A Case of Loose Anagen Syndrome in an African American Girl

We present the case of 7‐year‐old African American girl with loose anagen syndrome. Although this is a common cause of hair loss in Caucasian children, and there have been reports of cases occurring in dark‐skinned children of North African and Middle Eastern descent, to our knowledge there have been no cases reported in black children of sub‐Saharan African ancestry. We present this case to broaden the differential diagnosis of hair loss in African Americans.     

Localized osteolysis in stable, non-septic total hip replacement

We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.     

Mode of onset of simple phobia subtypes: further evidence of heterogeneity

Previous research has demonstrated heterogeneity of the simple phobia diagnostic category. As a further test of the notion of heterogeneity of the DSM-III-R simple phobia diagnostic category, mode of onset was examined in a sample of simple phobic outpatients. Patients were separated into one of four subtypes: animal or insect, blood and injury, situational, and choking-vomit phobias. Careful study yielded five distinct mode-of-onset categories. Two researchers independently determined the mode of onset for the patients studied: direct trauma, spontaneous, vicarious learning, gradual, and lifelong. Significant mode of onset differences were observed across groups. Situational phobics reported a preponderance of spontaneous onsets as compared to the other groups studied. These results offer further evidence of the heterogeneity of the simple phobia diagnostic category and also support the contention that situational simple phobias are closely related to agoraphobia.     

Outcome measurement in the correction of mandibular asymmetry.

This study related clinical assessments of the severity of mandibular asymmetry with computerized measurements, obtained by digitizing mandibular outlines from standardized facial photographs. Four ratios were calculated: area (size), compactness (shape), perimeter (length of outline), and moment (center of area). When comparing clinical severity with computer assessment, significant correlations were observed; those for area and compactness were the highest. Sixteen patients subsequently underwent corrective surgery, and their ratios were used to relate the degree of improvement to the original severity of the asymmetry. The posttreatment ratios were also used to audit the outcome, comparing the patients' scores as a group with results previously obtained from patients with normal symmetry and mild asymmetry. Posttreatment outcomes were significantly different from the normal outline group but were comparable with outcomes of patients with mild mandibular asymmetry. The system provided a sensitive, noninvasive method of assessing treatment change and could be useful in providing an objective means of quantifying treatment outcomes.     

Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program Substudy.

OBJECTIVES: The purpose of this study was to determine quality of life (QOL) and exercise performance (EP) in patients with persistent atrial fibrillation (AF) converted to sinus rhythm (SR) compared with those remaining in or reverting to AF. BACKGROUND: Restoration of SR in patients with AF improving QOL and EP remains controversial. METHODS: Patients with persistent AF were randomized double-blind to amiodarone, sotalol, or placebo. Those not achieving SR at day 28 were cardioverted and classified into SR or AF groups at 8 weeks (n = 624) and 1 year (n = 556). The QOL (SF-36), symptom checklist (SCL), specific activity scale (SAS), AF severity scale (AFSS), and EP were assessed. RESULTS: Favorable changes were seen in SR patients at 8 weeks in physical functioning (p < 0.001), physical role limitations (p = 0.03), general health (p = 0.002), and vitality (p < 0.001), and at 1 year in general health (p = 0.007) and social functioning (p = 0.02). Changes in the scores for SCL severity (p = 0.01), functional capacity (p = 0.003), and AFSS symptom burden (p < 0.001) at 8 weeks and in SCL severity (p < 0.01) and AF symptom burden (p < 0.001) at 1 year showed significant improvements in SR versus AF. Symptomatic patients were more likely to have improvement. The EP in SR versus AF was greater from baseline to 8 weeks (p = 0.01) and to 1 year (p = 0.02). The EP correlated with physical functioning and functional capacity except in the AF group at 1 year. CONCLUSIONS: In patients with persistent AF, restoration and maintenance of SR was associated with improvements in QOL measures and EP. There was a strong correlation between QOL measures and EP.     

Incidence and nature of farm-related injuries among Pennsylvania Amish children: implications for education.

INTRODUCTION: Farming is a dangerous occupation and results in injuries not only to farm workers, but also to families living on farms. Children raised on a farm are at particular risk because the farm is a place where they live, play, and work. Farming is the main Amish occupation, and because Amish farming techniques differ from those used on other us farms, it is important that health care providers recognize the causes of injuries that may occur on Amish farms. However, little is documented about farm-related injuries in Amish children, so we decided to document the incidence and nature of these injuries in Pennsylvania. METHODS: This study was done by reviewing the die botschaft, a weekly newspaper written by the Amish. All references to farm-related injuries among children in Pennsylvania were recorded. RESULTS: During a 5-month period, a total of 89 injuries, including 5 fatalities, were found: male children sustained 64 injuries, and female children sustained 25 injuries. Falls were the most commonly reported mechanism of injury, followed by incidents involving livestock. Both types of events most often resulted in an orthopedic injury. DISCUSSION: Injury to children in the Amish community is a significant problem that needs to be addressed and evaluated by the Amish themselves and in coordination with other health care providers, including emergency nurses. With the information obtained in this study, injury prevention strategies tailored to the Amish way of farming could be developed and implemented.     

Focal glomerulosclerosis in the remnant kidney model--an inflammatory disease mediated by cytokines

BACKGROUND: The mechanism of progression of established renal disease remains unclear. While a low protein diet slows this progression, the role of cytokines in this process has been little investigated. METHODS: We investigated cytokine expression by Northern blot and immunohistochemistry in two groups of 5/6 nephrectomized rats (5/6 Nx) fed a normal (24%) or low (6%) protein diet and compared them with sham operated controls. RESULTS: The rats on 6% protein diet had significantly less focal glomerulosclerosis (FGS) (17.4 +/- 4.4 vs 27.4 +/- 8.8%, P < 0.05) and global sclerosis (GGS) after 7 weeks (0.4 +/- 0.8 vs 3.5 +/- 2.1% of glomeruli P < 0.05). Both experimental groups showed three times control levels of MCP-I expression after 2 weeks. However in the 5/6 Nx 6% protein group the expression decreased at 4 weeks (1.5 times controls) and reached control levels after 7 weeks. In contrast, the 5/6 Nx 24% protein group exhibited a further marked increase after 4 weeks (5.6 times controls) and was still two-fold higher after 7 weeks. TGF-beta expression was modestly but consistently increased at all time points (120-160% of controls), with no difference between the two study groups. Neither IL-1 beta or TNF-alpha was detectable at any time. Immunohistochemistry demonstrated TGF-beta intracellularly in distal tubular cells in both experimental and control animals, while MCP-1 protein was found in the area of FGS and in the apical pole of distal tubular cells in both experimental groups. Glomerular and interstitial ED1 positive cells were significantly increased after four weeks in the 5/6 Nx 24% protein group (P < 0.05). CONCLUSIONS: A 'mechanical' injury to the kidney clearly results in an inflammatory response associated with the upregulation of MCP-1. A low protein diet modulates the expression of MCP-1 and improves the morphological sequelae seen after renal ablation.