Legal consent for vasectomy of a mentally-retarded minor

The medicolegal aspects of sterilizing mentally retarded minors are discussed. In general, courts have jurisdiction over minors and have authority to issue orders for the protection or welfare of a minor. A case cited concerned an attempt to have a mentally retarded adult woman with two illegitimate children sterilized. The attempt was denied by the court because her parents had no authority to act for her since she was an adult and no guardian had been appointed who had control over her person. No cases of this nature concerning minors could be found. The consent of the parents might be sufficient reason for sterilization in the case of a minor.     

Specificity and mechanism of the benzidine formation in pharmaceutical analysis (author's transl)

Specificity and Mechanism of the Benzidine Formation in Pharmaceutical Analysis The formation of benzidine dyes from tertiary aromatic amines, amides, imines and some similar benzoheterocyclic compounds is reported. A positive colour reaction is given when:

• a The compound is stable under the reaction conditions.
• b The electron density in the aromatic ring system is sufficiently high.
• c There are no substituents in p-position which cannot be removed during the reaction.
• d The aromatic ring is not perpendicular to the rest of the molecule.
• e The nitrogen in the investigated heterocyclic compounds is not allowed to be in a sp² state.

From these facts evidence is given for a special mechanism of the benzidine formation in strong acidic media.     

Validity of the detection of wheelchair propulsion as measured with an Activity Monitor in patients with spinal cord injury

STUDY DESIGN: Validation study. OBJECTIVES: An accelerometry-based Activity Monitor (AM) has proven to be a valid instrument to quantify mobility-related activities (lying, sitting, standing, walking, cycling, general (noncyclic) movement). The aim of this study was to assess whether, additional to other activities, wheelchair propulsion (hand-rim wheelchair propulsion and handbiking) can be validly detected by the AM in patients with spinal cord injury (SCI). SETTING: Rehabilitation center. METHODS: In all, 10 patients with SCI (aged 19-63 years; five patients with poor triceps strength and five patients with good triceps strength) participated. Patients performed a series of representative daily life activities (involving wheelchair propulsion and nonwheelchair propulsion activities), according to a standard protocol, in a seminatural setting. Continuous registrations of signals from body-fixed accelerometers were made and the AM output (after automatic analysis) was compared with visual analysis of simultaneously made video recordings (reference method). Validity scores (agreement, sensitivity, specificity) between the output of the AM and the video analysis were calculated. RESULTS: Agreement, sensitivity and specificity for the detection of wheelchair propulsion were overall 92 (range, 87-96)%, 87 (76-99)% and 92 (85-98)%, respectively. Sensitivity was smaller in patients with poor triceps strength compared to patients with good triceps strength; 81 (76-89)% and 95 (89-99)%, respectively (P<0.01). Mean overestimation in duration of wheelchair propulsion by the AM was 3.9% (P<0.05). CONCLUSION: Besides already validated other activities, wheelchair propulsion (hand-rim wheelchair propulsion and handbiking) can be validly detected by the AM in patients with SCI, both with good and poor triceps strength. Therefore, the AM offers the possibility to obtain objective and detailed information on all major mobility-related activities performed by patients with SCI. SPONSORSHIP: Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting.     

A long-term study of the efficacy of oxandrolone in hyperlipoproteinemias.

Oxandrolone, an anabolic steroid, significantly reduced serum triglycerides in type III, IV, and V hyperlipoproteinemia, with a concomitant decrease in pre-beta lipoproteins. Its slightly enhancing effect on serum cholesterol and absolute increase in beta lipoproteins might eventually discourage its administration in type II patients. Alpha lipoproteins always remained at low levels. In addition to its hypotriglyceridemic action,, oxandrolone induced a slight reduction in uric acid and alkaline phosphatases. Untoward side effects were not observed even after prolonger therapy. Therefore, oxandrolone might deserve a place among the few available triglyceride-reducing therapies.     

The manipulative patient: an interactional approach

The words manipulative or manipulation are used in the contemporary psychiatric literature to describe certain persons and their habitual modes of behavior. The terms represent an attempt to describe some essential quality of the patient's style of relating to others. In the following discussion, we will attempt to shift this perspective to a more interpersonal one, seeing the attribution of this label as part of a sequence of communication, mutual perception, and struggle between caretaker and patient. The accusation that a patient is manipulative signals the disruption of the helping process.     

