Translation,cultural adaptation and construct validity of the German version of the Adult Social Care Outcomes Toolkit for informal Carers (German ASCOT-Carer)

Quality of Life Research - The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal...     

Pharmacokinetics,cerebrospinal fluid penetration,and metabolism of piroxantrone in the Rhesus monkey

Summary Piroxantrone is an anthrapyrazole derivative with broad anti-tumor activityin vitro and less cardiac toxicity than the anthracyclines. The metabolic pathways and central nervous system penetration of piroxantrone have not been determined. In this study we examined the pharmacokinetic behavior of piroxantrone in plasma and cerebrospinal fluid in a non-human primate model. In addition, a urinary metabolite of piroxantrone was isolated and its cytotoxicity evaluatedin vitro. The disappearance of piroxantrone from plasma after an intravenous dose of 150 mg/m² given over 60 minutes was biexponential with mean t_1/2 alpha of 1.0 minutes and a mean t_1/2 beta of 180 minutes. The mean area under the curve was 220 M·min and the clearance was 1420 ml/min/m². Piroxantrone was not detectable in the cerebrospinal fluid.Piroxantrone and three other compounds not present in pre-treatment samples were detected in urine. The major urinary metabolite was isolated. Its cytotoxicity against MOLT-4 cellsin vitro was at least one log less than that of piroxantrone. In addition, one of the other compounds detected in urine was determined to be a glucuronide conjugation product of the major metabolite.The results of this study may be useful in the interpretation of the activity and toxicity of piroxantrone in clinical trials.     

Plastic surgery

Plastic surgery is all too often thought of as an indulgence of the rich and famous with little attention paid to the repair of bodies and limbs disfigured or deformed by accident or illness. Surgeons look to management to address those issues that create an insecure base for planning the service and for its organisation nationwide.     

Effect of exercise on calf muscle pump function in patients with chronic venous disease

BACKGROUND: Musculoskeletal dysfunction may be associated with poor calf muscle pump function in patients with chronic venous ulceration. The aim of this study was to evaluate the effects of physical exercise on calf muscle pump function. METHODS: Twenty patients were recruited into a 6-week intensive exercise programme. Calf muscle function and calf muscle pump function were assessed using an isokinetic device and air plethysmography respectively, before and after the exercise programme. RESULTS: There was significant improvement in calf muscle pump function, measured as increased ejection fraction and decreased residual fraction (P < 0.05); however, venous reflux was not altered (P > 0.05). Calf muscle strength and endurance parameters all increased, but not significantly (P > 0.05). CONCLUSION: Poor calf muscle pump function in patients with chronic venous ulceration can be improved by physical exercise.     

A Review of the Diagnostic Methods Reported in the Journal of Autism and Developmental Disorders

This review summarizes subject selection and diagnostic procedures documented in the Journal of Autism and Developmental Disorders. One hundred forty-two empirical articles published between February 1993 and April 1997 were examined. Reviewers independently evaluated articles using a coding instrument developed by the authors. Results indicated that a majority of researchers reported the use of one or more standard diagnostic criteria in classifying their subjects. However, numerous studies did not report the methods by which the diagnostic criteria were quantified or applied. Additionally, there was a lack of clear specification of inclusion and exclusion criteria for comorbid disorders. Improving the documentation of diagnostic practices in research on autism will benefit researchers and practitioners.     

Neuroendocrine Tumors of the Head and Neck: A Selected Review with Emphasis on Terminology

Virtually every variant of neuroendocrine neoplasia can occur, at least rarely, in the head and neck region. This review focuses on the terminology surrounding neuroendocrine carcinomas of the larynx and their distinction from morphologically similar but biologically distinctive neoplasmas. It is suggested that rare typical laryngeal carcinoids be labeled as such. There is little evidence that these lesions are part of a morphologic continuum. In contrast, more common “carcinoid-like” carcinomas, previously referred to as “atypical carcinoids” are more appropriately labeled as “moderately differentiated neuroendocrine carcinomas”. These neoplasms should, in turn, be distinguished from “small cell neuroendocrine carcinomas,” although these latter two neoplasms do represent a morphologic and behavioral spectrum. Light microscopic and immunohistochemical features distinguishing neuroendocrine carcinomas of the larynx from paraganglioma, metastatic medullary carcinoma, malignant melanoma, and basaloid squamous cell carcinoma are presented. The second portion of this review outlines the clinicopathologic features of two head and neck neoplasms exhibiting varying degrees of neuroendocrine differentiation. Olfactory neuroblastomas have well-developed neuroendocrine differentiation, almost invariably arise from the olfactory mucosa, typically exhibit low-grade cytologic features, and may have protracted clinical course with an approximately 50% overall 5-yr survival. In contrast, sinonasal undifferentiated carcinoma is a microscopically high-grade neoplasm with minimal, abortive neuroendocrine features, a highly aggressive clinical course, and virtually 100% mortality. They can arise throughout the sinonasal region. Presented at the Endocrine Pathology Society—USCAP Meeting, Washington, DC, March 23, 1996.     

