Neuropathic foot ulceration in patients with myelodysplasia.

To determine if a significant relationship existed between type of operation and eventual development of pedal skin breakdown in a spina bifida patient population, 72 feet in 36 ambulatory patients with low lumbar or sacral myelomeningocele were followed for an average of 14 years 5 months. Using a clinical classification for foot suppleness and position, we determined that foot rigidity, nonplantigrade position, and performance of surgical arthrodesis were clinical indicators that had a strong statistical relationship with eventual development of neuropathic skin changes.     

Prevention of catheter-associated bacteriuria: clinical trial of methods to block three known pathways of infection

The simultaneous use of methods to block all three known pathways of bacterial entry into the bladders of catheterized patients has been suggested because of the limited effectiveness of individual methods that block single pathways. We conducted a randomized controlled trial to assess the prevention of bacteriuria in patients, using a three-way system that included a hydrophilic polymer-coated and preconnected sealed catheter system, daily catheter care, and disinfection of the outflow tube of the drainage bag with povidone-iodine (i.e., methods to block bacterial entry at the urethral insertion site, at the catheter drainage tube junction, and at the outflow tube). Among treated patients, 14 (4.7%) of 300 acquired bacteriuria as compared with 15 (4.9%) of 306 who did not receive the protocol treatments. Only 3 of 29 episodes of bacteriuria occurred in patients whose meatal cultures did not contain gram-negative bacilli or enterococci; thus migration of bacteria in the periurethral mucous sheath appeared to be the most common pathway by which bacteria gained entry into the bladder in this study. Catheter care and disinfection of the drainage bag outflow tube as used in this study remain unproven methods of preventing catheter-associated bacteriuria. Preconnected catheters with junction seals were used in both treated and untreated patients and, on the basis of previous studies, appear to be effective in reducing junction disconnections and bacteriuria. Therefore we conclude that the use of several simultaneous measures to prevent catheter-associated urinary infections is no more effective than the use of preconnected catheters with junction seals alone and is clearly more expensive.     

Correlates of depression in new onset pediatric inflammatory bowel disease

Of thirty six children with new-onset inflammatory bowel disease given a Kiddie-SADS interview, five children were depressed and ten had some depressive symptoms. Depressed children had less severe illness, and were more likely to have a maternal history of depression, more life events, and families characterized by less cohesion and more conflict. Initial support provided by a grant from the Crohn's and Colitis Foundation of America, Inc.     

Hospital admissions of Aborigines and non-Aborigines in Western Australia, 1977-1988.

Aborigines were admitted to hospital in Western Australia 2.8 times as frequently as other persons in 1977-1988. Their highest relative admission rates were in the 0-5 years age group, mostly for respiratory and gastrointestinal infections. Relative admission rates (all ages) for some categories were: infectious and parasitic, 4 to 10-fold; respiratory, 5-fold; nervous system, 4-fold; injury and poisoning, 3 to 5-fold; mental disorders, double the non-Aboriginal rate. Admissions for respiratory illnesses were consistently much higher in Aborigines of all ages. There were some significant declines in relative hospital admission rates for Aborigines over the study period.