[Early childhood intervention - access to risk families and support through actors from the health-care sector]. / Frühe Hilfe für Familien und Frühgeborene - Zugangswege und Unterstützungen aus dem Gesundheitsbereich.

Interdisciplinary cooperation and networking determine the success of activities for supporting families at risk for early childhood abuse. The integration of the healthcare sector might be important.The medical standard of perinatal care at the University hospital includes information exchange about family risk factors which may contribute to an increased risk of child abuse within the first year of life. As a result, the -pediatrician offered supporting services for the families at the time of the second examination during the official childhood health screening program (U2). A team of family-sponsorship was established and evaluated.In 281 of 1238 risk-factor questionnaires at least one stress factor was detected and 97 families had high-impact family stress. Families under the supervision of a family midwife or youth services had a significantly higher number of risk factors. The family-sponsorship program was institutionalized and positively evaluated by the families.The time of a hospital delivery is an excellent opportunity for the evaluation of familial risk factors and for the provision of supporting services. To increase the acceptance of such services by the families at risk repeated assessment of risk factors and support offers are required.

Evaluation of percutaneous penetration of natural rubber latex proteins.

Latex allergy is recognized worldwide as a serious health risk. To date, exposure assessment and intervention strategies have focused primarily on respiratory protection; this work evaluates the potential role of dermal protein penetration in the development of latex allergy. In vitro penetration models using flow-through diffusion cells and both human surgical specimens and hairless guinea pig skin (CrL: IAF/HA) demonstrated iodinated latex proteins (ammoniated and non-ammoniated) penetrating into and through both intact and abraded skin. Although less than 1% penetration was observed with intact skin, up to 23% of latex proteins applied to abraded skin were recovered from receptor fluid within 24 h of exposure. Phosphoimaging of the concentrated effluent revealed proteins ranging in size from 3 to 26 kDa. Using a (3)H(2)O penetration assay to evaluate barrier integrity, the amount of latex protein penetration was found to positively correlate with the degree of dermabrasion. Immunohistochemistry of the skin localized latex proteins in the Langerhans cell-rich epidermis and in the dermis. Both in vitro penetration studies and immunohistochemistry supported the use of hairless guinea pig skin as a surrogate for human skin in evaluating latex protein penetration. In studies performed in vivo, 35% of hairless guinea pigs topically exposed to latex proteins (100 microg) 5 days per week for 3 months demonstrated elevations in latex-specific IgG1. The implication for these data is that the skin is not only a plausible route for latex sensitization but can be a major exposure route when the integument has been compromised.

Is wound infiltration with anesthetic effective as pre-emptive analgesia? A clinical trial in appendectomy patients.

OBJECTIVE: To assess the efficacy of wound infiltration with local anesthetic in reducing postoperative pain after a muscle-splitting incision for appendectomy. DESIGN: A double-blind, placebo-controlled, randomized clinical trial. SETTING: The Royal Columbian Hospital, a university-affiliated community hospital. PARTICIPANTS: Forty-three patients scheduled to undergo emergency appendectomy were randomized into treatment (21) and control (22) groups. Five patients were excluded from the treatment group. INTERVENTIONS: Local anesthetic infiltration of the wound before incision (treatment group) and saline infiltration (control group). MAIN OUTCOME MEASURES: Postoperative analgesic requirements, pain assessment by visual analogue scale and length of hospital stay. RESULTS: No significant difference in analgesic use was seen between the 2 groups, as measured at 3 stages (Mc = control mean [standard deviation], Mt = treatment mean [standard deviation]): (a) in the recovery room, intravenous morphine use was Mt = 6.6 mg [8.6] v. Mc = 10.1 mg [7.2]; (b) in the first 2 postoperative days, intramuscular meperidine use was Mt = 309 mg [181] v. Mc = 278 mg [125] on day 1 and was Mt = 121 mg [132] v. Mc = 97 mg [128] on day 2; (c) in the final 5 days of follow-up, oral analgesic use was Mt = 11 [17] tablets v. Mc = 21 [16] tablets (acetaminophen with codeine). Pain assessments at rest, on a scale of 1 to 10, were found to be no different between groups, ratings being Mt = 4.7 [2.1] v. Mc = 4.5 [2.0] on day 1. Length of hospital stay averaged 3.0 days in both groups. CONCLUSIONS: Infiltration with local anesthetic before incision does not pre-empt postoperative pain from a muscle-splitting incision used for appendectomy.

