A review of canine atlantoaxial joint subluxation.

Atlantoaxial subluxation was first reported in dogs nearly fifty years ago. Since that time a better understanding of the aetiologies predisposing to joint laxity and instability has been achieved. Surgeons however are still trying to address the problems associated with stabilizing this joint which by nature is often required in small juvenile dogs. This review describes the various techniques used, discussing the associated benefits and complications thereby allowing the clinician to make an informed decision on the best treatment for the individual patient.

Diagnostic Exercise: Circling and Behavioral Changes in a Cat.

A 4-year old spayed male domestic shorthair cat was presented with a history of circling and behavioral changes. Neurologic examination showed mild proprioceptive deficits. The lesion was localized in the forebrain, and magnetic resonance imaging revealed the presence of a large midline intracranial mass extending from the frontal lobe to the tentorial region of the brain. Euthanasia was elected due to poor prognosis. Histopathologic evaluation confirmed the presence of a mass composed by sheets and aggregates of large round/polygonal cells and multinucleate cells associated with deposits of cholesterol clefts, scattered hemorrhages and hemosiderin-laden macrophages. Immunohistochemistry showed that the round/polygonal cells and multinucleate cells were strongly positive for major histocompatibility complex class II antigen, variably positive for CD18, and occasionally positive for S100. Subsets of spindle cells showing variable expression of vimentin, S100, and neuron-specific enolase were also present. The final diagnosis was cholesterol granuloma. Differential diagnosis with meningioma is discussed.

What makes sex offenders confess? An exploratory study.

This study examines correlates of offender confession in criminal sexual conduct cases involving children. The cases consist of all closed court files (N=318), spanning the last 10 years from a single jurisdiction. This jurisdiction has a community-wide protocol for handling child sexual abuse cases, a high rate of charging (69%), a high rate of confession (64%), and high rates of pleas to sex crimes (77%). To determine what factors were associated with suspect confession before adjudication, we examined characteristics of the suspect, the child, the abuse, and the system using bi-variate and multi-variate analysis. The following four variables are associated with suspect confession: (1) having the state police conducting the law enforcement part of the investigation, (2) more serious abuse, (3) younger age of the suspect, and (4) having a court appointed (as opposed to a retained) attorney.

Child sexual abuse: a case study in community collaboration.

OBJECTIVE: This is an exploratory study that describes the process and outcomes of a Midwestern US community's approach to case management of child sexual abuse. METHOD: Data were abstracted from 323 criminal court files. Specific information gathered included child and suspect demographic data, law enforcement and CPS involvement, child disclosure patterns and caretaker responses, offender confession, offender plea, trial and child testimony information, and sentences received by offenders. Both case process and outcome variables were examined. RESULTS: In this community, criminal court records reflect a sex offense confession rate of 64% and a sex offense plea rate of 70%. Only 15 cases went to trial and in six the offender was convicted. CONCLUSION: Communities can achieve successful outcomes when criminal prosecution of sexual abuse is sought, but the child's testimony is not necessarily the centerpiece of a successful case. In this study, desired outcomes were a consequence of the collaborative efforts of law enforcement, CPS, and the prosecutor's office, which resulted in a high confession and plea rate.

[Zafirlukast therapy of patients with mild-to-moderate bronchial asthma]. / Zafirlukast alkalmazása enyhe-középsúlyos asthma bronchialéban szenvedö betegeken.

The recently compiled clinical experiences support the previous theory, that the cysteinil-leukotriens have an important role in the pathomechanism of bronchial asthma. Zafirlukast is a selective antagonist of the receptor 1 of cysteinil-leukotriens, and its use reduces the severity of asthma symptoms. The effect of 20 mg zafirlukast b.i.d was studied in 31 patients with mild-moderate asthma bronchiale. During the 6 week treatment period, even several hours after the first zafirlukast dose the pulmonary function improved significantly. This effect sustained during the whole treatment period, the patients' symptoms lessened and there was a significant reduction in the frequency of beta-2 agonist's use. No adverse events causally related to zafirlukast's use were detected. Zafirlukast is an efficient therapy of mild to moderate asthma bronchiale.

The polygraph, its use in cases of alleged sexual abuse: an exploratory study.

