Family Functioning and Social Support in the Adaptation of Caregivers of Children With Sickle Cell Syndromes

Objective: To examine moderating effects of family functioningand social support on the relationship of child-related stressorsto caregivers' psychological adaptation in a sample of caregiversof children with a chronic illness. Method: Participants were 67 caregivers of children and adolescentswith sickle cell syndromes. We conducted MANOVAs and subsequenteffect size calculations to determine if family functioningwould buffer the effects of caring for difficult-to-manage childrenwith this illness. Results: Findings supported a moderator effect of family functioningon the association of children's externalizing behavioral problemsto caregivers symptoms of hostility. Greater levels of cohesiveand adaptive family functioning buffered the potential detrimentaleffects of caring for children perceived as hard to manage.No significant associations were obtained between measures ofcaregivers' psychological adaptation and the severity of theirchildren's disease. Conclusions: We make recommendations for family systems interventions,particularly for caregivers of children with behavior problems.     

Traumatic haemarthrosis causing femoral head subluxation

We report seven children in whom traumatic haemarthrosis of the hip had produced lateral subluxation of the femoral head, which is different from the apparent displacement seen in Perthes' disease. In all seven cases, aspiration of the haemarthrosis allowed reduction of the femoral head, and follow-up for a mean of 14 months revealed no evidence of avascular necrosis of the proximal femoral epiphysis. Traumatic haemarthrosis of the hip in children appears to be a clinical entity which can produce femoral head subluxation. Aspiration and traction is the treatment of choice and can cure the condition.     

ISCHAEMIA-REPERFUSION INJURY TO THE INTESTINE

Ischaemia-reperfusion injury (IRI) is of obvious relevance in situations where there is an interruption of blood supply to the gut, as in vascular surgery, or in the construction of free intestinal grafts. It is now appreciated that IRI also underlies the gut dysfunction that occurs in early shock, sepsis, and trauma. The events that occur during IRI are complex. However, recent advances in cellular biology have started to unravel these underlying processes. The aim of this review is to provide an outline of current knowledge on the mechanisms and consequences of IRI. Initially, IRI appears to be mediated by reactive oxygen metabolites and, at a later stage, by the priming and activation of polymorphonuclear neutrophils (PMN). Ischaemia-reperfusion injury can diminish the barrier function of the gut, and can promote an increase in the leakage of molecules (intestinal permeability) or the passage of microbes across the wall of the bowel (bacterial trans-location). Ischaemia-reperfusion injury to the gut can result in the generation of molecules that may also harm distant tissues.     

Buried inferiorly based gluteus maximus musculocutaneous flap for reconstruction of large, recurrent ischiopubic pressure sores

The ischium is the most common site for recurrence of pressure sores in the paraplegic population. Successful reconstruction of these wounds depends on the total excision of ulcer, soft tissue debris, bony prominence, and the durability of the soft tissue repair. The V-Y gluteus maximum musculocutaneous flap based on the inferior gluteal vessels can be advanced medially, deepithelialized, and buried to fill large, deep soft tissue ischial wounds. Local rotational flaps close the superficial wound. This buried flap, although not previously described, is useful for the reconstruction of large ischiopubic pressure sores initially or at the time of recurrence.     

Immunopathology of glomerulonephritis associated with chronic woodchuck hepatitis virus infection in woodchucks (Marmota monax).

Retrospective analysis of necropsy findings of 705 woodchucks was performed to determine the prevalence and morphology of immune-mediated glomerulonephritis, its relationship to woodchuck hepatitis virus (WHV) infection, and the presence of major WHV antigens. Twenty-six woodchucks had glomerular lesions. Renal tissue of the 26 animals was evaluated histologically and immunohistochemically for immune-mediated glomerulonephritis. Of these 26 animals, immune-mediated glomerulonephritis was diagnosed in six, all of which were chronic WHV carriers. Membranous glomerulonephritis was identified in three animals, two of which also had mesangial proliferation. Host immunoglobulin was present within the mesangium and along capillary loops in all three. Woodchuck hepatitis virus core antigen (WHcAg) was present along capillary loops of two of these animals, one membranous and one mixed, and in the mesangium of all three. Woodchuck hepatitis virus surface antigen (WHsAg) deposition was similar to WHcAg deposition but was only present along capillaries in those animals with mixed nephritis. The remaining three animals had mesangial proliferation. WHsAg and host immunoglobulin deposition were predominately mesangial; WHcAg was not detected. Transmission electron microscopy showed thickening of the capillary loop basement membranes and subepithelial electron-dense deposits in animal one, and deposits in the mesangium in animal six.     

Ageing of intravenous glucose solutions

The pH and acid content of 63 glucose-based solutions was measured up to eight years after their expiry. The pH ranged from 2.27 to 4.33. Newly manufactured solutions with 5 per cent or less of glucose which were packaged in plastic bags contained in the order of 0.01 mEq/L of acid per gram of glucose. Solutions with higher glucose concentrations had lower pH and greater acid. As solutions in bags became older, pH decreased and acid increased. In contrast, 25 per cent and 50 per cent glucose solutions in glass containers were much less acid and showed only slight changes with age in pH or acid. The greater rate of acid increase in glucose solutions in plastic bags may be due to the bags being permeable to oxygen and thus allowing slow oxidation of the glucose.     

Assessing hearing problems within a community survey.

Community surveys are increasingly being used as a method of collecting health and lifestyle data. This report describes the use of a simple question on hearing difficulties within such a survey. A systematic sample of 2.5% of the electoral register of the four Parliamentary constituencies of Cardiff, Wales, was drawn. Of the 5145 individuals in the sample, 83% responded. Age and social class explained much of the variability in reported hearing difficulties. A recent fall and cigarette consumption were associated with hearing problems, but the contribution of alcohol consumption while potentially important did not reach statistical significance. This self-administered community survey provided hearing data which are consistent with other specialized studies and is a viable route for the assessment of community needs.