Substantive validity of working memory measures in major cognitive functioning test batteries for children

Working memory scales of commonly used measures of cognitive functioning for children are evaluated for substantive validity by comparing processes needed for subtest performance to component processes in Baddeley's working memory model. Comprehensive measures of working memory need to assess phonological and visuospatial working memory as well as storage-retrieval and manipulation in both components. The Wechsler Intelligence Scale-Fourth Edition (WISCIV) working memory index and the Woodcock-Johnson III Tests of Cognitive Abilities broad short-term memory factor do not assess visuospatial working memory. The Stanford-Binet Intelligence Scales, Fifth Edition and WISCIV Integrated have potential for being comprehensive, substantively valid measures of working memory, but they need improvement and further investigation. It is imperative that solid, empirically based definitions of constructs serve as the foundation for comprehensive assessment when measures are used to form hypotheses and make decisions regarding a child's future.

Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building

There has been increased concern over health effects related to potential exposure of building occupants to bioaerosols. We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination. We performed environmental tests to evaluate potential exposure to fungi, and we used mycotoxin-specific IgG antibody in serologic studies in the attempt to evaluate exposure to mycotoxins. Extensive fungal contamination was documented in many areas of the building. Penicillium, Aspergillus, and Stachybotrys species were the most predominant fungi found in air sampling. Our serologic test was not useful in differentiating workers who were probably occupationally exposed to mycotoxins from those who were not; however, it did yield evidence that individuals may make specific IgG antibodies to macrocyclic tricothecene mycotoxins. Further research is needed concerning health effects related to bioaerosol exposures, particularly regarding markers of exposure to specific fungi that may produce mycotoxins. In the absence of clinical tools specific for evaluation of mycotoxin-related illness, a systematic clinical approach for evaluating persons with suspected building-related respiratory illness is warranted.

Bilateral metachronous rupture of the patellar tendon

We present a case of a 37-year-old man who sustained a rupture of his left patellar tendon approximately 48 hours after rupturing his right patellar tendon. This temporal pattern illustrates two important aspects of patellar tendon injury-that rupture of the degenerated patellar tendon may occur without any prodromal warning and that it may elude detection even if the patient is examined by several physicians.

The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: a French prospective multicentre study

OBJECTIVE

To evaluate in a prospective multicentre study (five centres) the preliminary results regarding efficacy and morbidity of the new tension-free transvaginal tape (TVT) technique in the treatment of urinary stress incontinence (USI) in women.

METHODS

From November 1996 to May 1999, 52 women of mean age 64 (range 37--91) years underwent the TVT procedure to treat isolated grade 2 or 3 USI (44 cases) or grade 1 or 2 USI associated with uterine or rectal prolapse surgery (8 cases). Twenty-nine patients (55.8%) presented recurrent USI (1--4 previous procedures). Clinical data showed urethrovesical junction hypermobility in 35 cases (67.3%), isolated intrinsic sphincter deficiency (ISD) in 17 cases (32.6%) and pelvic organ prolapse in 8 cases. Urodynamics confirmed ISD in 27 cases (51.9%) with a mean urethral closure pressure of 18.5 (range 7--25) cm H(2)O. All data were collected by surgeons on a questionnaire.

RESULTS

The surgical procedure was performed under spinal cord anaesthesia in 82.7% of patients (local anaesthesia 11.5%) with a mean operation time of 30 (range 20--60) min for TVT implantation. Six bladder injuries (11.5%) were identified and the needle was repositioned. Mean hospital stay was 2.5 (range 1-7) days in the group who underwent TVT alone. Mean follow-up of continence was 15.2 (range 6--36) months: 83% of patients were dry and 17% were improved. Nine patients (17.3%) required self-catheterization for 2--10 days postoperatively. No recurrence of USI, defect healing or tape rejection were reported.

CONCLUSION

TVT is a new technique for the surgical treatment of USI which is useful for recurrent cases. The advantages are simplicity, low morbidity, reproducibility and reduced operative time. These early results indicate the technique is effective in correcting incontinence and is locally well tolerated. But these are preliminary data and the long-term outcome on USI and the urethra is needed.

Liposomal daunorubicin in the treatment of relapsed or refractory non-Hodgkin's lymphoma

PURPOSE

To assess the efficacy and toxicity of liposomal daunorubicin administered as a two-hour intravenous infusion to patients with relapsed or refractory non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

Eligible patients had relapsed or refractory NHL with measurable or evaluable disease, and low grade, select intermediate grade, or mantle cell pathologic types. Prior exposure to an anthracycline or anthracenedione was allowed. Liposomal daunorubicin at a dose of 100 mg/m2 was given intravenously over a minimum of 120 minutes every 3 weeks. as a single agent.

RESULTS

Thirty-three patients were accrued: twenty-three (70%) had low-grade histologies; six (18%) had intermediate-grade histologies (follicular large-cell and diffuse small cleaved); and four (12%) patients had mantle-cell lymphoma. Eighteen (55%) had received two or more prior regimens; fourteen (42%) received a prior anthracycline. A median of six cycles of liposomal daunorubicin were administered (range 1-15). Of 31 patients evaluable for response, 2 complete and 10 partial remissions were documented for a major response rate of 39% (95% confidence interval (CI): 22%-58%). The median duration of response was 19.5 months (range 4.3-41.1+). Six responders (50%) had received a prior anthracycline; one responder had mantle-cell histology. The major toxicities were grade 3 or 4 neutropenia in 26 patients (79%), mild to moderate nausea in 22 (67%), and fatigue in 16 (48%).

CONCLUSIONS

Liposomal daunorubicin at 100 mg/m2 every three weeks has activity in patients with relapsed or refractory NHL, including patients with prior exposure to an anthracycline. Further studies of liposomal daunorubicin in combination with other agents are warranted.