Growth of Pakistani children in relation to the 1990 growth standards

This study was designed to compare the growth of Pakistani schoolchildren in the UK with the 1990 UK growth standards. Measurements of height, weight, and sitting height were performed on 785 Pakistani schoolchildren aged 5-14 years with the mean values for each age and sex being plotted on the UK growth standards. The results were expressed as SD scores relative to the 1990 reference data. The mean height for the boys was only 0.2 SD scores below the mean for the new growth standards with the mean height for the girls being 0.4 SD scores below the mean. The mean values for weight and body mass index were 0.3 and 0.5 SD scores less than the mean for boys and girls respectively. This study demonstrates that the growth of Pakistani schoolchildren in the UK is comparable to the 1990 UK growth standards with only minor differences. It is not safe to assume that short stature or low body weight in a Pakistani child is due to his or her ethnic background.

Esophageal pressure measurements in cardiopulmonary exercise testing

STUDY OBJECTIVES

We sought to determine the adaptability and effectiveness of a new esophageal balloon technique to measure changes in esophageal pressure (Pes) as a reflection of pleural pressure with progressive incremental exercise testing in normal subjects.

DESIGN

An 8F (0.9 cm) esophageal balloon catheter (Smart Cath; Allied Health Products; Riverside, Calif), a CP-100 pulmonary monitor (BiCore Monitoring Systems PC-100; Irvine, Calif), and a flow transducer (Var flex; Allied Health Products; Riverside, Calif) were connected to a breathing valve (model 2700; Hans-Rudolph Inc; Kansas City, Mo). This apparatus was then used to measure Pes during a graded cardiopulmonary exercise test (CPX) to symptom limitation.

SETTING

University-affiliated Veterans Affairs Hospital.

PARTICIPANTS

Eight nonsmoking volunteers with normal results of pulmonary function tests.

INTERVENTIONS

Plots of deltaPes against pressure time product (PTP), minute ventilation (VE), and oxygen consumption (VO2) were obtained. Pes at baseline, anaerobic threshold (AT), and maximum oxygen consumption (VO2max) were obtained by comparing the Pes measurements from the computer printout to the corresponding breath-by-breath measurements on the CPX.

MEASUREMENTS AND RESULTS

The flow transducer (Varflex) connection added only 20 mL of dead space to the standard mouthpiece apparatus. The mean maximum work performance was 203+/-32 W. The mean VO2max was 29+/-9 mL/kg/min. The Pes at AT was 16+/-3 cm H2O. The Pes at maximal exercise was 42+/-16 cm H2O.

CONCLUSION

The small esophageal balloon was well tolerated by all subjects. Plots of deltaPes vs PTP, VE, and VO2 demonstrated a linear correlation. This apparatus could be added to the standard CPX to assess the contribution of the diaphragm and respiratory muscles in patients with dyspnea.

Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development

Investigated problem-solving ability and reported regimen adherence among children, early adolescents, and middle adolescents with IDDM in response to hypothetical social situations where a choice between diabetes regimen adherence and peer desires must be made. Sixty-seven 8- to 17-year-olds with IDDM from two distinct U.S. geographical areas participated. Results indicated that compared to children with IDDM, adolescents with IDDM had better problem-solving abilities in response to social pressure situations, possibly reflecting their greater cognitive maturity. However, adolescents were also more likely to choose behaviors that are less regimen adherent. Differences in levels of problem-solving ability and adherence between the two regional subsamples were also found. Similar developmental patterns were found in both groups, showing the robust nature of the observed age-related trend of decreasing adherence in social situations despite increasing problem-solving abilities. Findings were interpreted in the context of normal adolescent development. Results are conceptually important for those interested in the transaction between peer and social influences and adherence for children and adolescents with IDDM, as well as other health behaviors.

Effect of severity of meningitis on fungicidal activity of flucytosine combined with fluconazole in a murine model of cryptococcal meningitis

We studied the effect of the severity of meningitis on the response to therapy with fluconazole and flucytosine in a murine model of cryptococcal meningitis. Meningitis was established by intracerebral injection of Cryptococcus neoformans. The severity of meningitis was varied by delaying the onset of treatment from 3 to 7 days. Animals were sacrificed after 14 days of treatment, and the numbers of C. neoformans per gram of brain tissue were quantified. The range of effective dose combinations of fluconazole and flucytosine became progressively reduced as the severity of meningitis increased. The magnitude of treatment effect, as measured by the numbers of CFU/gram of brain tissue, was also reduced with increasing severity of meningitis. In this model, as the severity of meningitis increases, higher doses of fluconazole are required to achieve equivalent levels of activity. The combination of fluconazole and flucytosine appears to have the most-potent antifungal effects. This is most readily observed in animals with more-severe meningitis.