Treatment of patients with chronic adenoiditis and abnormal coagulation

Chronic adenoiditis (CA) prevails among ENT diseases in children. It often demands surgical intervention. Frequent hemorrhagic complications during adenotomy necessitate assessment of the patient's hemostasis. A preoperative examination of 43 children has detected primarily dysaggregation thrombocytopathies. Streptococcus pneumoniae is a dominating etiological agent. Chronic focal infection is involved in pathogenesis of systemic disorders in CA including those provoking coagulatory disturbances. An algorithm of hemostatic disorders diagnosis in CA children is proposed as well as an effective program of targeted pre- and intraoperative hemostatic therapy.     

Quantitative mass spectral evidence for the absence of circulating brain natriuretic peptide (BNP-32) in severe human heart failure

C-terminal brain (B-type) natriuretic peptide (BNP)-32 is a widely used clinical biomarker for the diagnosis, prognosis, and treatment of heart failure (HF). The 32-aa peptide is synthesized primarily in the atrial and ventricular myocardium and constitutes the mature biologically active form of immature BNP (pro-BNP). There has been mounting evidence that suggests BNP circulates in different structural forms that impact HF diagnosis and in vivo activity. Herein, we have developed and used an immunoaffinity purification assay to isolate endogenous BNP-32 from New York Heart Association class IV patient plasma for subsequent analysis by nano-liquid chromatography (LC) electrospray ionization Fourier transform ion cyclotron resonance (FT-ICR) MS. We have introduced stable isotope-labeled BNP-32 to the assayed plasma to enable quantification of endogenous levels of BNP-32. Unlike the chemically nonspecific point-of-care tests (POCTs) and RIAs used worldwide to quantify BNP-32 from plasma, FT-ICR-MS (unprecedented mass measurement accuracy) coupled with LC (retention time) affords extraordinary molecular specificity, and when combined with the use of internal standards is able to confidently identify and quantify BNP-32. The significance of this work is despite exceedingly high circulating levels of BNP-32 in the New York Heart Association class IV patients as determined by POCTs (>290 fmol/ml) nano-LC-electrospray ionization-FT-ICR-MS data did not reveal any endogenous BNP-32. These results provide molecularly specific evidence for the absence of circulating BNP-32 in advanced-stage HF patients and suggest the existence of altered forms of BNP that are contributing to the POCT values.     

Prospective echocardiographic evaluation of atrioventricular conduction in fetuses with maternal Sjögren's antibodies

OBJECTIVE: Fetal complete atrioventricular block (AVB) occurs in 2-5% of Sj?gren's antibodies (SSA/SSB)-positive pregnancies with substantial morbidity and mortality. We evaluated the incidence of 1 degrees and 2 degrees AVB by measuring Doppler-derived mechanical PR intervals. STUDY DESIGN: We compared mechanical PR intervals of fetuses of SSA/SSB positive mothers referred to a single cardiology center between 1997 and 2003 with control fetuses and fetuses with 1 degrees or 2 degrees AVB confirmed by magnetocardiography or postnatal electrocardiogram. RESULTS: One hundred thirty-nine fetal echocardiograms performed on 59 SSA/SSB-positive pregnant women at 24.3 +/- 5.0 weeks gestation were compared with 150 controls. Mechanical PR intervals of the study group (120.5 +/- 9.8 milliseconds) and controls (120.6 +/- 8.7 milliseconds) were the same but differed significantly from fetuses with 1 degrees and 2 degrees AVB (191.5 +/- 29.6 msec). CONCLUSION: The incidence of 1 degrees and degrees 2 fetal AVB in SSA/SSB-positive pregnancies is low and can be identified by abnormal mechanical PR interval.     

Sexual abuse, antisocial behaviour and substance use: gender differences in young community adolescents

OBJECTIVE: To investigate gender-specific relationships between self-reported sexual abuse, antisocial behaviour and substance use in a large community sample of adolescents. METHOD: A cross-sectional study of students aged, on average, 13 (n = 2596), 14 (n = 2475) and 15 years (n = 2290), from 27 schools in South Australia with a questionnaire including sexual abuse, frequency and severity of substance use, depressive symptomatology (CES-D), family functioning (McMaster Family Assessment Device), and antisocial behaviour (an adapted 22-item Self-Report Delinquency Scale). Logistic regression analyses using HLM V5.05 with a population-average model were conducted. RESULTS: In the model considered, reported sexual abuse is significantly independently associated with antisocial behaviour, controlling for confounding factors of depressive symptomatology and family dysfunction, with increased risks of three- to eightfold for sexually abused boys, and two- to threefold for sexually abused girls, compared to nonabused. Increased risks of extreme substance use in sexually abused girls (age 13) and boys (ages 13-15) are more than fourfold, compared to nonabused. Age differences were not statistically significant. CONCLUSION: Childhood sexual abuse is a risk factor for the development of antisocial behaviour and substance use in young adolescents. Clinicians should be aware of gender differences.