes cytokeratins 8,18 (Moll's catalogue) expressed in simple epithelia and their tumours, as well as cytokeratins expressed in complex stratified squamous epithelia, permits identification of a wider range of epithelial derived tumours. This wider spectrum of reactivity may allow these antibodies to be used in a diagnostic panel for the identification of poorly differentiated tumours.
Abstract Background Despite the proven benefits of early palliative care and national initiatives to increase access, patient communication regarding these services remains elusive. Many theories in the fields of health communication, psychology, and medicine offer valuable insights for early palliative care and uncertainty communication. While these various fields study communication and have developed communication theories, the discipline of nursing must also recognize and research its unique communicatory role. Therefore, this paper aims to a) provide a comprehensive literature review on nurse palliative care communication addressing chronic uncertainty in life-limiting illness, b) define the Reconceptualization of Uncertainty in illness Theory (RUIT) and Problematic Integration Theory (PIT) within a nursing Unitary Caring Science (UCS) worldview and, c) synthesize these theories and literature review into a unique conceptual framework for early palliative care communication in nursing. Method Turner’s theory synthesis methodology was combined with a comprehensive PRISMA literature review to produce an overarching framework that transcends and interprets existing theories. The literature search was conducted in July of 2023 and updated in May 2024 using Pubmed, PsychINFO, and EBSCOhost databases. A second literature search was undertaken to identify applicable uncertainty theories in chronic or LLIs. This theory-oriented search used health communication and nursing theory textbooks, reference chaining from our first comprehensive literature review, and keyword searches of applicable theories in Pubmed, PsychINFO, and EBSCOhost databases. Results This theory synthesis highlights the integrality of all facets of uncertainty for those living with severe life-limiting illnesses (personal factors, types of uncertainty, and the nursing communicatory process) and conceptualizes uncertainty communication as a series of events happening simultaneously, not simply a cause-and-effect process. Discussion The framework resulting from this synthesis encourages nurses' holistic understanding of the complex nature of uncertainty in life-limiting illness, highlights the integral communicatory role nurses have in their patients’ health and wellness, and promotes further nursing-specific communication research. Future implementation nursing research focusing on enabling nurse-initiated early palliative care communication will support patients' values and dignity throughout more than a single hospital stay but their entire disease trajectory.
Abstract Objective —To determine total stiffness and gap stiffness of an external fixation system in a canine mandibular fracture gap model incorporating a full interdental pin as the only point of rostral fixation in a bilateral type-I external fixator. Sample Population —10 canine mandibles. Procedure —Bilateral mandibular ostectomies were performed between premolars 3 and 4. A type-I external fixator incorporating a full interdental pin was placed to stabilize a 0.5-cm fracture gap. Four pin configurations (intact mandibular bodies with fixator; ostectomized mandibular bodies and complete fixator; ostectomized mandibular bodies with caudal pins of rostral fragment cut; ostectomized mandibular bodies with all pins of rostral fragment cut) were tested in dorsoventral bending 5 times on each mandible. The full interdental pin remained intact in all configurations. Total stiffness and gap stiffness were determined for each configuration on a materials testing machine. Results —Total stiffness of intact mandibles was significantly greater than that of ostectomized mandibles, regardless of external fixator configuration. However, total stiffness and gap stiffness were not significantly different among different external fixator configurations applied to ostectomized mandibles. Conclusion and Clinical Relevance —External fixator configurations with only the full interdental pin engaging the rostral fragment were as stiff as configurations that had 2 or 4 additional pins in the rostral fragment for the applied loads. External fixators for rostral mandibular fractures may be rigidly secured with rostral fragment implants applied extracortically, avoiding iatrogenic trauma to teeth and tooth roots. ( Am J Vet Res 2001;62:576–580)
Abstract Objective To study biomechanical characteristics of the normal and surgically altered canine thoracolumbar vertebral column to determine the effects of surgery and trauma on lateral stability. Animals The T13-L1 vertebral motion units of 48 mixed-breed dogs were dissected free of surrounding musculature and prepared for biomechanical testing by cross-pinning the vertebral bodies and mounting in polymethylmethacrylate. Procedure Normal and surgically altered spinal specimens were subjected to lateral bending. The mean slope of the bending moment versus angular displacement curve and the load to failure were compared between treatment groups and significance was determined by the method of least squares ( P < 0.05). Specimens were surgically altered by facetectomy, lateral fenestration, diskectomy, and combinations of these procedures. Each specimen was subjected to lateral bending to failure at a rate of 2.5 cm/min in a swing arm bending jig designed to simulate 4-point bending and subject the specimen to pure bending. Results Only specimens undergoing diskectomy had a significant decrease in slope and load at failure. Unilateral and bilateral facetectomies and fenestration induced a nonsignificant decrease in stiffness, compared with control specimens. Conclusions Fenestrations and facetectomies do not appear to increase the risk of injury to the canine thoracolumbar spinal cord during lateral bending. Clinical Relevance Fenestrations and facetectomies, as used in routine laminectomies, may be performed without concern for significant destabilization of the spine in lateral bending; however, it is possible that thoracolumbar spinal fractures involving only the vertebral body may significantly destabilize the spine in all modes of bending. ( Am J Vet Res 1996;57:1228-1232)
Summary We report a case of a 37 year old man who presented with vomiting and colicky abdominal pain and who was found to have microscopic haematuria. Radiological-examination showed a right hydronephrosis apparently caused by a paracaecal tumour extending to involve the right ureter. This was resected and proved histologically to be a mesenteric fibromatosis. The patient has none of the factors predisposing to the development of this lesion, in particular Gardner’s syndrome. Eight months following surgery he appears to have made a full recovery. Previous publications on this rare intra-abdominal neoplasm are reviewed.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book evaluates the proposition that the forces supposedly driving the process of globalization have important implications for the relationship between: supra national, national and sub national state structures; organizational structures, work and employment; and regional governance structures. It explores the potential of regional innovation strategies in less favoured regions and concludes a criticism for confining themselves to a narrow 'metric of development'. The book discusses the importance of knowledge generation and distribution to support national competitiveness in the biotechnology field. It addresses questions of governance and new governance structures. The book deals with an issue that is often overlooked, downplayed or simply ignored in much recent debate on globalization, New Regionalism and development generally. A defining feature of globalization is the re-emergence of the local and regional economy as an important unit of innovation.
