Interactive skills of infants with their high-risk mothers

In this pilot study, the interactive skills of infants with their high-risk, substance-dependent mothers were explored in residential treatment from pregnancy until the infant was 6 months of age. Fourteen mother-infant pairs were videotaped in feeding and free play situations at 6 months after birth. A comparison, low-risk group consisted of 12 ordinary Finnish mother-infant pairs with minimal clinical risks. The findings show significantly higher levels of dyadic interactive deficiencies among the high-risk mother-infant pairs compared to the low-risk pairs, displayed especially in the feeding situation as lack of mutuality and flat, empty, constricted affective tone of interaction. Also, more interactive deficiencies were found among the high-risk infants compared to the low-risk infants, but the differences were not significant. In this study, this finding might reflect the reduced amount of somatic complications and the benefits of treatment, the impacts of which were not explored. The differences between the high- and low-risk infants were displayed as more withdrawal, depressed mood and avoiding behavior and as less alertness and attentional abilities, robustness and focus on parent's emotional state among the high-risk group.     

A case study of amnion rupture sequence with acalvaria, blindness, and clefting: clinical and psychological profiles

The purpose of this article is to report the case of a 10-year-old girl born with anophthalmia, bilateral oblique facial clefts, and missing scalp and bones over the temporal and parietal areas of the cranial vault bilaterally. Early amnion rupture seems to be the most probable cause of this rare combination of anomalies. Because no similar case has been reported in the literature so far, we describe here the clinical and psychosocial history of this unusual patient, who has been able to live the intellectually and socially normal life of a blind child in spite of the major craniofacial deformities. The already completed and possible future therapeutic strategies are discussed.     

Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results

OBJECTIVE: We sought to evaluate the early angiographic and clinical outcomes of the first session of endovascular coil occlusion of a large number of patients with intracranial aneurysms treated by five neurointerventionalists during a decade at a single center. METHODS: We performed retrospective analyses of pre- and postprocedural angiographic studies and early clinical outcomes. Enrolled patients underwent endovascular treatment of intracranial aneurysms with detachable coils. RESULTS: A total of 1811 aneurysms in 1579 patients were treated with coil occlusion. Of these, 90 to 100% occlusion of 86.5% of the aneurysms was achieved. In 82.3% of the procedures, no complications occurred. The clinical outcome profile at primary discharge according to the Glasgow Outcome Scale was as follows: Grade V, 74.6%; Grade IV, 6.7%; Grade III, 11.1%; Grade II, 3.1%; and Grade I, 4.5%. In patients with large aneurysms with wide necks, a lower occlusion rate and an increased complication rate were encountered. The use of three-dimensional and fibered coils resulted in higher occlusion rates. Balloon remodeling and stent deployment increased the complication rate. Previous aneurysm rupture, procedural complications, and vasospasm correlated with poor outcome. Of the patients in poor grade after aneurysm rupture, 42% recovered to Glasgow Outcome Scale Grade IV or V, as opposed to 90% of patients who were treated for unruptured aneurysms. The ischemic complication rate was 9%, and the hemorrhagic complication rate was 3%. The early procedural morbidity rate was 5.3%, and the procedural mortality rate was 1.5%. The management mortality rate was 4.4%. CONCLUSION: These data confirm the safety and efficacy of endovascular coil occlusion for patients with intracranial aneurysms.     

Micronutrients and the risk of type 1 diabetes: vitamin D, vitamin E, and nicotinamide

Evidence from animal experiments and human observational studies suggests that some dietary micronutrients may protect against the development of type 1 diabetes. The most promising data so far have been obtained for a beneficial role of vitamin D. Beneficial effects of vitamin E (or other antioxidants) in diabetes development remain hypothetical. Despite plausible theoretical background evidence from animal experiments and supportive data from pilot studies, randomized, controlled trials using nicotinamide have not provided any evidence for a beneficial effect.     

