The relationship of bone properties using high resolution peripheral quantitative computed tomography to radiographic components of hip osteoarthritis.

OBJECTIVE: Positive associations between radiographic osteoarthritis (OA) and areal bone mineral density (BMD) have been demonstrated and appear strongest when bony features of OA are considered. To date, these associations have not been assessed using HRpQCT. DESIGN: A total of 318 participants (170 men and 148 women), aged 72.1-81.4 years from a non-selected cohort, underwent HRpQCT of the distal radius and tibia along with hip radiography. Differences in bone microarchitecture were assessed between those with and without osteophytes, sclerosis or joint space narrowing (JSN) in either hip. RESULTS: Men with osteophytes alone had significantly higher radial trabecular volumetric BMD (Tb.vBMD) and radial and tibial trabecular thickness (Tb.Th). Men with both sclerosis and osteophytes had significantly higher cortical volumetric BMD (Ct.vBMD) and cortical thickness (Ct.Th) at the distal tibia than those with osteophytes alone (P < 0.05). These relationships were maintained after adjustment for age and Body Mass Index (BMI), and were not replicated in women. Bone microarchitecture did not differ significantly in those with JSN from those without it in men or women. CONCLUSIONS: Our findings suggest higher Tb.vBMD and Tb.Th in men with osteophytosis but higher tibial Ct.vBMD and Ct.Th in men with hip joint sclerosis. These results do however require replication in other cohorts.

Radiation processing: adapting to a changing world.

The 15th International Meeting on Radiation Processing was held in London, UK, on 21-25 September 2008. It provided a forum for researchers, academics, the radiation processing industry and its users and regulators to review progress. This report focuses on the developments relevant to medical device sterilisation in products, processes, technology and the regulatory environment that were examined at the event.

Sterilisation technology choices during. Product design and development.

Sterilisation is a critical and integral stage in the manufacture of a sterile device. It should, therefore, be recognised at the design stage of the device if the desired confidence in the end product and potential benefits of sterilisation options are to be achieved. This article highlights some of the issues to consider when selecting the most appropriate sterilisation method.

Enhancing dissipation of aroclor 1248 (PCB) using substrate amendment in rhizosphere soil.

Soils contaminated in the laboratory with Aroclor 1248 (PCB) were amended with biphenyl and plant residues that are known to induce PCB degradation, and planted with crops that inherently stimulated PCB dissipation in a previous study to determine if the combination of soil amendment and planting could further enhance PCB dissipation beyond that shown by planting alone. The plants used were flat pea (Lathyrus sylvestris), reed canarygrass (Phalaris arundinacea), and burr medic (Medicago polymorpha). They were grown in laboratory microcosms at a 12h photoperiod in soil containing 50mg/kg PCB. Portions of soil were amended with biphenyl (1,000 mg/kg), ground pine needles, or orange peels (2% w/w), and a portion was left unamended to serve as control. After nearly 100d, PCB recoveries ranged from 69% of initial applications in unplanted soil to 65, 59 and 55% of initial levels in soils that were unamended but planted with flat pea, reed canarygrass and burr medic respectively. PCB recoveries in soils that were amended, but left unplanted ranged from 59% of initial applications in pine needle amended-soil to 48 and 45% in biphenyl- and orange peel-amended soils respectively. Combinations of soil amendment and planting enhanced PCB dissipation in soil compared to planting alone, except the combination of biphenyl amendment and planting with burr medic, where the soil still contained nearly 80% of the initial PCB additions after about 100 d. Estimates of bacterial populations were generally slightly to significantly higher in orange peel and biphenyl-amended soil than in unamended soil, except in biphenyl-amended soil that was planted with burr medic, where bacterial counts were significantly lower than in most of the other treatment combinations.

Optimizing cost and service in sterilization.

Controlling sterilization costs is a necessity if medical device manufacturers are to remain competitive. This article looks at ways the industry can reduce these costs and also considers the benefits to be gained by improving relationships with sterilization contractors.

School-based HIV prevention. A promising model.

This article explores connections between the mental health and educational systems by profiling the Redefining Actions and Decisions (RAD) curriculum, a theory-based, developmentally informed HIV education program for middle and high schools. RAD was developed by Deborah R. Schoeberlein and evaluated by Dr. John Brett. RAD's public health approach, which has gained considerable attention at the national level, argues that HIV prevention, either through risk-abstinence or risk-reduction techniques, is an appropriate strategy for safeguarding community health.

Case study: missed diagnosis and mistreatment of unrecognized comorbid Graves disease.

Comorbid medical conditions are known to complicate the course and treatment of psychiatric disorders. This case study provides the first published report of Graves disease exacerbating the symptoms of Tourette's disorder and attention-deficit hyperactivity disorder (ADHD). The lack of diagnosis of the Graves disease compromised the efficacy of the treatment of Tourette's disorder and ADHD. This case study supports the need to the consider increased risk of a second immunoendocrinological disorder in the presence of diabetes mellitus type I, one of the several disorders that comprise the syndrome of polyglandular autoimmune endocrinopathy type II.

Case study: carbamazepine treatment of juvenile-onset bipolar disorder.

The literature devoted to juvenile-onset bipolar disorder has rapidly expanded in the past 5 years with an emphasis on new concepts of prevalence and comorbid conditions. In the process of enlarging the knowledge base about the phenomenology of juvenile-onset bipolar disorder, this new literature has generated considerable controversy but has provided little information about pharmacotherapy. In the following case series, carbamazepine appeared to be a safe and effective treatment for juvenile-onset bipolar disorder. Controlled studies are necessary before any definitive conclusions can be reached about the efficacy of carbamazepine in the treatment of this form of bipolar disorder.

