Cannula cricothyroidotomy and rescue oxygenation with the Rapid-O2™ oxygen insufflation device in the management of a can't intubate/can't oxygenate scenario.

We describe the successful use of cannula cricothyroidotomy and the Rapid-O2™ oxygen insufflation device (Meditech Systems Ltd, Dorset, UK) for rescue of a can't intubate/can't oxygenate (CICO) scenario in a patient with severe airway haemorrhage post-debridement of laryngeal amyloidosis. This case highlights the practical utility of a cannula technique for CICO rescue when appropriate equipment is used and when institutional measures are taken to prepare for this rare anaesthetic crisis.

Psychiatric co-morbidity in caregivers and children involved in maltreatment: a pilot research study with policy implications.

OBJECTIVE: The purpose of this study was to determine the lifetime incidence of mental disorders in caregivers involved in maltreatment and in their maltreated child. METHODS: Lifetime DSM-III-R and IV psychiatric diagnoses were obtained for 53 maltreating families, including at least one primary caregiver and one proband maltreated child or adolescent subject (28 males, 25 females), and for a comparison group of 46 sociodemographically, similar nonmaltreating families, including one proband healthy child and adolescent subject (22 males, 22 females). RESULTS: Mothers of maltreated children exhibited a significantly greater lifetime incidence of anxiety disorders (especially post-traumatic stress disorder), mood disorders, alcohol and/or substance abuse or dependence disorder, suicide attempts, and comorbidity of two or more psychiatric disorders, compared to control mothers. Natural fathers or mothers' live-in mates involved in maltreatment exhibited a significantly greater lifetime incidence of an alcohol and/or substance abuse or dependence disorder compared to controls. The majority of maltreated children and adolescents reported anxiety disorders, especially post-traumatic stress disorder (from witnessing domestic violence and/or sexual abuse), mood disorders, suicidal ideation and attempts, and disruptive disorders. Most maltreated children (72%) suffered from comorbidity involving both emotional and behavioral regulation disorders. CONCLUSIONS: Families involved in maltreatment manifest significant histories of psychiatric comorbidity. Policies which target identification and treatment of comorbidity may contribute to breaking the intergenerational transmission of maltreatment.

Pseudotumour in von Willebrand disease.

Pseudotumour is a rare complication of haemophilia; it has previously been reported in patients with moderate or severe haemophilia and rarely in mild disease. We report a case of a proximal pseudotumour occurring in a 36-year-old patient with mild von Willebrand disease (vWD) who made a good recovery with conservative management. Surgery has been advocated as the optimal treatment for proximal pseudotumours due to the risk of continued bleeding and progression. However, in mild haemophilia or vWD, where the risk of spontaneous bleeds is low, conservative management may be an appropriate alternative.

EPSDT in the Commonwealth of Pennsylvania, 1967-1991: a case study of a federally-sponsored, state-administered program.

Understanding the state-level processes that can shape the operations of health and welfare programs is of particular importance today. This article describes the process by which the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program was implemented in the Commonwealth of Pennsylvania. The case study highlights the factors that facilitated and hindered the transformation of this federal policy into a local program. Implications for children's health programming are identified.

Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant.

PURPOSE: We report two cases in which retained nuclear fragments in the anterior chamber after phacoemulsification and posterior chamber lens implant resulted in intraocular complications. METHODS: Case reports. RESULTS: In two eyes of two patients, retained nuclear fragments resulted in minimal anterior chamber reaction but substantial corneal edema and reduced visual acuity. Topical anti-inflammatory medications did not alter the postoperative course. Improvement occurred only when the nuclear fragments were surgically removed. CONCLUSIONS: Retained nuclear fragments in the anterior chamber can cause corneal edema and reduced vision that may be reversed by removing the fragments.

G CSF: A First Line Therapy for Autoimmune Neutropenia?

This paper studies the use of recombinant human Granulocyte Colony Stimulating Factor (rh G CSF) as a single treatment modality in serologically proven autoimmune neutropenia. We present six cases, all of whom had severe neutropenia resulting in recurrent infections and oral ulceration. A response, characterised by an increase in mean neutrophil count and a reduction in infective episodes, was demonstrated in all cases.

Obstetric outcome in women with congenital uterine malformations.

Ninety-eight cases of congenital uterine malformations were diagnosed with hysterosalpingography (HSG). Symmetric uterine malformations, composed of bicornuate uterus, uterus didelphys and septate uterus, constituted 80% of the cases. Of them, 75% were of the bicornuate type. Infertility (55%) and a suggestion of cervical incompetence (24%) were the main indication for HSG. Premature deliveries (29%), spontaneous first-trimester abortions (24%), ectopic pregnancies (3%), abnormal fetal presentations (23%) and a high cesarean section rate (27.5%) occurred in those patients. The highest rate of first-trimester abortions (47%) and the lowest rate of term deliveries (21%) occurred in the group with T-shaped uteri as compared to a 7% rate of early abortions (P less than .05) and 61% rate of term deliveries (P less than .03) in the unicornuate uterus group. In 30% of the patients with uterine malformations, cervical incompetence was diagnosed. Improved obstetric outcomes occurred in patients treated with cervical cerclage. There was a statistically significant difference between the number of premature deliveries and spontaneous late abortions in the group without cerclage (50%) and that with cerclage (21%) (P less than .001).

The effect of amniotic fluid on intraperitoneal adhesion formation--an experimental study.

In an attempt to investigate the relative paucity of intraperitoneal adhesions after cesarean sections, we tested the effect of amniotic fluid on adhesion formation in rat model. Trauma was induced to the uterine serosa in 40 rats. Amniotic fluid was intraperitoneally instilled in 20 rats and saline in another 20 rats acting as controls. No inhibitory effect of the amniotic fluid could be demonstrated. The effect of the amniotic fluid and the saline solutions on fibroblastic proliferation was examined in vitro using fibroblastic cell cultures. No direct effect on fibroblast proliferation was found. It is concluded that it is not the direct effect of the spilled amniotic fluid that inhibits adhesion formation after the performance of cesarean sections.

