Trends in fractures and fatalities of farmyard injuries in Ireland: a 10 year analysis.

The farming and agricultural sector remains one of Ireland's primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.

Use of emollients in atopic dermatitis.

Atopic dermatitis (AD) is a common inflammatory skin disorder that has strong financial and psychosocial impacts. Its pathogenesis is related to increased transepidermal water loss due to a defective skin epidermal barrier. Emollients serve as first-line therapy during both acute flares and remission. However, their use is poorly characterized, posing therapeutic challenges to clinicians and patients. In this article, we review available evidence to provide recommendations, aiming to standardize and optimize the use of emollients in AD. Literature search was performed using Pubmed and Google. All articles were retrieved using Pubmed. Recommendations were graded based on the British Medical Journal's Grading of Recommendations Assessment, Development and Evaluation system and the American Academy of Family Physicians' Strength of Recommendation Taxonomy. Emollients should be applied post-bathing. However, the need for immediate application is debatable. The optimal frequency for application is still undetermined, but multiple applications daily are encouraged. Ideally, a balance should be achieved between patient's compliance and clinical efficacy. Emollients hold the potential to act as steroid-sparing agents, but more well-designed studies are pertinent for a definite conclusion. At present, it is recommended that 250-500 g of emollients be applied every week. Finally, primary prevention of AD by regular application of emollients in high-risk infants cannot yet be recommended.

Best practice in primary care pathology: review 8.

This eighth best practice review examines four series of common primary care questions in laboratory medicine: (i) sodium abnormalities; (ii) faecal occult blood testing; (iii) warfarin management; and (iv) sputum cytology in diagnosis of bronchopulmonary malignancy. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

Arthrodesis of Little Finger Distal Interphalangeal Joint in Flexion to Regain Sporting Ability.

BACKGROUND: Finger injuries are common in the sport of hurling. Injury to the little finger distal interphalangeal joint (DIPJ) often occurs when a high dropping ball impacts on the outstretched finger. The little finger contributes to approximately 15% of grip strength. Injury therefore results in reduced grip strength and may impair the ability of players to grip or catch a ball. METHODS: Six elite hurlers with post-traumatic arthritis of their non-dominant little finger DIPJ underwent arthrodesis in 30 degrees of flexion. Kirchner wires were inserted for up to 8 weeks to achieve fusion of the joint. Patients were evaluated after recovery using a dynamometer to assess grip strength, the DASH questionnaire and a sport specific questionnaire. RESULTS: All arthrodeses achieved bony union without complication. All patients reported a resolution of their pain and recovery in their ability to catch & retain a ball. Measurements of grip strengths were comparable between hands. DASH scores improved by up to 47 points. All scores were less than 5 at final follow-up. CONCLUSIONS: Grip strength decreases when fingers are immobilized in full extension. In sports that require catching or gripping a ball or a bat, arthrodesis of the DIP joint in flexion can improve grip strength and hand function. Fusion in 30 degrees of flexion for hurlers results in restoration of function and resolution of pain. Little finger DIPJ arthrodesis is a valid method of treating posttraumatic arthritis in ball and bat sports.

A brief staurosporine treatment of mitotic cells triggers premature exit from mitosis and polyploid cell formation.

At any point during the progression of many tumor types, cells can develop a hyperploid DNA content. Hyperploid tumors are significant more aggressive, with a higher growth rate and a poor patient prognosis. Yeast genetics have implicated three important genes involved in DNA ploidy changes: cdc2, cyclin b, and a specific inhibitor of the p34(cdc2)/cyclin B kinase, rum1. Mutations in these genes uncoupled the dependence mitosis on DNA replication in the fission yeast, Saccharomyces pombe. It was proposed that the inactivation of the mitotic kinase complex, p34(cdc2)/cyclin B, induces a G(1), state wherein the cells re-replicate their DNA without an intervening mitosis. We show in this report that treatment of only M phase-arrested mouse cells, with the protein kinase inhibitor staurosporine, induced polyploidy. Nocodazole-arrested metaphase FT210 cells were pulsed with 100 ng/ml of staurosporine for 1 h. This 1-h treatment results in the inhibition of the mitotic p34(cdc2) kinase. The inhibition of the mitotic kinases leads to a reduction in the histone H1 and H3 mitotic-associated phosphorylations, chromosome decondensation and nuclear membrane reformation. When released into normal growth medium, these cells are reset to a G(1)state, re-replicate their DNA without completing mitosis, and become octaploid.

