The adult with cerebral palsy.

Important aspects of eliciting a proper history, obtaining a review of systems, and performing a physical examination in adults with cerebral palsy are presented. Information regarding diagnosis, etiology, and epidemiology of cerebral palsy as well as suggestions for performing examinations and procedures on uncooperative and extremely dysmorphic patients are included. A MEDLINE search of all English-language publications related to cerebral palsy from 1985 to 1999 was conducted. Other older references also were obtained from articles published during this period. Our personal experiences in caring for a group of approximately 300 adults with cerebral palsy and other developmental disabilities in specialized centers for nearly a decade are used frequently throughout this review. Emphasis is given to studies of adults. Studies of children are included because there is a lack of data on adults. These studies are identified as such in the text, with extrapolation to adults only where there is a sound clinical or scientific basis. The number of adults with cerebral palsy is increasing. This growth is due to increased survival of low-birth-weight infants and increased longevity of the adult population. Depending on clinical status and the age at which survival is calculated, 65% to 90% of children survive until adulthood. Despite these observations, there is a lack of information in the literature and a lack of relevant post-graduate training programs for physicians in the adult health care system.

The adolescent patient.

The physician must establish a confidential and trusting relationship with the adolescent patient. All states allow treatment of adolescents over 18 without parental consent and some allow treatment for special problems such as venereal disease or drug abuse before 18. The depressed adolescent often presents with behavioral problems, school failure, or medical symptoms. The medical history should include a description of the pregnancy and delivery, immunizations and childhood diseases, family history of coronary disease, sexual activity, school performance, and drug use. The physical examination should include an evaluation of growth and sexual development, blood pressure determination, a breast examination in older teenagers, and a pelvic examination if the patient is sexually active or if a gynecologic problem is suspected. All adolescent patients need a urine analysis and hematocrit test. Sexually active patients need a serologic test for syphilis, gonorrhea culture, and Papanicolaou smear. Determination of cholesterol and triglyceride are needed when there is a history of a myocardial infarction in a first-degree relative younger than age 50 years.

Development of antibodies reactive in antibody-dependent cellular cytotoxicity in infectious mononucleosis.

Serial sera from patients with infectious mononucleosis were examined for the emergence of antibodies reactive in antibody-dependent cellular cytotoxicity tests, using Epstein-Barr virus-superinfected Raji cells as targets. For this specific purpose, the antibody-dependent cellular cytotoxicity test proved to be of limited sensitivity because only relatively high serum dilutions can be tested dependably, due to prozone effects at low serum concentrations, and because antibody-dependent cellular cytotoxicity reactions at the 5% level are not always statistically significant. Under the conditions of the test, antibody-dependent cellular cytotoxicity-reactive antibodies were not measurable, or only barely measurable, in early-acute-phase sera, but they became detectable during convalescence and increased thereafter, gradually over many months to the range of titers seen in healthy persons after long-past-primary Epstein-Barr virus infections. The percentages of antibody-dependent cellular cytotoxicity ultimately attained were on the order of 20% in most patients and healthy individuals, but in others did not exceed 10%. The likely identity of the antibodies reactive in the test with antibodies to late Epstein-Barr virus-determined cell membrane antigens has been discussed.

Infectious mononucleosis and the Epstein-Barr virus.

Recent elucidation of the relationship between the Epstein-Barr virus and infectious mononucleosis has resulted in the development of new diagnostic serological tests, and has amplified our knowledge of the epidemiological and clinical aspects of the disease. The history, epidemiology, clinical characteristics, diagnostic features, and therapy of infectious mononucleosis are reviewed. This is done in the light of recent knowledge concerning the Epstein-Barr virus as well as previous studies employing the traditional diagnostic criteria of heterophil positivity, the classical clinical symdromes, and characteristic changes in the blood cell count. Immunological studies concerning host resistance and its occasional failure are reviewed with particular reference to T and B lymphocyte activity in the disease.

An example of a presentation to a university administration recommending gynecological and contraceptive services.

PIP: A 1971 poll at Drexel University showed that 89% of the female student body polled favored the hiring of a gynecologist by the University health center. 85% felt the health center should prescribe contraceptives. A subsequent poll in 1972 showed that 49% had had gynecological problems while at Drexel and 65% had received contraceptives during that period. It is recommended that contraceptives be provided through the health service on a fee-for-service basis because: 1)students are significantly in favor of it; 2)67% would use the service; 3)the service could be less expensive than the private physicians and more personal than the Planned Parenthood clinic now used by the students; and 4) the psychically damaging effects of unwanted pregnancy and abortion could be avoided. Gynecological services should be provided free of extra charge by the health center.^ieng