Profiles of strengths and weaknesses in dyslexia and other learning difficulties.

A total of 83 children with different special educational needs (SEN) assessments were contrasted with a control group (N = 40) without special needs on measures that aimed to identify potential areas of strengths as well as weaknesses in these SEN groups. Carefully selected groups of dyslexics, dyspraxics, children with specific language difficulties, moderate learning disabilities, attention deficits and emotional/behavioural disorders were assessed on measures of literacy, phonological and verbal skills, non-verbal ability, problem behaviour scales and cognitive interference. Scores indicated that individual measures were relatively poor at specifically differentiating one SEN group from the controls and that all SEN groups presented evidence of literacy deficits despite potentially different causes for such acquisition difficulties. For most of the six SEN groups targeted, assessments that considered strengths as well as weaknesses provided a profile that specifically differentiated the group from the controls in contrast to the other SEN groups tested.

Anesthetic management of a labouring parturient with urticaria pigmentosa.

PURPOSE: To report the anesthetic management of labour pain and Cesarean section in a patient with urticaria pigmentosa at risk for systemic mastocytosis. CLINICAL: A 37-yr-old patient with a history of urticaria pigmentosa and an allergic reaction to a local anesthetic agent was seen in consultation at 36 weeks gestation. She previously tested negative for an allergy test to lidocaine. Recommendations to avoid systemic mastocytosis included: avoidance of histamine-releasing drugs, using lidocaine for labour epidural, and regional anesthesia in case of a Cesarean section. The patient presented at term in labour. Intravenous fentanyl was used for early labour, followed by a combined spinal-epidural. The spinal contained lidocaine and fentanyl, but because of pruritus, the epidural infusion contained lidocaine only. Most likely because of tachyphylaxis to lidocaine, an epidural bolus of lidocaine with epinephrine failed to provide adequate anesthesia for a Cesarean section. The block was supplemented with nitrous oxide by mask, with fentanyl postdelivery. Postoperative pain control was managed with an epidural infusion of lidocaine and fentanyl for three days. The patient was discharged without complications four days postsurgery. CONCLUSION: Proper allergy testing prior to pregnancy is important to help the management of labour pain and anesthesia for Cesarean section in a patient at risk for systemic mastocytosis.