Comparing the validity of clinician-generated diagnosis of conduct disorder to the diagnostic interview schedule for children.

Clinician diagnoses of conduct disorder (CD) were compared to the diagnoses of CD generated by a structured interview against an observed criterion. Participants were 534 youth from a large residential program in the Midwest for delinquent youth. Rates of in-program CD behaviors were gathered from staff observations of the youth over a 9-month time period. Youth diagnosed with CD by the Diagnostic Interview Schedule for Children (DISC) displayed significantly more CD behaviors in the first 6 months of treatment compared to both youth without an externalizing disorder and youth diagnosed with CD by a clinician. Youth diagnosed with CD by a clinician had rates of CD identical to youth without an externalizing disorder. Clinicians may have weighted contextual information more heavily, as this group was significantly more likely to have an arrest record. Results support the use of structured interviews and provide evidence that typical clinician diagnoses may lack adequate validity.     

On the mechanism of kidney stone disintegration by acoustic shock waves

In the present study we have, by theoretical and experimental investigations, especially concentrated on the importance of acoustic streaming, transient cavitation and microstreaming in the fluid close to the stone. Artificial stones, round stones 20 mm in diameter made of Plaster of Paris or rectangular flat stones, 25 x 25 x 15 mm, were suspended in a water bath at the focus of an EDAP LT01 lithotripter. "Unprotected" stones were disintegrated while stones surrounded by a layer of silicone showed no or very small disintegration. For successful destruction of the calculus, it seems to be essential that the stones are surrounded by a liquid, i.e., water.     

Role of extrastimulus site and tachycardia cycle length in inducibility of atrial preexcitation by premature ventricular stimulation during reciprocating tachycardia

Preexcitation of the atria during reciprocating tachycardia (RT) by a premature ventricular complex occurring when the His bundle is refractory provides direct evidence of the presence of accessory atrioventricular (AV) connection. The impact of ventricular stimulation site and RT cycle length on inducibility of atrial preexcitation was assessed in 38 patients with RT utilizing a single accessory AV connection (right free wall in 5 patients, left free wall in 21 and posterior septal/paraseptal in 12). Extrastimuli were inserted at right ventricular (RV) apical, left ventricular (LV) septal and LV free wall sites. Inducibility of and magnitude of atrial preexcitation increased as stimulation site approached accessory AV connection site. Thus, for RV free wall connections, RV extrastimuli preexcited the atria in 5 of 5 patients, LV septal in 1 of 5 and LV free wall in 0 of 4. For LV free wall accessory connections, RV extrastimuli preexcited the atria in only 3 of 21 patients, compared with 12 of 17 with LV septal and 20 of 21 with LV free wall stimulation. Additionally, the magnitude of atrial preexcitation achieved was related to RT cycle length, diminishing as cycle length shortened. Finally, in a few instances both RV apical and LV free wall extrastimuli failed to elicit preexcitation in patients with a posterior septal connection. Thus, ventricular pacing site and RT cycle length contribute importantly to induction of atrial preexcitation by ventricular extrastimulation technique and should be considered during evaluation of patients with RT in whom accessory AV connections may be present.     

Hand injuries in children

Hand injuries in children are seen frequently in the office and the emergency room. Basic principles determine which fractures, tendon injuries, dislocations, nerve injuries, fingertip injuries, infections, and amputations can be treated by the primary physician and which should be referred to a specialist.     

Corneal foreign bodies of coconut origin.

Corneal foreign bodies of varied nature have been reported, however, vegetable foreign bodies in the cornea have seldom been described. A case is reported of a male from the Marshall Islands in the Pacific who retained a number of deep corneal foreign bodies after being struck in the eye by a piece of a coconut shell. The foreign bodies caused considerable inflammation which ceased after they were exposed and removed by means of a centrally based lamellar corneal flap. The patient's eye has remained quiet for 4 months following removal of the foreign bodies.     

Antibodies against membrane interleukin 1 alpha activate accessory cells to stimulate proliferation of T lymphocytes.

Some monoclonal antibodies (mAbs) against interleukin (IL) 1 alpha have been found to activate antigen-presenting cells (APC, human peripheral blood monocytes and B lymphocytes), so that unstimulated T lymphocytes cultured with them are induced to proliferate and secrete IL-2. Control mAbs of the same isotypes and mAbs against IL-1 beta do not activate APC. In the absence of APC, mAbs against IL-1 alpha do not induce proliferation of T lymphocytes. Mitomycin C-treated activated APC still induce T-cell proliferation. Proliferation of T lymphocytes cannot be induced by culture supernatants and requires contact with APC activated by mAbs against IL-1 alpha. The observations imply that surface membrane IL-1 alpha can function as a triggering molecule on APC, which could play an important role in the initiation of immune responses by T lymphocytes.