Diode laser thermal keratoplasty to correct hyperopia

PURPOSE: We investigated long-term efficacy, predictability, stability, and safety of diode laser thermal keratoplasty (DTK) to correct hyperopia. METHODS: DTK was performed on 24 eyes (18 patients). Eight eyes with high hyperopia (mean +4.75 +/- 0.63 D; range +3.50 to +5.50 D) received 12 pairs of coagulation spots at 6-mm and 7-mm treatment zone diameters; eight eyes with low hyperopia (mean +2.25 +/- 0.40 D; range +1.50 to +2.75 D) received eight coagulation spots at 8 mm, and eight eyes with low hyperopia (mean +1.50 +/- 0.46 D; range +1.25 to +2.25 D) were treated to induce mild myopia (-1.50 D) in the non-dominant eye for monovision using eight pairs of spots at 7 and 8-mm diameters. Minimum follow-up was 18 months. RESULTS: Mean decrease in cycloplegic refraction at 18 months was 5.00 +/- 0.38 D in the high hyperopia group, 1.75 +/- 0.19 D in the low hyperopia group, and 3.25 +/- 0.27 D in the presbyopia group. Mean increase in uncorrected visual acuity (UCVA) at 18 months was 8.125 +/- 2.1 Snellen lines in the high hyperopia group, 6.625 +/- 0.744 lines for low hyperopia; decrease of 1.00 +/- 1.85 line occurred in the presbyopia group. Near UCVA in the presbyopia group improved by 3.875 +/- 0.83 Jaeger lines. Best spectacle-corrected visual acuity (BSCVA) was restored by 3 months in all eyes. CONCLUSION: DTK was an effective and fairly safe procedure, with reasonable predictability and stability. Nomograms for laser energy level, treatment zone diameter, and number of spots need improvement.     

Familial risk in testicular cancer as a clue to a heritable and environmental aetiology

We used the nation-wide Swedish Family-Cancer Database to examine the risk for testicular cancer in offspring through parental and sibling probands. Among 0-68-year-old offspring, 4082 patients had testicular cancer in years 1961-2000, among whom 68 (1.67%) had an affected father/brother. Standardized incidence ratios (SIRs) for familial risk were four-fold when a father and nine-fold when a brother had testicular cancer. Histology-specific risks (for the testicular cancer) were similar for sons of affected fathers, but were higher among brothers for teratoma and seminoma than for mixed histologies. Standardized incidence ratios for either histology depended on the age difference between the brothers: 10.81 when the age difference was less than 5 years compared to 6.69 for a larger age difference. Parental colorectal, pancreatic, lung and breast cancer and non-Hodgkin's lymphoma and Hodgkin's disease were associated with seminoma among sons. Seminoma risk was also increased when a sibling had melanoma. Teratoma was associated with parental lung cancer and melanoma. The high familial risk may be the product of shared childhood environment and heritable causes. Familial cases of fraternal pairs with an early-onset teratoma represent a challenge for gene identification.     

Familial aggregation of Hodgkin lymphoma and related tumors

BACKGROUND: The importance of genetic factors in the etiology of Hodgkin lymphoma (HL) has been suggested by family and population studies. However, the spectrum of malignancies associated with common genetic etiology and the effects of gender and age on familial risk have not been established. METHODS: Diagnoses of lymphoproliferative malignancies were compared in 15,799 first-degree relatives of 5047 patients with HL versus 32,117 first-degree relatives of 10,078 control probands from Sweden and in 7185 first-degree relatives of 2429 patients with HL versus 27,434 first-degree relatives of 8,495 control probands from Denmark using marginal survival models. RESULTS: The risk of HL in relatives of patients with HL was increased significantly in both populations, with relative risks of 3.47 (95% confidence interval [95% CI], 1.77-6.80) in Sweden and 2.55 (95% CI, 1.01-6.45) in Denmark and a pooled estimate of 3.11 (95%CI, 1.82-5.29). In Sweden, risks for relatives of patients also were increased significantly for chronic lymphocytic leukemia and non-Hodgkin lymphoma (in males). Relative risks were higher in males compared with females and in siblings of patients compared with parents and offspring of patients. Relatives of patients with earlier-onset disease were at higher risk for HL. CONCLUSIONS: HL has an important familial component, which is stronger in families of affected individuals age < 40 years, in males, and in siblings, and it is shared with some (but not other) lymphoproliferative malignancies. The cumulative lifetime risks are very small, however, for the development of HL de novo or in first-degree relatives of affected patients.