A case of thoracic aortic dissection presenting as lateral pleuritic chest pain.

An unusual presentation of thoracic aortic dissection in a 73 year old man is described. He was admitted to hospital with severe left sided pleuritic chest pain. Examination on admission was normal apart from minor tenderness on palpation of the left lower chest wall. Chest x ray showed cardiomegaly with right lung shadowing, and ventilation/perfusion scan was negative. Spiral computed tomography done on the fourth day showed a false lumen on the ascending aorta. He underwent surgery but deteriorated postoperatively because of intrathoracic bleeding and developed cardiac tamponade from which resuscitation was not possible.

Syntactic delay and pragmatic deviance in the language of fragile X males.

The expressive language of 19 fragile X [fra(X)] males with chronological ages between 5 and 36 years and Vineland Adaptive Behavior Scores between 21 and 79 was examined for syntactic as well as pragmatic proficiency. The production of deviant repetitive language was observed with this group, corroborating the results of an earlier study with a smaller sample of fra(X) males. In contrast, when 2 syntax scores, mean length of utterance (MLU), and Index of Productive Syntax (IPSyn) were derived from naturalistic language observations, the relation of complexity to length was observed to be very similar to the known relationship of these 2 facets of syntactic ability in normal preschoolers. These results, and the absence of correlations between syntactic scores and proportions of deviant repetitive language are consistent with the notion that the syntactic development of fra(X) males is typically delayed rather than deviant. For effective assessment and remediation of communicative problems associated with the syndrome to be developed, it is argued, language must be considered as a combination of competencies rather than as a unitary skill.

Early syntactic development of dyslexic children.

The syntactic development of preschoolers who later became disabled readers was compared to that of children who were similar to the dyslexics in sex, socioeconomic status, and IQ, but who became normal readers. Expressive and receptive syntactic abilities were examined longitudinally from age 30 to 60 months. The dyslexic group was poorer than the control group on all measures until the age of five, at which time both groups exhibited similar syntactic proficiency. The etiological relation of language development to reading disabilities is discussed.

Continuity between childhood dyslexia and adult reading.

If reading disabilities were the result of developmental lags, disabled readers should catch up to their peers in proficiency at maturity. As a test of this hypothesis, current literacy skills were assessed for adults who did, and did not, have childhood reading disabilities. Contrary to the developmental lag hypothesis, most of the former group remained poor readers in adulthood, in many cases reading more than two standard deviations below levels predicted by IQ. Both within and between groups, very similar relationships were observed between reading level and: word recognition; phonic analysis; prose comprehension; reading speed; spelling ability and error types; and tolerance for visual and semantic text transformations. Other purported characteristics of dyslexia differentiated disabled from normal adult readers with only limited success. The results have implications for theoretical, methodological, and practical issues in the study of dyslexia in childhood as well as adulthood.

Preschool literacy experience and later reading achievement.

During their children's preschool years, parents were asked about the frequencies of adult reading, parent-child reading, and children's solitary book activities in the home. Parental responses were compared for three groups of children defined according to the parents' reading skills and the children's reading achievement in Grade 2. The results indicated that the 22 preschoolers who became poorer readers had less frequent early literacy-related experiences than the 34 children who became better readers.

Very early language deficits in dyslexic children.

At 2 1/2 years of age, children who later developed reading disabilities were deficient in the length, syntactic complexity, and pronunciation accuracy of their spoken language, but not in lexical or speech discrimination skills. As 3-year-olds, these children began to show deficits in receptive vocabulary and object-naming abilities, and as 5-year-olds they exhibited weaknesses in object-naming, phonemic awareness, and letter-sound knowledge that have characterized kindergartners who became poor readers in other studies. These late preschool differences were related to subsequent reading status as well as to prior language skills, but early syntactic proficiency nevertheless accounted for some unique variance in grade 2 achievement when differences at age 5 were statistically controlled. The language deficits of dyslexic children were unrelated to maternal reading ability and were not observed in children from dyslexic families who became normal readers. The implications of the results for etiological issues are discussed.

Development of children with early language delay.

