Proliferative myositis in a child. A case report.
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Child↗
Biomedical subjects
M Malone
Publications and source records attributed to M Malone.
Acquisition and generalization of social skills by high school students with mild mental retardation.
Initial acquisition of social skills by high school students with mild mental retardation was measured during the social skills training game Stacking the Deck. Generalization probes were conducted outside of the training setting (immediately preceding and following training, and 6 weeks posttraining). Due to the high degree of dissimilarity between stimuli in and outside of the training setting, we hypothesized that generalization of skills to nontraining environments would be minimal. Two replications of an initial single-case study were conducted. Students demonstrated acquisition of social skills across game conditions. Immediate generalization of trained social skills did not occur. A possible "deferred generalization" effect was evidenced at 6 weeks posttraining. Results were discussed with respect to the "integrity of common stimuli" and opportunities to respond.
Adolescent↗
Beta blocker use in the treatment of community hospital patients discharged after myocardial infarction.
OBJECTIVE: To explore the reasons for underutilization of beta blocker treatment after acute myocardial infarction. DESIGN: A retrospective chart review. SETTING: Two large community hospitals in Milwaukee, Wisconsin. PATIENTS/PARTICIPANTS: All subjects (n = 694) discharged alive from July 1, 1990, to June 30, 1991, who had a diagnosis of acute myocardial infarction were eligible. Of these, 250 had missing data, resulting in a final sample of 444. RESULTS: Twenty-nine percent of the 444 patients were prescribed beta blocker therapy on discharge. Characteristics of the patients and their treatment associated with receipt of beta blocker therapy were identified with a logistic regression model. The adjusted odds ratios were 0.52 for female gender, 0.34 for no health insurance, 0.21 for chronic obstructive pulmonary disease, 0.46 for congestive heart failure, 0.28 for atrioventricular block, 1.86 for hypertension, 1.93 for chest pain during acute myocardial infarction, and 4.65 for prehospital beta blocker use. Prescription of beta blocker therapy was also influenced by receipt of other treatment modalities. The adjusted odds ratios were 0.23 for receipt of beta blocker therapy associated with myocardial revascularization, 0.18 for prescription on discharge of calcium channel blockers, and 0.22 for receipt of angiotensin-converting enzyme inhibitors. CONCLUSION: A minority of patients discharged after acute myocardial infarction receive beta blocker therapy, and women are only half as likely as men to receive it, after controlling for other factors. Though there are no data relating to whether calcium channel blockers or angiotensin-converting enzyme inhibitors lessen the protective effect of beta blocker therapy post-acute myocardial infarction, it would appear that these agents are frequently being used in lieu of beta blocker therapy for post-acute myocardial infarction patients.
Adrenergic beta-Antagonists↗
Adrenal cortical tumours in children.
Adrenal cortical tumours are uncommon in children. For many years it was thought that the majority were malignant with a poor prognosis. Pathological criteria for malignancy are unreliable for these tumours in childhood. The radiological findings in seven children are presented. Large tumour size (> 6 cm diameter) and radiological appearances such as a complex echo pattern were considered to provide useful indicators of malignancy.
Adenoma↗
Use of supplemental oxygen during bystander-initiated CPR.
