Tactile and pain thresholds in the intra- and extra-oral regions of symptom-free subjects

The aim of the present study was to evaluate the tactile detection threshold (TDT), the filament-prick pain detection threshold (FPT), the pressure pain threshold (PPT), and the pressure pain tolerance detection threshold (PTOL) at multiple measuring points in the orofacial region of normal subjects. Sixteen males and 16 females (age range from 20 to 41 years) participated. The TDT and the FPT were measured on the cheek skin overlying the central part of the masseter muscles (MM), on the maxillary gingiva, and at the tip of the tongue, using Semmes-Weinstein monofilaments. The PPT and PTOL were measured at the central part of the MM, using a pressure algometer. The pain intensity during the FPT, PPT and the PTOL measurements was assessed on a numeric rating scale (NRS). The tongue tip had the lowest value in TDT and FPT compared to the other sites. Females showed a significantly lower TDT and FPT at the cheek skin than males. Further, measurements of PPT and PTOL confirmed the previously reported higher thresholds in males. In contrast, while the intra-oral threshold measurements revealed no gender differences, a significantly higher pain perception as evaluated using NRS, was seen in the males. A strong correlation was found between the pain responses at the same measuring site (FPT, PPT, and PTOL over the MM). In addition, the TDT and the pain responses were also correlated positively.     

Evaluation of the morphological effects of TDT 067 (terbinafine in Transfersome) and conventional terbinafine on dermatophyte hyphae in vitro and in vivo

TDT 067 is a novel, carrier-based dosage form of terbinafine in Transfersome (1.5%) formulated for topical delivery of terbinafine to the nail, nail bed, and surrounding tissue. We examined the effects of TDT 067 and conventional terbinafine on the morphology of dermatophytes. Trichophyton rubrum hyphae were exposed to TDT 067 or terbinafine (15 mg/ml) and examined under white light, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Subungual debris from patients treated with TDT 067 in a clinical trial was also examined. Exposure of T. rubrum hyphae to TDT 067 led to rapid and extensive ultrastructural changes. Hyphal distortion was evident as early as 4 h after exposure to TDT 067. After 24 h, there was complete disruption of hyphal structure with few intact hyphae remaining. Exposure to terbinafine resulted in morphological alterations similar to those seen with TDT 067; however, the effects of TDT 067 were more extensive, whereas a portion of hyphae remained intact after 24 h of exposure to terbinafine. Lipid droplets were observed under TEM following 30 min of exposure to TDT 067, which after 24 h had filled the intracellular space. These effects were confirmed in vivo in subungual debris from patients with onychomycosis who received topical treatment with TDT 067. The Transfersome in TDT 067 may potentiate the action of terbinafine by delivering terbinafine more effectively to its site of action inside the fungus. Our in vivo data confirm that TDT 067 can enter fungus in the nail bed of patients with onychomycosis and exert its antifungal effects.     

Video Assisted Laser Surgery (VATS) in Pediatric Thoracoscopy

Laser thoracoscopy has proven to be a safe and effective technique for operating on every kind of intrathoracic diseases in childhood, arising from the lungs, mediastinum, pericardium and pleura. Video assisted thoracoscopy combined with laser (laser-VATS) makes it possible to treat children suffering from difficult congenital and acquired disorders. We want to report our experience with laser-VATS in 92 children whose age ranged from one day to fourteen years. Most of these cases were congenital malformations: 16 cysts, 5 CCAM, 15 lymphangiomas and hemangiomas, 6 bronch. fistulas, 6 tumors, 5 chylothorax, 4 thymectomies and 2 pericardectomies. The advantages of laser VATS are reduced blood loss and an uncomplicated postoperative course without death. In four cases conversion to conventional thoracotomy was necessary and in six recurrencies a second thoracoscopy was performed. No further complications occurred. Therefore we would like to recommend thoracoscopic laser application in childhood.     

The lived experience of adult survivors of childhood cancer.