Trichotillomania: a comprehensive behavioral model

As our knowledge of chronic hair pulling as neither rare nor benign has increased, so has the need for a comprehensive framework to guide our conceptualization of this disorder for both research and clinical work. Such a model is presented which incorporates (a) the varied antecedents that both cue the impulse to pull and facilitate pulling, (b) the wide array of behaviors involved in the actual pulling, and (c) the full range of consequences of pulling. The cyclical nature of pulling episodes is highlighted.

Acute oropharyngeal palsy is associated with antibodies to GQ1b and GT1a gangliosides

Three patients with acute oropharyngeal palsy had high titre anti-GQ1b and anti-GT1a IgG antibodies. No patients had ophthalmoplegia or ptosis. In all patients limb ataxia or areflexia were present without notable limb weakness. These patients describe an oropharyngeal variant of Guillain-Barré syndrome in terms of anti-GQ1b antibody reactivity and show that high titre anti-GQ1b antibodies, serologically indistinguishable from those found in Miller Fisher syndrome, can occur in a clinical setting without ophthalmoplegia. The anti-GQ1b and anti-GT1a antibody assays may be helpful tests when considering the differential diagnosis of acute oropharyngeal palsy.

Multiple rice body formation in chronic subacromial/subdeltoid bursitis: MR appearances

Multiple rice body formation is an unusual complication of chronic bursitis. Clinically and macroscopically, it can resemble synovial osteochondromatosis. Radiographic and MR appearances, however, may allow an accurate pre-operative diagnosis. The imaging features of two middle-aged women with multiple subacromial/subdeltoid bursa rice bodies are described.

Divorce versus intact parental marriage and perceived risk and dyadic trust in present heterosexual relationships

The relationship between parental divorce and intimate relationships in late adolescence was estimated for 60 undergraduates (17 men, 43 women). Subjects from divorced families were assessed to address whether they perceived their present heterosexual relationship to be risky and if they were less trusting of their partners than were subjects from intact families. Divorce appears to be transmitted through generations in a family. Dyadic Trust and Perceived Risk were investigated as two learned components passed down within families, thereby contributing to a cycle of divorce. A correlation was found between parents' marital status and children's trust in their dating partners. An inverse relationship was indicated; when ratings of trust are low, ratings of perceived risk are high. A possible order of this relationship was discussed, i.e., low dyadic trust preceded perceived risk. One implication of these findings was that children of divorced parents may benefit from being shown how failures in relationships may result from negative expectations.

Ear clicks in palatal tremor caused by activity of the levator veli palatini

We describe a patient who developed palatal tremor and presented with ear clicks that appeared to originate from activity of the levator veli palatini and not the tensor veli palatini. This was treated with botulinum toxin. We discuss the motor innervation of the palate in the context of our case, our findings in terms of classification, and how the lower cranial nerve nuclei are involved in the etiology of palatal tremor.

Surgical management of haemangioendothelioma of the spine

Four patients with haemangioendothelioma of the spine which was treated surgically are presented. Two were male and two female, mean age 30 years (range 5-60). All tumours were sited in the thoracic spine between T5 and T10; three were primary and one metastatic from a hepatic haemangioendothelioma. Each patient had a significant neurological deficit at presentation; three were paraplegic. A diagnosis of vertebral neoplastic disease was suggested on plain radiographs, and in three cases this was supported by computed tomography or magnetic resonance imaging. Two patients underwent anterior decompression and posterior instrumented stabilisation, one anterior decompression alone and one posterior decompression followed by tumour vessel embolisation and then anterior decompression. Intra-operative blood loss was a significant feature despite the use of hypotensive anaesthetic techniques and local haemostatic agents. Three of the tumours were tested for Factor VIII (a tumour for vascular tumours), and all proved positive. In these, sufficient histological material was available to grade the tumours according to the classification of Campanacci et al. [1]. All were grade II. Three patients recovered completely from paraglegia; one had residual mild spasticity which required the use of a walking aid. The mean improvement in Frankel grade was 2.5 (range 1-4). In two the tumour recurred outside the spine within 18 months; one had subsequently died. The presentation, investigation and results of surgery for haemangioendothelioma of the spine are presented. Particular attention is drawn to the neurological status at presentation, the effect of pre-operative tumour embolisation and the dramatic recovery that can be achieved in these patients following surgery.

