The incidence and severity of shoulder dystocia correlates with a sonographic measurement of asymmetry in patients with diabetes.

The objective of this paper is to examine the relationship between fetal asymmetry measured sonographically and the incidence and severity of shoulder dystocia in diabetic patients. Ultrasound data were collected retrospectively from examinations of women with gestational and pregastational diabetes who delivered at University of California, Irvine Medical Center from 1993-1995. Sonographic fetal asymmetry was quantified by calculating the difference between the abdominal diameter and the biparietal diameter in centimeters (AD-BPD). The residual AD-BPD was a patient's actual AD-BPD at the time of the ultrasound minus the mean AD-BPD obtained in our population at the patient's gestational age. The correlations between fetal asymmetry and the incidence and severity of shoulder dystocia were assessed using an analysis of variance as well as a logistic regression analysis. Mild shoulder dystocia was defined as a delivery requiring McRobert's maneuver and/or suprapubic pressure, while severe shoulder dystocia was assessed when delivery of the posterior arm with Wood's corkscrew maneuver was required. One hundred twenty-three women met the inclusion criteria for the study. Dividing the cohort into three groups based on AD-BPD residual values resulted in the following AD-BPD residual ranges and incidences of shoulder dystocia: Group I, -1.80 to -0.32 cm (9.8%), Group II, -0.31 to 0.32 cm (19.5%), and Group III .33 to 2.0 cm (34.1%), (p <0.03). The residual AD-BPD difference correlated with the incidence of shoulder dystocia after controlling for maternal age, weight, parity, birth weight, and the gestational age at ultrasound (P <0.03). Similar results were found with regards to dystocia severity as the mean residual AD-BPD difference between those with no dystocia, mild dystocia, and severe shoulder dystocia was -0.09, 0.23, and 0.46 cm, respectively, (p <0.006). The residual AD-BPD correlated with the severity of shoulder dystocia after controlling for the above-mentioned confounding variables (p <0.05) in a regression analysis. There is a direct correlation in diabetic patients between the level of fetal truncal asymmetry measured sonographically and the incidence and severity of shoulder dystocia.

Keratin subtypes of small cell lung cancer.

The molecular forms of keratin in small cell lung cancer (SCLC) cell lines and tumors were examined with antikeratin monoclonal antibodies. Immunostaining of SCLC by antikeratin antibody and examination by fluorescence microscopy indicates population heterogeneity in keratin content. Intensity of immunostaining is often weak. However, polyacrylamide gel electrophoresis and immunoblotting reproducibly demonstrate the presence of keratin and allow analysis of the keratin subtypes. The finding of keratin subtypes closely associated with the development of keratinizing epithelium (the 68 kDa basic keratin) in SCLC was unexpected in a tumor that is regarded as poorly differentiated. The cytoskeletal composition of SCLC suggests the presence of a heterogeneous population with a significant proportion of cells expressing highly differentiated epithelial properties.

The chronically mentally ill case management--more than a response to a dysfunctional system.

The service systems which assist the long-term mentally ill to function in the community have been routinely described as fragmented and uncoordinated. The development and implementation of case management has been seen as one response to this dysfunctional system. This article examines case management from the perspective that case management is a needed function no matter how coordinated and integrated the system. From this perspective, case management is driven by the clients' goals and not the systems' goals. Case management is viewed as a process by which the person with severe psychiatric disability is supported in negotiating for the various services that they want and need. Four unique activities are identified as performed by the case manager: Connecting with Clients, Planning for Services, Linking Clients with Services, and Advocating for Service Improvements. Case management must be seen as a uniquely human response to the client's specific service needs and overall goals. For persons with long-term psychiatric disabilities, case management brings to life the human dimension of the human service system.

Training mental health workers in psychiatric rehabilitation.

Staff members from nine mental health agencies were trained in psychiatric rehabilitation technology. The trainers then received intensive followup to assist them in implementing the technology in their own agencies. Evaluation of the impact of the "training of trainers" strategy suggested that mental health workers were able to acquire and apply the skills of psychiatric rehabilitation. The training strategy also appeared to be effective in helping the agencies adopt the philosophy, principles, and skills of psychiatric rehabilitation.