Suppurative myositis in children

Three cases are reported of pyogenic (non-tuberculous) myositis involving the ilio-psoas and/or iliacus muscles in children presenting to John Hunter Hospital, Newcastle, Australia, in a 12-month period. In one, cultures grew Haemophilus influenzae type B and in the other two Staphylococcus aureus was isolated. Biopsy of the abscess cavity from the second child confirmed an antecedent haematoma as the underlying cause. The third had underlying sacroiliac septic arthritis with a history of antecedent trauma. The classification, investigation, and treatment of myositis is discussed.

Lamellar biogels: fluid-membrane-based hydrogels containing polymer lipids

A class of lamellar biological hydrogels comprised of fluid membranes of lipids and surfactants with small amounts of low molecular weight poly(ethylene glycol)-derived polymer lipids (PEG-lipids) were studied by x-ray diffraction, polarized light microscopy, and rheometry. In contrast to isotropic hydrogels of polymer networks, these membrane-based birefringent liquid crystalline biogels, labeled L-alpha,g, form the gel phase when water is added to the liquid-like lamellar L-alpha phase, which reenters a liquid-like mixed phase upon further dilution. Furthermore, gels with larger water content require less PEG-lipid to remain stable. Although concentrated (approximately 50 weight percent) mixtures of free PEG (molecular weight, 5000) and water do not gel, gelation does occur in mixtures containing as little as 0.5 weight percent PEG-lipid. A defining signature of the L-alpha,g regime as it sets in from the fluid lamellar L-alpha phase is the proliferation of layer-dislocation-type defects, which are stabilized by the segregation of PEG-lipids to the defect regions of high membrane curvature that connect the membranes.

Effect of ranitidine on intragastric pH and stress-related upper gastrointestinal bleeding in patients with severe head injury

We conducted a double-blind, placebo-controlled study to evaluate the effects of ranitidine on intragastric pH and upper gastrointestinal tract bleeding in severe head injury patients. Within 24 hr of the precipitating trauma, 34 adults with Glasgow coma scale scores < or = 10 were randomized to a 6.25 mg/hr ranitidine continuous infusion or placebo for a maximum of 72 hr. Intragastric pH was recorded via an intragastric pH electrode. Patients with hematemesis, hematochezia, bright red blood, or "coffee ground" nasogastric tube aspirates plus a 5% decrease from baseline in hematocrit were considered to have gastrointestinal bleeding. Ranitidine patients maintained a significantly greater mean pH than placebo patients (placebo 2.2, ranitidine 4.1; P < 0.01). All patients had at least two bleeding risk factors at study entry. No ranitidine patients (0/16) developed bleeding compared with five (5/18) placebo patients (P < 0.05). Ranitidine continuous infusion provided consistent intragastric pH control and significant protection from stress-related upper gastrointestinal tract bleeding in a high-risk patient population.

The process of loneliness for female adolescents: a feminist perspective

Although it has not been established that females are lonelier than males, adolescents are particularly vulnerable to loneliness. A feminist, grounded-theory study was conducted to explore the everyday loneliness experiences of 10 white, middle-class females living in an urban/suburban area in New Brunswick, Canada. Creating Connections, the core variable, emerged as the social process involved as the young women learned to deal with loneliness. The complexity of the phenomenon is evident in the fact that various combinations of disconnecting factors and intervening factors were found to influence the dimensions of loneliness (i.e., intensity and duration). The interaction of these factors and various strategies used to manage loneliness--creating connections, emoting, and creating actions--completed the nonlinear process. A significant, yet paradoxical, finding was that the relationships that were helpful in the resolution of loneliness could also be responsible for its creation and maintenance.

The relationship between health beliefs, adherence, and metabolic control of diabetes

There is evidence that an individual's health beliefs influence performance of health behaviors. The purpose of this study was to determine whether health beliefs in persons with diabetes could be modified during a clinical education program and whether the health beliefs were related to adherence to self-care instructions and metabolic control of diabetes. Health beliefs and HbA1c were measured at baseline in 189 adult outpatients with diabetes. Diabetes educators then attempted to modify health beliefs that were not conducive to positive health behaviors. Following education, some health beliefs were modified in a positive direction. Modest, but statistically significant increases in perceived severity of diabetes, perceived ability to carry out recommended behaviors, and perceived benefits of treatment were observed. Although HbA1c improved significantly in a subgroup of patients, this improvement could not be directly associated with any health belief or with self-reported adherence by the measures used in this study.