Little is known about the long-term impact of surviving childhood cancer. Most children diagnosed with cancer now survive into adulthood due to advances in medical treatment. Although the number of survivors of childhood cancer has increased, a review of the literature revealed a paucity of studies that explores survivorship of childhood cancer from the perspective of the adult survivor. The purpose of this phenomenological study was to examine the lived experience of 12 adults who survived childhood cancer. This research methodology allows the meaning or essences of experiences that occurred to be uncovered. Four themes emerged from these data: (1) ongoing consequences for having had cancer, (2) living with uncertainty, (3) the cancer experience is embodied into one's present sense of self, and (4) support is valued. The results of this study demonstrate that a childhood cancer experience affects the life of each survivor, which results in specific health care needs. This knowledge is important as the number of survivors increases. Knowledge of their concerns is imperative prior to providing appropriate health care.     

The needs of young people with disabilities in transition from paediatric to adult services

Transition to adulthood requires consolidation of identity, achievement of independence establishment of adult relationships and finding vocation. Those with disabilities and health problems experience difficulty in this through lack of social opportunity. There are 340,000 affected UK individuals of 16-29 years. Most, having survived childhood disability, may experience later deterioration in functional level. Most will require long term monitoring. Health needs include treatment for the complications and progression of their condition, appropriate treatment for everyday, and unrelated diseases, and health maintenance knowledge. Leaving a cohesive paediatric service and entering the uncoordinated adult health services has been described as hurtling into a void'. Therefore, number of health service models have been proposed, including the person-focussed model, a disease-focussed model, a hospital-based model, a team-based outside the health service, a named person, a voluntary organisation and a primary care model. For those with complex disabilities an interdisciplinary team comprising a consultant in Rehabilitation Medicine, (who will facilitate referral to other medical consultants) occupational therapy, speech therapy, psychology and social work input with support from physiotherapy and nursing addresses all these needs. Young Adult Teams can both teach skills, and facilitate health and other service usage. This whole area of work is under-researched. The outcomes for disabling childhood conditions must be investigated, and planning for adulthood must influence the pattern of care in childhood. The most urgent need is to set up effective services for young adults, which will help to ensure that their 50 years of adulthood have quality of life.     

Protection against nerve toxicity by monoclonal antibodies to the sodium channel blocker tetrodotoxin

The sodium channel blocker, tetrodotoxin (TDT), was conjugated to keyhole limpet hemocyanin (KLH) and used to immunize BALB/c mice. Anti-TDT antibodies were detected in serum by ELISA and reached stable levels 4-5 wk after the first immunization. Spleens from immunized mice were fused with NS-1 mouse myeloma cells and approximately 9,329 resultant hybrids were screened by ELISA for reactivity to TDT. Two stable hybrids were isolated, subcloned, and characterized. These hybrids, termed TD13a1 and TD2C5, secreted specific anti-TDT antibodies that recognized TDT but not the related sodium channel blocker, saxitoxin (STX), as determined by competition ELISA. Both antibodies were of the IgG1k subclass with Ka's approaching 10(7) M-1. The inhibitory ability of these antibodies was tested by a competitive displacement assay for [3H]STX on rat brain membranes. Both antibodies strongly inhibited TDT binding to membranes. A nanomole of TD2C5 was able to bind approximately 1.8 nmol of TDT, whereas a comparable amount of TD13a1 bound half as much. Furthermore, TD2C5 was able to protect against TDT-induced reduction of peripheral nerve action potentials in rat tibial nerve when administered in situ. These antibodies thus represent potentially useful reagents for neurobiologic research, detection of toxin contamination and diagnosis of poisoning, and may provide protection against the toxicity of TDT in vivo.     

Transport time for blood culture bottles: underlying factors and its consequences

In the present study we investigated transport times for blood cultures from three tertiary-care hospitals to Karolinska University Laboratory and identified predictors of long transport times. Concomitantly, consequences of delayed incubation on total detection time (TDT) were analyzed by in vitro sepsis models. A total of 909 blood cultures were studied. The median (interquartile range) transport time was 9 (3–15) h. The hospital accommodating the microbiology laboratory had the shortest transport time compared to the other two hospitals (P < 0.0001). Samples taken between 16:00–24:00 had longer transport times compared to samples taken between 8:00–16:00 and 24:00–08:00 (P < 0.0001). In vitro experiments showed that TDT was longer for samples pre-incubated at room temperature (RT) for 19 h compared to the ones pre-incubated for 2 h or 9.5 h (P < 0.0001). In conclusion, off-site location, time of sampling and number of transports per day were related to, and predictors of transport time.     