Change in maternal depressive mood: unique contributions to adolescent functioning over time

There is substantial evidence of the relationship between maternal depressive mood and problematic child functioning. The vast majority of studies in this area concentrate on cross-sectional designs and depressive mood at one point in time. In contrast to the existing literature, the goal of this study was to investigate the relation of change in maternal depressed mood across time and adolescent functioning, including the possible moderating effects of gender of the adolescent and the marital status of parents. Regression analyses indicated that increased depressed mood across one year predicted teacher report of higher levels of externalizing and internalizing problems and lower levels of social competence, above that which could be predicted from the initial assessment of depressed mood. With one exception, neither gender nor parental marital status qualified the findings. The results suggest that static levels of maternal depressive mood are not sufficient for forecasting adolescent functioning. Future research needs also to consider change in such mood.

Economic evaluation of immunoprophylaxis in children with recurrent ear, nose and throat infections

This study compares the costs of immunoprophylaxis versus no immunoprophylaxis in children with recurrent ear, nose and throat (ENT) infections (otitis media and rhinopharyngitis) using ribosomal immunotherapy ('Ribomunyl'). The per-patient cost of ribosomal immunotherapy (FF297) is offset by direct savings garnered through the prevention of many acute infectious episodes. The net 6-month per-patient savings associated with immunoprophylaxis range from FF272 to FF1704, depending on the indication and the type of treatment-cost estimate. Saved healthcare resources include physician consultations and visits, laboratory tests, medicotechnical services (audiometric tests) and antibiotic therapy. Sensitivity analysis of efficacy and treatment-cost estimates enabled threshold ranges of incremental efficacy to be identified. Cost-equivalence between the 2 treatment options was found to exist when the incremental efficacy of immunoprophylaxis lay between 7.4 and 17.5% (recurrent otitis media), and between 8.9 and 26.1% (recurrent rhinopharyngitis). Thus, even when clearly lower incremental efficacy rates than those reported in controlled clinical trials (approximately 40 to 60%) are assumed, ribosomal immunotherapy can still be expected to be cost effective. An analysis of the perspectives of the various payers in the French healthcare system demonstrated that net savings occurred for all payers involved. However, social security insurance would gain most from an immunoprophylaxis programme. Based on the evidence presented here for France, physicians and payers should give increased attention to this treatment option.

Elimination of infection in pulpectomized deciduous teeth: a short-term study using iodoform paste

This study was conducted to retain the pulp-involved deciduous teeth in dental arches and were restored to function by elimination of infection in pulpectomized deciduous teeth using iodoform paste. Clinically the teeth were evaluated for pain, mobility, and presence or absence of sinus for 3 months. We concluded that the iodoform paste is a suitable root canal filling material for single-visit pulp canal treatment in chronic pulp-infected deciduous teeth.

Nerve root hypertrophy in chronic inflammatory demyelinating polyneuropathy

A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) and central demyelinating disease is described in whom striking nodular filling defects on multiple lumbar-sacral nerve roots, mimicking neurofibromata, were observed at myelography and magnetic resonance imaging. We suggest that these lesions are secondary to recurrent segmental demyelination and remyelination and that the differential diagnosis of this radiological feature should include CIDP.

Strategic planning: a practical approach

Strategic planning identifies a department's environmental factors while establishing its purpose, mission, philosophy and goals and developing a long-range plan and objectives. This hospital's practical approach mirrors the nursing process related to assessment, diagnosis and planning, implementation and evaluation.

The role of paternal variables in divorced and married families: predictability of adolescent adjustment

The predictability of adolescent adjustment, based on teacher reports, in divorced and married families was examined in relationship to four variables: paternal mood, spouse-ex-spouse relationship, father-adolescent relationship, and parental visitation. Analyses indicated that the father-adolescent relationship was predictive of adolescent functioning in divorced families, and the spousal relationship and paternal mood were similarly predictive in married families.