STUDY OBJECTIVE: To evaluate the efficacy of three methods by which rescuers can breathe supplemental oxygen to increase their delivered oxygen concentration (FDO2) during single-rescuer, bystander-initiated CPR. DESIGN: Controlled, randomized, crossover study. SETTING: Simulation in laboratory setting using a CPR manikin. SUBJECTS: Thirteen-volunteer convenience sample group. INTERVENTIONS: Volunteers trained only in basic life support performed ventilation only and full CPR on a CPR manikin using room air and each of three supplemental oxygen delivery methods: nasal cannula, oxygen supply tube, and demand valve. The volunteers received minimal instruction on how to use the supplemental oxygen delivery methods. MAIN OUTCOME MEASURES: Peak FDO2 and peak carbon dioxide concentration; American Heart Association-defined ventilation and CPR compression performance indices. The data were analyzed using Duncan's method of analysis of variance. RESULTS: The mean peak FDO2 during ventilation-only/full CPR for the baseline (room air ventilation) and each supplemental oxygen delivery method (at specified flow rate) was: baseline (room air), -17.96% +/- 0.56%/16.77% +/- 0.56%; nasal cannula (at 10 L/min), -31.77% +/- 3.06%/27.01% +/- 3.68%; oxygen supply tubing (at 15 L/min), -36.82% +/- 9.93%/30.41% +/- 4.88%; and demand valve, -78.17% +/- 9.10%/68.22% +/- 7.10%. CPR performance was not hampered by the use of the supplemental oxygen methods. CONCLUSION: The use of supplemental oxygen increases the rescuer's FDO2 during ventilation-only and full CPR without interfering with CPR performance.
Adult↗
Waxy keratoses of childhood.
Three cases of waxy keratoses of childhood occurring in two families are described. The disorder seen in these three cases appears to be clinically and histopathologically distinct from previously described familial disorders of keratinization, which also feature multiple discrete papules.
Child↗
Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure.
A general health status measure (the UK Sickness Impact Profile) was used to assess health-related quality of life in 212 cancer patients [143 women, mean (SD-standard deviation) age 55.3 (11.7) years] compared to 105 age-sex matched control subjects [71 women, mean (SD) age 54.7 (12.2) years]. The four main areas of impairment in the cancer patient group were work, recreation and pastimes, home management and sleep and rest. The majority of patients were unable to work or working shorter hours due to their disease. A diagnosis of cancer was likewise found to have a major impact on active leisure pursuits and led to reduced participation in social and community activities. Patients had particular problems in carrying out household chores and maintenance or repair work in the house. Many patients had difficulty sleeping at night and tended to sleep during the day or rest for much of the day. The majority of studies of quality of life in oncology patients concentrate upon alterations in symptoms, such measures would fail to detect impairment in the aspects described above. Greater attention should be directed towards addressing issues such as changes in employment status and the need for help in the home to improve the overall care of cancer patients.
Activities of Daily Living↗
Quality of life of patients receiving home parenteral or enteral nutrition support.
Limited data are available on the impact of enterally or parenterally supplied home nutritional support on quality of life. Data from national registries have been useful in identifying the outcome of different patient groups in terms of their functional capacity and rehabilitation status. Results in patients with inflammatory bowel disease are used as the 'gold standard' for this type of therapy. The annual cost of home parenteral nutrition can range from $US100 000 to $US150 000 per patient, depending on the frequency of feeding. Only one cost-utility analysis has been reported in the literature, based on a Canadian home parenteral nutrition programme which suggested that the estimated quality-adjusted survival of patients receiving this treatment is 4 times greater than if they had not been treated. There are many controversial areas associated with the use of home parenteral and enteral nutrition, including the treatment of patients with terminal malignant disease or severe dementia, and those infected with human immunodeficiency virus. To date, the clinical benefit of providing this type of nutritional support for these patient groups has not been clearly demonstrated. Prospective randomised controlled trials are necessary to evaluate the costs and benefits of this expensive high technology treatment.
Cost-Benefit Analysis↗
Teacher-identified oral language difficulties among boys with attention problems.
Teachers evaluated the language functioning of 95 boys, aged 6.5 to 13.8 years, identified as having attention problems (AP, n = 30), learning disability (LD, n = 33), or average achievement (AA, n = 32). The three groups did not differ significantly (p > .05) in their frequency of articulation problems. Significantly (p < .05) more AP boys were rated as having pragmatics problems than both of the other groups. AP boys were also viewed as having a higher frequency of receptive/expressive language problems than were AA boys, but not compared with LD boys. LD and AA boys did not differ in their ratings for pragmatics problems, but more LD than AA boys were perceived as having receptive/expressive problems. The average incidence of all types of language problems was highest for the AP boys at 42% with poor pragmatics representing their most frequently rated language difficulty. AP boys' pragmatics difficulties seemed to be characterized by greater difficulty in maintaining than initiating a conversation compared with the other two groups. This difficulty was positively associated with the teachers' ratings of the AP boys' impulsivity.
