Duplication of the lower third of the internal jugular vein--case report and surgical implications.

Duplication of the internal jugular vein is rare with a reported incidence of 0.4%. Most are located in the upper third and are almost always unilateral, duplication of the lower third is less common. In the case presented the vein divided above the omohyoid muscle with one branch passing superficial and the other deep to the muscle. Failure to recognise this anomaly could result in iatrogenic damage to the superficial branch in particular, with brisk and unexpected haemorrhage during neck dissection.

A two-minute paper-and-pencil test of symbolic and nonsymbolic numerical magnitude processing explains variability in primary school children's arithmetic competence.

Recently, there has been a growing emphasis on basic number processing competencies (such as the ability to judge which of two numbers is larger) and their role in predicting individual differences in school-relevant math achievement. Children's ability to compare both symbolic (e.g. Arabic numerals) and nonsymbolic (e.g. dot arrays) magnitudes has been found to correlate with their math achievement. The available evidence, however, has focused on computerized paradigms, which may not always be suitable for universal, quick application in the classroom. Furthermore, it is currently unclear whether both symbolic and nonsymbolic magnitude comparison are related to children's performance on tests of arithmetic competence and whether either of these factors relate to arithmetic achievement over and above other factors such as working memory and reading ability. In order to address these outstanding issues, we designed a quick (2 minute) paper-and-pencil tool to assess children's ability to compare symbolic and nonsymbolic numerical magnitudes and assessed the degree to which performance on this measure explains individual differences in achievement. Children were required to cross out the larger of two, single-digit numerical magnitudes under time constraints. Results from a group of 160 children from grades 1-3 revealed that both symbolic and nonsymbolic number comparison accuracy were related to individual differences in arithmetic achievement. However, only symbolic number comparison performance accounted for unique variance in arithmetic achievement. The theoretical and practical implications of these findings are discussed which include the use of this measure as a possible tool for identifying students at risk for future difficulties in mathematics.

Development of a Childhood Attachment and Relational Trauma Screen (CARTS): a relational-socioecological framework for surveying attachment security and childhood trauma history.

BACKGROUND: Current psychometric measures of childhood trauma history generally fail to assess the relational-socioecological context within which childhood maltreatment occurs, including the relationship of abusers to abused persons, the emotional availability of caregivers, and the respondent's own thoughts, feelings, and actions in response to maltreatment. OBJECTIVE: To evaluate a computerized approach to measuring the relational-socioecological context within which childhood maltreatment occurs. METHOD: The psychometric properties of a Childhood Attachment and Relational Trauma Screen (CARTS) were evaluated as a retrospective survey of childhood maltreatment history designed to be appropriate for completion by adults. Participants were undergraduates (n=222), an internet sample (n=123), and psychiatric outpatients (n=30). RESULTS: The internal reliability, convergent, and concurrent validity of the CARTS were supported across samples. Paired differences in means and correlations between rated item-descriptiveness to self, mothers, and fathers also accorded with findings of prior attachment and maltreatment research, illustrating the utility of assessing the occurrence and effects of maltreatment within a relational-socioecological framework. CONCLUSIONS: Results preliminarily support a new survey methodology for assessing childhood maltreatment within a relational-socioecological framework. Further psychometric evaluation of the CARTS is warranted.

Lymphatic malformations of the head and neck-current concepts in management.

Lymphatic malformations of the head and neck, also known as lymphangiomas or cystic hygromas, are a diverse group of lesions. They can be small and superficial or large and extensive, and management can be a challenge. Surgically they can be difficult to remove completely because of their poorly defined borders and the potential for damaging neighbouring structures. We review the dilemmas posed in diagnosis and treatment, and discuss the contemporary management of these interesting entities including sclerotherapy, which is gaining popularity.

Squamous cell carcinoma arising in dentigerous cysts.

We present two cases of squamous cell carcinoma (SCC) arising in dentigerous cysts. Malignant transformation in dentigerous cysts is rare giving rise to diagnostic difficulties. We propose imaging at an early stage to reduce delays in diagnosis.

Help-seeking for children with mental health problems: parents' efforts and experiences.

Parents who contacted 1 of 15 children's mental health agencies in Ontario, Canada reported on where and why they were seeking mental health services for their 4- to 17-year-old children. Parents contacted an average of four agencies (± 1.7; range = 1-14) in the previous year. Approximately one-half of parents were looking for either multiple types of treatment, or help for different problems, across agencies. The complex pattern of help-seeking evidenced in our study likely increases the burden on the mental health care system and on families, and may reduce the likelihood that families will connect with the most appropriate treatment.

