Buruli ulcer in an 18-day-old baby.

Buruli ulcer is an indolent disease that needs aggressive curettage of caseous subcutaneous tissue beneath the undermined skin. We report the successful treatment of an 18-day-old baby.

Effectiveness and safety of intranasal ipratropium bromide in common colds. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To determine the tolerability and clinical effectiveness of intranasal ipratropium bromide for the treatment of symptoms of common colds. DESIGN: Multicenter, double-blind, randomized trial. SETTING: 3 university student health services. PATIENTS: 411 previously healthy persons 14 to 56 years of age who had cold symptoms that had lasted for no more than 36 hours, rhinorrhea subjectively judged to be of at least moderate severity, and documented nasal discharge of at least 1.5 g over a 1-hour observation period. INTERVENTION: Either 1) ipratropium bromide nasal spray 0.06% in buffered salt solution, two 42-micrograms sprays per nostril administered by metered pump spray; 2) control nasal spray, which consisted of buffered salt solution; or 3) no treatment. Treatments were self-administered three or four times daily during waking hours for 4 days. After receiving their morning dose, patients stayed at the study center for 6 hours on study day 1 and 3 hours on study day 2; symptom severity was recorded and nasal mucus discharges were collected and weighed hourly during these periods. RESULTS: Ipratropium recipients had 26% less nasal discharge than controls (P = 0.0024) and 34% less nasal discharge than untreated patients (P = 0.0001). Severity of rhinorrhea as judged subjectively was reduced in ipratropium recipients by 31% compared with controls and by 78% compared with untreated patients (P = 0.0001 for both comparisons). In addition to being associated with reductions in daily assessments of the severity of rhinorrhea (P < or = 0.003), ipratropium was associated with reduced sneezing on study days 2 (20% difference; P = 0.03) and 4 (30% difference; P = 0.02) but not with reduced nasal congestion compared with the control spray. Ipratropium was generally well tolerated but was associated with higher rates of blood-tinged mucus (16.8% in the ipratropium group compared with 3.6% in the control group; P = 0.01) and nasal dryness (11.7% in the ipratropium group compared with 3.6% in the control group; P = 0.021) than the control spray. Patient assessments of the overall effectiveness of treatment were more favorable for ipratropium than for the control spray (P < or = 0.026) or for no treatment (P < or = 0.002) on each day of inquiry (study days 1, 2, and 5). CONCLUSIONS: Intranasal ipratropium bromide provides specific relief of rhinorrhea and sneezing associated with common colds.

Self-report study of impulsive and delinquent behavior in college students.

PURPOSE: This self-report study of college students sought to examine the relationship between risk-taking and delinquent behavior, to develop reliable measures of impulsiveness and attraction to thrill-seeking and risk-taking, and to measure the relationships among conventional correlates of delinquent behavior, personality factors, and delinquent behavior itself. METHODS: A sample of 296 undergraduate college students completed questionnaires pertaining to delinquent behavior and other activities, identification with educational goals and behavior, and attraction to thrill-seeking and risk-taking behavior, as well as items from the Self-Control and Socialization scales of the California Personality Inventory. RESULTS: Males who measured high in thrill-seeking behavior and low in self-control reported significantly more property delinquency. Interpersonal delinquency was most influenced by a lack of self-control. There was a negative correlation between substance abuse and socialization. The reasons most often given for property and substance delinquency were "fun/thrills" while those most often given for interpersonal delinquency involved "anger/revenge." CONCLUSION: Variables representing conventional sociological theories have often been treated as the immediate causal factors in juvenile delinquency, but their impact may be mediated through factors such as impulsiveness and an attraction to thrill-seeking and risk-taking.

Ectopic pregnancies and intraoperative autotransfusion.

Ruptured ectopic pregnancies are common in the tropics. They rapidly lead to anaemia and shock, but autotransfusion is simple and safe and can be practised easily by the simplest of surgical departments.

Is neighborhood racial succession place-specific?

This paper evaluates the geographic generality of the succession model of neighborhood racial change for the period 1970 to 1980. Using census data on racially mixed tracts, we determine whether white-to-black compositional shifts were equally common across the four regions and 58 central cities in our sample. Substantial variation occurred by region in the incidence and magnitude of racial succession; tracts in western cities departed most markedly from expectations. Even in other regions, some cities experienced more numerous instances of stability and displacement than of succession. These region and city effects persist when neighborhood characteristics believed to influence racial transition are controlled.

Cesarean section--indications and risks in rural Zaire.