The lived experience of childhood cancer: one sibling's perspective.

The demands of cancer on children and their parents have been studied and understood for many years now. However, very little focus has been placed on one other very important part of the family system--the siblings. In the health care profession today, there is a growing awareness that the psychosocial needs of siblings of children with cancer are less adequately met than those of other family members. Research suggests that siblings are particularly vulnerable to adjustment difficulties (depression, anger, anxiety, feelings of guilt, and social isolation), and they experience similar stress to that of the ill child Siblings have been identified as the most emotionally neglected and unhappy of all family members during serious childhood illnesses. The purpose of this study was to gain a better understanding of the lived experience of one 14-year-old sibling's experience with childhood cancer. Through the qualitative research process of phenomenology, the researcher gained a greater understanding of the participant's experience and how the childhood cancer experiences affected her and her family. Themes that emerged through the process of content analysis included emotional intensity, increased empathy for others, personal growth, need for support, and desire to help others.     

The 3p21.1-p21.3 hereditary vascular retinopathy locus increases the risk for Raynaud's phenomenon and migraine

Previously, we described a large Dutch family with hereditary vascular retinopathy (HVR), Raynaud's phenomenon and migraine. A locus for HVR was mapped on chromosome 3p21.1-p21.3, but the gene has not yet been identified. The fact that all three disorders share a vascular aetiology prompted us to study whether the HVR haplotype also contributed to Raynaud's phenomenon and migraine in this family. Whereas the parent-child transmission disequilibrium test (TDT) did not reach significance, the sibling TDT revealed that the HVR haplotype harbours a susceptibility factor for Raynaud's phenomenon and migraine. Identification of the HVR gene will improve the understanding of the pathophysiology of HVR, Raynaud's phenomenon and migraine.     

The impact of cancer on the physical,psychological and social well-being of childhood cancer survivors

PurposeNotwithstanding the advances in medical treatment, childhood cancer survivors are at risk of adverse physical, psychological and social effects of the cancer treatment. The purpose of this study was to examine the impact of cancer and its treatments on the physical, psychological and social well-being of Hong Kong Chinese childhood cancer survivors.MethodA total of 137 childhood cancer survivors (aged 9–16 years), who had their medical follow-up in an oncology out-patient clinic were invited to participate in the study. Participants were asked to respond to the standardized measures of depressive symptoms and self-esteem. Additionally, 15 participants from the group were selected for a semi-structured interview.ResultsThe results revealed that more than half of the participants presented depressive symptoms. Results also found that the mean depressive symptom scores for childhood cancer survivors were statistically significant higher than those of school children without cancer (p = 0.01), while the mean self-esteem scores for the survivors were statistically significant lower (p < 0.01). Additionally, qualitative interviews indicated that cancer and its treatments have great impact on the daily life of childhood cancer survivors.ConclusionThe study reveals that cancer and its treatments have a great impact on the physical, psychological and social well-being of survivors. It is essential for healthcare professionals to develop appropriate interventions with the aim of promoting physical, psychological and social well-being for these children. Most importantly, it is crucial to help them develop a positive view of the impact that the cancer experience has upon their lives.     

Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature

BACKGROUND: Recent empirical evidence suggests that childhood abuse may be related to the experience of chronic pain in adulthood. To date, a systematic quantitative review of the literature has not been presented. OBJECTIVES: The purpose of this study was to use meta-analytic procedures to evaluate the strength of existing evidence of the association between self-reports of childhood abuse and the experience of chronic pain in adulthood. METHODS: Analyses were designed to test the relationship across several relevant criteria with 4 separate meta-analyses. RESULTS: Results of the analyses are as follows: 1) individuals who reported being abused or neglected in childhood also reported more pain symptoms and related conditions than those not abused or neglected in childhood; 2) patients with chronic pain were more likely to report having been abused or neglected in childhood than healthy controls; 3) patients with chronic pain were more likely to report having been abused or neglected in childhood than nonpatients with chronic pain identified from the community; and 4) individuals from the community reporting pain were more likely to report having been abused or neglected than individuals from the community not reporting pain. CONCLUSION: Results provide evidence that individuals who report abusive or neglectful childhood experiences are at increased risk of experiencing chronic pain in adulthood relative to individuals not reporting abuse or neglect in childhood.     

