Persons with developmental disabilities exposed to interpersonal violence and crime: strategies and guidance for assessment

PURPOSE: Persons with developmental disabilities are frequently exposed to interpersonal violence and crime, directed at themselves and others, and are in need of specific interventions tailored to their unique needs. CONCLUSIONS: What may be different in comparison to other survivors are the:ways therapeutic interventions are adapted so that fears and ongoing concerns can be effectively expressed and addressed. PRACTICE IMPLICATIONS: Persons with developmental disabilities may benefit from a variety of interventions in the treatment of intrapsychic trauma after exposure to interpersonal violence and crime.     

Trauma exposure and the drug endangered child

This study examines the differences in trauma exposure and the response to those events between drug endangered children (DEC) and non-drug endangered children involved in the child welfare system. This data represents the experiences of 1,127 children randomly selected from the state's child protective service database and represents 20% of all open cases during 2005-2006. Archival data were analyzed to determine the presence of exposure using DSM-IV-TR posttraumatic stress disorder (PTSD) Criterion A1, and whether or not the child's response to exposure met PTSD Criterion A2. Results reveal high rates of trauma exposure in the DEC group and indicate that trauma exposure and trauma response did significantly vary across groups. Implications for the assessment and treatment of child welfare-involved children are drawn.     

PHARMAC funding of 9-week concurrent trastuzumab (Herceptin) for HER2-positive early breast cancer

A 9-week regimen of trastuzumab (Herceptin) given concurrently with a taxane will be funded for HER2-positive early breast cancer patients in New Zealand. The use of trastuzumab in this population has been investigated in sequential (after chemotherapy) or concurrent (with taxane chemotherapy) settings. Five RCTs have been reported--HERA, NSABP B31, NCCTG N9831, BCIRG 006, and FinHer. Uncertainty persists about optimal regimen duration, dose and sequencing, how to minimise cardiotoxicity, and long-term clinical outcomes. The evidence for the 9-week concurrent regimen was sufficient to justify funding. This regimen has shown results comparable to longer duration treatments; allows more patients to be treated; is relatively cost-effective; and DHBs have indicated they can provide sufficient ancillary support services. Longer duration regimens remain unfunded because of uncertainty surrounding long term clinical benefits and risks; the high cost; effects on DHB services; and their consequential unfavourable relative cost effectiveness. New data--from the sequential treatment arm of trial N9831, showing benefits that were small and statistically non-significant, and the HERA 23-month follow-up, suggesting a waning in efficacy with time--have since cast further doubt on the extent and durability of the sequential 12-month regimen's efficacy. DHBs and PHARMAC remain open to funding longer duration regimens if cost effectiveness improves significantly and budget/resource implications become acceptable. PHARMAC has committed to international efforts (the SOLD trial) to resolve questions of optimal treatment duration.     

Antispasm therapy using combination of midazolam and propofol for severe tetanus]

A 68-year-old healthy woman without any evidence of recent wound, developed nuchal pain, difficulty in swallowing and trisumus in 10 days. Because of respiratory failure due to generalized muscle spasm, she was intubated and required mechanical ventilation. Midazolam was administered as an antispastic therapy followed by human tetanus immune globulin and tetanus toxoid. Propofol was added on 9 days after intubation, since muscle spasm such as opisthotonus or respiratory spasm did not improve under midazolam and intermittent administration of vecuronium. Thereafter, her muscle spasm and hypertensive response were well controlled. The authors suggested that a combined use of midazolam and propofol was an optional antispastic therapy in patients with severe tetanus.     

Isolation, structure, and synthesis of novel 4-quinolinone alkaloids from Esenbeckia leiocarpa

Two new biocidal quinolinone alkaloids, 3-methoxy-1-methyl-2-propyl-4-quinolone [1] and 2(1'-ethylpropyl)-1-methyl-4-quinolone [2], were efficiently isolated using reversed-phase recycling hplc from the leaves of Esenbeckia leiocarpa. The structures were determined through spectroscopic data and confirmed by total synthesis. These alkaloids have antifeedant activities against the pink bollworm, Pectinophora gossypiella.     

Pineoblastoma showing unusual ventricular extension in a young adult--case report.

A 19-year-old male presented with a 4-week history of headache. Neurological examination showed bilateral papilledema. Computed tomography revealed a pineal region mass with remarkable obstructive hydrocephalus. Magnetic resonance imaging showed a pineal region tumor continuously invading through the tectum into the cerebral aqueduct and the fourth ventricle with the preservation of the adjacent structures. The tumor appeared an iso- to hypointense mass on T1-weighted images, a heterogeneous iso- to hyperintense mass on T2-weighted images, and a heterogeneously enhanced mass after administration of contrast medium. Histological examination after endoscopic biopsy confirmed that the tumor was a pineoblastoma. Radiotherapy was given to the whole brain and the spinal cord, and magnetic resonance imaging showed complete remission of the tumor. Pineoblastomas are highly malignant tumors with seeding potential through the neighboring ventricle or along the meninges, and this type of tumor becomes larger with local extension. We found no previous reports of the continuous extension into the fourth ventricle. The present case showed ventricular extension with minimal mass effect to adjacent structures, and did not disturb ventricular configuration. According to the unusual finding of ventricular extension, this rare case of pineoblastoma requires adjuvant chemotherapy.