Case study: delicate skin cutting: management beyond the skin and implications of superficial habitual self-mutilation

A 16-year-old girl accompanied by her mother was noted to have several thin, well healed brown lines on the distal third of her left flexural forearm (Figure). She admits to having recently made these marks by skin cutting. She feels depressed and at times feels life "is not worth living." She denies alcohol or substance abuse or true suicidal ideation, plan, or intent. Her mother describes her as previously well adjusted and a good student who has become erratic and moody in the past 6 months, with worsening school performance. Her father had a history of depression and alcoholism and died 3 years ago. She is undergoing psychotherapy and pharmacotherapy with sertraline with good results. She has not cut her skin in 3 months. Her mood and behavior have improved.     

Ferritin concentrations in dried serum spots prepared by standard compared with simplified approaches: a validation study in Guatemala City

BACKGROUND: Spot ferritin assay on dried serum spot (DSS) samples provides reliable and accurate assessment. Standard DSS preparations, however, involve precise serum aliquots and require some skill and training of field personnel. OBJECTIVE: We evaluated the validity of the spot ferritin assay on DSS samples prepared by simplified approaches and standard technique in Guatemala City. DESIGN: Venous blood (5 mL) was obtained from 104 subjects aged 24 +/- 15 y (x +/- SD) and transferred into nonheparin-containing (2 plain and 2 self-sealing) capillary blood collection tubes. Three DSS samples were prepared: A (standard, 20 microL serum), B (blot, approximately 30-35 mm serum column), and C (dispenser, 20 microL serum pushed directly from self-sealing capillary tubes with a dispenser). Spots were air-dried and placed in hermetic plastic bags with a desiccant. Two weeks later, entire spots for DSS A and C samples and a circle in the center for DSS B samples were analyzed. RESULTS: DSS ferritin A, B, and C correlated strongly with traditional ferritin (r = 0.71-0.88, P < 0.001). The geometric mean (-1 SD and +1 SD) values for the DSS A, B, and C and traditional ferritin methods were 27.5 (12.6, 60.2), 32.4 (13.5, 77.6), 27.5 (11.7, 64.6), and 30.2 (13.8, 66.1) microg/L, respectively, and did not differ significantly. The difference in ferritin values by various DSS approaches compared with the traditional approach was small (<4 microg/L; P > 0.05). CONCLUSIONS: Simplified and standard DSS methods provide accurate iron-status assessment in population studies. The simplified DSS approaches for serum ferritin measurement need to be evaluated further in populations in whom iron deficiency is prevalent.     

Cricothyroid approximation and subluxation in 21 male-to-female transsexuals

OBJECTIVES: To evaluate the medium-term outcome of cricothyroid approximation and subluxation (CTAS) with postoperative speech therapy for pitch elevation in male-to-female transsexuals. STUDY DESIGN: Retrospective study of male-to-female transsexuals who underwent pitch-raising surgery between November 1996 and August 2001. METHODS: Twenty-one male-to-female transsexuals opted for surgical feminization of their voices after inadequate improvements with speech therapy alone. Electrolaryngographic measurements were obtained by a single speech therapist of modal fundamental frequencies and the percentage of irregularities before, at 2 weeks, and 6 months after surgery. All 21 patients underwent CTAS, and 20 underwent simultaneous cosmetic thyroid chondroplasty by a single surgeon. RESULTS: Electrolaryngographic results 2 weeks after surgery showed an average postoperative gain in modal frequency of free speech of 71.05 Hz (95% confidence interval [CI]: 42.9-99.2, P < .001). There was a concomitant average rise in irregularities of 9.9% (95% CI 0.7-18.5, P = .03). At median follow-up of 6 months after six sessions of speech therapy (n = 15), there was a decrease in irregularities to preoperative levels. The overall gain at 6 months in modal frequency of free speech was 56.9 Hz (95% CI 38.3-75.4, P < .001). Smoking and age did not predict a worse outcome. CONCLUSIONS: Cricothyroid approximation effectively raises pitch in male-to-female transsexuals. There is a concomitant rise in voice irregularities that is effectively addressed by speech therapy.     

The continuous glucose monitoring sensor in neonatal intensive care

OBJECTIVE: To determine the feasibility of continuous glucose monitoring in the very low birthweight baby requiring intensive care, as these infants are known to be at high risk of abnormalities of glucose control. METHOD: Sixteen babies were studied from within 24 hours of delivery and for up to seven days. RESULTS: The subcutaneous glucose sensors were well tolerated and readings were comparable to those on near patient whole blood monitoring devices. CONCLUSION: Continuous glucose monitoring is practical in neonates, giving detailed information about glucose control.