SUMMARYEarlier in vitro studies suggest opposing roles of laminin and fibronectin in regulation of differentiated properties of vascular smooth muscle cells. To find out if this may also be the case in vivo, we used immunoelectron microscopy to study the distribution of these proteins during formation of intimal thickening after arterial injury. In parallel, cell structure and content of smooth muscle ␣-actin was analyzed. The results indicate that the cells in the normal media are in a contractile phenotype with abundant ␣-actin filaments and an incomplete basement membrane. Within 1 week after endothelial denudation, most cells in the innermost layer of the media convert into a synthetic phenotype, as judged by loss of actin filaments, construction of a large secretory apparatus, and destruction of the basement membrane. Some of these cells migrate through fenestrae in the internal elastic lamina and invade a fibronectin-rich network deposited on its luminal surface. Within another few weeks a thick neointima forms, newly produced matrix components replace the strands of fibronectin, and a basement membrane reappears. Simultaneously, the cells resume a contractile phenotype, recognized by disappearance of secretory organelles and restoration of ␣-actin filaments. These findings support the notion that laminin and other basement membrane components promote the expression of a differentiated smooth muscle phenotype, whereas fibronectin stimulates the cells to adopt a proliferative and secretory phenotype. (J Histochem Cytochem 45:837-846, 1997)

A total of 298 subjects were randomized to treatment. Of those subjects included in the intent-to-treat efficacy analysis (n = 291), a statistically greater proportion of the MFNS group than the placebo group had improvements in investigator-assessed nasal congestion score between baseline and end point (the primary outcome) (74.3% vs 46.8%; p < 0.001). Significant benefits of MFNS were also seen for secondary end points, including polyp size, sense of smell, peak nasal inspiratory flow, therapeutic improvement, and quality-of-life measures. MFNS was well tolerated, with no unusual or unexpected adverse events.

The checklist increased OR teams' awareness of patient-related issues, the procedure and expected risks. It also enhanced team communication and prevented communication failures. Our findings support use of the WHO checklist in various surgical fields.

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Objectives: The World Health Organisation has developed a Surgical Safety Checklist to improve patient safety during surgery. This checklist has reduced postoperative morbidity and mortality. Prior to checklist implementation, we wanted to evaluate how it would fit into the process of otorhinolaryngology-head and neck surgery and whether it would have an impact on the awareness of safety-related issues. Design: A structured questionnaire was addressed to the operating room team after consecutive operations during a 1-month period before and after checklist implementation. Setting and participants: This study was conducted at the Department of Otorhinolaryngology at the Helsinki University Central Hospital as a part of a multicentre study. Responses were received regarding 288 operations before and 412 after checklist implementation. Main outcome measures: The questions concerned patient-related safety checks, teamwork and communication.Results: The checklist improved verification of the patient's identity (P < 0.001). Awareness of the patient's medical history, medication and allergies increased (P < 0.001). Knowledge of the names and roles among the team members improved. The otolaryngologists and anaesthesiologists discussed possible critical events more often (P < 0.001), and postoperative instructions were better recorded after use of the checklist. In addition, the checklist enhanced communication between operation team members. Conclusions: Our study confirms that the Surgical Safety Checklist fits well into the surgical working process in otorhinolaryngology-head and neck surgery improving the sharing of patient-related medical information between team members. Development of a specific checklist for otolaryngology calls for further study.Adverse events in surgery often result from simple human error. All types of surgeries including otolaryngology are prone to complications related to the wrong side ⁄ wrong site, wrong procedure and wrong patient (WSPE). These complications are often preventable by reducing risk for serious mistakes. 1-5The World Health Organisation (WHO) has developed a Surgical Safety Checklist to improve patient safety in the operating room. In an international multicentre study, this checklist was associated with significant reductions in complications and deaths regardless of the healthcare system or the economical setting. 6 Few studies concern implementation of this checklist in various surgical surroundings, which has diminished complications in urgent surgery by more than a third. 7 In paediatric surgery, it has improved teamwork and communication. 8 Similarly, in a study on trauma and orthopaedic patients, team communication improved, but no significant reduction in early complication emerged.The idea of the checklist is to be an add-on security tool for the defined safety standards. This checklist should be customised, some suggest, to meet the needs of quite different surgical specialities and institutions. 8,9 Thus far, authors have failed to find published data on checklist...