Age of initiating selected health-risk behaviors among high school students in the United States.

PURPOSE: To estimate and compare the age of initiation of alcohol use, cigarette smoking, sexual intercourse, and marijuana use among female and male students in U.S. high schools. METHODS: Using data from the 1991 and 1993 national school-based Youth Risk Behavior Surveys, life-table analysis was used to create hypothetical cohorts to estimate age of initiation of selected health-risk behaviors. The sample size was 12,272 in 1991 and 16,296 in 1993, with an overall response rate of 68% in 1991 and 70% in 1993. RESULTS: Male students initiate each of these behaviors earlier than female students, but the pace of initiation for females accelerates so that by age 15 years the cumulative proportion of male and female students who have initiated these behaviors is similar. For both female and male students, the youngest cohort appears to initiate use of alcohol and sexual intercourse at earlier ages than older cohorts. Similarly, the younger cohorts of female students appear to initiate smoking cigarettes and using marijuana at earlier ages than older cohorts. CONCLUSIONS: Many high school students are initiating alcohol use, cigarette smoking, sexual intercourse, and marijuana use at early ages. These data suggest a need for intensive intervention programs by middle/junior high school to motivate and prepare students to avoid these behaviors. Clinicians should begin screening and counseling for risk behaviors in early adolescence.

Prolonged parenteral meperidine analgesia during pregnancy for pain from an abdominal wall mesh graft.

BACKGROUND: Although successful pregnancy has been reported in women with prosthetic mesh abdominal wall grafts, the complication of severe pain in pregnancy from shearing of the graft has not been described. We report an unusual case of severe pain in pregnancy caused by abdominal wall stretching by the enlarging uterus. Pain was controlled with long-term intravenous meperidine analgesia. CASE: A 21-year-old multigravida with a previously placed mesh graft for multiple abdominal wall hernias presented at 30 weeks' gestation with severe abdominal pain. Meperidine patient-controlled analgesia at a mean dose of 14.2 mg/kg/day controlled the symptoms, allowing pregnancy prolongation for 28 days before induction of labor at 34 weeks when fetal lung maturity was confirmed. CONCLUSION: This is the first reported case of the use of high-dose patient-controlled parenteral narcotic analgesia in a woman whose abdominal wall mesh graft partially sheared from its attachments. The patient went on to have a successful vaginal delivery.

Continuous tissue pH monitoring in the term fetus.

Since Saling's work in 1961, many investigators have attempted to perfect methods to detect fetal acidosis during labor. A system for continuous tissue pH monitoring of the fetus is evaluated in this study of 59 patients. There was poor correlation of tissue pH values and capillary scalp pH values in 19 cases (r = 0.487), and no significant correlation of tissue pH values to the outcome measurements of Apgar scores and cord gas levels. The benefits realized were those of monitoring the trend of tissue pH over time. We believe that a continuous pH monitoring system offers several advantages over intermittent fetal scalp sampling. Further refinement of the technology employed may offer such a system in the future.

An active management approach to the postdate fetus with a reactive nonstress test and fetal heart rate decelerations.

Reports have shown that a reactive nonstress test (NST) with decelerations in the postdate patient is associated with an increase in perinatal morbidity. Based on these observations, patients who exhibited this fetal heart rate (FHR) pattern during NST had labor induced. The purpose of this report was to determine what impact, if any, this approach had on subsequent maternal and fetal outcome. The pregnancy outcome of 470 patients who delivered during 1984 within seven days of their last NST was compared with data from this institution in 1980. The last NST was reactive in 420 patients (89.4%) and nonreactive in 50 (10.6%). Fetal heart rate decelerations occurred in 130 patients (27.7%); of these, 96 (73.9%) were reactive and 34 (26.1%) nonreactive. Postdate patients whose last NST was reactive with decelerations had similar outcomes to patients with a nonreactive NST on their last test, but less favorable outcomes than patients with reactive tests alone. Comparison with data from our institution in 1980 shows that prompt induction of labor in the postdate patient with a reactive NST and decelerations resulted in significantly lower perinatal morbidity, with no corresponding increase in maternal morbidity. These results lead us to conclude that a reactive NST without FHR decelerations is a reliable indicator of fetal well-being in the postdate pregnancy. However, in the postdate pregnancy with a reactive NST with FHR decelerations, induction of labor is indicated.

Lipoma of the frontal bone.

A 61-hear-old man was followed up for more than 17 years with what was thought to be fibrous dysplasia of the frontal bone. Postmortem microscopic examination of the lesion showed an intraosseous lipoma with myxomatous foci and bony metaplasia involving the frontal and orbital portions of the frontal bone.

Senile mecular degeneration. A clinicopathologic correlation of two cases with neovascularization beneath the retinal pigment epithelium.

The histopathologic findings in two cases of senile macular degeneration were correlated with the premortem clinical studies, from the onset in both cases and through the disciform stage in one case. In case 2, the postmortem eyes were obtained only one month after ophthalmoscopic, fluorescein angiographic, and fundus photographic studies were performed, all on the same day. Our report not only adds to the few clinicopathologic correlations of the lesions in senile macular degeneration reported in the literature, but also presents the first reconstruction to scale of subretinal pigment epithelial (sub-RPE) neovascularization. Our results confirm the diagnosis of sub-RPE neovascularization and serous detachment of the retinal pigment epithelium. Drusen were correlated as to number and general location but not individually. Serous detachment of the neurosensory retina was found histopathologically but not clinically.