In a retrospective study in rural Zaire, 10.2% of all deliveries were conducted by cesarean section. Common indications were contracted pelvis and uterine dysfunction (37%) and previous cesarean delivery (32%). Compared with normal delivery, mortality was higher after cesarean section. Cesarean section should only be performed by well-trained personnel and when vaginal delivery is deemed inappropriate.

Malignant tumors in children of northeastern Zaire. A comparison of distribution patterns.

In an effort to better understand the epidemiology of cancer in Zaire, a retrospective review of biopsy-proven malignant tumors was undertaken. Of 188 biopsies taken from children aged 0-15 years over a 4.5 year period, 73 (39%) revealed malignancy. Fifty-six percent of patients with malignant tumors were boys. Lymphoma was the most common tumor (28 patients, 15 with Burkitt's Lymphoma). Sarcoma (15 patients), carcinoma (8 patients), Wilms' Tumor (6 patients), and retinoblastoma (5 patients) were also seen. Lymphomas were most heavily represented in the first 5 years of life, while sarcoma and carcinoma accounted for most of the malignancies in children after 10 years of age. Lymphomas and sarcomas are relatively more common in Zaire than in North America and Europe, while leukemia and central nervous system tumors are notably less common in Zaire. In view of current limitations on health care in rural Zaire, cancer care should be directed toward early diagnosis, quick referral for appropriate surgical care, and use of the limited arsenal of chemotherapy.

Changing patterns of Kaposi's sarcoma in N.E. Zaire.

A minor change in the pattern of Kaposi's sarcoma has been noticed in north-east Zaire. This is characterized by a small increase of the number of confirmed diagnoses, together with the appearance of the disease amongst women, who tend to be of a younger age group. These data suggests the appearance of a new aetiological factor in the area. From recent reports from other parts of Africa we speculate that this might be the appearance of HTLV-III virus.

PIP: Kaposi's sarcoma has been a familiar phenomenon to physicians in Central Africa for many years. In its classic presentation, Kaposi's sarcoma is a very slowly progressive disease of the extremities characterized by purple or hyperpigmented nodules, local chronic edema, and a typical histologic picture. There appears to be no connection between this endemic form of the disease and acquired immunodeficiency syndrome (AIDS). However, workers in the northeastern corner of Zaire are now encountering cases of atypical Kaposi, especially among females, that may be associated with seropositivity to the AIDS virus. In this area, the number of cases of Kaposi's sarcoma has increased from an average of 7/year before 1983 to 14 cases/year in 1983-85. From 1971-80, only 1 woman was diagnosed with Kaposi's sarcoma; however, 13 cases were confirmed among women in 1981-85 (5 in 1985 alone). The 10 women diagnosed in 1983-85 averaged 32 years of age and the 34 men diagnosed in this period averaged 40 years of age, indicating a trend toward younger age at onset of disease. The recent Kaposi's sarcoma cases have been of the nodular variety, with occasional visceral involvement. The changes in the pattern of Kaposi in northeast Zaire suggest the appearance of a new etiological factor in the area, quite possibly human immunodeficiency virus imported from other parts of Africa.

A comparison of the metabolism and elimination of benzanilide and salicylanilide in the rat.

1. The metabolism and elimination of benzanilide and salicylanilide in rats were compared. 2. For both compounds, greater than 70% dose was excreted in urine with 20% in faeces, in 3 days. 3. With [14C]benzanilide and [14C]salicylanilide, 40% and 35% respectively of the 14C was excreted in the bile in 24 h. 4. Benzanilide was metabolized to 4'-hydroxybenzanilide (24%), 2-hydroxybenzanilide (salicylanilide, 19%) and 2'-hydroxybenzanilide (13%), with small amounts of 4-hydroxybenzanilide. 5. Salicylanilide was excreted unchanged (56%) with small amounts of the 5-hydroxy and 4'-hydroxy-derivatives. 6. All metabolites were present as glucuronide conjugates; the free aglycones were not found.

Measles vaccination in Zaïre--when and how?

Of 121 children vaccinated for measles in Zaïre, antibody studies revealed that 69% sero-converted. These included 53% of children vaccinated by two shots of a dermojet (0.2 ml i.d.) and 80% of children vaccinated by 0.5 ml subcutaneously. Whilst a dermojet gives less good results, a decision on its use needs to be made in each individual situation, particularly taking into account the quantity of vaccine available for the number of children presenting for vaccination. At six months of age 59% of children sero-converted. This did not reach 100% until 16 months of age. In view of the young age of children getting measles in Zaïre, there would seem to be value in vaccinating at six months, but this needs to be repeated at 16 months if full cover is required.