Lichen striatus

Lichen striatus is a self-limiting inflammatory condition of unknown etiology in which the lesions follow the lines of Blaschko. We report a series of 61 cases of this condition in children, describing the clinical features, age distribution, and season of onset. The preponderance of cases in the preschool-age group and onset in the spring and summer months support the hypothesis of an environmental agent, possibly an infection, in the etiology of the condition.

Client assessment tool: a means to enhance nurse-client-physician collaboration

The fast pace of a headache clinic prompted the authors to develop chart forms which covered all aspects of history and treatment specific to headache clients. The effort proved to be beneficial in promoting better communication between caregivers and clients due to ease and thoroughness of documentation. Use of such a tool may promote cost effectiveness, better nurse-client-physician relationships and ultimately improved client outcomes.

Amniotic alpha-fetoprotein in the prenatal diagnosis of congenital nephrotic syndrome of the Finnish type

Congenital nephrosis of the Finnish type (CNF) is rare outside Finland, where the incidence may be as high as 1 in 2000 live births. Neonates with the disorder develop renal failure within the first months of life and without renal transplantation, the prognosis is extremely poor. This case report describes a woman's three pregnancies, two of which were affected with CNF.

A preliminary study of factors that influence children's sense of competence to manage their asthma

This study identifies several factors that appear to influence children's sense of competence to manage their asthma. The study examined a consecutive series of 62 children and adolescents who had been admitted to hospital for management of their asthma. Self-reports rating their sense of competence to manage their asthma were obtained from all the children. In addition, reports were obtained of the children's motivation to achieve healthy functioning, their sense of control over their health, and parental knowledge of childhood asthma management. Results from the study suggest that older children, children who are more intrinsically motivated to achieve healthy functioning, and children with parents who are knowledgeable about asthma management feel more competent to manage their asthma. It is suggested that the effectiveness of asthma self-management programs for children may be improved if there is a better understanding of the psychological factors that influence children's sense of competence to manage their asthma.

Functional cerebral imaging in the evaluation and radiotherapeutic treatment planning of patients with malignant glioma

PURPOSE

Functional magnetic resonance imaging (MRI) and positron emission tomography are relatively new modalities of great potential value in the evaluation, treatment, and subsequent follow-up care of patients with malignant glioma. We report our experience with the incorporation of functional imaging data into radiation therapy three-dimensional (3-D) treatment planning.

METHODS AND MATERIALS

Over a 24-month period, a total of 37 positron emission tomography and 29 functional MRI studies have been conducted on eight consecutive patients prior to, during, and following the completion of radiation therapy. Functional imaging was conducted prior to radiation therapy treatment planning and at approximate 3-month follow-up time intervals.

RESULTS

In two patients, functional imaging provided additional information over conventional imaging modalities and resulted in subsequent modification of conventional radiation therapy treatment planning.

CONCLUSION

Although it is premature to make definitive statements regarding the use of these new imaging parameters in the prognostic setting, functional imaging may likely prove to be a useful adjunct in the initial evaluation, radiation treatment planning, and follow-up care of patients with malignant glioma.

Attention-deficit hyperactivity disorder: magnetic resonance imaging morphometric analysis of the corpus callosum

OBJECTIVE

The following study seeks to document possible differences in corpus callosal area and shape between children with attention-deficit hyperactivity disorder (ADHD) and controls.

METHODS

Fifteen carefully diagnosed right-handed male subjects with ADHD with overactivity symptomatology were compared to 15 right-handed male control subjects. The corpus callosum was divided into seven areas on the midsagittal slice of a magnetic resonance image with shape analysis also conducted.

RESULTS

An exploratory shape analysis showed no significant differences in shape between the groups. No group differences were found in the area, length, or anterior regions of the corpus callosum. The ADHD subjects were found to have significantly smaller posterior corpus callosum regions than the control group, with the splenium accounting for most of the variance between the groups.

CONCLUSIONS

The splenial area of the corpus callosum is smaller in children with ADHD than in a sample of normally developing children. These smaller areas may relate to commonly seen sustained attention deficits which in turn negatively impact on the development of more advanced levels of attention such as self-regulation. Further study of the regions surrounding the splenial area is suggested to determine whether they are correlated in size to the smaller corpus callosum.

