Results of prevention programs with adolescents

Programs for preventing smoking and alcohol and drug abuse have radically changed in the past decade. Instead of being regarded as a health or discipline problem that involves only a few deviant adolescents, drug use has begun to be viewed as social behavior that is functional for adolescents, not capricious, and is normative for that population. The most successful prevention programs have sought to delay the onset of tobacco use. Based on theoretical and etiological research, these programs target factors that have repeatedly been predictive of adolescent smoking, alcohol and drug use. The programs teach adolescents (1) why people their age smoke tobacco or use alcohol and drugs; (2) how these meanings get established by peers, older role models and advertising; (3) how to resist these influences to smoke or to use alcohol and drugs; and (4) life skills and competencies to counterbalance the functions that drug use serves. Because of the association with the onset of smoking and the onset of using other drugs, these strategies are being studied for alcohol use and other drugs. In addition, elected peer leaders are trained to conduct these activities with their classmates and act as new role models for non-use. Evaluations of these approaches are optimistic. Studies in northern California and Minnesota reveal 50-70% reductions in the onset of smoking. Botvin's 'Life Skills Training' program demonstrates success in delaying heavy alcohol and marijuana use.     

Extracellular Enzyme Activities by Basidiobolus and Conidiobolus Isolates on Solid Media./Extrazelluläre Enzymaktivitäten bei Basidiobolus- und Condiobolus-Isólaten auf festen Medien

Summary: Fifty-seven isolates of Basidiobolus from reptiles and amphibians, and 7 other obtained from the American Type Culture Collection (ATCC) in Maryland were studied for their extracellular enzyme activities on solid media. The Conidiobolus isolates studied included 4 recovered from Nigerian soil and additional 4 obtained from the ATCC All these isolates produced active extracellular lipase and protease and failed to exhibit amylase, deoxyribonuclease and ribonuclease activities. The significance of the findings is discussed.
Zusammenfassung: Fünfundsiebzig Basidiobolus-Isolate aus Reptilien und Amphibien und sieben weitere aus der American Type Culture Collection (ATCC) in Maryland wurden auf Aktivtäten extrazellulärer Enzyme auf festen Medien untersucht Die untersuchten Conidiobolus-Isolate schlossen vier aus nigerianischen Böden und vier weitere aus der ATCC ein. Alle Isolate zeigten extrazellulär Lipase- und Proteaseaktivität Amylase-, Desoxyribonuclease- und Ribonucleaseaktivität war jedoch nicht nachzuweisen. Die Bedeutung dieser Befunde wird diskutiert.     

Haemoglobin A1 and congenital malformation

Two hundred and thirty pregnancies were studied in 196 diabetic women. Seven women with babies found to have major malformations had a higher median first trimester haemoglobin A1 (12.9%) than the median HbA1 (10.8%) in those with normal babies (p = 0.06). No relationship was found between the occurrence of minor malformations and first trimester maternal haemoglobin A1. Two of the seven congenital malformations were diagnosed antenatally at a time when therapeutic abortion could be offered. Expert antenatal ultrasound scanning should be offered to all pregnant diabetic women as poor glycaemic control at the time of conception and organogenesis, as evidenced by raised first trimester HbA1, predisposes to congenital malformation.     

Prolonged remission of lymphangitis carcinomatosis from breast cancer

Lymphangitis carcinomatosis has a grave prognosis. We report a case from carcinoma of the breast that responded completely and durably to chemotherapy.     

Hirschsprung's disease in young adults

Hirschsprung's disease is rarely seen in the young adult, and presents unique problems in management because of the massive dilatation and hypertrophy that occur proximal to the aganglionic rectum or the rectosigmoid colon. The diagnosis, which may be suspected by barium enema, is confirmed by suction or full-thickness biopsy of the rectum that may be complemented by anal manometry. Based on our experience with eight patients, a two-stage surgical reconstruction is recommended, with a preliminary sigmoid colostomy through the normally innervated colon and an associated defunctionalized stoma constituting the initial operation. The distal colonic stoma permits cleansing of the caudal colon while the normally innervated proximal colon reverts to near normal caliber, usually within 2 to 6 months. This approach is in accord with the recommendation of Fairgrieve. Reconstruction using a Duhamel or Soave procedure has given good results. The Duhamel procedure seems preferable when a considerable discrepancy remains between the ganglionic and aganglionic segments of rectum.