Adolescent↗
Acoustic analysis of infantile stridor: a review.
The review compares five methods that utilise electronic/computer acoustic processing techniques for the analysis of infantile stridor sounds. The first method uses traditional spectrographic techniques to produce time/frequency/intensity three-dimensional representation of the waveform. The second method is computer-based and uses the fast Fourier transformation (FFT) to show the frequency composition of the waveform. The third uses linear prediction coefficients (LPCs) to produce a power spectrum and inverse filtering to estimate the cross-sectional area of the human upper airway. The fourth technique employs a proprietary digital filterbank to analyse normal infant vocalisations, which may be used as a control by subsequent researchers. In the fifth method, a physiologically based digital filterbank, designed to closely model the human ear response, is proposed. It is envisaged that this approach will offer the flexibility of all the previous techniques and also closely model the analysis procedure carried out using subjective auscultation. It is concluded that none of the above techniques are sufficiently robust to provide unambiguous diagnosis of stridor type and that a reappraisal is required in terms of feature extraction so that relevant features can be identified. To this end, the authors propose that a physiologically based model of the human airway, including the vocal cords, be developed as an aid to the assessment of acoustic features.
Acoustics↗
The diagnosis of Hirschsprung's disease.
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Fluorescent Antibody Technique↗
Chemotherapy effects on hepatoblastoma. A histological study.
The histopathological features of hepatoblastoma in 17 patients treated with preoperative chemotherapy were compared with those in 11 patients not subjected to chemotherapy during the same 11-year period. Tumor necrosis was more extensive in patients receiving preoperative chemotherapy. Two tumors, however, were apparently unaffected by chemotherapy. There was no obvious correlation between the extent of necrosis and the number of courses of chemotherapy. There also seems to be no evidence of preferential ablation of a particular morphological type of tumor. The most notable feature in cases treated with chemotherapy was the extensive presence of osteoid. Osteoid was present in 36% of untreated cases, occupying < 5% of the surface area, compared with 82% in the treated group. In seven cases, osteoid occupied > 40% of the surface area. This finding raises speculation about the role of chemotherapy in the maturation of tumors that have an inherent ability to differentiate. A long-term study is needed to clarify the prognostic significance of mature heterologous elements in hepatoblastoma.
Adolescent↗
Soft tissue tumours in childhood.
The spectrum of soft tissue tumours in young adults is very similar to that in more mature individuals, while those in childhood form a distinct group rarely seen outside the first decade. The majority of these are benign vascular or fibroblastic proliferations; in young children they may be highly cellular and mitotically active, but malignancy should be diagnosed with caution. Congenital soft tissue tumours constitute a special group in which the clinical outcome may be particularly difficult to predict from the histological appearances. This review focuses on those malignant soft tumours which are either peculiar to childhood or which manifest special features in childhood. Some recently recognized benign soft tissue tumours which occur mainly in childhood are also described. The fibromatoses are not discussed. As a guide to the appropriate treatment regime, the main histological distinctions to be drawn are between: 1 tumours of neuroectodermal origin (Ewing's sarcoma and primitive neuroectodermal tumour); 2 other sarcomas; and 3 the fibromatoses and other benign and potentially locally aggressive lesions requiring local excision. Immunohistochemical staining may be of considerable help in achieving the correct diagnosis, but it is vital that a panel of antibodies be applied and the results critically assessed. Cytogenetic analysis is also of growing importance, characteristic karyotypic abnormalities having been demonstrated in Ewing's sarcoma/primitive neuroectodermal tumour, alveolar rhabdomyosarcoma and synovial sarcoma.
Child↗
Early treatment of juvenile xanthogranuloma of the iris with subconjunctival steroids.
