School-age children's safety attitudes, cognitions, knowledge, and injury experiences: how do these relate to their safety practices?

BACKGROUND: A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously. OBJECTIVE: To examine children's safety attitudes and cognitions more thoroughly and assess how these factors, along with children's safety knowledge and injury experiences, relate to children's safety practices. METHODS: Over several classroom sessions, boys and girls in two age groups (7-9, 10-12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences. RESULTS: Fewer safety practices were reported by older than younger children and boys than girls. Children's attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model. CONCLUSION: Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children's safety practices. Implications of these results for injury prevention programming are discussed.

Lipoid proteinosis: case report and review of the literature.

Lipoid proteinosis is a rare autosomal recessive disorder, characterized histologically by infiltration of periodic acid Schiff-positive hyaline material into the skin, upper aerodigestive tract, and internal organs. Classical clinical features include skin scarring, beaded eyelid papules, and laryngeal infiltration leading to hoarseness. Moreover, the infiltrates in the tongue and its frenulum limit lingual movements and cause speech difficulties. Usually, the hoarse voice is present at birth or in early infancy, as the first manifestation. In more severe cases, diffuse infiltration of the pharynx and larynx might cause respiratory distress, at times requiring tracheostomy. The disorder has recently been shown to result from loss-of-function mutations in the extracellular matrix protein 1 gene on chromosome 1q21. The function of the protein extracellular matrix protein 1 gene is still unclear, although an important role in skin physiology and homeostasis has been hypothesized. In this report, the case is described of a 6-year-old girl with lipoid proteinosis. Histopathological examination of a laryngeal biopsy specimen showed massive deposits of eosinophilic, periodic acid Schiff-positive, and diastase resistant material in the lamina propria corroborating the clinical diagnosis of lipoid proteinosis. Molecular analyses in this patient also confirmed the clinical diagnosis. The proposita was a compound heterozygote for a new small rearrangement (543de1TG/ins15) in exon 6, and a nonsense mutation (Arg243Stop) in exon 7. Together with previously documented mutations in the extracellular matrix protein 1 gene, this study supports the hypothesis that exons 6 and 7 are the most common sites for extracellular matrix protein 1 gene mutations in lipoid proteinosis.

Multicenter study of immunoscintigraphy with radiolabeled monoclonal antibodies in patients with melanoma.

A multicenter study was performed to analyze the efficacy of 99mTc- and 111In-labeled F(ab')2 fragments of monoclonal antibody (MoAb) 225.28S (reactive with a high molecular weight melanoma associated antigen) to radioimage malignant lesions in patients with melanoma. A total of 254 melanoma patients, carrying 412 documented melanoma lesions, were studied in 10 nuclear medicine departments. A total of 377 lesions were visualized in 206 patients; in particular (a) 250 of 412 known lesions were visualized in 159 of 191 patients known to carry melanoma lesions; (b) 95 occult lesions were visualized in 61 patients of the same group; and (c) 32 lesions were visualized in 15 of 63 patients without diagnosed lesions. The melanomic nature of 101 of 127 radioimaged occult lesions was confirmed by clinical criteria and/or by additional laboratory investigations. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments of MoAb 225.28S can provide clinically useful information. Analysis of the variables influencing the outcome of immunoscintigraphy with 99mTc- and 111In-labeled F(ab')2 fragments of MoAb 225.28S confirmed the role of size, anatomic site, and level of high molecular weight melanoma associated antigen in melanoma lesions. Such analysis also showed, for the first time, the influence (a) of the isotope used to radiolabel the antibody fragments and (b) of the clinical stage of the patients. The present study has shown good agreement in the results obtained by the 10 nuclear medicine departments, suggesting that immunoscintigraphy with radiolabeled F(ab')2 fragments of MoAb 225.28S is a reliable procedure.

Immunoscintigraphy of adenocarcinomas by means of radiolabeled F(ab')2 fragments of an anti-carcinoembryonic antigen monoclonal antibody: a multicenter study.