Diagnosis of bovine venereal campylobacteriosis by ELISA

An enzyme-linked immunosorbent assay (ELISA) measuring IgA antibodies in the vaginal mucus was used to diagnose bovine venereal campylobacteriosis in 241 herds with infertility and abortions. The presence of the disease was confirmed on 84 farms (34.8%) and it was suspected on a further 27 farms (11.2%). The specificity of the ELISA was found to be 98.5% but in the absence of a reliable comparative test sensitivity can not be estimated. Vaccination against campylobacteriosis will not interfere with the IgA ELISA because only IgG is present in the vaginal mucus of vaccinates. Because of the possibility of false reactions caused by antibody fluctuations in individual cattle, the ELISA is best used as a herd test. It appears that at present the vaginal mucus IgA ELISA is the test of choice for the diagnosis of bovine venereal campylobacteriosis.

Outpatient care of the headache client: a challenging specialty

Care of persons with headache is complex because they often present with symptoms that are difficult to classify and manage. Pharmacologic interventions for headache prevention and acute attacks, as well as behavioral and life-style changes, can significantly improve the quality of life for many. Advocacy begins by exploring all aspects of physical and emotional health so the client is involved in the holistic approach to headache management. The caregiver-client relationship evolves gradually with continued education, reassessment and mutual problem solving. Counseling and education are the major focus of nursing care in this specialty. Qualitative research is needed to give more insight about the management of this pain condition which for centuries has plagued or even disabled its victims.

Anterior dental crossbite: relationship between incisor crown length and incisor irregularity before and after orthodontic treatment

The purpose of this study involving a sample of children with single central incisor crossbite was to determine the relationship between clinical crown lengths of the crossbite and noncrossbite mandibular incisors, incisor irregularity, and orthodontic correction of the crossbite. In addition, for comparison, the normal maturational change in position of the labial gingival margin of mandibular incisors not undergoing orthodontic correction was examined. Twenty-one children treated for single central incisor crossbite were matched individually by gender and age to a comparison group. Pre- and post-treatment mandibular central incisor crown lengths and incisor irregularity were measured. In 10 of the 21 anterior crossbite cases, the crown length of the crossbite incisor was more than 1.5 mm greater than that of the noncrossbite incisor. This difference improved with orthodontic treatment by a combination of apical movement of the gingival margin of the noncrossbite incisor (0.9 +/- 0.8 mm) and coronal movement (0.2 +/- 0.6 mm) of the gingival margin of the crossbite incisor. In contrast, for the remaining 11 anterior crossbites without such a crown length difference, and for the comparison cases, the gingival margins of both mandibular central incisors moved equally from pre- to post-treatment by 0.5 +/- 0.5 mm in an apical direction. Pretreatment crown length difference between crossbite and noncrossbite incisor was associated strongly to incisor irregularity (P < or = 0.005, r = 0.65). Orthodontic correction of the crossbite produced an improvement in irregularity index (IR) that was greatest in those anterior crossbite cases with a pretreatment crown length difference.(ABSTRACT TRUNCATED AT 250 WORDS)

The management of acute bronchiolitis. Thoracic Society of Australia and New Zealand

The management of acute bronchiolitis is mainly supportive, but infants require minimal handling. Of those who are hospitalized, less than 3% require intensive care and ventilation but in these children the condition is life threatening. Oxygen, fluid replacement and careful observation remain the cornerstones of management. Bronchodilators should be avoided in young infants and antiviral therapy should only be considered in critically ill infants who have an underlying cardiopulmonary condition.

Difficult decisions in endoscopic sinus surgery

In this article, case studies from four separate clinicians are presented along with comments. These cases offer unusual examples of problems that occur with endoscopic sinus surgery.

Use of the holmium: yttrium aluminum garnet (Ho:YAG) laser for cranial nerve decompression: an in vivo study using the rabbit model

A study was designed to evaluate the utility and safety of the holmium:yttrium aluminum garnet (Ho:YAG) laser for precise bony decompression of neural canals. In vivo rabbit studies were performed to measure temperature changes and nerve degeneration which occurred when the facial canal was decompressed with the laser as compared to the diamond burr. Marked temperature elevations were noted with the laser (n = 4), but not with the burr (n = 4). Seven of nine nerves decompressed with the laser revealed moderate to severe degeneration, whereas two control nerves decompressed with the drill demonstrated only minimal degeneration. It is concluded that this laser should not be used for nerve decompression unless better control of temperature elevation can be achieved.

Coagulation, fibrinolytic, and inhibitory proteins in acute myocardial infarction and angina pectoris

BACKGROUND AND METHOD

The role of thrombus formation in the pathogenesis of acute myocardial infarction (AMI) and unstable angina pectoris has been well established. However, comprehensive and systematic studies of the blood coagulation, fibrinolytic, and inhibitory proteins are not available in patients with these conditions. Fourteen patients with AMI, 10 patients with angina pectoris, and 32 normal volunteers were studied. Plasma antigen concentrations and/or activities of high-molecular-weight kininogen (HMWK), fibrinogen, fibronectin, plasminogen, D-dimer, tissue plasminogen activator (t-PA), alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, protein C, total and free protein S, antithrombin III (AT-III), von Willebrand factor (vWF), factors (F) XII, XI, IX, VIII, VII, X, V, II, and XIII, and plasma antiplasmin activity were measured using appropriate functional or immunologic assays.

