Large intraosseous arteriovenous malformations (AVM) of the maxilla are rare lesions, which are probably hamartomas. We report a case of an 8-year-old child who presented with exsanguinating hemorrhage after an attempted dental biopsy. The management of dental intraosseous AVMs includes transarterial embolization and direct intralesional injection of liquid acrylic (NBCA). This approach avoids mutilating surgery and its sequelae in children. We present this case for its rarity and the intralesional use of acrylic glue in its management.

Angiography↗

PubMed2000

Doctors suspended in child health inquiry

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Journal Article↗

PubMed2000

Why the high rate of dropout from individualized cognitive-behavior therapy for bulimia nervosa?

OBJECT: To investigate predictors of dropout from cognitive-behavior therapy for bulimia nervosa. METHOD: Pretreatment assessment measures were examined including the Eating Disorder Inventory-2, Body Satisfaction Questionnaire, Beck Depression Inventory, Beck Hopelessness Scale, the Locus of Control of Behavior Scale, and demographic and behavioral measures. RESULTS: Forty-three percent (n = 14) of clients with a DSM-IV diagnosis of bulimia nervosa dropped out of treatment prematurely. No differences were found between treatment completers and dropouts with respect to the initial severity of bulimia-related symptoms. Noncompleters were, however, found to have significantly higher depression and hopelessness scores as well as elevated levels of external locus of control. Discriminate analysis showed that these variables resulted in a 90% prediction accuracy of individuals who prematurely dropped out of treatment. DISCUSSION: Results suggest a need to focus treatment directly on factors such as hopelessness and depression in addition to standard bulimia procedures to ensure clients are able to engage in therapy.

Adolescent↗

PubMed2000

Monitoring Wadi El Raiyan lakes of the egyptian desert for inorganic pollutants by ion-selective electrodes, ion chromatography, and inductively coupled plasma spectroscopy.

Wadi El Raiyan is a great depression located southwest of Cairo in the western desert of Egypt, one of the most arid regions of the world. In 1973, Wadi El Raiyan was connected with the agricultural wastewater drainage system of the El Faiyum province to provide a reservoir for the wastewater that exceeded the capacity of Lake Qarun north of the province. Pollutants from agricultural waste including pesticides and fertilizers as well as other effluents of industrial activities and runoffs certainly will pass into the biotic elements of the ecosystem. This report presents the status of inorganic pollutants including anions, cations, and trace metals in the two lakes and the surrounding springs of Wadi El Raiyan using ion chromatography, ion-selective electrodes, and inductively coupled plasma emission spectroscopy. The report also includes the levels of selected metals in the vegetation community of the area. The result of this investigation revealed a great improvement in water quality of the Wadi El Raiyan lakes compared to 1988 report by Saleh et al. Mercury was not detected in any of the samples and the level of lead was significantly reduced. Cadmium levels were much higher than those seen earlier. The higher level of cadmium might be used as an indicator to track the contamination of water by human waste. Concentrations of common anions were not significantly different from those reported earlier. However, an increase in the level of cyanide was observed. Levels of heavy metals in vegetation around the lakes were also found to be lower than previously reported.

Anions↗

PubMed2000

Chronic traumatic anterior knee pain.

Chronic anterior knee pain following a direct injury to the front of the knee is common. The persistent symptoms can be troublesome. There is a paucity of documentation regarding its definition, natural history and prognosis. We have reviewed 46 (92%) of a consecutive series of 50 patients with chronic traumatic anterior knee pain, in which other significant acute knee pathology was excluded. After a mean follow-up of 4 years and 8 months only 4% of patients were pain free, 68% had moderate or severe pain and 28% mild pain. Twenty percent felt they were improving, 59% were static and 17% were deteriorating. The commonest clinical findings were patello-femoral crepitus (96%), local tenderness (72%) and difficulty in squatting or kneeling (72%). Few patients improve beyond 2 years and continued improvement is unlikely. In patients referred for specialist advice this is a clinical syndrome characterised by persistent debilitating symptoms resistant to treatment.

Activities of Daily Living↗

PubMed2000

Fluorescent labeling of recombinant proteins in living cells with FlAsH.

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Amino Acid Sequence↗

PubMed2000

Candidate genes showing no evidence for association or linkage with Alzheimer's disease using family-based methodologies.

Alzheimer's disease (AD) is a genetically complex and heterogeneous disorder. To date, a large number of candidate genes have been associated with the disease, however none of these findings has been consistently replicated in independent datasets. In this study we report the results of family-based analyses for polymorphisms of five such candidates on chromosomes 2 (interleukin-1beta, IL-1B), 3 (butyrylcholinesterase, BCHE), 11 (cathepsin D, CTSD; Fe65, APBB1) and 12 (lipoprotein receptor-related protein-1, LRP1) that were all suggested to be associated with AD in recent case-control studies. To minimize the possibility of spurious findings due to population admixture, we used a family-based design applying the sibship disequilibrium test (SDT) as well as two-point parametric linkage analyses on families from the National Institute of Mental Health (NIMH) Genetics Initiative. Contrary to the initial reports, none of the polymorphisms that were analyzed showed evidence for association or linkage with AD in our families. Our results suggest that the previously reported associations from case-control studies are either (a) false positive results, e.g. due to type I error or population admixture, (b) smaller than initially proposed, or (c) due to linkage disequilibrium with an as yet unidentified polymorphism nearby.