The modification and standardisation of the Harter self-esteem questionnaire with Scottish school children

This paper describes a study to modify an American questionnaire measuring self-esteem in children for use in the United Kingdom and also to obtain normative values for this questionnaire with Scottish school children aged 8–15 years. Five thousand children resident in the Lothian Region of Scotland, a 5% sample of the age group, were identified using a cluster sampling technique in order to provide a random sample of the general population for this age group. The main findings were as follows: children usually rated themselves higher than the midpoint on most subscales, indicating that they have a positive regard for themselves; boys tended to rate themselves higher than girls on most subscales except behaviour; scores tended to decline as children get older, especially for girls; global or overall self-esteem was highly correlated with the other subscales, especially physical appearance or attractiveness; self-esteem scores were not influenced by social class, school or religion. The modified Harter questionnaire can be used to measure self-esteem in several situations. These include comparisons between different groups of children, changes in self-esteem following treatment interventions or the effects of illness on children's psychological adjustment. Finally, the study has provided normative values for a Scottish population of school children aged 8–15 years.

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Zusammenfassung Die vorliegende Arbeit beschreibt eine Studie, die es sich zum Ziel setzt, einen amerikanischen Fragebogen zum Gebrauch für 8–15jährige Schüler in Großbritannien zu modifizieren. Der Fragebogen mißt das Selbstwertgefühl der Kinder und ein Hauptziel der Studie war die Erlangung von normativen Basiswerten.Die wichtigsten Ergebnisse waren wie folgt: Kinder schätzen sich auf den meisten Unterskalen höher ein als der Mittelwert, was auf ein allgemein positives Selbstwertgefühl schließen läßt; Jungen tendieren sich auf allen Unterskalen mit Ausnahme der behaviour-Skala höher einzuschätzen als Mädchen; die Werte nehmen im Allgemeinen ab, wenn die Kinder älter werden, was vor allem für Mädchen deutlicher ist; globalses Selbstwertgefühl ist stark korreliert mit den Ergebnissen der Unterskalen, vor allem solchen die körperliches Erscheinungsbild oder Atraktivität beschreiben; die Ergebnisse sind nicht mit Faktoren wie sozialer Schicht, Schule oder Religion korreliert.Der modifizierte Harter-Fragebogen für die Bestimmung des Selbstwertgefühls kann in mehren Situationen Verwendung finden: Kinder verschiedener Altersgruppen können verglichen werden; Veränderungen nach Behandlungseingriffen oder der Einfluß von erkrankungen auf diesen Aspekt der Psyche können gemessen werden. Und schießlich hat der Fragebogen normative Grundwerte für eine Population von schottischen 8–15jährigen Schülern geliefert.

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Résumé Cet exposé décrit une étude faite pour apporter des modifications à un questionnaire américain sur l'évaluation du Respect de Soi ches les enfants, afin qù'il puisse être utilisé au Royaume Uni et aussi afin de normaliser ce questionnaire pour les écoliers écossais âgés de 8 à 15 ans.Cinc mille enfants de la région écossaise de Lothian, une section représentative de 5% du groupe d'âge, one été identifiés, en se servant d'un groupe de techniques d'échantillonnage afin d'obtenir un échantillon prélevé au hasard, de la population générale dans ce group d'âge.Les conclusions principles sont les suivantes: Les enfants se classent eux-mêmes généralement plus haut que la moyenne dans la plupart des cas de figures analysés, indiquant ainsi qu'ils ont une opinion positive d'eux mêmes. Les garçons ont tendance à avoir une plus haute opinion d'eux mêmes que les filles dans tous les cas de figures excepté la conduite. Les résultats obtenus ont tendance à diminuer en fonction de l'âge plus élevé des enfants, particulièrement pour les filles. Globalement ou en général le respect de soi était mis plus en corrélation avec les autres cas de figures, tout spécialement l'apparence physique ou l'attrait feminin. Les évaluations du respect de soi n'ont pas été influencées par la classe sociale, l'institution scolaire ou la religion.Le questionnaire Harter modifié peut être utilisé pour évaluer le respect de soi dans plusieurs situations. Celles-ci comprennent des comparaisons entre différents groupes d'enfants, des changements dans le respect de soi intervenant après un traitement ou les effets de maladie sur l'adaptation psychologique des enfants.Pour terminer, cette étude a permis d'obtenir des valeurs normalisées pour une population d'écoliers écossais âgés de 8 à 15 ans.

     

Growing fractures of the skull

Tne cases of growing fractures seen in the last 10 years are presented. Six of the patients sustained their injury within the first six months of life. The defects formed rapidly, several within two or three months after injury. There was enlargement of the defect in only one case after the date of discovery. Although the defects involved the parietal bone most commonly, in four out of 10 the lesion crossed either the coronal or the lambdoid suture. The edges of the defects were usually thickened; in some areas they were saucer-shaped but in two cases there was erosion of the outer table of the skull at a distance from the margin of the defect, the erosion being related to an extracranial fluid-filled cavity in continuity with a porencephalic cyst. The ipsilateral ventricle was usually dilated and in a number of cases was associated with a porencephalic cyst. In no case was a "leptomeningeal cyst" found beneath the defect at operation. A detailed review confirms many of the findings previously described but suggests that the pathology of the condition is still not fully understood. Computed tomography, undertaken in one case, appears to be the examination of choice. Further light may be thrown on the pathogenesis of this condition by the use of intracystic, intrathecal, and intraventricular water-soluble contrast media.