Visual recovery following optic nerve decompression for chronic compressive neuropathy.

PURPOSE: Visual failure due to optic nerve compression is a common indication for decompressive surgery. Most data only refer to the odds of improvement, deterioration or remaining the same. However, patients frequently wish to know more detail about the outcomes of surgery. Our aim was to assess the visual outcome from optic nerve decompression for visual failure in detail in order to help counsel patients pre-operatively. METHODS: Sixty-eight patients undergoing 71 operations to decompress 87 optic nerves between 1991 and 2007 were identified. Thirty-four decompressions were performed via a transzygomatic and 37 via a transbasal approach. Fifty-two patients had meningiomas, 3 pituitary adenomas, 3 craniopharyngiomas, 3 chordomas, 2 adenocarcinomas, 2 fibrous dysplasia, 1 schwannoma, 1 granular pituitary tumour and 1 olfactory neuroblastoma. Visual acuity and fields were recorded pre-operatively, immediately post-operatively, at first follow-up and at most recent follow-up. RESULTS: Forty-three eyes (49.4%) experienced an improvement in either acuity or fields. Twenty-four (27.5%) were unchanged and 20 (22.9%) deteriorated. Average improvement was 0.88 Snellen lines (logMAR 0.13). Improvement was seen between immediate post-operative acuity and first follow-up in 52%, but 22% suffered a late deterioration after 1 year. There was no relationship between age, duration of symptoms, pathology, approach or redo surgery and visual outcome. There was a complex relationship between pre-operative visual acuity and post-operative improvement and outcome. Better pre-operative acuity predicted better outcome and greater odds of improvement, although patients with poor pre-operative vision had a greater average magnitude of improvement. CONCLUSIONS: Patients experience significant benefit from optic nerve decompression irrespective of pre-operative visual status. Although early decompression is desirable, good results can still be obtained in patients with severe visual failure. Detailed data on visual outcome can help counsel patients pre-operatively to aid decision-making and set expectations.

How parents seek help for children with mental health problems.

Parents seeking help for their child's mental health problem face a complicated system of services. We examined how parents navigate the various services available. Sixty parents contacting a children's mental health center were interviewed regarding their efforts and rationale in seeking help for their child. On average, in the year prior to the interview parents sought help for two different child problems, contacted five different agencies or professionals for help, and parents and/or children received two different treatments. One fifth of the time parents said they accepted treatments that they did not want. Almost all parents (87%) were simultaneously in contact with more than one agency at some point within the previous year. Future help-seeking models need to capture the iterative referral process that many parents experience.

Serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 following chemotherapy for advanced breast cancer.

BACKGROUND: Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) appear to influence the growth of breast cancer cells in vitro, and epidemiological studies suggest higher serum IGF-I levels increase the risk of breast cancer. IGF-I and IGFBP-3 have therefore been measured in women with advanced breast cancer to determine if changes in serum levels predict the response to treatment by chemotherapy. METHODS: Serum IGF-I and IGFBP-3 levels were measured in 14 patients before and after 1 week of chemotherapy. Changes in serum levels were compared with duration of survival. RESULTS: Mean basal serum levels of IGF-I and IGFBP-3 were not significantly different between patients with advanced breast cancer and controls or women with early breast cancer. Serum IGFBP-3 fell significantly 1 week after initiation of chemotherapy. Patient survival was not significantly related to baseline IGF-I or IGFBP-3 levels, but when the fall in serum levels 1 week after starting treatment was expressed either as absolute change or as a percentage of baseline, those individuals with a decrease in IGFBP-3 greater than the median had significantly poorer survival (median survival 5.5 months vs 18 months). These results were independent of other prognostic variables such as previous disease-free survival, and were also unaffected by the change in serum albumin with treatment. The fall in IGF-I and IGFBP-3 with chemotherapy mainly occurred in those with hepatic metastases, but prediction of survival was explained solely by the extent of the fall in IGFBP-3. CONCLUSIONS: This preliminary study has shown that serum IGFBP-3 falls significantly following initiation of chemotherapy and the extent of reduction significantly predicts the response to treatment.

Maternal emotional responses to preterm birth.

Mothers of 144 preterm infants with varying degrees of neonatal illness were interviewed prior to their infants' discharge from neonatal intensive care. Their major concerns were for the infants' survival rather than their own welfare. Husbands, parents, and, for members, church were seen as the major sources of support.