F(ab')2 fragments of anti-carcinoembryonic antigen (CEA) monoclonal antibody F023C5, determined to be more suitable than intact IgG and Fab fragments for immunoscintigraphy, were labeled with 131I or conjugated to DTPA for instant 111In-labeling, and administered i.v. (2-3 mCi/0.5 mg) to 509 patients in 11 nuclear medicine departments: 284 patients had gastrointestinal adenocarcinomas, 204 had nongastrointestinal adenocarcinomas and 21 were control; serum CEA was elevated in 169 patients, normal in 115, and not determined in 225. The following results were obtained: (a) no adverse reactions; (b) tumor imaging in 324 patients (in particular, in 81.5% CEA-seropositive and in 69.0% CEA-seronegative patients); (c) no significant difference in sensitivity among the results of the 11 departments; (d) no significant difference in overall sensitivity between 131I-and 111In-labeled immunoradiopharmaceuticals; (e) the fraction of documented lesions imaged was 73.3% in CEA-seropositive and 53.7% in CEA-seronegative patients; (f) the detection of liver metastases was hampered, particularly when using the 111In-labeled reagent, by nonspecific radioactivity uptake; (g) the major cause of negative immunoscintigraphy results was a lack of CEA in tumor lesions, as documented by immunohistochemistry; (h) lesion size is also important since the sensitivity was 64% for lesions up to 2 cm in diameter and 84% for larger lesions; (i) many "unexpected" radiolocalizations were recorded. Most were identified as occult tumor lesions. In 35 patients, this finding contributed to the early detection of tumor recurrences.

Effects of IV methylprednisolone on brain atrophy in relapsing-remitting MS.

BACKGROUND: IV methylprednisolone (IVMP) has been used to treat relapses in patients with relapsing-remitting (RR) MS, but its effect on disease progression is not known. Furthermore, there are no data on the impact of IVMP on T1 black holes or whole-brain atrophy. OBJECTIVE: To determine the effect of IVMP on MRI measures of the destructive pathology in patients with RR-MS and secondarily to determine the effect of IVMP on disability progression in patients with RR-MS. METHODS: The authors conducted a randomized, controlled, single-blind, phase II clinical trial of IVMP in patients with RR-MS. Eighty-eight patients with RR-MS with baseline Expanded Disability Status Scale (EDSS) scores of < or =5.5 were randomly assigned to regular pulses of IVMP (1 g/day for 5 days with an oral prednisone taper) or IVMP at the same dose schedule only for relapses (IVMP for relapses) and followed without other disease-modifying drug therapy for 5 years. Pulsed IVMP was given every 4 months for 3 years and then every 6 months for the subsequent 2 years. Patients had quantitative cranial MRI scans at study entry and after 5 years and standardized clinical assessments every 4 to 6 months. RESULTS: Eighty-one of 88 patients completed the trial as planned, and treatment was well tolerated. Baseline demographic, clinical, and MRI measures were well matched in the two study arms. Patients on the pulsed IVMP arm received more MP than patients on the control arm of the study (p < 0.0001). Mean change in T1 black hole volume favored pulsed IVMP therapy (+1.3 vs +5.2 mL; p < 0.0001), as did mean change in brain parenchymal volume (+2.6 vs -74.5 mL; p = 0.003). There was no significant difference between treatment arms in the change in T2 volume or annual relapse rate during the study. However, there was significantly more EDSS score worsening in the control group, receiving IVMP only for relapses. There was a 32.2% reduction (p

Characterizing an ectopic secreting carcinoid with indium-111-DTPA-D-Phe-pentetreotide.

UNLABELLED: This report describes a technique that increases the specificity of 111In-pentetreotide as evaluated in a patient with ectopic Cushing syndrome. METHODS: Two separate SPECT studies were performed with different pharmacologic protocols, both including treatment with cold octreotide. The imaging protocol provides acquisitions at 4 and 24 hr after injection. The quantitative approach was based on the ROI activity (manually designed) of an area of pathological lung uptake (ROI-T) versus background (ROI-NT). Histological, histochemical and specific mRNA measurements confirmed the presence of an SSR2 receptor carcinoid in the lung. RESULTS: The time course of ROI-T/ROI-NT is a linear increase between 4 and 24 hr. Washout with cold octreotide diminished the ROI-T activity content and the saturation protocol increased ROI-T/ROI-NT, confirming the specific nature of the uptake. CONCLUSION: Displacement and saturation protocols in 111In-pentetreotide imaging demonstrated the specificity of tumor binding.

