Spondylo-epiphyseal dysplasia tarda. The X-linked variety in three brothers.

Three brothers with the X-linked variety of spondylo-epiphyseal dysplasia tarda are presented. Their clinical courses differed: one was relatively free of symptoms, the second had slowly progressive osteoarthritis of the hip, and the third had an acute, disabling arthritis necessitating total hip arthroplasty. The clinical features of this disorder are reviewed.

Treatment of winged scapula by pectoralis major transfer.

We report the transfer of the sternal part of the pectoralis major to the lower pole of the scapula in 15 patients with winged scapula. At follow-up after 1 to 16 years nine had a satisfactory result and were gainfully employed, though in four of these re-operation had been necessary. Two patients had fair results; the transplant functioned, but they had limited voluntary control. Four were failures: two had had paralysis of other shoulder girdle muscles in addition to the serratus anterior. The indications for the operation are discussed.

Managing challenging behaviour in the community: methods and results of interactive staff training.

A necessary condition for a high quality of community care in relation to challenging behaviour is staff training in appropriate methods. This paper describes the application of a practical 'interactive staff training' approach with n = 101 staff, featuring the use of focused and experiential learning in teams. The findings indicated that the course was socially acceptable to the participants, led to a significant improvement in their knowledge of nonphysical methods, and resulted in written guidelines for managing their own clients' challenging behaviour. Furthermore, agreements were clarified on how these guidelines would be implemented by each team following training. Implications are drawn for improved evaluation of this promising training programme, including developing the measures of learning and adding a generalisation assessment.

The use of Doppler ultrasound in the diagnosis of chronic cerebrospinal venous insufficiency.

Chronic cerebrospinal venous insufficiency (CCSVI) may be associated with multiple sclerosis, and its treatment has been shown to potentially benefit patients with this condition. Color-assisted duplex imaging is used to assess the anatomical and physiological parameters of cerebrospinal venous function and to diagnose CCSVI. Standardized examination protocols as well as the diagnostic criteria used are important elements in ensuring reproducibility of results between centers. The objective of this article is to describe the technique our laboratory has used to assess patients for the presence of CCSVI using Doppler ultrasound.

An osteoid osteoma in an open distal femoral epiphysis. A case report.

An osteoid osteoma occurred in the distal femoral epiphysis of an 11-year-old boy. Only eight other cases of this tumor in an open epiphysis have been reported. An image intensifier was used to place the tip of a wire in the center lesion. Removal through a small incision with a bone trephine placed over a guiding Kirschner wire was curative. Bone peripheral to the lesion was replaced, allowing early mobilization without support.

Back school. An overview with specific reference to the Canadian Back Education Units.

The Canadian Back Education Units (CBEU) in a review of 6418 participants found a significant subjective improvement in 69% of the participants. This figure improved to 80% when only patients who experienced back pain for six months or less were considered. Ninety-seven percent of the participants considered the back education program helpful. Patients who had completed their high school education, who believed that they understood the mechanism of the pain, and who recognized an emotional component to the problem had the best results. Functional improvement was most pronounced in the activities most often performed. Patients with pain persistently radiating below the knee and patients receiving workmen's compensation did not fare as well. Using a computer analysis of the variation in test scores from pretest to the review class, a statistically valid positive correlation was established between the patient's subjective improvement and the amount of information retained. The CBEU are an efficient, effective, well received, and cost-effective therapeutic modality in the conservative treatment of chronic low back pain.