Use of WhatsApp in an oral and maxillofacial surgery department at a major trauma centre and its role during major incidents: our experience.

WhatsApp (Facebook), which is a popular instant messaging "app" that is available on several platforms globally, allows users to share text, images, and video (and much more) over an end-to-end encrypted connection. We have investigated its use among the oral and maxillofacial surgery junior trainees' WhatsApp group at King's College Hospital, a level one trauma centre in London, and reviewed existing studies. On five of the seven days analysed, there were 191 communications. Most (n = 127, 67%) were related to administrative issues and patient care (n = 62, 33%). Only two (1%) related to neither and were classified as "other". No communications were sent to the group over the weekend. WhatsApp is a popular means of communication among junior trainees within our department, and can be used to send concise information to several people at once, often more quickly than by telephone, pager, or email. The technology, however, should be used carefully, and it raises important questions on confidentiality, which have recently been addressed by the medical director of the NHS in the wake of its use as a "cascade mechanism" during major terrorist incidents. We also discuss the potential value of emerging methods of communication that have been specifically designed for use in healthcare.

Solitary fibrous tumour of the tongue: a series of four cases.

BACKGROUND: Solitary fibrous tumour is a soft tissue tumour of mesenchymal origin. It was first described in the pleura and has since been reported in many anatomical locations. Thirteen cases in the tongue have hitherto been reported. A positive CD34 result has traditionally been used to confirm the diagnosis, although this is often non-specific to solitary fibrous tumour. To date, nuclear STAT6 expression has not been reported in solitary fibrous tumour of the tongue. METHOD: This paper presents a further four cases of solitary fibrous tumour of the tongue, the largest series to date. Clinical, histopathological and immunohistochemical findings are detailed, including nuclear STAT6 expression. RESULTS: All four cases were positive for CD34; two cases showed nuclear expression of STAT6. The tumours were excised completely and there have been no recurrences in at least one year. CONCLUSION: Solitary fibrous tumour should be considered as a differential diagnosis for tongue swellings, with the potential to recur.

High-grade transformation in splenic marginal zone lymphoma with circulating villous lymphocytes: the site of transformation influences response to therapy and prognosis.

In a series of 48 patients with splenic marginal zone lymphoma (SMZL) with circulating villous lymphocytes, we describe the clinical and laboratory features of nine cases that transformed to high-grade B-cell lymphoma. These patients had a significantly greater incidence of peripheral lymph node involvement at diagnosis when compared to SMZL patients who did not transform (P < 0.03). While transformation in the bone marrow is frequently refractory to therapy and associated with poor outcome in SMZL, lymph node transformation responds well to chemotherapy with durable progression-free and overall survival.

Prolymphocytic leukaemia of B- and T-cell subtype: a state-of-the-art paper.

Prolymphocytic leukaemias of B and T cell subtype are rare diseases. Despite recent advances in immunophenotyping and molecular cytogenetics, leading to a better understanding of the underlying cell biology of the prolymphocytic leukaemias, prognosis for these patients remains poor. Purine analogues and monoclonal antibodies have shown efficacy in B-cell prolymphocytic leukaemia although further studies are warranted. Monoclonal antibody therapy with alemtuzumab has significantly improved outcome in T-cell prolymphocytic leukaemia (T-PLL) but responses are still transient and further disease progression is inevitable. While allogeneic stem cell transplant is an attractive option, due to the older age group of T-PLL patients the morbidity and mortality associated with the procedure is significant.

Lack of clinical efficacy of rituximab in the treatment of autoimmune neutropenia and pure red cell aplasia: implications for their pathophysiology.

We describe 11 patients with severe refractory autoimmune cytopenias treated with the anti-CD20 monoclonal antibody rituximab. Six patients had autoimmune neutropenia (AIN), two had pure red cell aplasia (PRCA), one had AIN and autoimmune haemolytic anaemia, one had AIN and immune thrombocytopaenia purpura (ITP) and one had PRCA and ITP. Rituximab was administered at a dose of 375 mg/m(2) as an intravenous infusion weekly for 4 weeks. Six of eight patients with AIN and all three patients with PRCA did not respond. Two patients died: one with resistant AIN and autoimmune haemolytic anaemia died of pneumocytis pneumonia infection, and one with PRCA and ITP died of an acute exacerbation of bronchiectasis. Rituximab in AIN and PRCA appears to be less effective than Campath-1H when compared to historical data from our group. This supports the hypothesis that T cells may be important in the pathophysiology of AIN and PRCA.