Five infants with biopsy proved juvenile xanthogranuloma of the iris were reviewed. Early treatment with subconjunctival injection of steroids and topical steroid drops resulted in regression of the lesion in four patients. One patient, reviewed at the age of 8 months after glaucoma which had developed secondary to the iris xanthogranuloma, had been treated by surgery alone: the visual outcome was very poor.
Administration, Topical↗
Inadvertent intravenous administration of an elemental enteral nutrition formula.
OBJECTIVE: To report a case of intravenous infusion of an elemental enteral nutrition formula. CASE SUMMARY: A 65-year-old woman with a high-output jejunostomy required fluid and electrolyte replacement via a central line and enteral nutrition support via a gastrostomy tube. She inadvertently received 160 mL of half-strength elemental enteral nutrition formula (Vivonex TEN) via her central venous catheter. After four hours of the infusion, the patient felt ill and was found to by hypotensive and pyrexic. Over the next 24 hours she developed severe back pain and diffuse muscle tenderness. Her creatine kinase concentration was mildly elevated and there were no electrocardiographic changes. There was no rise in serum amylase concentration. Her renal function deteriorated markedly over the following three hours but responded to hydration and diuretic therapy. Liver enzymes, slightly elevated prior to this event, remained unchanged. Blood cultures were negative, but prophylactic therapy with vancomycin and ceftazidime was instituted. The patient recovered and was discharged eight days later. DISCUSSION: Previous reports of inadvertent intravenous administration of enteral feedings have described such complications as osmolarity, microembolism, hypersensitivity, and septicemia. This patient's nonfatal outcome may have been related to the infusion of the enteral formula via the central rather than the peripheral route, the infusion of an elemental rather than a whole protein formula, and the use of sterile water to reconstitute the formula. CONCLUSIONS: Particular care should be taken when a patient has more than one catheter implanted on the chest or abdomen (e.g., central venous or peritoneal dialysis catheter). It is important that inservice training is provided and written protocols are available for the safe infusion of enteral formulas.
Aged↗
Technique and use of transbronchial biopsy in children and adolescents.
Since July 1988, a total of 92 transbronchial biopsies (TBB) have been performed in 18 patients (aged 3-16 years). Twelve patients (67%) were heart-lung transplant (HLT) recipients undergoing surveillance for pulmonary graft rejection and infection. The remainder included immunocompromised patients at risk of opportunistic infections (n = 4), patients with fibrosing alveolitis (n = 1) and a collagen vascular disorder with suspected lung involvement (n = 1). TBB was performed through either a fiberoptic (n = 50) or a rigid (n = 41) bronchoscope, all under general anesthesia. On one occasion a cardiac bioptome was used through an endotracheal stent. The sensitivity of TBB for diagnosing acute and chronic rejection in HLT patients was 88% and 60%, respectively (specificity, 91% and 100%). Definitive diagnoses were made in 4 (67%) of the non-HLT group. Bronchoalveolar lavage (BAL) was performed during each procedure for microbiological and cytological examination. Thirty-four pathogenic organisms including Pseudomonas aeruginosa (16/34), Staphylococcus aureus (8/34), and Candida albicans (5/34) were isolated from BAL culture. Complications included pneumothorax (8%), transient pyrexia (7%), and dyspnea (2%).
Acquired Immunodeficiency Syndrome↗
3 beta-hydroxy-delta 5-C27-steroid dehydrogenase deficiency; effect of chenodeoxycholic acid therapy on liver histology.
The second step in the pathway for synthesis of bile acids from cholesterol is catalysed by the enzyme 3 beta-hydroxy-delta 5-C27-steroid dehydrogenase. Deficiency of this enzyme has been reported to produce cholestatic liver disease with progressive cirrhosis. Treatment with chenodeoxycholic acid led to clinical and biochemical improvement in one patient. We report a further child with this disorder who presented with prolonged neonatal jaundice followed by symptoms of malabsorption of fat-soluble vitamins. Bile acid replacement therapy resulted in clinical and biochemical improvement; it was also possible to demonstrate improvement in the histological appearance of the liver biopsy 4 months after commencing treatment.
3-Hydroxysteroid Dehydrogenases↗