Diabetes and youth resources for school nurses: an update from the National Diabetes Education Program.

In response to the challenge of diabetes in youth, the National Diabetes Education Program (NDEP) has developed free, evidence-based education materials and online resources for school nurses, parents, and children living with or at risk for diabetes. This article highlights some of NDEP's resources and identifies ways for school nurses to use them with students and their families.

The effect of clozapine on cognition and psychiatric symptoms in patients with schizophrenia.

Psychiatric symptoms and cognition were assessed in 13 patients with schizophrenia, one patient with schizoaffective disorder, and one patient with psychosis not otherwise specified while they received a conventional neuroleptic and again after an average of 15 months on clozapine. Despite improvements in psychiatric symptoms, attention, memory, and higher-level problem-solving were essentially unchanged. This suggests that certain cognitive deficits are relatively independent of psychotic symptoms in schizophrenia, and are probably central and enduring features of the disorder. Cognitive disability appeared to have been rate-limiting in the sample's rehabilitation, as patients' social and vocational adjustment remained marginal during the study. We also observed that treatment with clozapine was associated with a decline in some memory functions; the potent anticholinergic properties of the drug may have been responsible for this.

Multiple miliary osteoma cutis.

We describe the clinical, radiographic, histologic, and metabolic features of an unusual case of multiple miliary osteoma cutis in an otherwise healthy 57-year-old woman. Although the pathogenesis of this rarely reported entity is not fully understood, the novel application of a dynamic bone study revealed a high rate of internal bone remodeling within the lesion. This finding prompted a brief therapeutic trial of a diphosphonate, not previously reported in the treatment of this condition.

Melanoma in children.

Four cases of malignant melanoma in children younger than 17 years of age are presented. Several preexisting conditions increase the risk of development of melanoma during childhood. These include giant congenital melanocytic nevi, the familial dysplastic nevus syndrome, and xeroderma pigmentosum. The role of small congenital lesions and sporadic dysplastic nevi in the development of melanoma in children is less clear. The signs and symptoms associated with melanoma in children are similar to those in adults, as are the histopathologic features, biologic behavior, and treatment of this tumor. The inadequacy of available therapy for metastatic melanoma underscores the necessity for the early diagnosis and prompt surgical treatment of melanomas in children.

Thyroid hormone and the TRH stimulation test in refractory depression.

Seven of 21 refractory depressed patients responded within 7 days to combined thyroid hormone-antidepressant treatment. Five of the 7 responders revealed evidence of subclinical hypothyroidism, suggesting that this subpopulation of depressed patients may benefit most from adjunctive thyroid hormone.

Acrodermatitis in breast-fed premature infants: evidence for a defect of mammary zinc secretion.

Two 9-week-old, breast-fed premature infants developed acrodermatitis and hypozincemia because of low zinc content in their mothers' breast milk. All symptoms of zinc deficiency disappeared within seven days after the infants were treated orally with zinc and did not recur when zinc was discontinued after 11 months (infant 1) and three weeks (infant 3). After a subsequent term pregnancy, one of the mothers had lower breast milk zinc content (P less than .025) and greater exponential decline (P less than .025) of zinc content through 40 weeks of lactation compared with 34 control subjects. Her second infant (infant 2) had hypozincemia at 7 months of age but did not develop clinical zinc deficiency. When the mothers of the affected infants took oral zinc supplements, there was no increase in their breast milk zinc content. Zinc secretion into breast milk appears to be a controlled process that is independent of maternal zinc intake or serum zinc level. Breast milk may be low in zinc because of defective mammary secretion and this may lead to severe symptomatic zinc deficiency in premature infants.

Acne vulgaris associated with antigonadotropic (Danazol) therapy.

A case of a young woman in whom nodulocystic acne developed while being treated for endometriosis with danazol, an antigonadotropic drug, is described herein. Although this agent, a derivative of 17 alpha-ethinyl testosterone, has been noted to possess weak androgenic properties, it has not been widely appreciated that danazol's androgenic side effects, particularly acne and seborrhea, occur frequently and may require prompt treatment.