The body as art.

For millennia people have altered the appearance of their bodies with cosmetics, jewellery, tattoos, piercings, and other surgical procedures. It would appear that they wish to conform to a perceived 'ideal body', although the actual appearance of such a body is subject to temporal, cultural and geographical change. In contemporary society the media are largely responsible for providing the yardsticks against which individual body shape is measured. Today the desired form is generally young, slim, tanned and blemish-free. Sadly, dissatisfaction with body image can be the source of great unhappiness and may even lead to suicide. Interested scholars have debated the meaning of beauty for centuries but it seems that every human society has its own standards. At the simplest it would appear that youth and symmetry are the most highly prized ingredients. There is no doubt that those who fit the conventional standards of attractiveness are treated better by society. Individuals have an inalienable right to their own body appearance, and to alter it as they see fit, however such modifications may not always be in their own best interests. Practitioners of cosmetic procedures must be alert to clients with histories of weight fluctuation, unrealistic body image, or low self-esteem. Psychological disorders may present with dysmorphophobic symptoms. Doctors providing cosmetic services need to be adept at diagnosing psychological illness.

Medium-term outcomes are comparable with short-term outcomes in children with attention deficit hyperactivity disorder treated with stimulant medication.

OBJECTIVE: To compare the short- and medium-term effects of psychostimulant medication in children with attention deficit hyperactivity disorder (ADHD). METHODS: Seventy-three children with ADHD participated in a double-blind crossover study of dextroamphetamine (DEX) and methylphenidate (MPH; results previously reported). At the completion of this study, subjects continued to take the preferred stimulant. Subjects were restudied 6-9 months later. The principal outcome measures were the Revised Conners' Parent and Teacher Rating Scales. RESULTS: Fifty-three families (73%) returned the follow-up surveys. At 6-9 months, mean T scores were still significantly lower than the mean at baseline for all factors of both the CPRS-R and CTRS-R (P < 0.01). There were no statistically significant differences between scores at 6-9 months and scores at the completion of the corresponding medication period in the crossover trial. CONCLUSIONS: After 6-9 months treatment with stimulant medication, ratings remained significantly better than at baseline. This suggests that the early benefits of stimulants are sustained for at least 6 months.

Child and parent perceptions of stimulant medication treatment in attention deficit hyperactivity disorder.

OBJECTIVE: To evaluate child and parent perceptions of treatment with stimulant medication in a sample of children with attention deficit hyperactivity disorder (ADHD). METHODOLOGY: Child and parent perceptions questionnaires were completed for 102 subjects participating in a double-blind, crossover trial of methylphenidate (MPH) and dexamphetamine (DEX). RESULTS: Most children viewed medication effects favourably, although 12.7% and 18.8% of children reported feeling worse than usual when taking MPH and DEX, respectively. There was disagreement between the child's and parents' perceptions of response in over one quarter of cases. Most disagreements involved parents viewing the child's response favourably, but the child rating reporting an unfavourable outcome. Side-effects were the main determinant of children's perceptions of adverse response. CONCLUSIONS: A substantial proportion of children with ADHD experience treatment with stimulant medication adversely. Side-effects are the principal determinant of negative child perceptions. Parental report is usually in agreement with child report; however, parental report alone is not infallible in providing reliable information regarding effects as experienced by the child.

Speech recognition performance of older children with cochlear implants.

HYPOTHESIS: The primary purpose of this study was to determine if children, > or =5 years old, with onset of deafness before the acquisition of spoken language (i.e., prelingually deafened) derived more benefit from multichannel cochlear implants than from conventional hearing aids. It was hypothesized that children who used oral communication (speech plus listening) would demonstrate higher levels of performance after implantation than children who used total communication (English sign system plus speech and listening). BACKGROUND: Previous research suggests that prelingually deafened children given implants at an older age derive limited benefit from these devices. Changes in candidacy criteria and advances in technology, however, may make cochlear implants a more viable treatment option for this group of patients. METHODS: A repeated-measures design was to used to compare patients' preoperative performance with hearing aids to postoperative performance with the CLARION cochlear implant after 3 and 6 months of device use. Pre- and postoperative performance were analyzed separately for children who used oral and total communication. RESULTS: Both groups of children (oral and total communication) demonstrated significant postoperative improvement on all outcome measures over time. Postoperative scores of the children who used oral communication were significantly higher than those of the children who used total communication on four of the five outcome measures. CONCLUSIONS: Prelingually deafened children who do not receive cochlear implants until > or =5 years of age derive significant benefit from current implant devices compared with that obtained with conventional hearing aids. The greatest benefit is derived by children who use oral communication, with much more limited benefit demonstrated by children who use total communication.

Use of a parent-report scale to assess benefit in children given the Clarion cochlear implant.

OBJECTIVE: To assess the auditory skills in everyday situations of prelingually deafened children with Clarion cochlear implants compared with hearing aids used preoperatively. STUDY DESIGN: The Meaningful Auditory Integration Scale (MAIS) was used to determine the preoperative and postoperative auditory skills of the children. RESULTS AND DISCUSSION: After implantation, the children showed improvement in three skill areas: bonding to the device, spontaneous alerting to sound in everyday situations, and ability to derive meaning from sound in the environment.

Space shuttle flight (STS-45) of L8 myoblast cells results in the isolation of a nonfusing cell line variant.