Alleles↗

PubMed2000

Mental health care reforms in Britain and Italy since 1950: a cross-national comparative study.

This paper discusses a cross-national comparative study, which compares the implementation and geographical outcomes of mental health reforms in Britain and Italy since 1950. Working within a cross-national framework, the research adopts a sensitivity to the role of place by exploring the social and spatial restructuring of mental health care service provision in two localities - Sheffield and Verona. By focusing upon the local experiences of mental health care reform, the research strives to gain a clearer understanding of why local geographies of mental health care provision appear to vary across space, both within national boundaries and across them.

Cross-Cultural Comparison↗

PubMed2000

Why are patients prescribed psychotropic drugs by general practitioners? Results of an international study.

BACKGROUND: There has been growing interest in factors that might influence the prescription of psychotropic drugs in general practice. METHOD: This was a multi-centre study using a two-phase stratified sampling strategy in primary care facilities from 14 different countries to determine factors associated with the prescription of psychotropic drugs. RESULTS: A total of 1763 consecutive GP attenders aged between 16 and 65 years of age were recruited. Although antidepressants were used more for depressive disorders and anxiolytics for patients with anxiety, the differential diagnosis was otherwise not an important factor in prescribing behaviour. Antidepressants and anxiolytics were prescribed twice as frequently in client centred clinics following a 'personal physician model' as opposed to non-client centred settings, where care was less personalized. The reverse was true of hypnotics (adjusted odds ratio of 0.5). General practitioners with a positive view of their undergraduate psychiatric training and who had had further postgraduate experience in the speciality were significantly less likely to prescribe medication, and if they did they were more likely to use antidepressants. Older patients were significantly more likely to be prescribed psychotropic medication. Several other patient factors emerged when individual classes of medication were considered; these included the loss of a spouse and the absence of physical ill health in the case of antidepressants, and female sex, fewer years of schooling and unemployment in the case of anxiolytics. CONCLUSIONS: Social, health care and GP factors are at least as important as clinical features in the prescription and choice of psychotropic medication.

Adult↗

PubMed2000

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 2: audit of service process.

An audit of atopic eczema management, conducted on behalf of the British Association of Dermatologists, examined service structure (phase 1), process (phase 2) and outcome (phase 3). In phase 2, an on-site case-note audit was conducted in 19 hospital dermatology departments randomly selected from the original sample of 187 centres across the U.K. In total, 630 sets of notes were examined for completeness of: (i) information given to general practitioners (GPs) in clinic letters and (ii) facts relevant to the management of atopic eczema recorded in the patients' notes. In general, the information given to GPs in the clinic letters was good, with the recording of diagnosis, treatment and follow-up approaching the 100% working standard. Factual information such as site and severity of eczema (83% and 74%), and presence or absence of asthma (53%) were better recorded than quality of life issues such as sleep loss secondary to itching (21%) and effect on school, work or social life (6%). On average, only 51% of all audit measures were recorded across all centres, with slight variation between centres (41-61%). The centre with the best recording had a purpose-designed data sheet for doctors to complete when seeing new patients with atopic eczema. Such data sheets may help improve case-note recording. Similar data sheets for patients to complete may be more time-efficient.

Adolescent↗

PubMed2000

The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: audit of service outcome.

Service outcome was examined by a preconsultation (part 1) and a 6-week postconsultation (part 2) patient questionnaire in 29 hospital dermatology departments randomly selected from an original sample of 187 centres across the U.K. The outcome measures were: quality of life as measured by the Dermatology Life Quality Index (DLQI) and Children's DLQI (CDLQI), improvement in sleep loss, improvement in worse aspect of skin disease and return to work or school. Three hundred and fifty-two questionnaires (115 adults, 237 children) were completed for part 1, and 235 (67%) replied to part 2. The mean DLQI at initial consultation was 12.5, dropping to 9.7 at 6 weeks (P = 0.001). The mean CDLQI at initial consultation was 10.5, dropping to 8.7 at 6 weeks (P < 0.001). Forty-nine per cent of adults and 44% of children had a > 25% relative improvement in score, which did not meet the 60% working standard. Forty-four per cent of adults and 47% of children had an improvement in sleep loss at 6 weeks, falling short of the 70% working standard. Sixty-one per cent of adults and 59% of children had an improvement in the worst aspect of their skin condition at 6 weeks, falling short of the 80% working standard. Of the 20 adults and eight children off work/school during part 1, 70% of adults and 87.5% of children had returned to work/school by 6 weeks. This met the 80% working standard for children but not for adults. On a national scale, only one of the eight working standards for service outcome was met, although most of the working standards were met by at least one of the 11 National Health Service administrative areas. This study presents the first national data on the outcomes of a representative sample of atopic eczema patients seen in secondary care. Small sample sizes, instruments which may be insensitive to change, as well as local factors such as case-mix, baseline severity and staff to patient ratios need to be taken into account when interpreting these results. Nevertheless, the results of this baseline audit suggest that the outcome of patients with atopic eczema following secondary care consultation may not be as good as some doctors believe. This suggests that an improvement in practice, a re-evaluation of the working standards, or both, is needed and should be examined in future audit cycles.

Adolescent↗