The effects of dimercaptosuccinic acid and other chelating agents on the retention of platinum in the rat kidney after treatment with cisplatin.

The ability of three chelating agents, dimercaptopropanesulphonate (DMPS), dimercaptosuccinic acid (DMSA), and diethylenetriaminepentaacetic acid (DPTA), to reduce the retention of platinum in the kidneys was tested in male Sprague-Dawley rats treated 24 h previously with Cisplatin. DMPS and DMSA, when given as four daily doses of 1 mMol/kg, increased the urinary excretion from 10.1% +/- 1.2% to 13.6% +/- 1.3% and 13.5% +/- 2.6%, respectively, but only DMSA caused a small but significant reduction in the kidney platinum content. DTPA was totally ineffective. It is concluded that none of these agents is likely to be useful for the reduction of Cisplatin-induced renal toxicity in the clinical situation.

Prescribing competence of junior doctors: does it add up?

BACKGROUND: Prescribing errors complicate a significant number of paediatric admissions. Ongoing training and monitoring of prescribing competency in junior doctors has occurred in Cardiff since 2001, alongside national measures aimed at improving training and competency. AIM: Ongoing monitoring of junior doctors' prescribing competency to assess the effect of these national and local initiatives. METHODS: Junior doctors receive training and subsequent assessment on prescribing competency at induction. A 1 h bleep-free session concerning paediatric prescribing precedes completion of four prescribing tasks. British National Formulary for children and calculators are provided. Those scoring 0 or 1 are retrained before prescribing is permitted. Our previously published data of doctors between 2001 and 2004 was compared with assessment in 2007. RESULTS: 30 junior doctors were assessed in 2007 (32 in 2001-2004). All four questions were answered correctly by 22/30, compared to 10/32 (31%) in 2001-2004. The mean score in 2007 was 93.3% compared to 57.8% previously (see table 1). Comparison of means with previous results demonstrated statistically significant improvement with a mean difference of 36% (95% CI 24 to 47). In 2007, eight (27%) doctors got just one question wrong and no doctor answered all questions incorrectly. In 2001-2004, 22/32 (67%) made at least one error during previous assessment, and one doctor answered all questions incorrectly. Table 1Prescribing assessment scores in 2001-2004 and 2007 Answer scores2001-2004 (n=32)2007 (n=30)All questions correct10 (31%)22 (73%)One incorrect08 (27%)Two incorrect13 (41%)0Three incorrect8 (25%)0All questions incorrect1 (3%)0 CONCLUSION: Ongoing monitoring of junior doctors' prescribing ability has demonstrated improvements which may be due to local and national training initiatives.

Amyloid in basal cell carcinomas.

Stromal or intratumour deposits of amyloid were found in thirty of forty-six randomly selected basal cell carcinomas. Amyloid was found less often in histologically aggressive tumours than in other sub-types. Immunoglobulins, predominantly IgM, were demonstrated in all but one of these thirty cases, corresponding to the distribution of the amyloid deposits. Electron microscopy revealed 'early' amyloid in one case which showed numerous stromal IgM bodies on immunofluorescence but no evidence of amyloid by routine histochemical methods.

Inhibition of B-cell function by concanavalin-A-induced suppressor cells.

The in vitro immune response of normal spleen cells to the thymus-independent antigen dinitrophenylated levan (DNP-LE) was found to be inhibited by suppressor cells induced previously by concanavalin A (Con A) in vitro. At various suppressor to target cell ratios, the level of suppression observed was comparable to that seen in anti-sheep erythrocyte (SRBC) responses. Consequently, it is suggested that B cells constitute a direct target for Con-A-induced suppressor cell activity.