Bracing for infantile scoliosis: no sedation needed.

Mehta casting technique applied under anesthesia is standard treatment for infantile scoliosis (IIS). However, concern has been raised about frequent anesthesia in children less than three years. The development of a customized thoracolumbar sacral orthosis (TLSO) could avoid the risks of Mehta casting. To develop a bracing technique for IIS that achieves patient compliance and scoliosis correction. Nine patients with ISS were offered a custom TLSO as an alternative to Mehta casting. One patient declined due to an insurance issue. No anesthesia was required for measurement or fitting of the TLSO. A temperature sensitive monitor recorded wear time. Brace success was determined by radiographic correction and adherence to prescription of greater than 18 hours per day. Eight patients had brace treatment with mean(range): age 19(12-44) months, curve magnitude 34° (22-44°), rib vertebral angle of greater than 20° with follow-up 17(3-28) months. In brace correction was less than 15 degrees in 6 of 8 patients. Compliance monitor recorded wear: 4 patients ≥ 18 hours, 2 patients 16-18 hours, 1 had 14 hours, and 1 monitor malfunctioned and could not be read. Brace design evolved to maximize ipsilateral abdominal relief away from the lateral apical shift of the design. Foam lining was added to prevent skin irritation through the relief opening. Average number of braces per year =2.2. A customized TLSO can achieve in brace correction comparable to Mehta casting with acceptable compliance and without the need for general anesthesia, while allowing bathing and skin care.

Equine proliferative enteropathy: a cause of weight loss, colic, diarrhoea and hypoproteinaemia in foals on three breeding farms in Canada.

Proliferative enteropathy (PE) is a transmissible enteric disease caused by Lawsonia intracellularis. An outbreak of equine PE was diagnosed in foals from 3 breeding farms. Most foals had been weaned prior to the appearance of clinical signs, which included depression, rapid and marked weight loss, subcutaneous oedema, diarrhoea and colic. Poor body condition with a rough haircoat and a potbellied appearance were common findings in affected foals. Respiratory tract infection, dermatitis and intestinal parasitism were also found in some foals. Haematological and plasma biochemical abnormalities included hypoproteinaemia, transient leucocytosis, anaemia and increased serum creatinine kinase concentration. Postmortem diagnosis of PE was confirmed on 4 foals based on the presence of characteristic intracellular bacteria within the apical cytoplasm of proliferating crypt epithelial cells of the intestinal mucosa, using silver stains, and by results of PCR analysis and immunohistochemistry. Antemortem diagnosis of equine PE was based on the clinical signs, hypoproteinaemia and the exclusion of common enteric infections. Faecal PCR analysis was positive for the presence of L. intracellularis in 6 of 18 foals tested while the serum of all 7 foals with PE serologically evaluated had antibodies against L. intracellularis. Most foals were treated with erythromycin estolate alone or combined with rifampin for a minimum of 21 days. Additional symptomatic treatments were administered when indicated. All but one foal treated with erythromycin survived the infection. This study indicates that equine PE should be included in the differential diagnosis of outbreaks of rapid weight loss, diarrhoea, colic and hypoproteinaemia in weanling foals.

Rapid-release and coat-core formulations of nisoldipine in treatment of hypertension, angina, and heart failure.

Nisoldipine, a dihydropyridine calcium antagonist, has greater vascular selectivity than other calcium channel antagonists and does not depress the intact myocardium in vivo. It should be taken on an empty stomach. Both rapid-release and coat-core formulations are available for clinical use, but only the coat-core formulation extends antihypertensive, antiischemic, and antianginal effects throughout the dosing interval when given once daily. The coat-core formulation in daily doses of 10 to 40 mg does not cause the proischemic effects reported with the rapid-release formulation. When given as monotherapy, the coat-core formulation is highly effective in lowering blood pressure to a similar extent as other long-acting calcium channel blockers, diuretics, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors. The antihypertensive effects are potentiated when the coat-core formulation of nisoldipine is given in combination with lisinopril. In patients with stable angina pectoris nisoldipine coat-core increases exercise duration, reduces anginal frequency and myocardial ischemia, and is effective as monotherapy or in combination with a beta-blockers. In monotherapy the drug is as effective as other long-acting calcium channel blockers or a beta-blocker. The effects of nisoldipine coat-core in patients with heart failure are unclear at present.

Prognostic implications of stable versus transient "borderline features" in bulimic patients.

BACKGROUND: This study examined the association between "borderline features" and treatment response in bulimic patients. METHOD: Treatment response was assessed in 69 bulimic patients over 6 months of treatment (and 1-year response in 44 of the patients). Patients were classified as a function of whether "borderline features" were (1) "stably" present (at pretreatment and after 3 months), (2) "transiently" present (at pretreatment only), or (3) "absent" (at both time points). RESULTS: The stably borderline profile coincided systematically with Axis II comorbidity (not with mood disorders) and was generally predictive of poorer 6- and 12-month response of eating and comorbid symptoms. Hierarchical regressions showed predictive effects to have a partial independence from effects caused by concurrent eating symptoms and depression. CONCLUSION: Results highlight the importance, with respect to prognosis in bulimia nervosa, of establishing the temporal stability of features that imply character disturbance.

Eating and psychiatric symptoms as a function of Axis II comorbidity in bulimic patients. Three-month and six-month response after therapy.

