Deliberate self-poisoning: the need for a new approach

New community-based preventive initiatives are required if a reduction in deliberate self-poisoning is to be achieved. Local epidemiological data can be used in a health education approach, directed at professionals who have the most contact with potential cases of deliberate self-poisoning and also to those people falling within identified high-risk groups. Such initiatives require defined outcome measures and a number are proposed. The implications for data collection on deliberate self-poisoning are discussed.     

Reflex sympathetic dystrophy following total knee replacement

Twenty-nine patients who eventually had a diagnosis of reflex sympathetic dystrophy (RSD) following total knee replacement were treated with lumbar sympathetic blocks with local anesthetic. The diagnosis was made based on the complaint of constant pain unrelated to physical activity in the absence of overt sepsis or implant loosening. In six of these cases, other factors may have clouded the diagnosis. Thirteen (44.8%) patients obtained complete relief following an average of 1.8 blocks. Three of these patients had symptoms for more than two years. Twelve patients had complete or partial relief for varying periods of time, but the relief was not sustained. Three obtained no relief at all, and in one the block could not be successfully carried out. This success rate, while shedding no light on the etiology or diagnostic accuracy, has encouraged the authors to continue with this method of treatment in such cases.     

Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk

OBJECTIVES: This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program. METHODS: One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable. RESULTS: Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools. CONCLUSIONS: Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.     

Psychological influences on the perception of immune function

BACKGROUND: Perception of deficiencies in immunity are common in a number of patient complaints. However, little is known about the way in which individuals form perceptions about the competence of their immune system. In two studies we examined the relationship between subjects' perceptions of their immune functioning, physical symptoms, mood and measures of immunity. METHODS: In Study 1, 20 healthy volunteers completed global ratings of their immune system functioning, as well as mood and symptom reports, twice a week for 5 weeks. At the same time, blood samples were taken to assess serum IgA, IgG, and IgM antibodies. In Study 2, another sample of 58 subjects completed the same measures weekly for 5 weeks and their blood was tested for concentrations of CD3, CD4, CD8, and CD16 lymphocytes. RESULTS: We found perceptions of immune functioning to be unrelated to the concentrations of serum antibodies or blood lymphocytes. Immune perceptions were strongly related to mood and in particular, feelings of fatigue and vigour. The experience of recent physical symptoms, while not as strong as mood variables, was also important in perceptions of immune functioning. CONCLUSIONS: Mood seems to be an important determinant in the perception of immune function, and complaints about immune dysfunction in clinical situation should be investigated with this possibility in mind.     

Penetrating trauma to the tricuspid valve and ventricular septum: delayed repair

Penetrating cardiac trauma can result in a wide range of injuries to intracardiac structures. Missile injury, in particular, can cause damage in more than one cardiac chamber that may be difficult to identify at initial emergent operation. We report a case of late repair of traumatic ventricular septal defect and tricuspid valve perforation from gunshot wound. This case illustrates the importance of thorough examination of intracardiac anatomy during emergent and delayed repair for penetrating cardiac trauma.     

Cognitive and behavioral outcome following mild traumatic head injury in children.

OBJECTIVES: To investigate outcome in children with mild traumatic head injury (THI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. DESIGN: Postconcussional symptomatology, behavior ratings, and neuropsychological test performance were examined at 1 week and 3 months postinjury. SETTING: Participants were recruited from successive presentations to emergency departments of two major hospitals. PARTICIPANTS: 130 Children with mild THI were compared with 96 children having other minor injuries as controls. RESULTS: Children with mild THI experienced headaches, dizziness, and fatigue but exhibited no cognitive impairments, relative to controls, at 1 week postinjury. By 3 months, symptoms had resolved. However, 17% of children showed significant ongoing problems. They were more likely to have a history of previous head injury, learning difficulties, neurological or psychiatric problems, or family stressors. CONCLUSIONS: Persisting problems following mild head injury in children are more common in those with previous head injury, preexisting learning difficulties, or neurological, psychiatric, or family problems. These "at-risk" children should be identified in the emergency department and monitored.     

Sertoli cells enhance the survival of co-transplanted dopamine neurons

One of the major issues in neural transplantation is the low survival rate (<5%) of transplanted dopamine (DA) neurons [3]. Recently it has been shown that it is possible to enhance the survival of these neurons, which in turn may decrease the amount of tissue that is required for each transplantation patient. The present paper demonstrates a novel approach for enhancing neuronal survival by co-transplantation of neuronal tissue with Testis-derived Sertoli cells (SC). This strategy could improve neuronal survival through the provision of trophic support.     

The early introduction of percutaneous renal biopsy in Italy

BACKGROUND: Percutaneous renal biopsy, based on the use of an aspiration needle and the patient in the sitting position, was first described by Iversen and Brun in 1951. In 1954, Kark and Muehrcke described the use of the cutting Vim-Silverman needle on patients in the prone position, with a substantial improvement in the rate of success. The 1961 CIBA Foundation Symposium on renal biopsy marked the coming of age of this technique. During the 1950s in Italy, several individuals played a part in promoting and developing percutaneous renal biopsy. Because this pioneer work has received insufficient attention, we describe the contributions of Italians to the early introduction of this technique. METHODS: The Italian and international literature about percutaneous renal biopsy of the period 1951 through 1965 was reviewed. In addition, structured interviews with surviving members of the Italian researchers who first used renal biopsy were conducted. RESULTS: The first renal biopsies in Italy were performed in 1951 in Pisa by the group of Ernico Fiaschi (1913-1989). In their hands, renal biopsy became a tool to investigate the pathogenesis of renal diseases in particular, while simultaneously using the early application of immunofluorescence and electron microscopy. In 1954, Pietro Leonardi (1914-1991) and Arturo Ruol (born 1924) introduced renal biopsy in Padova; they used this technique extensively and published one of the first monographs on the subject. In 1957, Vittorio Bonomini (born 1928) introduced renal biopsy in Bologna, and in subsequent years used this technique to focus on the study of pyelonephritis. CONCLUSIONS: Our historical research shows that Italian groups were among the first to use and develop percutaneous renal biopsy both as a clinical tool and an investigative tool. This article gives international credit to their work.