Clinical child psychology: Fundamental intervention questions and problems

This paper explores intervention concerns fundamental to clinical psychologists working with children. The discussion is organized around four basic questions: What is intervention? Who or what should be the focal point of intervention? Whose interests are being served? How can intervention efficacy be improved? In discussing these matters, the presentation (a) stresses the inappropriateness of any presumption that child interventions, by nature, are altruistic or that the primary focus should be on changing children, (b) reviews problems arising from conflicts between socialization and helping and among the various interested decision making parties, and (c) underscores the current danger of overemphasizing immediate outcomes in evaluating intervention.     

Nerve conduction and biopsy correlation in over 100 consecutive patients with suspected polyneuropathy

Neuropathy was classified physiologically and histologically as normal, axonal, demyelinative, or indeterminate using specific motor nerve conduction (NC) and sural sensory nerve biopsy (NB) criteria. Physiological and histological diagnoses were concordant in 63%, and minimally discordant in 14% of patients. The most important discordant patients were 6 with demyelinative neuropathy, 4 by NC, of which 2 were pure motor syndromes, and 2 by NB, both predominantly sensory syndromes. In the 55 patients with predominant axonal degeneration on biopsy, the extent of NC slowing was determined. As compound motor and sensory nerve action potential (CMAP and SNAP) amplitude declined, distal motor latency increased, whereas motor and sensory conduction velocity (CV) did not. Minimum F response latency increased as motor CV decreased, more in lower than upper extremity nerves. We conclude that: (1) except for sensory neuropathy, routine motor NC studies generally suffice in identifying demyelinative neuropathy; (2) NC slowing in axonal neuropathy is usually slight but may result in significantly prolonged distal motor latencies when CMAP amplitude is very low, and prolonged F wave latency when motor CV is slightly low; and (3) The physiologic criteria employed in this study rarely misclassifies neuropathy as demyelinative in patients with predominant axon loss on biopsy. © 1994 John Wiley & Sons, Inc.     

Acute renal failure in the neonate.

Acute renal failure is a common occurrence in the neonatal intensive care unit. This article summarizes pathophysiology, causes, differential diagnosis, methods of prevention, management, and outcome of acute renal failure in the neonate. Comparative roles of continuous arteriovenous hemofiltration and peritoneal dialysis are discussed.     

Laboratory monitoring of OxyContin (oxycodone): clinical pitfalls

Some patients have headaches that are refractory to standard treatments, and they require chronic administration of opioid analgesics. The use of opioids in a clinical setting must be closely monitored due to the medications' potential for addiction, abuse, and fatal interactions. Limited access to opioids and the demand for them outside the clinical setting leads to another danger. Patients can mislead their providers into prescribing opioids, intending to sell the medications instead of using them to alleviate their own pain. For protection of the patient, as well as the community, it is vital that such activity be prevented. We recently encountered a patient we suspected of abusing or misusing OxyContin (oxycodone). In order to determine whether the patient was taking the medication as prescribed, we ordered a urine-based immunoassay drug screen. The results were negative; the patient appeared to not have oxycodone in his system. Based on these results, we dismissed the patient from our practice. At the patient's request, a second test was performed, this time using gas chromatography-mass spectrometry. It indicated that the patient did indeed have sufficiently high levels of oxycodone in the urine. The minimum level threshold was too high to detect the presence of oxycodone in the immunoassay. We would like to help prevent future misunderstandings such as we experienced. To do so, we will first present the case of our patient, followed by a discussion of the actions taken. Finally, we will provide an overview of analgesic monitoring systems.     

Isolation of the gene and hypothalamic cDNA for the common precursor of gonadotropin-releasing hormone and prolactin release-inhibiting factor in human and rat.

Cloned cDNAs encoding the precursor protein for gonadotropin-releasing hormone (Gn-RH) and prolactin release-inhibiting factor (PIF) were isolated from libraries derived from human and rat hypothalamic mRNA. Nucleotide sequence analyses predict precursor proteins of 92 amino acids for both species and show identity between the human placental and human hypothalamic precursor proteins. Whereas the Gn-RH peptide structure is completely conserved in human and rat, the PIF domain of the precursor displays 70% interspecies homology. Genomic analyses revealed the presence of a single Gn-RH-PIF gene in human and rat containing sequences corresponding to the cDNA distributed across four exons.     

Cataract formation after initial trabeculectomy in young patients

OBJECTIVE: To evaluate the risk of cataract formation in young patients after initial trabeculectomy. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Thirty-four eyes from 27 patients undergoing initial trabeculectomy at the Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary (mean age, 43.7 years; range, 12-54 years). INTERVENTION: Follow-up averaged 42.6 months (range, 11-90 months). METHODS: Lens status was observed before surgery and at 3 months; 6 months; and 1, 2, 3, 4, 5, and 6 years after initial trabeculectomy. MAIN OUTCOME MEASURE: The main outcome measure was defined as cataract extraction for visually significant lenticular opacifications that developed after trabeculectomy. RESULTS: The rate of cataract extraction after initial trabeculectomy was 24% (n = 8). The average time from trabeculectomy to cataract extraction was 26 months (range, 5-58 months). Progression of lenticular opacities occurred throughout the follow-up period. There was no increased rate of cataract formation in subjects with uveitic and steroid-induced glaucoma when compared with all other types of glaucoma. In the patients with both eyes in the study, the first eye was a predictor of cataract progression in the fellow eye. CONCLUSIONS: Cataract is a common complication after trabeculectomy in young patients. The 24% rate of cataract extraction after trabeculectomy reported in this study is a significant risk of which young patients contemplating surgery should be aware.