Ocular microbial flora in immunodeficient patients.

The eyes of 20 patients with primary immunodeficiency syndromes were examined, and microbial cultures of their lids and conjunctivae were made. Nine patients had a history of recurrent external ocular infections, and six of these had active blepharitis or blepharoconjunctivitis at the time of examination. A single pathogenic bacterium was isolated from the lids and conjunctivae of six patients with a history of infection; a mixture of two possible pathogens was cultured from eyes of three other patients. Three of the nine patients with infections had impaired B-cell and intact T-cell immunity, whereas three patients had impaired B cell and T-cell immunity. Two patients had chronic granulomatous disease in which a defect in phagocytosis was the predominant immunologic abnormality, and one patient (with mucocutaneous candidiasis) had intact B- and T-cell function at the time of testing. Although the immunodeficient patients had a higher incidence of lid or conjunctival infection than 20 age-matched controls, the microbial flora of the lids and conjunctivae did not differ between the two groups.

Ketorolac, prednisolone, and dexamethasone for postoperative inflammation.

This 6-week, partially masked, three-arm, multicenter study was conducted to evaluate the postoperative anti-inflammatory efficacy of ketorolac, a cyclooxygenase inhibitor. The study setting was the clinical practice of six ophthalmic surgeons. The study enrolled 157 candidates for routine extracapsular cataract extraction or phaco-emulsification and posterior-chamber intraocular lens implantation. Patients who received any glucocorticoid or cyclooxygenase inhibitor within 1 week of surgery were excluded. All patients were treated with solutions of 0.5% ketorolac, 1% prednisolone acetate, or 0.1% dexamethasone instilled into the operative eye three times daily from 1 day before surgery to 4 weeks after surgery. Efficacy variables included the signs of anterior-segment inflammation, primarily cells and flare in the anterior chamber, as observed by slit-lamp biomicroscopy; fluorescein leakage across the blood-aqueous barrier as measured by fluorophotometry; and the rating of efficacy by the investigator. No significant differences were seen between ketorolac and either glucocorticoid in cells and flare. No significant differences were found in other signs of inflammation, except conjunctival hyperemia and Descemet's folds at week 2. Ketorolac showed significantly greater efficacy than the glucocorticoids against blood-aqueous barrier breakdown at day 5 and week 2, as demonstrated by the difference in fluorescein concentration between the operated and nonoperated eyes. Investigators did not detect any significant difference in rating for overall effectiveness and acceptability. These findings support the use of ketorolac as an alternative to glucocorticoids for the treatment of postoperative inflammation.

Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects.

