Intravascular carcinomatosis of the brain: a report of two cases.

Although central nervous system (CNS) metastases are common in advanced cancer, CNS involvement solely by intravascular tumor cells, known as intravascular carcinomatosis, is extremely rare. We report two cases of brain metastasis in which tumor cells were restricted to the vascular lumina without parenchymal involvement, resulting in ischemic lesions. The first patient is a previously healthy young woman who presented with symptoms of community-acquired pneumonia and progressed to respiratory failure. Computed tomography of the brain showed infarcts of differing ages. At autopsy, she was found to have widely metastatic cervical squamous cell carcinoma and cerebral tumor emboli with multifocal infarcts, mainly microinfarcts. The second patient is an elderly man with cognitive impairment and mild Parkinsonism who presented with symptoms of a urinary tract infection. Magnetic resonance imaging of the brain showed atrophy and changes suggestive of chronic microvascular ischemic disease. Postmortem examination demonstrated prostatic adenocarcinoma and cerebral tumor emboli with multifocal infarcts. These cases illustrate that this pattern of intracranial metastasis may rarely be a cause of cerebral ischemic lesions and emphasize the importance of thorough pathologic examination of the brain.

The interdisciplinary council on developmental and learning disorders diagnostic manual for infants and young children - an overview.

OBJECTIVE: To describe the Interdisciplinary Council on Developmental and Learning Disorders Diagnostic Manual for Infants and Young Children (ICDL-DMIC) created by representatives of the Interdisciplinary Council on Developmental and Learning Disorders. METHOD: A description of the rationale of the different sections of the ICDL-DMIC dealing with infants and young children, focusing on a classification system which integrates all components of development and functioning which have been traditionally addressed by different disciplines. RESULTS: A description of an in-depth approach to mental health diagnosis for infants and young children that goes beyond simply a description of symptoms and captures the qualities of the individual. CONCLUSION: The ICDL-DMIC presents an innovative approach to the assessment and diagnosis of infants and young children and their families, featuring a multi-dimensional classification system which uniquely considers the emerging functional emotional developmental capacities of the infant and young child and the developmental pathway to symptom patterns.

Climbing the symbolic ladder in the DIR model through floor time/interactive play.

The developmental, individual-difference, relationship-based model (DIR), a theoretical and applied framework for comprehensive intervention, examines the functional developmental capacities of children in the context of their unique biologically based processing profile and their family relationships and interactive patterns. As a functional approach, it uses the complex interactions between biology and experience to understand behavior and articulates the developmental capacities that provide the foundation for higher order symbolic thinking and relating. During spontaneous 'floor time' play sessions, adults follow the child's lead utilizing affectively toned interactions through gestures and words to move the child up the symbolic ladder by first establishing a foundation of shared attention, engagement, simple and complex gestures, and problem solving to usher the child into the world of ideas and abstract thinking. This process is illustrated by a case example of a young boy on the autism spectrum interacting with his father during 'floor time' over a 3 year period.

Child care research: a clinical perspective.

Two new studies on day care suggest that young children demonstrate increased aggressive behavior in relationship to time spent in day care and increases in cortisol levels in relationship to full-time, group-oriented, out-of-home care. These observations can be more fully understood in a clinical context that looks at individual differences in children, families, and child care environments. Factors likely to increase risk include sensory processing and modulation challenges; family stress; and lack of sensitive, nurturing interactions associated with less high-quality child care. Because 85% to 90% of current day care is not considered to be of high quality, individual families that can provide high-quality care need to explore carefully their options to see if it is possible to provide direct nurturing care for their infants and young children for at least half of the day.

Measuring functional developmental delay in infants and young children: prevalence rates from the NHIS-D.

In order to measure the prevalence of developmental delay among US infants and children, two types of questions were asked of parents in the 1994-95 National Health Interview Survey on Disability (NHIS-D). To measure functional delay (FD), questions from the Functional Developmental Growth Chart (FDQ), which measures specific age-appropriate tasks, were used. General delay (GD) was defined using the general type of questions about developmental delay that had been used in previous surveys. Using a nationally representative sample of 15 291 infants and children aged 4-59 months from the NHIS-D, analyses revealed that, according to these questions, approximately 3.3% had FD and 3.4% of the children had GD. However, only one-third of the children were identified by both sets of questions. Thus, two-thirds of the children identified as having FD were not recognised by their parents as having a delay. Conversely, many parents responded to the GD questions indicating that their child had a delay, but failed to indicate that their child had a functional problem. In addition, only 17% of the children with FD and 31% of those with GD were receiving special services. Multivariable logistic regression analyses found that children with both FD and GD were more likely to be male and to be living in families with incomes below 200% of the poverty level. The findings suggest that the general types of developmental delay questions used in national surveys may not identify children with functional delays. As parents failed to identify these children, it is possible that many of these children may be slipping through paediatric surveillance. Further research to evaluate the use of these measures in population surveys is recommended.

The relationship of maternal perception and maternal behavior: a study of normal mothers and their infants.

Normal mothers of nine-month-olds generally perceived their infants' behavior accurately. However, where maternal perceptual distortions did occur, they were associated with less maternal responsiveness and greater interference. These correlated with the mothers' anxiety level and with infant sleep problems. Maternal expectations thus seemed to be translated into specific maternal behavior which may be of significance in the child's psychosocial adjustment.