Generalized anxiety disorder patients seek evaluation for cardiological symptoms at the same frequency as patients with panic disorder

Although panic disorder (PD) and generalized anxiety disorder (GAD) have similar somatic symptoms, panic attacks with chest pain and/or palpitations may seem more likely to be mistaken for heart attacks because of their acute onset. One would therefore expect that PD patients are more likely than GAD patients to seek cardiological consultations. In a survey of 146 PD and 154 GAD patients entering a multi-site drug trial, we found virtually identical rates of such consults. Approximately 50% of each patient group sought medical evaluation for cardiac symptoms. Furthermore, 40% of each group had standard treadmill evaluations and 33% reported having an echocardiogram. This study suggests that future epidemiological studies in cardiology populations should include probes for generalized anxiety disorder.

Panic disorder history in the families of patients with angiographically normal coronary arteries

OBJECTIVE

The authors evaluated the diagnostic validity of an interview-based panic disorder diagnosis in cardiology chest pain patients with angiographically normal coronary arteries.

METHOD

Patient probands with normal coronary arteries (N = 65) were first contracted immediately after their normal angiogram and were given a structured diagnostic interview. On the basis of the results of the interview, probands were grouped as having panic disorder (N = 19), panic attacks that did not meet frequency criteria for panic disorder (N = 17), or no panic (N = 29). At a later time, patient probands were recontacted and given a structured family history interview that inquired about psychopathology in their first-degree biological relatives (N = 544).

RESULTS

As predicted, panic disorder was significantly more prevalent among the first-degree relatives of probands with normal coronary arteries diagnosed with panic disorder or panic attacks than among the family members of probands with normal coronary arteries without panic (17.4% versus 15.7% versus 4.0%). Family members of probands with panic attacks were significantly more likely to be diagnosed with major depression than were the family members of probands with no panic; however, differences did not reach significance for family members of the panic disorder proband group. Groups did not differ significantly in familial alcoholism.

CONCLUSIONS

These data support the construct validity of an interview-based panic disorder diagnosis among patients with chest pain and normal coronary arteries and suggest that these patients could benefit from treatment for panic disorder.

Panic disorder in the families of patients with normal coronary arteries and non-fear panic disorder

Patients with non-fear panic disorder (NFPD) meet DSM-III-R criteria for panic disorder, but do not report subjective fear or anxiety. Although apparently common in medical settings, this controversial group is in need of further diagnostic validation. This study assessed family history of panic disorder in patients with chest pain and normal coronary arteries (CP/NCA) and either NFPD, panic disorder with fear, or no panic. It was hypothesized that the two panic disorder groups would have similar, elevated rates of panic disorder in their first-degree relatives, compared to patients without panic. The results support the hypothesis; about 17% of the first-degree relatives of both NFPD and panic disorder patients were diagnosable with panic disorder according to proband interviews, whereas only 4.6% of the first-degree relatives of patients without panic were so diagnosable. These results support the diagnostic validity of NFPD in CP/NCA patients, because such patients had a family history of panic disorder similar to patients with a more classical panic disorder presentation. The lack of fear symptoms and behavior in NFPD may cause panic disorder to be overlooked as a potential cause of somatic symptoms in patients with no medical explanation for their condition.

Response to 35% CO2 in patients with chest pain and angiographically normal coronary arteries

OBJECTIVES

Several interview studies have suggested that panic disorder (PD) exists in patients with angiographically normal coronary arteries (NCA). Interview studies require corroboration by other studies in order to validate them. The purpose of this study is to test whether response to the inhalation of 35% CO2 reliably discriminates between PD and non-panic disorder patients in this population.

METHOD

Three groups were studied: six with NCA and PD, five with NCA and no PD, and ten in the control group. All subjects breathed room air, then 35% CO2 in a single-blind fashion. Each completed the Acute Panic Inventory (API) before and during the procedure.

RESULTS

The NCA-panic group scored significantly higher than the other two groups on the Acute Panic Inventory from baseline to post-inhalation.

CONCLUSION

Despite several methodological limitations including a relatively small number people in each cells, 35% CO2 was shown to trigger more intense responses in panic patients, thus helping to validate the interview findings.