The aim of the present study was to investigate the relationship between involvement of specific areas of the brain and the occurrence of depression and anxiety in patients with multiple sclerosis. We studied 95 patients (62 women and 33 men, mean age 39.5 years, SD 11.2) with definite MS, 97 patients (65 women and 32 men, mean age 40.7, SD 11.9) suffering from chronic rheumatoid diseases and 110 healthy subjects (71 women and 39 men, mean age 40.1, SD 12.7). The disability, the independence, the cognitive performances, the depressive and anxiety symptoms were assessed. The diagnosis of major depression was made according to the DSM-IV. The patients with multiple sclerosis underwent a 1.5 Tesla magnetic resonance examination including T1 and T2 weighted images. Calculation of regional and total lesion loads and brain volumes were performed. The number (%) of subjects with a diagnosis of major depression was 18 (18.9) among MS cases, 16 (16.5) among controls with chronic disease (p=NS), and 4 (3.6) among healthy volunteers (p < 0.0001). The Hamilton Depression and Anxiety rating scales median scores were 5 and 18, respectively in the MS patients, 5 (p= NS) and 14 (p= NS) in the chronic rheumatoid diseases controls, and 3 (p= < 0.0001) and 6 (p= < 0.0001) in the healthy controls. Both severity of depressive symptoms and diagnosis of major depression correlated, albeit weakly, with right frontal lesion load (r=0.22, p=0.035, and r=0.23, p=0.026, respectively) and right temporal brain volume (r=0.22, p=0.005 and r=0.22, p=0.036, respectively). The severity of depression was related significantly also with total temporal brain volume (r=0.26, p=0.012), right hemisphere brain volume (r=0.25, p=0.015), disability (r=0.30, p=0.003) and independence of MS cases (r=-0.26, p=0.01). The anxiety did not correlate significantly with any of the measures of regional and total lesion loads and brain volume or with any of the considered clinical variables. The similar frequency of depression and severity of depressive symptoms in MS patients and in chronic disease patients, the significant difference in this respect with the normal controls, and the significant correlation between depression and the disability measures would suggest a psychological reaction to the impact of the disease but the relationship between depression and the alterations in the frontal and temporal lobes of the right hemisphere supports, on the contrary, the causative role of organic brain damage. The lack of any significant association between symptoms of anxiety and either MRI abnormalities or clinical variables led us to the opinion that anxiety is a reactive response to the psychosocial pressure put on the patients.

Anterior uveitis in geographic or serpiginous choroiditis.

A 51-year-old man and a 45-year-old man had geographic or serpiginous choroiditis and anterior uveitis as shown by ophthalmoscopy and fluorescein angiography. Anterior uveitis, a previously undescribed feature of this disease, was found in both patients. Despite clear-cut evidence of inflammatory disease, corticosteroid therapy generally proved to be ineffective.

Immune complexes in uveitis.

We determined the incidence of immune complex increases, the nature of immune complexes, and the correlation between the immune complex level and clinical uveitis status in patients with chronic iridocyclitis and chronic diffuse uveitis. Ten of 16 patients with chronic iridocyclitis had increased levels of immune complexes, and this correlated with disease activity. Immune complexes were detected in ten of 12 patients with chronic diffuse uveitis. These complexes have a molecular weight of approximately 2 X 10(6) daltons. The antibody component of immune complex is IgG; however; the antigenic component of the immune complexes is unclear.

Sexual dysfunction in multiple sclerosis: a 2-year follow-up study.

BACKGROUND AND OBJECTIVE: Sexual dysfunction severely affects the quality of life of patients, but longitudinal studies of sexual function in multiple sclerosis are lacking. We performed a study on a group of patients with multiple sclerosis to evaluate the change in sexual function and to examine the relationship between sexual dysfunction and other clinical variables over time. METHODS: A 2-year follow-up study on 99 patients with definite multiple sclerosis. Information on sexual and sphincteric disturbances have been collected through face-to-face structured interviews. Disability, independence, cognitive performances and psychological functioning have also been assessed. Spearman rank correlation analysis corrected for multiple comparisons, and linear regression analysis have been performed to test variables relationship and remove the effect of potential confounding covariates. RESULTS: The proportion of patients with sexual dysfunction remained over 70% and did not change during the 2-year follow-up, but the extent and number of symptoms increased significantly The number of symptoms of sexual dysfunction did not change significantly after an exacerbation. Significantly, more patients than before the study resorted to counseling and discussed with doctors of sexual matters. In the univariate analysis, changes in sexual function over time correlated with changes in bladder function (r=0.47, p<0.0001) and EDSS score (r=0.41, p<0.0001), but the multivariate analysis demonstrated that only bladder dysfunction was independently related to sexual dysfunction (R=0.36, p=0.003) when the effect of psychological factors were removed. CONCLUSIONS: Symptoms of sexual dysfunction increase in significance and number over time in patients with multiple sclerosis. Relapses did not influence the number of symptoms of sexual dysfunction, but a worsening of pre-existing symptoms cannot be excluded. The change of sexual function appears to be independently associated to bladder dysfunction.

