Extraskeletal osteoclastomas responsive to dexamethasone treatment in Paget bone disease.

Giant cell tumors (GCTs) of bone, also called osteoclastomas, complicate Paget bone disease (PBD), though infrequently. Giant cell reparative granulomas (GCRGs), which are histologically similar to GCTs, also occur rarely in pagetic patients. A 45-yr-old black woman with neurofibromatosis, type I, and polyostotic PBD developed slowly-growing masses in the right posterior iliac and left upper parasacral regions. She had multiple cutaneous neurofibromas and café-au-lait spots. Serum alkaline phosphatase activity and urine hydroxyproline levels were elevated. Skeletal radiographs and bone scintigraphy showed changes of widespread PBD. Computerized tomography and magnetic resonance imaging (MRI) delineated masses in the right gluteal and the left lower lumbar paraspinal regions. Five additional smaller masses were found in the abdomen and in the pelvis. Biopsy of the right gluteal mass revealed a GCT. However, we found that this lesion had several histologic features distinct from those of giant cell reparative granulomas or GCT. In our patient's tumor, the huge polykaryons, like osteoclasts, expressed abundant tartrate-resistant acid phosphatase activity, whereas those of GCRG lack this enzyme. Although the polykaryons in conventional GCTs and GCTs in PBD express tartrate-resistant acid phosphatase activity, the location of these tumors in bone differs from the extraskeletal masses encountered in our patient. Furthermore, the larger size of the polykaryons and the greater number of nuclei in our patient's GCT differ from conventional GCTs, but not GCTs in PBD. Her extraskeletal osteoclastoma rapidly shrunk to one third its original size during 2 weeks of oral dexamethasone treatment. Significant clinical improvement lasted about 5 months before additional courses of dexamethasone therapy were necessary. Injections of synthetic salmon calcitonin alone did not affect the tumor's size. Thus, PBD can be complicated by extraskeletal tumors that seem to contain osteoclasts and are responsive to dexamethasone treatment.

The experience of pediatric cancer pain, Part I: Impact of pain on the family.

This two-part article reports on the results of qualitative data derived from the study on the impact of pediatric cancer pain on the family. Part I of this two-part article explores the family caregivers' description of a child with cancer, the helplessness experienced in the management of the child's pain, and the impact of pain on the entire family. Study findings support existing literature identifying inadequate assessment and management of pediatric cancer pain. Parents identified the benefits of pain management teams for the child and for themselves. Family caregivers also identified the stresses associated with managing pain at home. Part II will describe the role of the parents in managing their child's pain. This study provided valuable information that can enable health care professionals with an opportunity to intervene not only with the child but also with the family.

The experience of pediatric cancer pain, Part II: Management of pain.

This paper reports on the results of qualitative data derived from a study on the impact of pediatric cancer pain on the family. Part I of this two-part article reported on the family caregivers' description of a child with cancer, the helplessness experienced in the management of the child's pain, and the impact of pain on the entire family. This article will describe the role of the parents in managing their child's pain, including use of pharmacological and nondrug interventions, family caregivers' perspectives on what physicians and nurses could do to improve the care of patients in pain, and family caregivers' advice to other families when placed in a similar situation of trying to manage pediatric pain. Five major themes were identified related to the role of family caregivers in managing the child's pain. Parents also identified six major ways in which physicians and nurses could help to improve care related to pain management. Although some parents were unable to identify information that may be useful for other parents in similar situations, nine major themes were identified. Study data demonstrates the experience of family caregivers in caring for a child with cancer pain and provides health care professionals with information that can promote effective pain relief for the pediatric cancer patient with pain as well as address issues affecting the family.

[Technology development as social process: prospects and frontiers of social scientific elucidation of technological advancement]. / Technische Entwicklung als sozialer Prozess. Chancen und Grenzen einer sozialwissenschaftlichen Erklärung der Technikgenese.

This article provides an overview of the new developments in social scientific technology research which have changed considerably as a result of public debate and reactions to the importance of advancements in technology. The shift in emphasis, away from the effects of technology to its shaping, is described and certain hypotheses and concepts of advancement in the study of the social conditions underlying technical development processes are presented.

Patient cooperation in treatment with removable appliances: a model of patient noncompliance with treatment implications.

The uncooperative or noncompliant patient presents a substantial problem during treatment with removable orthopedic/orthodontic appliances. Frequently, the uncooperative patient is labeled as having a poor or defiant attitude toward orthodontic treatment. In contrast to this attitude model of patient noncompliance, this article presents an analysis of uncooperative behavior in terms of behavior-environment relationships. The authors bring together backgrounds of expertise in both clinical psychology and orthodontics. The behavioral model presented is applied to clinical orthodontic patients undergoing treatment with removable functional appliances. Preliminary research findings suggest that the behavioral model described is a successful system for the introduction of a removable device to be worn by the patient. The techniques described also are useful for the previously uncooperative patient undergoing remedial treatment. Another major benefit of using this strategy is found in the response of the children's parents. The approach reduces the potential for and frequency of parent-child conflicts over dental health. Currently, a small sample of children are being treated by the behavioral method. Both parents and patients are involved. A specific schedule for wearing of a removable appliance is identified, along with parental observations and rewards based on patient compliance. Once the youngster is regularly meeting criteria, the program is altered to increase the desired response of appliance wear. The behavioral model has implications for various aspects of orthodontic care, including the use of such appliances as the Fränkel, Bionator, headgear, intraoral elastics, and proper lip posture. On the basis of this functional analysis of behavior, implications for treatment and prevention of noncompliance in orthodontic patients are discussed.