Putative skin-protective formulations in preventing and/or inhibiting experimentally-produced irritant and allergic contact dermatitis.

The effectiveness of skin protective formulations was evaluated in a previously-described in vivo human model. All formulations failed to inhibit ammonium hydroxide and urea irritation. Only paraffin wax in cetyl alcohol statistically (p<0.01) reduced Rhus allergic contact dermatitis. 3 commercial formulations markedly (p<0.001) suppressed sodium lauryl sulfate irritation. Paraffin wax in cetyl alcohol was quantitatively the most effective formulation. These results suggest that some formulations may provide protective effects against certain, but not all, irritants or allergens.

Evaluating skin-protective materials against contact irritants and allergens. An in vivo screening human model.

2 acute irritants and 1 allergen were selected: sodium lauryl sulfate (SLS) representative of irritant household and occupational contact dermatitis, the combination of ammonium hydroxide (NH4OH) and urea to simulate diaper dermatitis, and Rhus to evaluate the effect of model protective materials. The putative protective materials and vehicle were applied to both ventral forearms of 10 subjects in each group, according to a randomized code. Test materials were spread over a marked 2.0 cm2 area, massaged in, allowed to dry for 30 min, and reapplied with another 30 min drying period. The model irritants and allergen were then applied (0.025 ml) to an Al-test occlusive patch, which in turn was placed for 24 h over each of the 8 designated sites. Inflammation was scored according to a clinical scale 72 h post-application. Paraffin wax plus Acetulan in cetyl alcohol, and beeswax plus Acetulan in cetyl alcohol, markedly (p < 0.001) suppressed SLS irritation. Paraffin wax plus beeswax in cetyl alcohol, and Acetulan in cetyl alcohol reduced NH4OH and urea irritation (p < 0.05), paraffin wax in cetyl alcohol significantly (p < 0.01) decreasing Rhus allergic contact dermatitis. This model, provides an easy approach to screening protectants. Its clinical significance requires comparison with an open rather than an occluded challenge.

Creation of a pedicle valve unit (PVU) for establishment of enteric continence. Experimental observations.

The aim of this study was to develop a natural tissue valve that could be anastomosed into any area of the gastrointestinal (GI) tract to act as a fecal "brake" and so establish enteric continence at that site. A 4-cm-long valve created from an intussuscepted small bowel pedicle was anastomosed into the cecum and brought out through the abdominal wall as a stoma in 11 rabbits. The animals were re-explored five weeks later for assessment of valve viability and continence and microscopic appearance. In all cases, the valve was fully continent in vivo. All valves were viable, and there was no anastomotic leakage. Pressure testing of the valve at reoperation revealed that 7 of 10 valves tested withstood pressures of 30 mmHg before and after catheterization and 6 of 10 were fully continent to cecal "blanching" pressure (50 mmHg). Valve failure was due to deintussusception in three cases. In four cases, valves were continent over 50 mmHg and showed no tendency to incontinence to bursting pressure of the cecum. We conclude that a continent pedicle valve unit (PVU) for placement in a variety of locations in the GI tract is feasible. The PVU has implications in the management of short-gut syndrome, incontinent ileostomy, continent cecostomy, and as a continent valve placed in the perineum for restoration of perineal defecation following proctectomy.

SEM studies on the in vivo uptake of Aspergillus terreus spores by alveolar macrophages.

Pulmonary reactions to fungal spores constitute an important aspect of occupational pneumoconioses. Experimental models using aerosols of Aspergillus terreus spores produce an acute, complement dependent, hypoxic reaction in rabbits. The purpose of this study was to explore the possible role of the alveolar macrophage in initiating this reaction. Rabbits and rats were intratracheally injected with Aspergillus spores and the fate of the spores was studied at various times thereafter by light and scanning electron microscopy complemented by heavy metal staining and backscattered electron imaging. The uptake of spores by macrophages on the surface of the alveoli and airways was extremely rapid and was virtually complete by 3 hrs. Very few polymorphonuclear leukocytes were seen in the lungs of exposed animals. Penetration of the lung epithelium by spores was minimal and was not directly observed. Alveolar clearance followed by mucociliary clearance of the spores was observed in the rats. Failure of the clearance mechanisms at the level of the respiratory bronchiole produced necrotising lesions that contained numerous free spores. This study illustrates the value of heavy metal stains combined with backscattered electron imaging for observing surface and subsurface features in biological tissues.