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Biomedical subjects

D E Newman

Publications and source records attributed to D E Newman.

36 records · Page 2Linked to original sources

The postmortem examination on the abused child. Pathological, radiographic, and legal aspects.

In this article we have described for a pathologist without forensic experience the need to describe meticulously all the injuries an abused child has suffered; the reasons for this required detail and attention; the need to exclude natural disease as the cause of death; the common radiographic features and morphology of injuries found in an abused child; the responsibility of the pathologist to the dead child and any living siblings; and have given an intimation of the legal processes which may follow.

Adolescent↗

Eye-pressing by visually impaired children.

Many children with severely impaired sight exhibit stereotyped mannerisms. Visual self-stimulation, e.g. eye-pressing and light-gazing, normally is restricted to the visually impaired; prolonged eye-pressing is the most common. This behaviour depends on onset of visual impairment, age, degree and quality of residual light, type of ocular abnormality, the presence of additional handicaps, and the activities in which the child is involved. Children with bilateral optic-nerve defects never press their eyes; those with retinal disorders tend to press vigorously. A possible physiological explanation is that self-stimulation occurs when the demand of the brain for meaningful visual information is not adequately met.

Adolescent↗

Day treatment programs for the Spanish speaking: a response to underutilization.

This article describes how a hospital-based Community Mental Health Centre in California, United States, addressed the problem of underutilization by its Spanish-speaking population. The authors present a clinical program model which can be duplicated without hiring large numbers of bilingual professionals. The program offers a comprehensive range of psychiatric treatment services to a particular minority population, and can be readily adapted to deliver mental health care to any national minority or ethnic subpopulation. All of the services for the Spanish-speaking seek to promote community integration, and are designed to provide therapeutic experiences in a foreign environment while maintaining cultural ties.

California↗

Intrinsic defects in the fetal alcohol syndrome: studies on 76 cases from British Columbia and the Yukon Territory.

Children diagnosed as FAS using standard criteria of maternal alcoholism, poor growth, delayed development and characteristic facial appearance underwent an investigative protocol involving skeletal x-ray surveys, cardiac assessments and intravenous pyelograms (IVP). Significant skeletal findings included cervical spine fusion in 20 of 46 children (43%), x-ray confirmation of microcephaly in 26/49 (53%) and abnormal thoracic cage development in 13/48 (27%). Thirty-nine of 54 children (72%) demonstrated a characteristic tapering of the shaft and occasional associated prominence of the tuft of the distal phalanges Bone age was delayed 2 standard deviations or greater in 14 of 51 children (27%). Cardiac lesions were found in 31 of 76 (41%) and a further 12 (16%) had functional murmurs. Lesions were ventricular septal defect 20 (26%), Tetralogy of Fallot 4 (5.1%), plus a variety of less frequent abnormalities. IVP's were limited to 19 random cases with 5 (26%) showing alterations from the normal. Cervical spine abnormalities of FAS as compared to the Klippel-Feil Syndrome are dissimilar and probably represent a different entity. Hand and lateral cervical spine x-ray studies are felt to be a useful adjunct to the diagnosis and management of the fetal alcohol syndrome.

Abnormalities, Drug-Induced↗

The radiolucent esophageal foreign body: an often-forgotten cause of respiratory symptoms.

Three children under 2 years of age with a history of respiratory symptoms for one to seven months, secondary to a radiolucent esophageal foreign body, are presented. Delay in diagnosis resulted in an acquired tracheosophageal fistula in two patients and a thoracotomy in all three patients. Physicians alert to the clinical presentation and aware of the proper radiographic investigation of radiolucent esophageal foreign bodies can reduce the morbidity and hospital stay for these patients.

Esophagus↗

Therapists' acceptance of peer review in a community mental health center.

Eighty therapists, the entire attending staff of a community mental health center, were interviewed to assess their perceptions of the center's interdisciplinary peer review system after it had been in operation for three and a half years. While many expressed reservations about parts of the system, about two-thirds felt that the review committee generally maintained an appropriate balance between quality of care and allocation of funds. More than 90 per cent found peer review an educational experience, and more than half said they would now choose to present casses to the committee even if not required to do so. Fifteen per cent felt they had experienced bias because of the professional disciplines of the reviewers. After presenting additional findings, the authors tell why they believe this particular system has a high degree of acceptance.

Attitude of Health Personnel↗

Effects of peer review on outpatient psychotherapy: therapist and patient follow-up survey.

Interviews with 80 therapists and 50 patients at a community mental health center revealed that peer review effectively monitored the appropriateness of treatment and allocated limited treatment funds without unduly interfering with established treatment patterns, relationships, or outcomes. Most therapists reported receiving helpful consultation from the peer review committee, and the process encouraged them to focus more clearly on treatment goals. On the other hand, patients were concerned about the committee's role in making decisions about their treatment. Therapists noted as a problem the lack of certainty in establishing a treatment contract prior to peer review since the contract with the patient must remain fluid during the evaluation period. The therapists and patients demonstrated remarkable agreement in their assessment of treatment progress and whether further therapy was needed.

Ambulatory Care↗

Hypochondroplasia.

Hypochondroplasia is an autosomal dominant discrete form of short-limbed dwarfism with roentgenographic changes similar to, but distinctive from, achondroplasia. The patients are normal at birth and in early childhood present with short-limbed dwarfism, thick body build, long trunk, normal head, moderate lumbar lordosis and broad, stubby hands and feet. A high incidence of mental retardation and absence of other neurologic complications is distinctive from achondroplasia. Diagnosis of hypochondroplasia is primarily radiogrpahic. No single diagnostic radiographic sign is present, and thus, a complete radiographic survey of the whole skeleton is required for diagnosis. Pertinent radiographic findings include a normal skull, short, broad long bones with prominent bony sites of muscle attachment, normal growth plate, prominent styloid process of the ulna and lateral malleolus of the fibula, shortened base of the iliac bones, horizontal hypoplastic low-set sacrum and mild narrowing of the interpediculate distance of the lumbar spine. Differential diagnosis is from other types of short-limbed dwarfism, particularly achondroplasia. Kozlowski, an authority on hypochondroplasia, believes this form of short-limbed dwarfism, if carfully searched for, may be more common than achondroplasia.

Achondroplasia↗

Instability of the upper cervical spine in Down syndrome.

This study of 64 Down syndrome children at British Columbia's Children's Hospital established that ligamentous laxity of the upper cervical spine may exist at more than one location. Instability at the atlantooccipital level is common and must be considered along with the previously documented atlantoaxial instability. Treatment should depend on room available for the spinal cord instead of absolute values of displacement.

Adolescent↗