OBJECTIVE: The study's objective was to examine the relationship of polygraph findings to other indices of likelihood of sexual abuse and to case decisions by prosecutors, child protection workers, and professional evaluators. METHOD: This is an exploratory study of 42 cases with sexual abuse allegations and polygraph results. Case record data were abstracted and coded, including polygraph results, child interviews, medical examinations, protective services records, police investigations, and professional evaluations. Descriptive statistics, bivariate analyses, and multivariate analyses were employed. RESULTS: Polygraph findings were unrelated to other evidence of likelihood of sexual abuse, that is to the child's statements or demonstrations of sexual abuse, medical evidence, psychological symptoms, or indicators of sexual abuse from sources other than the child. When alleged offenders passed polygraphs, criminal prosecution was not sought. However, failing polygraphs was not predictive of criminal prosecution. Decisions by child protective services to substantiate or not were weakly related to polygraph findings and consistently related to any indicators of possible sexual abuse. Decisions by professional evaluators about sexual abuse were best predicted by children's psychological symptoms. CONCLUSIONS: The findings reinforce already expressed reservations about the polygraph's utility in sexual abuse decision-making. Additional research is needed on decisions about the likelihood of sexual abuse.

Children's interview statements and behaviors: role in identifying sexually abused children.

Increased professional concern regarding the evaluation of suspected child sexual abuse has focused the attention of clinicians and researchers on the statements and behaviors of children during investigative interviews. The early philosophy of "believe the children" has given way to a search for consensus among professionals who perform these evaluations regarding what criteria should be used to identify sexually abused children. A small number of researchers have studied interviews with sexually abused children where other, independent criteria for validation are also present. Although this research has revealed interesting findings indicating promise, much more research is needed.

The parent-child interview: use in evaluating child allegations of sexual abuse by the parent.

The practice of using parent-child interviews to determine whether children have been sexually abused by the parent is called into question. The relevant literature is reviewed, and practical and ethical reasons for eschewing such interviews are discussed. Three case examples in which parent-child interviews were attempted or employed are described and discussed.

Possible explanations for child sexual abuse allegations in divorce.

Based on a clinical sample of 136 cases, four classes of child sexual abuse cases in divorce are proposed: divorce precipitated by discovery of sexual abuse; long-standing sexual victimization revealed after marital breakup; sexual abuse precipitated by marital dissolution; and false allegations made during or after divorce. Implications for clinical practice are discussed.

Postoperative echocardiographic study of patients following valvulotomy for critical valvular aortic stenosis.

Authors report on long term follow up of 12 patients operated with critical valvular aortic stenosis. They could perform control echocardiography in 11 patients 4-83 (mean 29) months after valvulotomy. The size and function of the left ventricle was found to be satisfactory, with elevated ejection fraction. The cause of the significant pressure gradient between the left ventricle and the aorta is discussed emphasizing the importance of echocardiography in determining the optimal time for valve replacement or homograft implantation.

Surgical management of pulmonary atresia with intact ventricular septum. Right ventricular size as a guideline for surgical intervention.

61 infants with critical valvular pulmonary stenosis (21 cases) or pulmonary atresia with intact ventricular septum (40 cases) were operated on between 1975-1989 in the Semmelweis University Medical School. Right ventricular volume, area, outflow tract dimension and tricuspid anulus diameter was measured by angiocardiography and echocardiography to evaluate right ventricular size, and to predict the operative outcome using these data. Our results suggested, that if the normalized right ventricular volume was less than 3 ml/m2, the normalized right ventricular area was less than 2.5 cm2/m2, and the normalized right ventricular area was less than 2.5 cm2/m2 and the normalized tricuspid anulus diameter was less than 1.2 cm2/m2/3 only a systemopulmonary shunt procedure is needed. In all other cases pulmonary valvotomy is necessary to decompress the right ventric and to help increase the right ventricular size. Where a different part of the right ventricle is hypoplastic a systemopulmonary shunt procedure is needed too. In the follow up period the right ventricular dimension and tricuspid valve diameter was measured by echocardiography. This noninvasive assessment can predict the preoperative diagnosis, postoperative outcome and demonstrates an adequate growth of the right ventricle after pulmonary valvotomy.

Characteristics of a clinical sample of sexually abused children: how boy and girl victims differ.

The article describes a clinical sample of 87 boy victims of child sexual abuse and compares them to 226 girl victims. Boys were on average 6.3 years of age at onset of the sexual abuse; girls were 5.5 years. Boys were more likely to be victimized by someone outside the family than girls, but about two-thirds of the boys were abused by someone within the family. Male victims were more often abused by someone who sexually abused other children than were female victims. The majority of perpetrators were men; however girls were more likely than boys to be abused by men, and boys by both men and women. Only a small percentage of the offenders were women acting alone, but boys were more likely to be abused by women than girls. In addition, data on the role relationship between victim and offender and how these relationships differ for boy and girl victims are presented.

Why sexual abuse? An exploration of the intergenerational hypothesis.

