Ecosystem objectives to support the UK vision for the marine environment.

European Maritime States already have commitments to protect species and habitats and maintain quality standards in coastal and offshore waters. These are a direct response to environmental legislation in Europe and commitments made to biodiversity conservation in OSPAR and at the World Summit on Sustainable Development. An integrated approach to management requires that these are consistent with the requirements for sustainable development, and include wider social considerations and active stakeholder participation. This review describes a hierarchical framework that incorporates the marine objectives and delivery statements of ecological, social and economic sectors. The framework leads from the UK's guiding principles for sustainable development, through visionary statements and strategic goals for high level delivery, to operational objectives and statements of action which deliver management. Parts of this hierarchy can already be populated for the UK, especially those at the higher levels. At the operational level, however, there is less clarity. The review shows that, despite some gaps, existing commitments for ecological components of the ecosystem are transparent and generally conform to this framework, due largely to high profile government funding of environmental protection and science and a single national vision for the marine environment. Specific objectives for six components of the ecosystem were developed; benthic habitats, seabirds and mammals, phytoplankton and zooplankton, fish, and physical/chemical quality of the water and atmosphere. The objectives included some that avoided limits and others that aimed to achieve targets, and for management to be effective it will be important to have a common understanding of how these can together be interpreted and made operational. In a review of 13 social and economic sectors, few provided a clear breakdown of objectives leading from a high level vision or a sustainable development principle. Six sectors did not have high level government targets for production or other measures of sectoral performance. Such commercial operations generally determine their own operational delivery targets based on market forces. Recent proposals in Europe to create an integrated framework for social, economic and environmental activities will need to carefully balance the development of a strong and competitive marine economy with existing international obligations to environmental protection.

El deseo de embarazo, una variable a indagar en las adolescentes / Wished pregnancy: a variable for to investigate in adolescents

Objetivos: Avanzar en el conocimiento respecto del deseo de embarazo en las adolescentes, y las relaciones que guardan con las conductas reproductivas, con las representaciones de género y con diversas variables psicosociales. Material y método: Se entrevistaron 100 pacientes, en forma no aleatoria, de la Sección Adolescencia, Hospital B. Rivadavia, que hubieran iniciado relaciones sexuales, 50 por ciento de las cuales habían estado alguna vez embarazadas. Se recogió información a través de dos procedimientos: una modalidad cuantitativa, por medio de una encuesta y otra cualitativa basada en entrevistas semidirigidas. Los datos fueron procesados con el S.P.S.S. resultados: 42 por ciento del total de las pacientes encuestadas manifestaron haber deseado un embarazo en algún momento de sus vidas. 6 por ciento consultaba porque buscaba un embarazo en el momento de la encuesta. Ante la pregunta de cuándo se había manifestado ese deseo 30 por ciento dijo desearlo en la actualidad, 22 por ciento en los últimos 12 meses, y la mitad en años anteriores. El deseo se manifestó en mayor proporción entre quienes habían abandonado sus estudios secundarios o sólo tenían nivel primario: 85 por ciento de las pacientes que estaban estudiando no deseaban quedar embarazadas. Respecto del uso de métodos anticonceptivos, 55 por ciento de las jóvenes que manifestaron no tener deseo de embarzo no utilizaban ninguno. De las pacientes que estuvieron embarazadas, 42 por ciento no refirió deseo de embarazo mientras que 58 por ciento sí lo deseó; 25 por ciento lo deseó en el último año, y 18 por ciento lo deseaba en ese momento. 35 por ciento de estos embarazos deseados fueron buscados y 52 por ciento no buscó el embarazo pero tampoco usó ningún método anticonceptivo. Conclusiones: Los datos obtenidos apoyan nuestra hipótesis acreca de la importancia de indagar en la consulta clínica sobre el deseo de embarazo- manifiesto o no- para crear así adecuadas estrategias asistenciales. Reafirmamos entonces que el deseo de embarazo, juntamente con otras variables, estaría sustentando ciertas conductas reproductivas

Subclinical rhythmic EEG discharge of adults: SREDA in two children.

Subclinical rhythmic electroencephalogram (EEG) discharge is an uncommon rhythmic EEG pattern that has been reported to occur in adults. It is thought to be a nonspecific finding with little clinical significance. This article reports this EEG pattern in two children and suggests it be called subclinical rhythmic EEG discharge of adults and children.

Correlación entre conocimientos y uso de métodos anticonceptivos en adolescentes / Correlation between knowledge and use of contraceptive methods in adolescents

A partir de la observación clínica de la discordancia entre conocimiento y uso de métodos anticonceptivos, hemos evaluado con diferencia de una década distintos parámetros relacionados a este tema. La implementación de métodos anticonceptivos no se logra solamente dando información y proveyendo anticonceptivos. Se deberá brindar una correcta educación sobre sexualidad teniendo en cuenta la conflictiva propia de la esta edad que surge de la asincronía madurativa bio-psico-social. Existen ciertas dificultades frecuentes de observar: * Distorción de la información. * Mensajes contradictorios del mundo adulto. * Mito de ser esteril o actitud omnipotente que la lleva a pensar "que ella no se va a embarazar". * Dificultad propia del adolescente para asumir la responsabilidad que significa aceptar y usar un método anticonceptivo. * Dificultad del médico en el manejo de la anticoncepción relacionadas con sus propios prejuicios y ansiedades sobre el tema. Nuestras observaciones apuntan a que: 1- La edad de inicio de relaciones sexuales se mantuvo en la misma edad promedio. 2- Existe actualmente un mayor conocimiento de los distintos métodos anticonceptivos no obstante lo cual la utilización de ellos sigue siendo igual que hace diez años, ratificando el concepto que "el conocimiento de un método anticonceptivo no implica capacidad de utilización"

A study and review of developmental dysgraphia in relation to acquired dysgraphia.