Application of a surface matching image registration technique to the correlation of cardiac studies in positron emission tomography (PET) by transmission images.

The aim of this work is to assess the accuracy of a surface matching registration (SMR) technique for the correlation of cardiac studies in positron emission tomography (PET). Registration parameters were estimated by matching corresponding body surfaces, extracted from transmission studies, aligned to the PET emission images to be correlated. The accuracy of the SMR technique in this specific application was assessed by computer simulations, phantom experiments and on clinical PET data. Registration accuracy was evaluated in relation to the body surfaces (external, internal and the combination of the two) used by the SMR method. Better results were found when matching shaped and irregular surfaces such as internal lung contours. The robustness of the method was verified for different counting statistics recorded in transmission images. A clinical validation of the SMR method was performed on fluorine-18-deoxyglucose PET cardiac studies.

Systemic absorption of 3H-fenticonazole after vaginal administration of 1 gram in patients.

Fourteen women, five with normal cervicovaginal mucosa (Group 1), five with cervical carcinoma (Group 2) and four with relapsing vulvovaginal candidiasis (Group 3) were enrolled and completed this open clinical trial. Each subject received a single dose of 1.82 +/- 0.3 g on average of vaginal paste (for ovules) containing about 1000 mg of 3H-fenticonazole nitrate (266 microCi). Twelve hours after vaginal administration, the paste was removed by vaginal washing. Blood, urine and stool samples were collected at specified time intervals for five days. Plasma, urine, stools and all used material in contact with the paste were assayed for radioactivity. No measurable levels of radioactivity were detected in plasma of subjects of Groups 1 and 3 while in 4 of the 5 subjects with cervical carcinoma (Group 2) fenticonazole was detected during the 24 h after administration with a peak level at about 8 hours. For a period of 5 days, 0.4-1.5% of the dose on average was recovered from urine, and 0.18-0.32% from feces. Based on the excretion data, the extent of vaginal absorption of fenticonazole nitrate in women with vulvovaginal candidiasis was 1.81 +/- 0.57% of the dose, while in women with normal cervicovaginal mucosa it accounted for 0.58 +/- 0.28% of the administered dose. In patients with cervical carcinoma, absorption was 1.12 +/- 0.53%. The maximum amount absorbed corresponds to an exposure of about 0.4 mg/kg of fenticonazole nitrate (for a subject weighing 50 kg). Consequently, the vaginal administration of one ovule containing 1000 mg of fenticonazole nitrate seems to be devoid of risk for patients.

Sudden deafness in children.

The authors present a report of 38 cases of sudden deafness (SD), observed in the Bambino Gesù Hospital in Rome. Twenty-six cases were due to infective causes, such as mumps, meningitis, measles, varicella or to physical trauma. The other 12 cases were defined as idiopathic (ISD) on the basis of their anamnestic and clinical findings. The etiological, prognostic and therapeutic aspects are discussed.

Cervical chordoma in childhood: clinical statistical contribution.

Parapharyngeal neoplasias are rarely noticed in childhood, since they have their peak incidence between the 2nd and 4th decade of life. The authors report a case of a 4-year-old patient presenting with a retrostyloid mass, accompanied by nasal obstruction and some difficulty in swallowing at 12 months of age. CT scanning well ascertained the delimitation of the tumor, but it was of no help in the differential diagnosis. In fact, after surgical excision, the histological examination of the specimen revealed a chordoma. This result was unexpected because of the region concerned and the lack of a CT demonstration of the cervical boney involvement. A cervical vertebral localization of a chordoma is rare in all age groups and it is of particular clinical and statistical interest in infancy.

Treatment of elevated intraocular pressure with concurrent levobunolol and pilocarpine.

