[Diagnostic workup and therapy of acute venous diseases]

Acute venous diseases, especially deep leg and pelvic vein thrombosis, present an angiological emergency and can lead to acute life-threatening events such as pulmonary embolism. Long-term consequences may be postthrombotic syndromes. In addition to stroke and myocardial infarction, deep leg and pelvic vein thrombosis are one of the most common cardiovascular diseases. Early diagnosis and rapid initiation of therapy are important.

Prevention of public health risks linked to bullying: a need for a whole community approach

Bullying is a very toxic psychosocial stressor associated with serious health problems and death, affecting both the victims and the bullies. This form of abuse or maltreatment occurs around the world and along the lifespan. Health professionals have the unique responsibility of promoting the development of community initiatives for the prevention of bullying and related health problems. This effort must include ongoing programs with elements of primary, secondary, and tertiary prevention. These programs should be supported and monitored by a public health policy with a strategy aimed at developing a whole community awareness about bullying and the related health risks, prohibiting bullying, and developing emotionally and physically safe environments in schools and workplace settings. Public health policy should mandate the monitoring, detection, and reporting of bullying incidents; provide guidance for school intervention; and offer guidelines for medical consultation.

Ethical dilemmas in the treatment of children with disabilities

Issues relating to the treatment of children with disabilities, such as withholding treatment, organ donation, research, genetic screening, and prenatal diagnosis, all present ethical dilemmas. These issues always need to be reviewed to determine which ethical considerations apply. Identifying relevant principles, one can conclude which take precedence and what is ethically permissible. As with so many other medical responsibilities, this can be consulted, learned, practiced and improved upon. Pediatricians caring for children with disabilities can study and enhance their capacity for ethical reflection, so as to participate fully in these important decision-making processes.

Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent

Fusobacterium necrophorum is a strict anaerobic organism responsible for a number of clinical syndromes known as necrobacillosis. Although meningeal infections with anaerobes are rare, delayed diagnosis and treatment can be potentially fatal. We report a unique case of Fusobacterium meningitis, mastoiditis, and sepsis in a previously healthy adolescent. Diagnosis and management of this condition are discussed in the context of a literature review.

Assessing African American adolescents' risk for suicide attempts: attachment theory

The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.

Testing the hypothesis of the multidimensional model of anorexia nervosa in adolescents

This study statistically tested six hypothesized risk factors of the model for anorexia nervosa. Forty-three adolescents with anorexia nervosa and 85 controls were administered the EAT, EDI, and FES. In addition, 43 parents of anorexics and 85 parents of controls completed the Family History Data Sheet, the FES, and the Perfect Child Questionnaire. Three of six hypothesized risk factors were confirmed: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Log-linear analysis indicated that the hierarchical model that best fit the data had significant two-way interactions with anorexia nervosa, G2 (11, N = 128) = 65.87, p < .001. In addition, alcohol and drug abuse or dependence figured prominently in the family history of patients with anorexia nervosa. The multidimensional model for anorexia nervosa holds up as an exploratory model of this condition in the adolescent age group.

Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass

To evaluate the long-term results of jejunoileal bypass in the treatment of morbidly obese adolescents, we studied 11 patients who underwent surgery between 1972 and 1974. More than 10 years after surgery, 45% of the patients had extremely satisfactory results (correction of morbid obesity). Three patients died within the year after surgery, two of them under extenuating clinical circumstances. There have been no subsequent deaths. All eight survivors were found to have metabolic abnormalities to various degrees. Two patients had a total of five pregnancies; each had one healthy infant, and three pregnancies ended in abortion (one spontaneous). Two patients had significant medical problems related to the procedure but basically remained in good health, whereas three patients had severe symptoms requiring reanastomosis. Of the five patients who continue with the bypass, none has become significantly obese. They have all maintained a weight loss of between 45 and 90 kg, and as adults express strong feelings in favor of the procedure. This series demonstrates that, although significant weight loss was maintained, and improvement in the quality of life for half of our patients was dramatic, side effects and complications continue to develop, mandating careful follow-up for an indefinite time.

[Complications after surgery of ENT-tumors. A comparison between preoperatively irradiated and nonirradiated patients]

Complications after preoperative high-dosage radiation of head and neck cancer are reported: 1. Preoperative radiation leads to complications in 42% compared to surgery alone in 20%. The results are statistically significant (alpha = 2%). 2. The complications after preoperative radiation are more severe (three ruptures of the carotid artery, three defects, which could only be managed by flap rotation). These results indicate the preoperative high-dosage radiation implies the risk of major surgical complications.

Obstetric care in a family health-oriented university associated neighborhood health center

The structure, staffing, and planning methods of the obstetric component of a family-oriented University Hospital associated family health care facility are briefly described. The interviews and screening procedures are outlined necessary to develop a broad data base for total health care planning. The roles of the members of the multiprofessional team employed are described with particular emphasis on the use of a nurse midwife as the primary obstetric care professional. Management procedures are referred to as well as the educational component present within such a program. The program is evaluated in terms of clinical outcome, patient and professional acceptance, and cost.