A survey of developmental dysgraphia in a population of 259 normal 13- and 14-year-old schoolchildren has been carried out. The neurological characteristics of handwriting impairments in the 25 children with the poorest handwriting skills are described. These data form the basis of a clinical classification of developmental dysgraphia. A group of simple clinical tests of handwriting and associated functions are offered for routine use. Because they are based on neurological principles relating to acquired dysgraphia, the classification and testing format may be used for correlation with neuro-imaging in research studies. More importantly, they may also facilitate both counselling and remediation for a particular child. The test battery could be modified for use in epidemiological surveys of neurodevelopmental disorders.

Distinctive MRI findings in a case of neurocysticercosis.

OBJECTIVE: To report a case of cerebral neurocysticercosis, in which cranial magnetic resonance imaging (MRI) was performed at the time of probable death of the cysticercus. CLINICAL FEATURES: A 15-year-old Indian boy with a focal seizure disorder presented with a low-grade fever and an increase in seizure frequency. Cranial MRI scanning demonstrated a small, cortically based nodule surrounded by a low-intensity ring and extensive oedema. INTERVENTION AND OUTCOME: Carbamazepine therapy was continued (without steroids) and a further MRI scan after one month showed resolution of the oedema, and a subsequent cranial CT scan showed calcification of the cortically based nodule. Praziquantel therapy was administered. CONCLUSIONS: Diagnosis of neurocysticercosis must often rely upon clinical and distinctive radiological findings. Death of the cysticercus may provoke an inflammatory reaction that may result in an increase in seizure frequency.

Cavum septum pellucidum and obstructive hydrocephalus.

Five patients presented with symptoms related directly to pressure effects from their cavum septum pellucidum with persistent or intermittent obstructive hydrocephalus. The most characteristic presenting symptoms were intermittent postural headache and postural loss of consciousness. If cysts of the cavum septum pellucidum are symptomatic and stereotactic cyst puncture or fenestration are ineffective, ventriculoperitoneal shunting should be carried out before resorting to more radical excision of the cyst.

The clinical significance of type 1 fiber predominance.

In the course of investigating children with hypotonia, muscle biopsy of the vastus lateralis frequently demonstrates greater than 55% predominance of the aerobic type 1 fibers of "type 1 fiber predominance" (T1FP). The clinical significance of T1FP is not well known. T1FP can be associated with a variety of neurological disorders but a significant proportion has no apparent cause. We followed up 23 children with T1FP to establish whether a neurological disorder subsequently became apparent or whether a distinct clinical entity of T1FP could be identified. Sixty percent of the children were found to have a specific neurological disorder, while 40% did not and may represent a distinct clinical entity. The majority of children with the clinical entity of T1FP improved although some were left with mild motor disability. Such information is important for counseling when patients with T1FP are first assessed.

Familial cyanotic breath-holding spells.

Breath-holding spells can be a source of considerable parental anxiety and are a frequent cause of referral to paediatric services. This report is of a family of seven siblings all of whom have suffered breath-holding spells, including three who developed breath-holding spells within the neonatal period, with the other four developing them at 3-4 months of age. All of the children have on occasions exhibited convulsive activity at the termination of the episode. All had normal initial electroencephalogram's (EEG) and one had centrotemporal spikes on his EEG when repeated at age 6 years. Anticonvulsant therapy resulted in a reduced frequency of breath-holding spells. The epidemiology, pathophysiology and therapy of breath-holding spells is discussed with reference to this unique family. This report gives further credence to the notion that there often may be a familial predisposition to breath-holding spells.

Enigmatic trigeminal sensory neuropathy diagnosed by facial skin biopsy.

Facial paraesthesia due to perineural malignant infiltration is a well recognised complication of basal and squamous cell carcinomas of the head and neck. Perineural involvement was originally attributed to involvement of the perineural lymphatics; however subsequent studies have demonstrated conclusively that these lymphatics do not exist and that the invasion occurs along the line of least resistance. Previous studies on perineural spread of carcinomas of the head and neck have emphasised diagnostic biopsy of an involved nerve (e.g. the infraorbital, mental or major branches of the trigeminal nerve), or at times craniectomy with exploration of the gasserian ganglion. We suggest that in many cases the diagnosis can be obtained by biopsy of the anaesthetic skin alone, without recourse to more involved biopsy techniques. The following case report illustrates this point.

Benign vascular sexual headache and exertional headache: interrelationships and long term prognosis.

There is a definite relationship between the vascular type of benign sexual headache and benign exertional headache. Forty five patients with benign vascular sexual headache were reviewed. Twenty seven (60%) experienced benign vascular sexual headache alone and eighteen (40%) had experienced both benign vascular sexual headache and benign exertional headache on at least one occasion. The mean age was 34.3 years with a male:female ratio of 5.4:1. Thirty patients with a history of benign vascular sexual headache were followed for an average of 74 months. A personal history of migraine was found in 47% of cases and a family history of migraine in 30%. Forty one per cent of patients with benign vascular sexual headache alone had recurrences after diagnosis, and stress and fatigue were considered major contributing factors to the initial and recurrent headache. Nine patients had experienced benign vascular sexual headache and benign exertional headache within 72 hours of each other on at least one occasion, often with a residual headache between the two. Four patients experienced their benign vascular sexual headache and benign exertional headache separated by months to years. The prognosis of benign vascular sexual headache and the clinical and possible pathophysiological relationships between benign vascular sexual headache and benign exertional headache are discussed. Knowledge of the interrelationships of these varieties of headache is valuable in the counselling of patients.