Sources of influence on intention to breastfeed among African-American women at entry to WIC.

To examine how individuals within a woman's life influence her infant feeding intention, we interviewed 441 African-American women on the breastfeeding attitudes and experiences of their friends, relatives, mother, and the baby's father. Women were interviewed at entry into prenatal care at clinics associated with one of four Baltimore WIC clinics chosen for a breastfeeding promotion project. Qualitative data were also collected among 80 women. Friends and "other" relatives were not influential. Grandmothers' opinions and experiences were important, but their influence was reduced after considering the opinion of the baby's father. The opinion of the woman's doctor was an independent predictor of infant feeding intention. Breastfeeding promotion programs should recognize the separate influence of fathers, health providers, and grandmothers in women's infant feeding decisions.

Surgical treatment of benign intracranial hypertension--subtemporal decompression revisited.

BACKGROUND: Subtemporal decompression, first advocated by Dandy for the treatment of benign intracranial hypertension or pseudotumor cerebri, has been replaced as a treatment mainstay by medical management using diuretics, steroids, and lumbar puncture. Failure of these forms of treatment has frequently led to insertion of cerebrospinal fluid shunts. METHODS: We have retrospectively reviewed the long term outcome of eight patients who were treated by subtemporal decompression (STD) for classical presentations of refractory benign intracranial hypertension. The follow-up period ranged from 8 to 26 years. RESULTS: Within 1 month of STD, deterioration in visual fields and acuity resolved in all eight patients. Five of eight patients required CSF diversion procedures after subtemporal decompression to control headaches. No patient experienced recurrent permanent visual deterioration after STD. CONCLUSION: STD may be the most effective treatment in both long and short term follow-up to provide lasting relief and prevention of visual morbidity caused by refractory benign intracranial hypertension.

The effect of a woman's significant other on her breastfeeding decision.

The infant feeding preferences of significant others have been shown to influence a pregnant woman's breastfeeding decision. Many researchers and policy makers are calling for the inclusion of a woman's significant other in the counseling and education of pregnant women regarding breastfeeding. This study reports on the impact of the significant other's infant feeding preferences and beliefs on a woman's intention to breastfeed, her initiation and successful initiation (longer than seven days) of breastfeeding. "Significant other" was defined as the person whom the pregnant woman reported as the one whose opinion "mattered the most to her" regarding feeding her infant. A randomly selected sub-sample of 133 women and their significant others was chosen from a larger infant feeding study. This sub-sample was heterogeneous with respect to age, education, and marital status. The women were interviewed during their third trimester of pregnancy and again at 7-10 days postpartum. Their significant others (71 percent baby's father and 29 percent baby's maternal grandmother), were interviewed during the woman's third trimester of pregnancy. Results indicate that a woman's intention to breastfeed is strongly and positively affected by the significant other's infant feeding preferences, initiation of breastfeeding is mediated through intention to breastfeed, and successful initiation of breastfeeding is also mediated through intention and is uniquely dependent on the pregnant woman's self-efficacy.

Syndrome of the cervical plexus caused by high cervical nerve root compression.

Lesions affecting the roots of the cervical plexus can cause a syndrome not previously described. The C3-C4 disc space is the most likely to be involved, but pressure on the C5 root can also produce facial, auricular, or retroauricular pain. Motor innervation to the diaphragm can be affected, and even the uppermost disc space at C2-C3 might be implicated. Findings on examination findings are sparse, although sensory impairment in areas of cervical plexus innervation has been observed. In a series of 1000 cervical decompression cases (both anterior and posterior) for disc disease or similar processes, only 10 instances of this syndrome have been found. Paresthesia or episodic shock-like pain affecting the ear, para-auricular, lower occipital, and mandibular areas prompted by head turning or extension are the most common complaints.

K23. A low-incidence antigen in the Kell blood group system identified by biochemical characterization.

An antibody in the serum of a gravida 4, para 3 woman reacted with red cells from two of her children, her husband, and his mother, but with none of more than 2100 reference red cell samples and blood samples from donors. The reactive antigen was inactivated by 2-aminoethylisothiouronium bromide or dithiothreitol-papain treatment. The antigen was immunoprecipitated from paternal red cells with maternal antibody and shown to migrate by sodium dodecylsulfate polyacrylamide gel electropheresis as a single protein of approximately 93,000 daltons. After transfer to nitrocellulose paper by Western blotting, the protein reacted with a rabbit antibody specific for Kell protein. The chemical inactivation and electrophoretic findings were characteristic of Kell group antigens. The reaction with the rabbit antibody establishes that the "new" low incidence antigen was an epitope on Kell group protein and must be coded for by the Kell gene. It has been designated K23.

"New" autoantibody specificity in autoimmune hemolytic anemia defined with red cells treated with 2-aminoethylisothiouronium bromide and a dithiothreitol-papain solution.

Specificity of IgG autoantibodies that react with random red cell samples but not with cells treated with 2-aminoethylisothiouronium bromide (AET)-previously was related to the Kell blood group system. We now describe an IgG autoantibody, from a patient who died with autoimmune hemolytic anemia, that reacted with random red cell samples, Ko cells, and with cells treated with a dithiothreitol-papain solution, but did not react with AET-treated cells or with Rhnull cells. Serological reactivity of the autoantibody is unlike that of IgG autoantibodies that do not react only with Rhnull cells. It appears that the reactive antigen is not part of the Kell or Rh systems, but is probably modified by the membrane anomaly present in Rhnull red cells.

Carotid artery occlusion in the management of selected giant intracranial aneurysms and carotid cavernous fistula: percutaneous use of the balloon catheter.

The percutaneous technique of balloon catheter occlusion of internal and common carotid arteries can produce long-term obliteration of aneurysms and fistulae. Fourteen difficult aneurysms and one carotid-cavernous fistula of the internal carotid artery were thus treated, with success achieved in 13 cases. This technique permits careful control of the occlusion. If neurologic symptoms develop during the procedure, rapid balloon deflation can reverse the deficits in most cases.

Unusual anomaly of the anterior cerebral artery: report of a case.

The rare occurrence of a low intracavernous internal carotid bifuraction is reported. The anterior cerebral blood supply emanated from this source. Two separate aneurysms at the bifurcation of the anomalous single anterior cerebral artery were operated on one year apart.

Use of computerized tomography in nonsurgical management of brain abscess.

Two patients with hematogenous brain abscesses demonstrated by computerized tomographic (CT) scans were successfully treated without surgical intervention. The first patient had congenital cyanotic heart disease and multiple brain abscesses complicated by presumed rupture into the ventricles. By the time these clinical diagnoses were established, she had shown substantial improvement after antibiotic therapy alone. The second patient with bronchiectasis had a single abscess in the dominant hemisphere. Medical management was successful. Subsequent CT scans in both patients provided reassurance that clinical improvement was accompanied by anatomical healing. The use of noninvasive diagnostic techniques should encourage the formulation of new criteria for the management of cerebral abscess in carefully evaluated and closely observed patients.