RELATIONSHIP OF RECOLLECTIONS OF FIRST DEATH EXPERIENCE TO CURRENT DEATH ATTITUDES

Previous research (Dickinson, 1992) has investigated adults memories of their first childhood experience with death. The present study extended this work to examine the relationship of various qualitative aspects of the rst experience with death to current death attitudes. College students (196 females, 101 males) described their first childhood death experience and provided memories of: (a) who died; (b) whether parental discussion of death had occurred; (c) whether they had unanswered questions at the time; and (d) whether they had cried at the time. They then completed the Death Attitude Profile-Revised (DAP-R; Wong, Reker, & Gesser, 1994). Results indicated that although boys and girls did not respond differently to the first death experience, gender did appear to moderate the relationship between the qualities of this experience and current death attitudes.     

Relationship of recollections of first death experience to current death attitudes

Previous research (Dickinson, 1992) has investigated adults memories of their first childhood experience with death. The present study extended this work to examine the relationship of various qualitative aspects of the rst experience with death to current death attitudes. College students (196 females, 101 males) described their first childhood death experience and provided memories of: (a) who died; (b) whether parental discussion of death had occurred; (c) whether they had unanswered questions at the time; and (d) whether they had cried at the time. They then completed the Death Attitude Profile-Revised (DAP-R; Wong, Reker, & Gesser, 1994). Results indicated that although boys and girls did not respond differently to the first death experience, gender did appear to moderate the relationship between the qualities of this experience and current death attitudes.     

Uncertainty in childhood illness: a synthesis of the parent and child literature

Uncertainty has increasingly been identified as an important construct in the clinical and empirical literature on families' responses to serious childhood illnesses. Most of the work has focused on parents' perceptions of uncertainty, but several recent studies have demonstrated that children are also affected by uncertainties inherent in the illness experience. Findings from 44 reports of parental uncertainty and 12 reports of children's uncertainty were reviewed to determine what is currently known about uncertainty in the context of acute and chronic childhood illness. Pertinent conceptual and methodological issues are identified and directions for future research are suggested.     

Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders

Aim. The aims of this study were to determine whether specific forms of childhood trauma predict eating psychopathologies and to investigate the mediating effects of the psychological symptoms of depression and obsessive‐compulsion between childhood trauma and eating psychopathologies in patients with eating disorders. Background. The highest probability of poor treatment outcomes in patients with eating disorders has been observed in those who experienced childhood trauma. Therefore, researchers are now examining whether childhood trauma should be considered a risk factor for eating psychopathology, but childhood traumatic experiences as predictors of eating psychopathology and their mediating variables has not been investigated sufficiently with this clinical population. Design. Survey. Methods. The subjects were 73 Korean patients with eating disorders. The Childhood Trauma Questionnaire, Eating Disorder Inventory‐2, Beck Depression Inventory and Maudsley Obsessional‐Compulsive Inventory were used to assess self‐reported childhood trauma in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect), eating psychopathology, depression and obsessive‐compulsion. Stepwise multiple regression analyses were used to explore whether these childhood traumatic experiences predict eating psychopathology and mediation analyses were conducted according to Baron and Kenny’s guidelines. Results. Emotional abuse, physical neglect and sexual abuse were found to be significant predictors of eating psychopathology. We also found that depression fully mediated the association between some forms of childhood trauma and eating psychopathology, while obsessive‐compulsion did not mediate this association. Conclusions. Future interventions for patients with eating disorders should focus on assessing the possibility of childhood trauma, especially in those patients with poor treatment outcomes. In addition, whether or not traumatised individuals exhibit depression is a more important predictor of eating psychopathology than the traumatic experience itself. Relevance to clinical practice. Early intervention for childhood trauma and depression might contribute to preventing eating disorders in traumatised individuals.     

Give peace a chance. Interview by Jenny Knight

Following a tough childhood in south London, Mustafa Shiyanbola has made a successful career in nursing. He is now using his personal experience to mentor others.