Morphology and immunology of circulating cells in leukaemic phase of follicular lymphoma.

Ten patients with follicular lymphoma presented with a high white cell count (45-220 x 10(9)/l) which resembled chronic lymphocytic leukaemia (CCL): all had pronounced splenomegaly and, except one, generalised lymphadenopathy. The blood lymphocytes were small with scanty cytoplasm, densely condensed nuclear chromatin, and deep clefts originating in sharp angles from the nuclear surface. CLL cells are larger, have more cytoplasm, a different pattern of chromatin condensation, and may have shallow nuclear indentations or foldings rather than clefts. The circulating follicular lymphoma cells had moderate to strong membrane immunoglobulins (SmIg), low mouse (M)-rosettes, strong reactivity with the monoclonal antibody FMC7, and occasional expression of the CD5-antigen; at least one third of cells in each case were positive with anti-cALLa (J5,CD10). Half the cases were referred as B-CLL but none had the typical B-CLL immunophenotype: weak SmIg, M-rosettes of greater than 50%, CD5 positive, FMC7 and J5 negative. The diagnosis of follicular lymphoma was confirmed by lymph node biopsy in seven of the 10 cases. The overall response to treatment was poor and five patients died within three years of diagnosis. This aggressive form of follicular lymphoma needs to be distinguished from B-CLL as different management is required.

Translocation t(11;13) and deletion of chromosome 7 in a patient with acute myelomonocytic leukemia.

A translocation between chromosomes 11 and 13, together with a deletion of the long arm of chromosome 7, was found in the bone marrow of a patient with acute myelomonocytic leukemia (AMMOL). All three breakpoints are believed to be associated with a predisposition to malignancy.

Effect of chronic cocaine on dopamine synthesis in the nucleus accumbens as determined by microdialysis perfusion with NSD-1015.

Reduced steady state formation of dihydroxyphenylalanine (DOPA) (47%) was found in the nucleus accumbens (N. ACC) of rats treated with ten days of repeated cocaine (10 mg/kg, i.p.) as compared to saline controls after NSD 1015 perfusion (10(-4) M) by microdialysis. In addition, prior to NSD 1015 perfusion, basal extracellular levels of the dopamine metabolite, dihydroxyphenylacetic acid (DOPAC) in the N. ACC were 33% lower in the chronic cocaine-treated animals. The results indicate the rate of dopamine synthesis in the N. ACC is significantly reduced by repeated cocaine administration.

Anomalous effect of mazindol on dopamine uptake as measured by in vivo voltammetry and microdialysis.

The effect of mazindol on the dopamine (DA) uptake system in the rat striatum was studied by in vivo voltammetry and microdialysis. An increase in the maximal uptake rate was observed by voltammetry 30 min after i.p. administration of 1, 5, 10, 15, and 20 mg/kg doses but not after a dose of 25 mg/kg, while stimulated release was enhanced at all doses. The increased maximal uptake is in contrast to increased levels of extracellular DA observed with microdialysis following mazindol administration. This divergence of action is anomalous in the context of current understanding of the DA uptake system.

Auto-immune haemolytic anaemia and Crohn's disease: a case report and review of the literature.

The association between ulcerative colitis and auto-immune haemolytic anaemia is well described. However, only two cases of auto-immune haemolytic anaemia occurring in association with Crohn's disease have been described in the literature. We report on a third case and discuss the importance of diagnosis and the therapeutic implications of this association.

Hypothyroidism and anaemia.

Hypothyroidism can lead to a wide variety of anaemic disorders, and numerous mechanisms are involved in the pathogenesis of these anaemias. Attention to the haematological status of hypothyroid patients is correspondingly important.

Excision-repair patch size in DNA from human KB cells treated with UV-light, or methyl methanesulfonate.