Myoblast cell cultures have been widely employed in conventional (1g) studies of biological processes because characteristics of intact muscle can be readily observed in these cultured cells. We decided to investigate the effects of spaceflight on muscle by utilizing a well characterized myoblast cell line (L8 rat myoblasts) as cultured in the recently designed Space Tissue Loss Flight Module "A" (STL-A). The STL-A is a "state of the art," compact, fully contained, automated cell culture apparatus which replaces a single mid-deck locker on the Space Shuttle. The L8 cells were successfully flown in the STL-A on the Space Shuttle STS-45 mission. Upon return to earth, reculturing of these spaceflown L8 cells (L8SF) resulted in their unexpected failure to fuse and differentiate into myotubes. This inability of the L8SF cells to fuse was found to be a permanent phenotypic alteration. Scanning electron microscopic examination of L8SF cells growing at 1g on fibronectin-coated polypropylene fibers exhibited a strikingly different morphology as compared to control cells. In addition to their failure to fuse into myotubes, L8SF cells also piled up on top of each other. When assayed in fusion-promoting soft agar, L8SF cells gave rise to substantially more and larger colonies than did either preflight (L8AT) or ground control (L8GC) cells. All data to this point indicate that flying L8 rat myoblasts on the Space Shuttle for a duration of 7-10 d at subconfluent densities results in several permanent phenotypic alterations in these cells.

Impact of active immunisation against enteritis necroticans in Papua New Guinea.

Enteritis necroticans, known locally as pigbel, has been a major cause of illness and death among children in the highlands of Papua New Guinea. After a successful trial of active immunisation against the beta toxin of the causative organism, Clostridium perfringens type C, immunisation of children was begun in 1980. The effects of the immunisation programme on pigbel admissions in 3 of the 5 major highland hospitals were assessed. In each of the centres studied the proportion of admissions due to enteritis necroticans dropped significantly after immunisation was introduced (p less than 0.001) and hospital admissions for pigbel in 1984-86, when immunisation was well established, were less than one fifth of previous figures.

Outbreak of nosocomial Flavobacterium meningosepticum respiratory infections associated with use of aerosolized polymyxin B.

Flavobacterium meningosepticum is an uncommon cause of adult nosocomial infection. On a medical/surgical intensive care unit we recently encountered an adult outbreak of respiratory colonization and infection caused by this organism, which was associated with the prophylactic use of aerosolized polymyxin B that had been used in an attempt to abort an outbreak of infection caused by highly resistant strains of Pseudomonas aeruginosa. Twenty isolates (95% from respiratory secretions) of F. meningosepticum from nine persons were identified during a 2 1/2-month period. No environmental source has been identified to date. Pneumonia developed in five patients, and two deaths associated with this organism occurred. All isolates were sensitive to ciprofloxacin; none were sensitive to other antibiotics tested, including third-generation cephalosporins, aminoglycosides, erythromycin, trimethoprim-sulfamethoxazole, antipseudomonal penicillins, aztreonam, and imipenem/cilastatin. Two patients with nosocomial pneumonia were successfully treated with oral ciprofloxacin. F. meningosepticum may emerge as an important pathogen if prophylactic use of polymyxin B becomes more widespread. Ciprofloxacin may become the agent of choice for treatment of this organism.

Renal scintigraphy and survival of indium-111-labelled platelets in patients with diabetic nephropathy.

Nine patients with overt diabetic nephropathy underwent renal scintigraphy and measurement of platelet survival time using indium-111-labelled platelets after treatment for six weeks with aspirin-dipyridamole (990 mg/225 mg/day) or placebo in a double-blind cross-over study. External scanning of the renal areas at 16 and 40 h post-injection showed no excess activity of indium-111 relative to background. Mean platelet survival was within the published normal range at 9.1 +/- 0.6 days and 7.6 +/- 1.4 days using linear and gamma function analyses respectively. Treatment with aspirin-dipyridamole was without effect. The results suggest that significant platelet deposition in renal blood vessels is not an important factor in the pathogenesis of diabetic nephropathy.

Secular change in birthweight of Asian babies born in Birmingham.

We have studied changes in the birthweight of Asian babies born alive at this hospital between 1968 and 1978. In 1978 Pakistani babies were 139 g heavier but Indian babies only 25 g heavier than 10 years earlier. Contributing to these changes were significantly fewer short mothers and primiparae among Pakistanis, and non-significant increases in gestational age and intrauterine growth (that is, weight centile after allowing for gestational age, parity, and maternal height). Among Indians there were significant increases in maternal height and gestational age, but parity was reduced and intrauterine growth did not increase. In both groups there were fewer teenage mothers, but whereas among Pakinstanis birth intervals of less than one year were less common, there was no such reduction among Indian mothers. The secular change suggests that genetic factors are unlikely to be the major reason why Pakistani babies born in Birmingham are lighter than European babies, and that environmental factors play an important role. Efforts to increase birthweight need to consider both the mothers' physical environment during pregnancy and prepregnancy factors influencing growth in childhood, age at first pregnancy, and birth interval. The study shows a need to describe an 'Asian' population with details of their sub-ethnic structure. The sub-ethnic and secular differences further suggest that a single 'Asian' standard for birthweight and intrauterine growth may be inappropriate; the use of international reference data with which all infants may be compared is preferable.