HIV prevention for teenage girls: relationships are the medium and the message.

HIV is a growing problem among young black and Hispanic women. Teenage girls' risk of HIV infection is primarily social in nature because sexual and/or needle-sharing behaviors typically occur in the context of relationships. Without cure or vaccine, the practice of safe or protected personal behaviors is absolutely critical to prevent new HIV infections. To optimize HIV-prevention efforts, clinicians can form caring and developmentally appropriate relationships that address HIV education. Medical HIV prevention for teenage girls is fundamentally about healthy relationships.

Intensive, integrated, in-home psychiatric services. The catalyst to enhancing outpatient intervention.

The authors introduce the Yale Intensive In-Home Child and Adolescent Psychiatric Service, a model of home-based care for children with severe psychiatric disturbances. This model synthesizes the principles and method of the wrap-around paradigm and in-patient child psychiatric practice within the reality of the managed care system. A clinical team, under the direct supervision of a child psychiatrist, works directly within the family to understand and address the multilevel transactions that have affected the child's ability to function in various domains and resulted in recommendations for intensive intervention, including psychiatric hospitalization. This article suggests that if the psychiatrist is to provide the highest level of care, cognizance of and involvement in the child's ecology are as essential for the child and adolescent psychiatrist as other aspects of the child's world and life. In the days of ever shortening patient lengths of stay, this model of care offers promise for both clinical and fiscal effectiveness.

Clozapine in the treatment of a young adolescent with schizophrenia.

Although recent reports have suggested that clozapine may be efficacious in the treatment of adolescents with schizophrenia, few studies have examined the use of clozapine in patients younger than 17 years of age. We describe highly successful trials of clozapine conducted in a 13-year-old girl and her cousin, both of whom developed severe symptoms of schizophrenia, which were refractory to neuroleptic medication, at the ages of 11 and 13 years, respectively. The pharmacology of and clinical experience with clozapine are reviewed.

The boundaries of attention deficit disorder.

This report examines distinctions and interrelationships among attention deficit disorder (ADD) and two closely related conditions: learning disability (LD) and oppositional/conduct (O/C) disorder. To evaluate our hypothesis that some of the difficulty in resolving the relationship between ADD and, particularly, O/C may reflect the consequences of selective referral patterns, we studied groups of children diagnosed as ADD from different referral sources. Results suggest that referral bias does exist and that children referred to mental health settings differ from those referred to pediatricians, child neurologists, or psychologists. Because of the nature of the subjects referred to mental health services, nonrepresentative associations may emerge. Rather than being considered as prototypical of all children with attention disorder, children referred to mental health facilities may represent simply an extreme of the continuum of ADD. Evidence suggests that many children with ADD will be represented by those referred primarily for attentional deficits and learning problems, rather than those with inattention, hyperactivity, or aggression referred for child psychiatric evaluation.

The role of advanced technology in inpatient child psychiatry: leading edge or useful aid?

New technology has played a catalytic role in advancing understanding of etiology, diagnosis, and treatment in virtually all fields of medicine. Child psychiatry, a relatively new medical specialty, has begun to employ such advanced technology in diagnosis and treatment monitoring. This current study demonstrates that, in an inpatient child psychiatric setting, such advanced technology has a positive diagnostic yield of 5% for new medical diagnoses and a cost of about 0.5% of the hospital bed cost. Other tests, such as psychotropic blood level monitoring and psychometric evaluation of cognitive functioning, have a much higher yield.

Fluoxetine treatment of children and adolescents with Tourette's and obsessive compulsive disorders: preliminary clinical experience.

Fluoxetine hydrochloride is the first selective serotonin uptake inhibitor introduced commercially in the United States. This report describes preliminary clinical experience with fluoxetine in 10 children and adolescents, aged 8 to 15 years, with primary obsessive compulsive disorder (OCD) or Tourette's syndrome (TS) plus OCD. In general, fluoxetine, which was administered from 4 to 20 weeks at a dosage of 10 or 40 mg per day, was well tolerated. Adverse effects included behavioral agitation/activation in four patients and mild gastrointestinal symptoms in two patients. No abnormalities were noted in the seven children who had follow-up EKGs. Five of the 10 patients (50%) were considered responders; their obsessive-compulsive symptoms decreased substantially during treatment with fluoxetine. Responder rates were similar in the primary OCD (two of four, 50%) and TS + OCD (three of six, 50%) groups. In conclusion, short-term fluoxetine administration appears to be safe in children and adolescents. Placebo-controlled trials are needed to further assess the efficacy of fluoxetine.

Childhood comorbidity of anxiety/affective disorders and behavior disorders.

Considerable data have been reported concerning comorbidity of various individual psychiatric disorders in children within the diagnostic supradomains of affect/anxiety disorders and behavior disorders as well as between these supradomains. To further examine such comorbidity, 35 psychiatrically hospitalized children were studied in terms of the prevalence of comorbidity, demographic and cognitive characteristics, adaptive functioning and maladaptive behaviors. The prevalence of comorbid behavior + affect/anxiety disorders exceeded 50% of the samples. Children with such comorbidity were similar to children with Behavior only diagnoses in terms of demographic and cognitive characteristics but differed in terms of adaptive functioning and maladaptive behaviors.

Fluoxetine overdose in an adolescent.

The response to and management of an acute ingestion of a large quantity of fluoxetine hydrochloride in a 13-year-old boy with Tourette's syndrome and obsessive compulsive disorder is described. The patient's symptomatic course following the ingestion included a grand mal seizure, depressed ST segments on EKG, nausea, dizziness, and headache. In general, the fluoxetine was well tolerated: all of the symptoms and signs remitted spontaneously.