Background It is recognised that longer-term needs after stroke may not be well addressed by current services. The aim of this programme of research was to develop a novel primary care model to address these needs and to evaluate this new approach. Objectives The work was divided into three workstreams: development of a primary care model development of a ‘Managing Life After Stroke’ programme (including self-management) for people with stroke evaluation of the effectiveness and cost effectiveness of these interventions. Design The development of the primary care model involved information gathering in the form of literature reviews, patient and public involvement workshops, qualitative studies (interviews and focus groups), a consensus study and a pilot study, all feeding into a multidisciplinary intervention development group that approved the final primary care model. In parallel, a further literature review, consultation workshops with healthcare professionals and patients and public involvement fed into the iterative development of the ‘My Life After Stroke’ programme. In the final phase of the programme, the two interventions were evaluated in a cluster randomised controlled trial, which included a process evaluation and within-trial cost-effectiveness analysis. Setting General practices in the East of England and East Midlands. Participants People with a history of stroke identified from general practice stroke registers. Interventions The Improving Primary Care After Stroke model of primary care delivery. This comprised five components: a structured review; a direct point of contact; improving communication between primary and secondary care; local service mapping; and training of primary care professionals. The ‘My Life After Stroke’ self-management programme for people with stroke comprised an initial individual session, four weekly group-based sessions and a final individual session. Main outcome measures The coprimary end points for the trial were two subscales (emotion and participation) of the Stroke Impact Scale v3.0 at 12 months after randomisation. Secondary outcomes included the Stroke Impact Scale Short Form, the EuroQol-5 Dimension, five level questionnaire, the ICEpop CAPability measure for Adults, the Southampton Stroke Self-Management Questionnaire and the Health Literacy Questionnaire. Data sources General practice records for health economic costing data. Patient questionnaires for outcomes. Results Trial: 46 clusters (general practices) were randomised with 1040 participants. At 12 months, there was a 0.64 (97.5% confidence interval −1.7 to +2.8) improvement in the emotion outcome in the intervention arm compared to the control arm and a 1.3 (97.5% confidence interval −2.0 to +4.6) increase in the participation outcome in the intervention arm compared to control. There was also no evidence of effect of the intervention on short form Stroke Impact Scale, quality of life (EuroQol 5 Dimension 5 level questionnaire), well-being (ICEpop CAPability measure for Adults), Southampton Stroke Self-Management questionnaire or health literacy (Health Literacy Questionnaire). Process evaluation: over 80% of participants received a review. Only a third of patients attended the ‘My Life After Stroke’ course. The direct point of contact service was hardly used. The local directory of services had variable take-up by healthcare professionals. It did not prove possible to support improved communication between primary and secondary care as originally intended. Training fidelity was high. Cost-effectiveness analysis: the intervention increased primary care workload and was associated with a non-significant, higher quality-adjusted life-year at 12 months. The incremental cost per quality-adjusted life-year was £20,863. Limitations There were differences in age, sex and proportion of people from minority ethnic groups in the trial population as compared to a typical general practice stroke register. Uptake of the intervention was variable. Ceiling effects were observed in the primary outcome measure. Follow-up was limited to 12 months. Conclusions This programme of research has reaffirmed the importance of addressing longer-term needs of people after stroke in the community. The most commonly expressed need is fatigue. The primary care model that we developed was not effective at addressing these needs. Our qualitative findings suggest that an intervention focused on patients earlier after their stroke or one which is more intensive might be effective. There was a mismatch between the needs reported by stroke survivors and evidence available for how to address these needs. Future work Research to inform who should be offered poststroke assessment of needs in the community in the longer term (after 6 months). Development and evaluation of interventions to address fatigue, low mood and cognitive problems in people with stroke in the community. Study registration This study is registered as PROSPERO 2015 CRD42015026602. Trial registration This trial is registered as ISRCTNCT03353519. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20001) and is published in full in Programme Grants for Applied Research ; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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