Diffuse cavernous haemangiomas of the upper limb

In the upper limb, diffuse cavernous haemangiomas occur infrequently but their treatment is often unsatisfactory and the result of surgical excision disappointing. Four cases of these diffuse haemangiomas are described and their management discussed.     

Effectiveness of dental health educational programs in schools

The largest and most important group that may be reached by health education is found in the school system. Children not only are fast learners and anxious to acquire new skills but also are at risk for the development of dental health problems. Therefore, regardless of the equivocal nature of the evidence regarding the effectiveness of school dental health educational programs, it is important that they continue to be developed. The programs created should have objectives, pretesting, participatory and cognitive experiences, periodic review of dental health program by an advisory committee, a liaison between school personnel and health professionals, and realistic models to assess the effects of the program on health. Because dental disease preventive programs and regimens such as water fluoridation, topical fluorides, dental sealants, and oral hygiene regimens are available that have the potential to eliminate dental disease, effort should be made to increase the awareness of the children who can benefit from them.     

Calcinosis at the site of leakage from extravasation of calcium disodium edetate intravenous chelator therapy in a child with lead poisoning

Painful calcinosis appeared at the wrist of an eight-year-old girl with lead poisoning. Careful history revealed that calcification occurred at the site of previous extravasation of calcium disodium edetate (EDTA) used in chelation therapy. Light microscopic, ultrastructural, electron activation, and X-ray diffraction studies demonstrated apatites with some suggestion of an admixture of octacalcium phosphate.     

Effects of tolazamide and exogenous insulin on pattern of postprandial carbohydrate metabolism in patients with non-insulin-dependent diabetes mellitus. Results of randomized crossover trial

To determine whether therapy with exogenous insulin or sulfonylureas results in a postprandial pattern of carbohydrate metabolism in patients with non-insulin-dependent diabetes mellitus (NIDDM) that resembles that in nondiabetic individuals, we employed a dual-isotope technique combined with forearm catheterization to examine meal disposition in NIDDM patients, before and after 3 mo of therapy with tolazamide and after 3 mo of therapy with exogenous insulin, with a randomized crossover design. Results were compared with those observed in nondiabetic subjects. Although both forms of therapy improved chronic glycemic control (glycosylated hemoglobin concentration went from 9.6 +/- 0.7 to 7.6 +/- 0.5 and 7.1 +/- 0.2%, respectively, P less than .01), exogenous insulin resulted in a lower postprandial glycemic response than tolazamide (P less than .001). Both agents comparably increased (P less than .01) fasting and integrated postprandial insulin concentrations. However, the initial rate of postprandial increase was greater with exogenous insulin (P less than .05). Tolazamide (P less than .05) but not exogenous insulin increased postprandial C-peptide concentrations. However, tolazamide did not improve the deficient early insulin release. Both agents (P less than .05) lowered postabsorptive hepatic glucose release (from 2.8 +/- 0.3 to 2.3 +/- 0.2 mg . kg-1 . min-1), but not to normal rates (1.8 +/- 0.1 mg . kg-1 . min-1).(ABSTRACT TRUNCATED AT 250 WORDS)     

Intraluminal allograft restoration of the upper femur in failed total hip arthroplasty

Deep-frozen cancellous allografts have been used to restore the proximal femur of 23 hips following failed total hip arthroplasty. The canal is cleared and reaming is performed under direct vision through a cortical window. A modified Huckstep prosthesis permits early weight-bearing on the distal femur regardless of the state of proximal bone, but retains the option for later restoration of proximal loading once grafts appear mature. This transfer has been performed on four occasions. All 23 patients have had relief of pain with early ambulation. The follow-up periods ranged from six to 30 months. With the exception of one deep infection, the grafts have not undergone resorption in this period of follow-up study. Consolidation appears slower when the defect has followed multiple operations than following an initial revision for prosthetic loosening. The basic bone bank facilities are required for the supply of frozen allografts.     

Radiotherapy in the management of pancreatic islet cell tumors

Malignant islet cell tumors are commonly treated with surgical resection. Chemotherapy is reserved for residual, unresectable, or metastatic disease. The role for radiotherapy has not been clearly defined. This article describes three cases of advanced islet cell tumors treated effectively with radiotherapy. This experience, in addition to that from other published reports, suggests that radiotherapy is a useful mode for treating advanced islet cell carcinoma.     

Unemployment causes ill health: the wrong track

It is not unemployment per se that causes ill health. It can be a very desirable state. There are no diseases specific to unemployment. Contrast this with employment. Unemployment shares with all other socio-environmental situations risk of exposure to common physical, social and psychological stressors that predispose to disease. Focus for action and research should be on reducing such stressors and not on provision of full employment. The former is likely to be possible and beneficial. The latter is likely to be impossible and carries a risk of making matters worse. As an immediate first step, that will reduce 'cratogenic' disease, people in authority should stop misleading the public into believing that unemployment is the cause of ill health.