Between July 1983 and January 1986, 54 patients with open-angle glaucoma or ocular hypertension were treated for 3 months with 2% pilocarpine hydrochloride (given four times daily) and one of two beta-adrenoceptor blocking drugs, levobunolol hydrochloride (0.5% [17 patients] or 1% [19 patients]) or 0.5% timolol maleate (18 patients), given twice daily. Before entry into the study all patients had had stable intraocular pressure (IOP) with treatment with 0.5% timolol and 2% pilocarpine. Stable IOP was successfully maintained in up to 88% of the patients in the two levobunolol-pilocarpine groups and in 83% of those in the timolol-pilocarpine group. Two patients experienced adverse reactions: one, who received timolol and pilocarpine, suffered blepharoconjunctivitis, and the other, who received 1% levobunolol and pilocarpine, experienced bradycardia. The results indicate that the levobunolol-pilocarpine regimens were as safe and effective as the timolol-pilocarpine regimen in stabilizing IOP.

Complex cognitive disruption in frontal dementia related to motor neuron disease.

We describe a patient in whom motor neuron disease and frontal dementia showed concomitant development. This patient underwent a detailed and sequential neurolinguistic assessment, which indicated an alteration in language planning, language comprehension, and morphosyntactic operations. He showed also attention deficit, abstract reasoning disturbances, and prosopoagnosia which became worse during the year follow-up. We suggest that a more specific and sensitive neurolinguistic and neuropsychological test battery must be used to detect and study the entire disruption of cognitive processes in frontal dementia related to motor neuron disease.

[Treatment of multiple sclerosis. The present and the future. Study Group on Diagnosis and Therapy of Multiple Sclerosis]. / Il trattamento della sclerosi multipla. Il presente ed il futuro. Gruppo di Studio per la Diagnosi e Terapia della Polisclerosi.

The last years have produced a plethora of new information including extensive studies, retrospective analysis and new perspectives on data interpretation on multiple sclerosis (MS) treatment. Considering how difficult it is to study a disease such MS with its variability, unpredictability and duration, it seems hard to resemble definite results from this experience. However, corticosteroids have been the mainstay of treatment for the management of acute relapses, showing the capacity to shorten the duration of relapses, accelerate the recovery. At present, interferon beta is generally considered to be the treatment of choice for patients with relapsing remitting disease. Glatiramer acetate is still not available in many parts of Europe, but its results demonstrate a reduction of relapses in 30% of cases. Most European experts only consider as alternative treatment the immunosuppressive drugs, chosen if patients demonstrate unacceptable side effects of interferon or clearly do not respond. Very different and even more confusing data still come from experimental trial in secondary progressive MS, where the target of treatment is to slow the progression of disability. Different drugs (methotrexate, mitoxantrone, linomide, steroids and even interferons) are employed, but the results are still debated. Future therapies are being derived from constantly changing and evolving concept of MS immunopathogenesis: therefore many experimental and clinical trials use anti-integrin antibodies or insulin growth factors, metallo-proteinase inhibitors or T-cell vaccination. Some of the above treatment may have a chance of producing the gaining control of the disease without much inner toxicity.

[Role of splenectomy in Chediak-Higashi syndrome in its accelerated phase]. / Ruolo della splenectomia nella sindrome di Chediak-Higashi (SCH) in fase accelerata.

Chediak-Higashi (C.H.S.) syndrome is a rare immunodeficiency, due to defective granulocyte activity. The syndrome is characterized by large inclusion bodies in the leukocytes, albinism, photophobia, nystagmus, and recurrent infections. Some patients develop hepatosplenomegaly, lymphadenopathy, pancytopenia and widespread organ infiltrates with mononucleated cells. This phase is called "accelerated (or lymphoma-like syndrome) phase". A 5 years old girl with C.H.S. in accelerated phase received initially medical treatment without improvement. A splenectomy was performed to remove the hypersplenism and the mechanical compression of the spleen on the gut. Few days after the splenectomy the fever and the pancytopenia disappeared. The pathological examination of the spleen showed multiple intraparenchymal abscesses. Unfortunately, six months after the operation, she died after an acute episode of pneumonia, with normal hematological pattern. The splenectomy may play a role in the "accelerated phase" of C.H.S., but new treatments (bone marrow transplantation) are necessary to remove the basic disease.