Using DSM-III-R criteria, the authors organized 61 bulimic patients into "Borderline," "Other Personality Disorder," and "No Personality Disorder" groups, and then examined eating and comorbid symptoms at 3-month intervals during 6 months of multimodal therapy. Personality-disorder classifications seemed to predict neither the severity nor responsiveness to treatment of bulimic symptoms; all groups showed reliable and clinically significant improvements in eating habits over time. Conversely, the borderline patients showed reliably more comorbid symptoms than did any other group; their scores on disorder-specific dimensions--like borderline "traits" and maladaptive defenses--remained distinctly elevated throughout treatment. Our findings indicate that 1) a "borderline/nonborderline" distinction predicts temporally stable--and theoretically meaningful--differences in comorbid profiles, and 2) there exists an intriguing degree of independence, at least during ongoing treatment, between severity of character pathology and degree of change obtained on eating symptoms. Theoretical and clinical implications are discussed.

Prognostic utility of subcomponents of the borderline personality construct in bulimia nervosa.

We examined various components of the 'borderline personality construct' as predictors of initial response to treatment in 61 bulimic patients. At pre-treatment, a 'borderline/non-borderline' distinction was established using DSM III-R criteria, and other components of 'borderline' pathology ('borderline traits', object-relations disturbances, maladaptive defences and mood pathology) were assessed using self-report. Self-reported eating and psychiatric symptoms were obtained at initial and three-month evaluations. Using hierarchical regression analyses, we controlled effects of initial eating and psychiatric symptoms, and then evaluated various measures of the borderline construct as predictors of later symptom severity. Categorical borderline PD diagnoses were linked to poorer response on eating attitudes and symptoms, and fine-grained analyses indicated that this prognostic effect might be mediated by mood and object-relations disturbances. Findings therefore seemed to isolate specific subcomponents of borderline personality pathology that predicted poorer response on eating symptoms.

Comorbid features in bulimics before and after therapy: are they explained by axis II diagnoses, secondary effects of bulimia, or both?

This study evaluated the extent to which personality disorder (PD) diagnoses drawn in active bulimics explained pretreatment and posttreatment comorbid features, once possible secondary effects of bulimia nervosa (BN) on the mental status were controlled. We used structured interviews to assign axis II diagnoses to 73 DSM-III-R bulimics, and then examined whether or not classification into borderline PD (BPD), other PD (OPD), or no PD (NPD) groups (a) predicted pretreatment and posttreatment differences in comorbid symptoms, and (b) explained the severity of comorbid symptoms independent of effects attributable to BN sequelae. Groups never differed on eating-symptom measures, with all showing satisfactory average improvements over 3 months. However, on pretreatment and posttreatment comorbid symptoms, BPD subjects displayed more depression, reliance on maladaptive defenses, and other pathological features than did other groups. More importantly, after controlling for the effects of possible sequelae of BN on comorbid symptoms at each point in time, a borderline/nonborderline distinction always explained significant residual proportions of variance in comorbid symptoms. These findings suggest that despite tendencies for BN to exacerbate concurrent symptoms, axis II diagnoses remain meaningful as indicators of comorbid features.

Retrospective search for bleeding diathesis among premature newborn infants with pulmonary hemorrhage after synthetic surfactant treatment. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group.

In an across study analysis of five multicenter, placebo-controlled trials of the synthetic surfactant, Exosurf Neonatal, involving infants with birth weights 700 gm or greater the incidence of clinical pulmonary hemorrhage was 1.9% in treated infants and 1.0% in control infants. To determine whether this apparent increase in pulmonary hemorrhage was the result of a bleeding diathesis, we retrospectively reviewed charts for 39 of 41 infants with clinical pulmonary hemorrhage. The incidence of nonpulmonary bleeding was the same in control- and surfactant-treated infants. Platelet counts, hematocrit values, and the number of transfusions with platelets or red blood cells did not differ between the two groups. There was no evidence that surfactant treatment was specifically associated with a generalized bleeding diathesis.

Relationships among borderline features, body dissatisfaction and bulimic symptoms in nonclinical females.

The present study evaluated the utility of combining measures of body dissatisfaction and borderline personality features in screening high-school girls who may be at risk for bulimia nervosa. Two samples (777 high-school girls and 22 bulimic women in-treatment) completed scales assessing borderline traits, body dissatisfaction, eating symptoms, and associated psychiatric disturbances. Students were divided into four groups, respectively showing: (a) high body dissatisfaction and borderline traits, (b) high body dissatisfaction alone, (c) high borderline traits alone, or (d) neither vulnerability component. Clinical and nonclinical groups were then compared for severity of eating and psychiatric symptoms. Girls displaying the combination of high body dissatisfaction and borderline traits (our presumed "high-risk" group) showed an elevated profile of eating and associated disturbances, highly comparable to the bulimic group. They were also more likely to receive threshold and subthreshold diagnoses of bulimia nervosa (according to simulated diagnoses based on self-report items) than subjects in other high-school groups. Implications of these findings were discussed with reference to the "two-component" model of eating disorders.

Herpes labialis treatment with acyclovir 5 per cent ointment.

Eighty patients who were culture-confirmed positive for recurrent herpes labialis were entered into a clinical trial. Sixty of these completed two episodes each in a randomized, double-blind, placebo-controlled clinical trial of 5 per cent acyclovir in a polyethylene glycol ointment base. The 5 per cent acyclovir ointment failed to show better clinical healing effects than placebo in both documented episodes. There were no serious side effects observed in either group.