Doppler waveform analysis and percutaneous dilatation of arteries in ischaemia of the lower limb.

Percutaneous transluminal dilatation of narrowed atheromatous arteries using the inflatable Gruntzig catheter is becoming an accepted non-surgical treatment for patients with disabling intermittent claudication of the lower limb. The use of doppler ultrasound to study limb blood flow in a group of patients having aortic or iliac dilatation is described.

The disturbed child. How important is the family?

Family dysfunction is an important determinant of childhood disturbance. Emotional disorders may present overtly or through somatic symptoms and the family doctor must be alert to their relationship to disturbances within the family. Early intervention may avert more serious problems in childhood.

Effect of family break-up and parent divorce on children.

Family break-up is a common experience in childhood today, yet reports of its effects on children vary considerably. Variables to be considered are the age, sex and previous experiences of the child as well as the observer's viewpoint (clinician compared with social scientist): the need for well founded research is obvious. Divorce is a process affecting all family members: parent disharmony and quarrels prior to the divorce appear to be more detrimental to a child's adjustment than the separation itself which may represent a relief of tension. Behaviour and emotional problems following divorce relate to litigation regarding custody and access (accusations of sexual abuse during access are not uncommon), and a diminution of living standards. Feelings of rejection, depression, anger and guilt are frequent in the immediate post-divorce period, but settle during the ensuing year. Family counselling, individual work with children (especially explanations for younger ones) and social support in the post-divorce period are suggested as a means of combating long-term, sometimes lifelong, sequelae.

Grasping the nettle: forensic child psychiatry.

Child psychiatry is becoming increasingly involved with the law. Other professionals have expertise in interpreting children's needs and behaviours to the courts, but child psychiatrists have unique skills and lawyers should be helped to understand what they have to offer. Difficulties in the dialogue between child psychiatry and the law are discussed. Training child psychiatrists to function efficiently in the legal system must be given priority by the newly established Faculty of Child Psychiatry.

The wider spectrum of child abuse.

Child abuse encompasses many facets aside from the acts of physical violence which have generally attracted attention. Sexual misuse of children often goes unrecognized, yet its effect on the mental health of the victim may be considerable; it may or may not be accompanied by violence, and it generally occurs within a setting of serious disturbance in the family. Clinical details of nine sexually abused children are described, and they serve to illustrate how this form of abuse may prevent. The management of these cases is discussed. Sexual abuse of children is a family problem and therefore must be the concern of the family doctor.

Psychiatric sequelae in children treated operatively for hydrocephalus in infancy.

This study reports on the prevalence of psychiatric disorder in 45 children of primary-school age who had been treated operatively for hydrocephalus in infancy. A high rate of disturbance was found; presumably this relates not only to neurological factors but also to the child's reaction to his handicaps and to the attitudes of significant people toward him. The symptomatology was predominantly neurotic, and since emotional disorder can be helped by psychological methods it is argued that early psychiatric intervention could improve the quality of life for these children.

The prevalence of psychiatric disorder in rural school children.

The multidetermined nature of psychiatric disorder in childhood calls for a detailed assessment of the individual and his family, and often a team approach to treatment. Since this involves contact with the family over a period of time the delivery of this type of service to children living in remote areas under conditions of geographical isolation can present considerable difficulty. A survey of 10- and 11-year-old children from the far West of Queensland showed a prevalence rate for psychiatric disorder of 10% among those whose parents were willing to complete a questionnaire and attend the child's school for interview. Although this is lower than rates obtained for children living in towns on the East coast and in the metropolitan Brisbane it still represents a sizeable group of children who require psychiatric help in areas where presently none is available. A method of family assessment and treatment for country children evolved by the psychiatric unit of a metropolitan children's hospital, shows the remoteness of home need not preclude the disturbed child from psychiatric expertise, although facilities must be augmented if children from an often forgotten sector of the Australian population are to be covered adequately.

Radionuclide determined pulmonary blood volume in ischaemic heart disease.

Most measurements of pulmonary blood volume have been based on the Stewart-Hamilton dye dilution principle and have required direct catheterisation of the cardiac chambers. Alternatively a precordial counter may be used to detect the composite right and left heart curves after an intravenous injection of radionuclide. We investigated the use of a gamma camera/computer system to determine the radionuclide dilution curves from individual cardiac chambers. Pulmonary transit time and pulmonary blood volume were measured in nine normal subjects, eight patients with angina pectoris but without heart failure, and 13 patients with ischaemic heart disease and left ventricular failure. Patients with heart failure had significantly greater (p less than 0.001) pulmonary blood volumes and pulmonary transit times than normal subjects or patients without heart failure. Reproducibility measurements of pulmonary blood volume, determined in 12 subjects, gave a coefficient of variation of 2.6%. The effect of posture on pulmonary blood volume was determined in six subjects lying supine and tilted at a 45 degree angle. A reduction in pulmonary blood volume in the tilted position was observed in each subject (p less than 0.005). This simple non-invasive measurement should allow more detailed assessment of physiological or pharmacological changes of the pulmonary vascular bed.

Computerized drug-use evaluation.

A drug-use evaluation (DUE) of angiotensin-converting-enzyme (ACE) inhibitors by both manual and computerized methods was conducted. Criteria for the use of ACE inhibitors were developed and approved. Fifty patients were randomly selected from 225 clinic outpatients who had begun taking an ACE inhibitor during a six-month period. The clinic medical records of each of the patients were reviewed by a pharmacist to determine compliance with the DUE criteria. At the same time, a computer program queried the computerized medical records of the same patients to evaluate adherence to the criteria. The manual method showed that ACE inhibitor therapy met threshold for two of the six criteria before exceptions were considered and for three criteria after exceptions were considered. Results for only two criteria met threshold when evaluated by the computer; the computer did not consider exceptions. There was good or excellent percent agreement between the manual and computerized methods for four of the six criteria. Kappa values showed that the agreement for five criteria was significant. A computerized method of evaluating drug use performed similarly to manual evaluation, but agreement was best for simply stated criteria.

Complete pre-operative imaging assessment of abdominal aortic aneurysm with spiral CT angiography.

PURPOSE: A prospective evaluation of spiral CT angiography (SCTA) as the sole pre-operative imaging modality for abdominal aortic aneurysm repair. MATERIALS AND METHODS: Spiral CT angiography was compared with conventional transfemoral angiography in 30 patients and results correlated with surgical findings in 22 patients. The following features were assessed: renal artery number and disease; upper and lower aneurysm extent; aneurysm size; perianeurysmal inflammation; iliac artery disease; radiation dose; and contrast usage. RESULTS: Spiral CT angiography agreed with conventional angiography in all cases of severe stenosis or occlusion of renal arteries and had 90% agreement overall for renal artery disease. Two of nine accessory renal arteries seen at conventional angiography were missed. For showing aneurysm extent SCTA was 100% sensitive, and performed better than conventional angiography. Aneurysm size was better shown with SCTA. In iliac disease SCTA, as performed in this study, was poor for mild-moderate disease, but detected four of six severely stenosed/occluded iliac arteries seen at conventional angiography. Prospective sensitivity for perianeurysmal inflammation was 33%. Radiation dose for SCTA was approximately twice and contrast dose approximately three times that for conventional angiography. CONCLUSION: Spiral CT angiography can provide all the necessary imaging information to plan aneurysm repair in the non-claudicant.