We have used the method of combined bromodeoxyuridine density label and radioactive label to measure the size of the repair patches appearing in the DNA of KB cells following treatment with UV-light or MMS. The repair patch size distribution was found to be the same for both agents, corresponding to the insertion of 34-40 nucleotides. These results, confirm recent results obtained by the bromodeoxyuridine-photolysis technique, that simple alkylating agents induce 'long patch' repair in human cells.

Excision repair of DNA in the presence of aphidicolin.

During excision repair of UV light or dimethyl sulphate (DMS)-induced damage to DNA the patch size for actively replicating KB or T98G cells is around 20 nucleotides. When confluent T98G cells or 'quiescent' KB cells are used the patch size is around 10 nucleotides. This value can be increased to around 20 nucleotides in T98G cells if a large excess of BrdUrd is included in the repair incubation medium. With 'quiescent' KB cells the patch size is not increased by excess BrdUrd. For all of these experimental conditions, when excision repair of UV or DMS damage takes place in the presence of aphidicolin, the patch size is found to be several times that found in its absence. Given the inhibitory specificity of aphidicolin for DNA polymerase alpha these results provide additional evidence that DNA polymerase alpha plays a role in the excision repair of DNA damaged by UV light or DMS. It is postulated that aphidicolin interrupts the processivity of the DNA polymerase alpha holoenzyme and allows an exonuclease to enlarge the repair site.

Metolazone and axillary vein thrombosis.

The usage of powerful diuretics, such as metolazone, may lead to thrombotic complications.

Insulin-dependent diabetes mellitus, myasthenia gravis, pernicious anaemia, autoimmune thyroiditis and autoimmune adrenalitis in a single patient.

Two classical autoimmune polyendocrine deficiency syndromes with heritable tendencies are described, Type 1 diabetes mellitus being associated with the Type 2 polyendocrine deficiency syndrome (Schmidt's syndrome). A man with Type 1 diabetes mellitus is described who developed an unusual combination of five autoimmune conditions (myasthenia gravis, Addisonian pernicious anaemia, adrenalitis and thyroiditis) which did not fit into the Type 1 or Type 2 classical polyendocrine deficiency syndromes. This suggests that the autoantibody, biochemical and haematological screening of affected individuals and their relatives should be extended to anticipate a wider range of potential autoimmune conditions.

Vertebral artery thrombosis: a rare presentation of primary polycythaemia.

Primary polycythaemia, also known as polycythaemia vera (PV), is a myeloproliferative neoplasm (MPN) which is associated with arterial and venous thrombosis and which can contribute to significant morbidity and mortality if untreated. Arterial thrombosis accounts for a large proportion of PV-related thrombotic events which may manifest as stroke and myocardial infarction. There is an abundance of literature documenting thrombosis arising in the cerebral vasculature secondary to PV. However, vertebral artery thrombosis associated with PV has not been previously described. We present a case of vertebral artery thrombosis as the presenting manifestation of PV. This case demonstrates the importance of recognising MPNs as a cause of an unusual presentation of thrombosis.

Best practice in primary care pathology: review 10.

This tenth best practice review examines four series of common primary care questions in laboratory medicine: (i) antenatal testing in pregnant women; (ii) estimated glomerular filtration rate calculation; (iii) safety testing for methotrexate; and (iv) blood glucose measurement in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

Falsely high glycated haemoglobin [HbA1C] because of haemoglobin OSU-Christiansborg.

Glycated haemoglobin (HbA1c) is routinely used to assess the degree of glycaemic control in diabetic patients. We report a case of a 73 year old diabetic woman who had an elevated HbA1c of 13.4%. She was on maximum oral hypoglycaemic agents and was commenced on insulin. However, her HbA1c continued to remain high at 20.4%. Subsequent tests revealed that she had a haemoglobin variant, Haemoglobin Osu-Christiansborg, causing the falsely high glycated haemoglobin.

Coexpression of cytokeratin and vimentin.

The reported incidence of cytokeratin and vimentin intermediate filament coexpression is rapidly expanding. An up-do-date list of the instances in which this occurs is presented and the implications of this event are discussed.