Child abuse: the experience of the island of Curacao, Netherlands Antilles

Provides a background to youth care services in Curacao and the Confidential Office for Cases of Child Abuse which was established with the specific objective of preventing child abuse and improving methods of detection, monitoring, and intervention. Evaluates the success of the office and discusses developments whcih have taken place since 1987 when the office ceased to function. Refers to efforts being made to establish better working relationships between the various health and welfare services, upgrading of knowledge and skills of workers in the field and to a resolution which was adopted that all agencies working for the welfare of youth should come together to find a working model for fighting child abuse. (AU)

Inhalation challenge with carbachol and isoproterenol to predict bronchospastic response to propranolol in COPD.

Disabling propranolol-induced bronchospasm occasionally prevents use of this drug in patients with chronic obstructive pulmonary disease (COPD). A means was developed to identify patients who have high risk for this adverse effect using bronchial challenge by inhaling the parasympathomimetic drug, carbachol, and isoproterenol. After baseline pulmonary function tests, 12 patients with varying degrees of COPD and 13 control patients underwent maximal beta-blockade using intravenously administered propranolol during cardiac catheterization followed by repeat pulmonary function testing. Seven of the patients with COPD and ten of the control subjects were restudied while taking propranolol orally for at least three weeks. The results indicated that the bronchodilator response to inhaled isoproterenol does not reliably identify patients who develop bronchoconstriction with propranolol, but bronchoconstriction after inhaling carbachol is indicative of the high risk of developing bronchoconstriction from propranolol.

Carriage and transmission of group B streptococci among STD clinic patients.

High rates of carriage of group B streptococci were found among men (38%) and women (42.3%) attending a clinic for sexually transmitted diseases. Swabs from the perineal/anorectal area gave the highest isolation rate and those from the urethra the lowest. The subpreputial sac was an important site for carriage of the organism, and there was a strong association between streptococcal isolation and balanitis. Of 92 couples studied, neither partner was colonised with group B streptococci in 36. In a further 36 one or other was colonised and in 20 both were colonised. Serotyping and phage typing showed that only three of these 20 couples were colonised with similar strains of the organism.

Rapid staining technique for Trichomonas vaginalis. Preliminary report.

A simple, rapid, staining method for the identification of Trichomonas vaginalis has been tested on cultured trichomonads and specimens of vaginal discharge. Fifty-eight stained slides of vaginal discharge were examined and trichomonads were correctly identified in the 31 specimens from patients with confirmed vaginal trichomoniasis. No false-positive results were obtained. This staining procedure could prove a useful addition to wet-film and cultural methods.

Delayed appearance of left-to-right shunt following aortic valvular replacement. Report of two cases.

Two cases are presented in which a left-to-right shunt occurred late following aortic valvular replacement. In one patient a fistula was found between the aortic root and the right atrium and ventricle. In the second patient a defect developed in the membranous septum, allowing shunting from the left ventricle to both the right atrium and right ventricle.

Hemodynamic and respiratory effects of morphine and butorphanol.

The hemodynamic effects of butorphanol, a potent synthetic narcotic-antagonist analgesic, were investigated and compared with those of morphine. A total of 20 patients were studied (8 butorphanol, 12 morphine) at the time of diagnostic cardiac catheterization. Butorphanol decreased pH, PCO2, and systemic artery pressure and increased PCO2, cardiac index, and pulmonary artery pressure. Morphine caused similar changes in pH, PO2, systemic artery pressure, and PCO2 but much smaller changes in cardiac index and no change in pulmonary artery pressure. The clinical implications and possible mechanisms are discussed.

Improved transport and culture system for the rapid diagnosis of gonorrhoea.

The Jembec/Neigon transport-and-culture system for the rapid diagnosis of gonorrhoea has been assessed by 167 sets of investigations in 128 named female contacts of infected men. The system offers the same advantages of efficiency and speed as the Transgrow transport-and-culture system, but it is also more flexible and much less time-consuming.

Penicillin sensitivity of gonococci. An evaluation of monitoring as an index of epidemiological control.

The penicillin sensitivities of 1,167 gonococci isolated during a 30-month period from male patients, and 794 gonococci isolated from female patients were analysed retrospectively. More strains from males were relatively resistant than those from females, and a higher proportion of relatively resistant organisms was isolated from each sex when the infection had been acquired outside the area served by the clinic. During the course of the study a fall in the number of relatively resistant strains was seen amongst the locally acquired organisms, whilst no such drop occurred in the strains acquired elswhere; it is postulated that improved contact tracing may have been responsible. Regular monitoring of the penicillin sensitivity of gonococci has been shown to be a sensitive index of gonorrhoea control.

Hemodynamic and metabolic responses to pacing in patients with chest pain and normal coronary arteriograms.

Hemodynamic and metabolic responses to pacing from either the coronary sinus or right atrium were evaluated in 41 patients with chest pain and normal coronary arteriograms. A group of patients (group II) with angina, lactate production, or significant ST segment depression had a significantly higher mean pulmonary capillary pressure on peak pacing or angina than did a group of patients considered to have a normal pacing response (group I). In 6 of 9 group II patients, the left ventricular end-diastolic pressure either rose abnormally with pacing or was greater than 14 mm Hg immediately after pacing and resembled that of a group of patients with coronary artery disease; Patients with a prolapsing mitral valve (group III) also had a significantly higher pulmonary capillary pressure on peak pacing as compared to those of group I, although abnormal left ventricular pressure responses occurred in only 2 of 9 of these patients. The stroke index was significantly lower in group III on peak pacing while group II was no different from group I. Lactate production occurred in 6 of 9 group II patients. However, only 1 of 6 patients with a prolapsing mitral valve who were studied for lactate production was found to produce lactate, suggesting a different mechanism for their pain.