Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus

Radiographs and clinical records of 61 patients with calcaneal fractures were studied. Twenty-one patients had diabetes mellitus, and 40 were nondiabetic. All diabetic patients were insulin dependent for more than 5 years and had clinically evident peripheral neuropathy. Eighteen of the diabetic patients had no history of significant trauma. Fourteen had calcaneal insufficiency avulsion (CIA) fractures limited to the posterior third of the calcaneus. The fracture pattern in this group occurred in the same plane as a fatigue-type calcaneal fracture. Fragments of the posterior tuberosity were usually displaced 10-30 mm and were frequently rotated. The mean time from diagnosis of diabetes mellitus to CIA fracture was 20 years. Fractures in the nondiabetic group and in the three diabetic patients with a history of trauma did not resemble the CIA pattern. In the nondiabetic group, there were no insufficiency fractures; 39 fractures occurred with significant force (eg, motor vehicle accident or fall from height), and 33 had extension to subtalar or calcaneocuboid joints.     

Dopamine D1 autoreceptor function: possible expression in developing rat prefrontal cortex and striatum.

Synthesis-modulating dopamine (DA) autoreceptor function was studied in vivo using gamma-butyrolactone (GBL) to block propagation along DA axons. DA synthesis was measured by the accumulation of L-3,4-dihydroxyphenylalanine (L-DOPA) after inhibition of aromatic L-amino acid decarboxylase. GBL treatment markedly increased DOPA accumulation in both the striatum and prefrontal cortex of developing rats. The selective DA partial D1 agonist SKF-38393 inhibited this GBL-induced rise in DA synthesis in both the striatum and prefrontal cortex of 15- and 22-day-old rats, but not in adults. The effects of SKF-38393 in developing rats were mimicked by the non-catechol D1 partial agonist CY-208-243, and were blocked by the D1 antagonist SCH-23390, suggesting receptor mediation. The mixed D2/D3 agonist quinpirole attenuated DA synthesis in striatum of both two-week-old and adult rats, but failed to inhibit the GBL-induced increase in DA synthesis in the developing prefrontal cortex. These findings suggest that synthesis-modulating D1-like receptor function may emerge transiently in the developing mammalian forebrain. In the adult striatum these functions appear to be subsumed by D2-like receptors, whereas all synthesis-modulating DA receptor function in prefrontal cortex appears to be essentially lost with maturation.     

What do health visitors contribute to the care of children? A study in the north of England.

All the health visitors in the north of England, and more than half the general practitioners, were sent questionnaires about the primary health care of children. More than 90% of the health visitors responded. Most of them took part in developmental screening and considered it primarily their responsibility; some conducted developmental or well baby clinics with no other professionals present. Clinics run by health authorities often occupied several hours per week, and were more frequently attended by health visitors than clinics run by general practitioners. Almost all the health visitors' remaining time was spent in attached practices, despite the fact that more than half said they had neither office nor clinic space of their own on practice premises. A high proportion of time was spent on clerical work; more help with this could free the health visitor to provide better developmental care for all children.     

Transmissible mink encephalopathy.

Transmissible mink encephalopathy (TME) is a rare disease of ranch-raised mink caused by exposure to an as yet unidentified contaminated food ingredient in the ration. The clinical and pathological similarities between TME and scrapie, together with the indistinguishable physicochemical characteristics of their transmissible agents, suggest that sheep may be the source of infection. However, experimental testing of oral susceptibility of mink to several different sources of sheep scrapie have been unsuccessful. These results indicate that either the feeding of scrapie-infected sheep tissues to mink is not the cause of TME, or that there exists a strain of sheep scrapie having high mink pathogenicity that remains unknown. Additional sources of sheep scrapie need to be tested in mink, and epidemiological investigations of new incidents of TME need to emphasise obtaining a thorough history of past feeding practices.     

Acquired Loss of Red-Cell Wj Antigen in a Patient with Hodgkin''s Disease

A patient with Hodgkin's disease became temporarily Wj-negative with alloanti-Wj in his serum. Four human autoantibodies, and 1 of 2 murine monoclonal antibodies, with serological characteristics of anti-Wj were nonreactive with his red cells, confirming that they have anti-Wj specificity. Six siblings of the patient are all Wj-positive. The patient was also temporarily Anton-negative, and cross-testing between Wj and Anton red cells and antisera showed mutual compatibility, indicating that the antigens are the same. The patient and 3 of his 6 siblings are also of the rare Lu: - 13 phenotype, providing the first evidence that this is an inherited characteristic.     

‘How Do You Remember You Ate…?’: A Delphi Technique Study to Identify Retrieval Categories From Fourth-Grade Children

Objective To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch.Design A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students’ self-reported lunch intake with observation.Statistical analyses For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category.Results After round 3, we found that 23 “near-consensus”categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used “taste/smell/texture”and “visual”in deference to “order items consumed”and “oral cue still present.”Applications These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet. J Am Diet Assoc. 1997;97:31–36.