The effect of prostaglandins and aspirin--an inhibitor of prostaglandin synthesis--on adhesion formation in rats.

The effect of intraperitoneal application of prostaglandins E2 and F2 alpha and of aspirin, a non-steroidal anti-inflammatory drug, on the formation of intraperitoneal adhesions was investigated in rats, in view of the main role of the body's reaction in adhesion formation. Intraperitoneal adhesions were induced by inflicting uniform trauma to the uterine serosa. It was demonstrated that prostaglandin E2 may increase adhesion formation and that intraperitoneal aspirin is able to inhibit its formation.

Cervical cerclage--its role in the pregnant anomalous uterus.

Twenty-nine cases of cervical incompetence were found among 98 women diagnosed as having a congenital uterine anomaly on hysterosalpingography, a high incidence of 30%. The highest incidence was found in the bicornuate uterus group--38%. The incidence of premature delivery and late abortion was higher in this group than in the rest of the patients with uterine anomalies (55% and 68%, vs. 45% and 32%). An obvious improvement in obstetrical performance was noted after cerclage. In the cervical incompetence group, term deliveries increased from 26% to 63%. Premature deliveries and late abortions dropped from 74% to 37%. Even in the patients with anomalous uterus without proven diagnosis of cervical incompetence, term deliveries increased from 64% to 96%, and pregnancies terminating prematurely dropped from 35.6% to 4%, following cerclage. No doubt exists as to the need for cerclage in cases of cervical incompetence. We also believe it should be performed prophylactically in cases of bicornuate uterus. The concept of routine prophylactic cerclage in all cases of uterine anomalies should be considered.

Prostaglandins--a role in adhesion formation. An experimental study.

The effect of intraperitoneal application of prostaglandins F2 alpha and E2 on adhesion formation was studied in the rat after traumatizing to the uterine serosa. Prostaglandins applied locally were found to increase intraperitoneal adhesion formation at the injury site, in comparison with controls. The effect of intraperitoneal application of prostaglandins F2 alpha and E2 on fibroblastic proliferation was examined in vitro, by fibroblastic cell culture of rat kidney, human kidney and human prepuce. No direct effect of prostaglandins on fibroblast proliferation could be demonstrated. It is concluded that prostaglandins play an important role in the process of adhesion formation. This effect is not related to fibroblast proliferation.

Asymptomatic bacteriuria in normal and high-risk pregnancy.

A routine urine culture was performed in 1130 normal pregnant women and in 211 high-risk pregnancies (136 diabetics and 75 women with a previous urinary tract infection). Asymptomatic bacteriuria was found in 5.9% of the normal pregnancies, 12.5% among the diabetics and in 18.5% of the previous urinary tract infection patients. The higher incidence of a clinical urinary tract infection among patients with asymptomatic bacteriuria was found statistically significant (p less than 0.001) in all three groups. A high correlation was found between a negative urine culture in early pregnancy and the absence of development of cystitis and pyelonephritis in later pregnancy. The incidence of asymptomatic bacteriuria in normal pregnant women who developed cystitis later in pregnancy was 33.3% and in those developing pyelonephritis, 66%. In the two high-risk pregnancy groups, the incidence of asymptomatic bacteriuria among those developing clinical infection was even higher, 58.3 and 85.7%, respectively, among the diabetics, and 60 and 66.6% respectively, among the previous urinary tract infection patients.

Calcium antagonist. Effect on adhesion formation.

In view of the role of the calcium ion in the inflammatory process, the effect of Diltiazem--a calcium antagonist--on the formation of intraperitoneal adhesions was studied in rats after induced trauma to the uterine serosa. It was found that intraperitoneal application of diltiazem inhibited adhesion formation to some extent, whereas intramuscularly administered Diltiazem did not. A dual effect of calcium antagonists on the formation of adhesions is suggested.

Advanced ultrasonic placental maturation in twin pregnancies.

The mean length of twin pregnancies is shorter than that of singleton pregnancies. The possibility that the shorter gestation of twins is associated with advanced fetal maturational changes was studied in relation to placental maturation. For this purpose, the sonographically determined placental gradings of 158 twin pregnancies and 474 singleton pregnancies were compared at different gestational ages. The percent distributions of placental grades, from I to III, were significantly different throughout the third trimester, with a preponderance of Grade III placentas in the twin group (p less than 0.001). Considering the reported association of Grade III placentas with advanced gestation as well as fetal lung maturity, the present study suggests earlier maturational changes in twin fetuses compared with singleton fetuses.

Crime at home and in the streets: the relationship between family and stranger violence.

Research and theory on violent behavior have treated aggression between intimates and aggression between strangers as separate phenomena. Major criminological works on violence and aggression have generally overlooked violence in the home. As a result, independent and distinct bodies of theoretical and practical knowledge exist regarding family violence and aggression toward strangers, and the relationship between family violence and violence directed against strangers is little understood. Estimates of the intersection of these behaviors vary extensively. Severity of domestic violence is associated with violence outside the home. Exposure to violence as a child consistently emerges as a strong explanatory factor for both domestic violence and the behavior of "generally" violent men. Behavior patterns appear to shift over time, from domestic violence only to violence toward both strangers and family members. However, an integrated theory of violent behavior by males provides explanations of both stranger and family violence. Early childhood socialization toward violence, modified by social and cultural supports during adolescence and adulthood, suggests a social learning paradigm. Hypotheses are developed that integrate and unify theories of stranger and family violence.