Biomedical subjects
Publications and source records attributed to K Cash.
The Wittgensteinian idea of family resemblances and meaning is explained. The idea of nursing is examined from this standpoint as are the knowledge claims of several influential nursing models. It is argued that the task of building a general model of nursing is theoretically impossible. The political and educational implications of the above argument are developed.
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We describe two patients who presented with vasculitic, ulcerative skin lesions that had the histologic features of lymphomatoid granulomatosis or angiocentric T-cell lymphoma. These patients were found to have antibodies to human T-cell lymphotropic virus type I.
BACKGROUND: Although red cell (RBC) antibodies of the Dombrock blood group system have been reported to cause acute and delayed hemolytic transfusion reactions, the difficulty in identifying these antibodies in patients with multiple RBC alloantibodies has not previously been discussed. The cases of four sickle cell disease patients who developed Dombrock system antibodies after transfusion, three of which were discovered in association with hemolytic transfusion reactions, are reported. CASE REPORTS: Patient 1 was a 36-year-old woman with multiple RBC alloantibodies. Because of the lack of an increment in hematocrit after transfusion, an investigation was performed; it revealed anti-Do(b) in the serum. Patient 2 was a 30-year-old woman with known anti-C, -E, -K, -S, -Fya, and -Bga. She had received a transfusion 10 days previously. Before further transfusion was begun, antibody identification revealed weak nonspecific reactions, which were thought to be HLA antibodies. She developed acute hemolysis during RBC exchange for acute chest syndrome; anti-Doa was identified in both the serum and eluate. She received 2 units of Do(a-) RBCs without complication. Patient 3 was a 35-year-old woman with known anti-C, -E, -K, -Fya, and -N and a warm autoantibody. Two weeks after transfusion, she had a delayed hemolytic transfusion reaction coincident with the identification of anti-Doa. Patient 4 was a 33-year-old woman with known anti-C, -V, -K, -Fya, -Fy3, Jkb, -S, -N, and -Ytb, who developed anti-Doa 8 weeks after transfusion. CONCLUSION: An association of Dombrock blood group system antibodies with hemolytic reactions is demonstrated in alloimmunized sickle cell disease patients. In all four cases, identification of Dombrock system antibodies was delayed because high-titer low-avidity antibodies, HLA antibodies, or autoantibodies were thought to explain the serologic findings. The presence of Dombrock system antibodies should be considered when unexplained serologic reactivity occurs during antibody identification in this population.
Recent manometric and radiological studies suggest that the upper oesophageal sphincter has poor compliance in patients with a pharyngeal (Zenker's) diverticulum. To test the hypothesis that this phenomenon is related to structural changes within the cricopharyngeus muscle we examined, histologically, muscle strips from 14 patients with a Zenker's diverticulum and compared them with control tissue obtained at autopsy from 10 non-dysphagic individuals. The cricopharyngeus muscle from patients and controls differed from inferior constrictor muscle by virtue of type 1 fibre predominance and greater fibre size variability. Ragged red fibres and nemaline bodies are a normal finding in the cricopharyngeus. Marked differences were observed in the cricopharyngeus muscle of Zenker's patients which demonstrated fibro-adipose tissue replacement and fibre degeneration. It is concluded that these structural changes may account for the observed diminished upper oesophageal sphincter opening and dysphagia in patients with Zenker's diverticulum.
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