The issue of sexual abuse in the family backgrounds of offenders and mothers of victims is explored in a clinical sample of 154 cases of intrafamilial sexual abuse. More than a third of the offenders and about half of the mothers had experienced or been exposed to sexual abuse as children. Cases were divided into those where the sexual abuser was the biological father in an intact family, those where he was a stepfather or mother's live-in partner, and those where he was a noncustodial father. In biological father cases, parents were about equally likely to have experienced sexual abuse during childhood, in the stepfather/live-in partner cases, the mother was more likely to have had such an experience, and in the noncustodial father cases, the offender was more likely to have come from a sexually abusive family.

Criteria for judging the credibility of children's statements about their sexual abuse.

One hundred and three cases of child sexual maltreatment, where offenders confessed to some level of their abuse, were examined to determine the extent to which the children's statements about their victimization contained three widely accepted clinical criteria of a true sexual abuse allegation. The results support clinical assumptions that the criteria in question were valid ones for determining the truth of a sexual abuse allegation in cases involving confessions of abusers.

Drug evaluation and registration in Hungary.

In Hungary, the actual drug evaluation and registration system reflects international standards and national traditions. The compulsory drug registration system that was established in 1933 was among the first in Europe. Laboratory control (since 1927), clinical trials (since 1951) and human clinical pharmaceutical experiments (since 1967) are prerequisites for new-drug approval. Applications should be sent to the National Institute of Pharmacy, which has the overall responsibility for the registration of pharmaceutical products. Applications are assessed on the basis of the drug's quality, safety, and efficacy. The procedure follows several steps: evaluation of chemical and pharmaceutical data by the staff of the National Institute of Pharmacy; evaluation of toxicologic and pharmacologic documentation with the help of the Committee on Drug Administration; after consultation with the Committee on Medical Research Ethics (mandatory in cases of original new drugs), authorized clinical pharmacologic investigations are conducted in the units of the Clinical Pharmacological Network, which are supervised by the National Center for Clinical Pharmacology; clinical trials; application for registration (scientific evaluation); and finally, application to the Ministry of Health for a marketing authorization. The process may be facilitated appreciably for preparations already registered in another country. Moreover, Hungary is an active member in the World Health Organization (WHO), Pharmaceutical Inspection Convention of the European Free Trade Association (EFTA PIC), the Council of Mutual Economic Assistance (COMECON), and other international pharmaceutical and clinical pharmaceutical collaborations.

Women who sexually abuse children.

This article describes a clinical sample of 40 women who sexually abused 63 children. Sixty percent of the female perpetrators victimized two or more children. Almost three-fourths of these women sexually maltreated children in polyincestuous family situations. More than four-fifths were mothers to at least one of their victims. The most common form of sexual activity was group sex; the next most common was fondling. The mean age of these women was a little over 26; they were poor and poorly educated. Their victims were also young, having a mean age of 6.4 years at the time the case was identified. About two-thirds of the victims were female and one-third were male. Female perpetrators evidenced marked difficulties in psychological and social functioning. About half had mental problems, both retardation and psychotic illness. More than half had chemical dependency problems, and close to three-fourths had maltreated their victims in other ways in addition to the sexual abuse.

Phase I-II trial of aclacinomycin A given in a four-consecutive-day schedule to patients with solid tumours. A South-East European Oncology Group (SEEOG) Study.

Aclacinomycin A (ACM) in a daily dose of 30 mg/m2 was infused over 1 h on 4 consecutive days to 50 patients. Myelotoxicity was acceptable, nausea and vomiting was frequent, hair loss was mild. Grade 1-2 cardiac rhythm abnormalities were observed in 12% of the patients. Between days 1 and 4 the heart rate and the corrected Q-T interval increased while the amplitude of the T wave decreased significantly, cardiac contractility remained unchanged. In 24 evaluable breast cancer patients 1 complete remission (4%) and 2 partial remissions (8%) lasting for only 2-3 months were seen. None of the 8 patients suffering from ovarial cancer benefitted from ACM therapy.

Unanticipated problems in the United States child protection system.

While the United States child protection system is widely recognized as probably the most sophisticated and wide-ranging in the world, it nevertheless has some inherent problems. This article addresses some of the negative effects of mandatory reporting and the lack of fit of a short-term crisis intervention treatment approach for a substantial proportion of the protective services population. Reporting may have detrimental effects on the client-reporter relationship. Further, over half of the cases investigated are not substantiated. Of concern are the impact on innocent families of being investigated and the waste of scarce worker resources on investigation. While some protective services families are well suited to a crisis intervention model, a large number are multiproblem families who are always in crisis and families with chronic problems for whom crisis intervention is totally inadequate. Furthermore, because of high caseload size, workers are often not available to intervene after they have investigated the case. The problems described have been exacerbated by funding cutbacks under the current United States administration. The child protection system, along with other social welfare programs, is at risk for being dismantled by the Reagan administration.