Myelogenous leukemia in adult inbred MHC-defined miniature swine: a model for human myeloid leukemias.

This manuscript reports on five cases of spontaneous myelogenous leukemia, similar to human disease, occurring within highly inbred, histocompatible sublines of Massachusetts General Hospital (MGH) MHC-defined miniature swine. In cases where a neoplasm was suspected based on clinical observations, samples were obtained for complete blood count, peripheral blood smear, and flow cytometric analysis. Animals confirmed to have neoplasms were euthanized and underwent necropsy. Histological samples were obtained from abnormal tissues and suspect lesions. The phenotype of the malignancies was assessed by flow cytometric analysis of processed peripheral blood mononuclear cells and affected tissues. Five cases of spontaneous myeloid leukemia were identified in adult animals older than 30 months of age. All animals presented with symptoms of weight loss, lethargy, and marked leukocytosis. At autopsy, all animals had systemic disease involvement and presented with severe hepatosplenomegaly. Three of the five myelogenous leukemias have successfully been expanded in vitro. The clustered incidence of disease in this closed herd suggests that genetic factors may be contributing to disease development. Myelogenous leukemia cell lines established from inbred sublines of MGH MHC-defined miniature swine have the potential to be utilized as a model to evaluate therapies of human leukemia.

Deliberate self-harm by burning: a retrospective case controlled study.

Thirty-seven referrals to a liaison psychiatry service after deliberate self-harm by burning were compared with a control group of people referred to the same service after deliberate self-harm by other means. We found that the group who self-harmed by burning were more likely to have psychotic symptoms, be prescribed psychotropic medication at the time of the self-burns and to be psychiatric inpatients at the time of self-harm compared with controls. The implications of the findings are discussed. The development of good communication and joint working between staff in psychiatry and burns units is particularly important to support the care of this group of patients.

Treatment of congenital melanocytic naevi with CO2 laser.

This study assesses the effectiveness of CO2 laser in treating congenital melanocytic naevi (CMN). A retrospective review of 12 patients with CMN treated with CO2 laser was carried out. In all cases, there was minimal visible naevus after treatment. Six patients developed hypertrophic scarring; this was significantly more likely following CO2 laser treatment on the anterior torso, flanks, or arms than on the back or buttocks (P = 0.01, 1-tailed Fisher exact test). We conclude that CO2 laser is an effective treatment for reducing visible pigmentation of CMN. However, it can cause hypertrophic scarring, which has not been reported before. This risk can be reduced by limited use in areas of the body where the dermis is thinner or there is a known risk of hypertrophic scarring. In addition, the cautious use of paint mode and prophylactic use of pressure or silicon dressings may also reduce the risk of hypertrophic scarring.

Breast augmentation should be on the NHS: a discussion of the ethics of rationing.

Every NHS clinician is under constant pressure to match limited resources to increasing demands. The GMC provides guidelines about how we should ration: 'you should always seek to give priority to the treatment of patients solely on the basis of clinical need'. However, this gives no indication as to what is 'need'. Often, in its application, certain assumptions are made about the nature of clinical need. To examine some of these assumptions in more detail, I will argue the case for a treatment that is on the borderline of the remit of NHS care--breast augmentation.