RESULTS

The AMI group showed a significant reduction in F XII activity, F XII activity-to-concentration ratio, and HMWK concentration. In addition, the AMI patients exhibited a significant elevation of plasma F XI activity, F IX concentration, and F IX activity, and vWF, fibrinogen, D-dimer, and t-PA concentrations. This was associated with significant reductions in F V, F II, and AT-III activity-to-concentration ratio. Many of the changes observed in AMI patients were also present in patients with angina pectoris. Furthermore, the latter group exhibited an elevation of F VIII activity, alpha 2-macroglobulin activity, and alpha 1-antitrypsin concentration and a significant reduction of antiplasmin activity despite a normal alpha 2-antiplasmin concentration.

CONCLUSIONS

The observed reduction of the plasma F XII activity-to-antigen concentration ratio combined with a reduced HMWK concentration suggests intrinsic pathway activation, while the elevation of the D-dimer concentration indicates thrombin generation and fibrin formation and degradation in the AMI group. The latter changes were also present in patients with angina pectoris. Both AMI and angina groups showed several other abnormalities of the coagulation, fibrinolytic, and inhibitory systems. The results suggest the presence of a prothrombotic state associated with the activation of coagulation and fibrinolytic systems in patients with acute myocardial ischemia or infarction.

Estimates of HIV infection among injecting drug users in Glasgow, 1985-1990

OBJECTIVE

To use research and surveillance studies in Glasgow (Scotland, UK) to estimate the number of current injectors infected with HIV, the total number of injectors infected up to the end of 1990 and the recent incidence of infection.

DESIGN

(A) Prevalence of injecting drug use was estimated using log-linear modelling. (B) Prevalence of HIV infection was determined from voluntary testing of a community-wide sample of injectors. (C) The number of infected current injectors was predicted by combining the distributions generated by (A) and (B). (D) Data on known HIV-positive injectors were used in conjunction with (C) to forecast the cumulative number of infected injectors.

RESULTS

The number of current injectors was estimated to be 9400; the prevalence of HIV infection among 447 injectors recruited to the HIV prevalence study during 1990 was 1.1%. From these data, the number of HIV-positive current injectors in 1990 was estimated to be between 52 and 138. Between 1985 and 1990, 110 known HIV-positive injectors were registered or received treatment in Glasgow for HIV-related diseases; the total number of cases estimated to have occurred during this period was between 110 and 300. The incidence of infection in Glasgow during 1990 was likely to have been low in light of the finding that only one case in the prevalence study had not previously been diagnosed HIV-positive.

CONCLUSIONS

Linkage of datasets from a variety of sources and studies has enabled the substantial refinement of estimates of the number of injectors and the proportion infected with HIV in Glasgow up to 1990.

Diagnosis of Pneumocystis carinii pneumonia by multiple lobe, site-directed bronchoalveolar lavage with immunofluorescent monoclonal antibody staining in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis

The yields of both induced sputum examination and bronchoalveolar lavage (BAL) have been reported to be decreased for breakthrough episodes of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients receiving aerosolized pentamidine chemoprophylaxis. This study assessed whether the yield of a single middle or lower lobe BAL could be increased by the utilization of two techniques: (1) indirect immunofluorescent staining with a combination of two murine monoclonal anti-Pneumocystis antibodies in addition to routine toluidine blue O and cytopathologic staining, and (2) the performance of multiple lobe, site-directed BAL (i.e., both upper lobe and middle or lower lobe lavage, including the lobe with the greatest radiographic abnormality). Results of 252 fiberoptic bronchoscopies performed at the National Institutes of Health and the Los Angeles County-University of Southern California Medical Center were analyzed. P. carinii pneumonia was documented in 21 episodes in patients who did not receive prior anti-Pneumocystis chemoprophylaxis and in 41 episodes in patients who received aerosolized pentamidine. Monoclonal antibody staining and multiple lobe, site-directed BAL resulted in similar diagnostic yields for P. carinii in the nonprophylaxis (100%) and aerosolized pentamidine (98%) groups. If BAL had been performed without monoclonal antibody staining and multiple lobe, site-directed lavage, then the yield would have decreased to 95% in the nonprophylaxis group and to 80% in the aerosolized pentamidine group.(ABSTRACT TRUNCATED AT 250 WORDS)