Four children with early language delays (ELD) were compared to a control group of 12 children with respect to their preschool language abilities from age 2 1/2 to 5 years and their verbal skills at the end of Grade 2. The language-delayed children each initially showed severe and broad impairments in syntactic, phonological, and lexical production. Over time, their deficits became milder and more selective, such that normal or nearly normal speech and language proficiency was exhibited by age 60 months. Nevertheless, when followed up 3 years later, three of the four cases were severely reading disabled. These findings are discussed with respect to prior findings and hypotheses about the sequelae of early language delay and the relationship of language development to reading achievement.

Phonological characteristics of words young children try to say.

To examine the possible persistence of phonological selectional constraints on young children's lexical choices, the words attempted in the conversational speech of a longitudinal sample of 12 normally-developing preschoolers from age 2;0 to 5;0 were scored for syllabic length, presence of consonant clusters, and distribution of constituent phonemes. Except at the youngest ages, few developmental changes in target word characteristics were seen, and the observed differences were largely accounted for by syntactic, lexical, and pragmatic factors. The results suggest that selectional constraints persist only briefly in the course of language acquisition.

A reconsideration of the relation between age and mean utterance length.

Although a linear relationship between age and utterance length during the preschool years has been reported, that result was only partially replicated from age 2 to 5 years in two new research samples, one cross-sectional and the other longitudinal in design. Instead, a deceleration in age curves, particularly beyond about 36 months, was observed in each sample. Some explanations and implications of the findings are discussed from normative and developmental viewpoints.

Form and function in early communication: language and pointing gestures.

Pointing gestures of verbally advanced 2-year-olds were contrasted with those of less advanced peers, in order to examine the relationships of gesture to language during the acquisition of each. Hypotheses regarding the replacement of gestural functions by speech as verbal skills improve, regarding developmental correspondences between the two communicative domains, and regarding the independence of language acquisition from nonverbal developments were drawn from evolutionary, structuralist, and nativist viewpoints, respectively. Both formal and functional aspects of each communicative skill were measured, and were shown to be largely unrelated, particularly in the gestural domain. No evidence that language replaced gesture for communication in ontogeny was obtained. Correspondences between gesture and language occurred only between functional aspects of each, and the independence of developing language from gestural advances was suggested by the findings.

The introduction of patient process re-engineering in the Peterborough Hospitals NHS Trust.

Patient process recognition and re-engineering (PPR) has become a major concern of recent health care development and management. This paper discusses the position of the National Health Service (NHS) in the UK; where it is at present and where it aims to be. It suggests that the work of the current government in developing community care is central to the work of both the Leicester Royal Infirmary and the Peterborough Hospitals NHS Trust, when building relationships between primary (community) and secondary (hospital) health care provision. This paper aims to examine whether and how PPR can improve patient processes in the NHS. It does this through a case study of PPR in Peterborough Hospital.

Incidence of uraemia and requirements for maintenance haemodialysis.

The biochemistry laboratory records of a 400-bed general hospital serving a population of about 120,000 showed that during the three-year period 1966-8 inclusive 487 patients had at some stage during their admission a blood urea of 100 mg/100 ml or more. Ninety per cent. were aged 50 or over, 79% were 60 or over, and 52% were 70 or over.The case notes of all patients with renal failure admitted during 1966 and 1967 were examined together with those of patients under 60 admitted during 1968. Three observers agreed about the most likely cause of the renal failure in 90% of patients whose case notes were available, or 74% of the total. The raised blood urea was thought to be due to "prerenal" factors in 60% of the patients, to acute tubular necrosis in 80%, to obstructive uropathy in 12%, and to "intrinsic" renal disease in 20%. Renal failure precipitated by such factors as cardiac failure, chest infections, cerebrovascular accidents, and shock was particularly common in old people.The hospital survey and replies to a questionnaire sent to all general practitioners in the area suggest that in the three-year period 14 patients may have been suitable for treatment by maintenance haemodialysis or renal transplantation. This represents a rate of about 39 per million per year under the age of 60 and 28 per million per year under 50.