Dropout and relapse during diabetes care

OBJECTIVE

To determine factors associated with dropout and relapse during chronic diabetes care.

RESEARCH DESIGN AND METHODS

Private practice outpatient treatment-education program for adult diabetes was surveyed. Retrospective analysis was done, involving 422 patients for up to 3 yr.

RESULTS

Of the patients in the study, 12% dropped out after the initial visit, and 33% of the residual cohort dropped out during each subsequent 6-mo period. Factors associated with dropout included distance from home to clinic > 100 miles, lack of insulin treatment, and cigarette smoking. In patients who remained in follow-up, a significant decrease in HbA1C occurred during the first 6 mo, but 40% of the patients relapsed between 6 and 12 mo. Frequency of relapse declined as time passed. Relapse was more frequent in women.

CONCLUSIONS

Dropout from treatment and relapse after temporary improvement account for a substantial amount of uncontrolled diabetes, and overcoming the obstacles of dropout and relapse has potential for significant improvement in diabetes care.

Thick malignant melanomas (greater than 3 mm Breslow) with good clinical outcome: a histological study and survival analysis

Thick malignant melanomas in general tend to have a poor prognosis, but exceptions occur where there may be no further recurrence. The reasons for this difference in clinical behaviour are not fully understood. We have looked at thick malignant melanomas (greater than 3.0 mm) in the East of Scotland that have no evidence of metastasis after a minimum of 6 years follow-up and compared the clinical and histological features with a similar group, associated with histological evidence of metastasis and/or death. Both groups received similar treatment regimes. We have identified 41 patients with thick melanomas in the former group. When compared with the control group, factors found to be significantly different between the two groups were: the nature of the lower margin of the tumour; vascular invasion; and anatomical location.

Thin malignant melanomas (less than 1.5 mm) with metastasis: a histological study and survival analysis

It is known that not all thin malignant melanomas have an excellent prognosis and that the specific features identifying the patients at risk of metastasis have not been fully elucidated. We have looked at thin malignant melanomas (less than 1.5 mm) in the East of Scotland that had proven metastasis and death, and compared the clinical and histological features with a similar group (less than 1.5 mm) that have had no further recurrence after a minimum of 6-year follow-up. We identified 26 patients with thin melanomas who had developed histologically proven metastasis and/or died following adequate surgical treatment of their primary lesion. When compared with the control group, factors found to be significantly different between the two groups and present in the group that did badly were (a) histological regression, (b) lesion size, (c) Clark level IV and (d) depth of the uninvolved dermis.

A patient education program to improve adherence rates with antituberculosis drug regimens

The design, logic, and results of a two-year health education study directed at improving rates of patient adherence to antituberculosis medical regimens are presented. An incentive scheme to reward positive health behaviors plus targeted educational counseling sessions was implemented in a randomized clinical controlled trial. The 205 subjects who participated in the study are categorized according to patients with active tuberculosis (n = 88) or preventive patients with no evidence of active disease (n = 117). Patients in each of these groups were randomly assigned to a special intervention (SI) group or a usual care (UC) control group and were followed monthly throughout their treatment program. While SI patients with active tuberculosis demonstrated higher levels of appointment-keeping behavior and mean percent of medication taken compared to UC patients, no statistically significant differences between the two groups were found. Preventive therapy patients assigned to the SI group, however, were significantly more likely than UC patients to remain in care during their 12-month regimen (64% vs 47%; p = .003). Furthermore, SI patients had significantly higher levels of adherence to their medical regimen compared to UC patients (68% vs 38%; p less than .001). These results demonstrate the positive effects of a structured health education program on the improvement of continuity of care and adherence behavior among patients with tuberculosis.