Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers.

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static "trait" of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

Thigh abscess due to Nocardia farcinica.

Nocardia farcinica is an uncommon cause of nocardiosis and usually infects immunocompromised individuals. We describe a patient with Hodgkin's disease and a thigh abscess due to N. farcinica. To the best of our knowledge, this has never been reported before in the English literature. It is important to recognize this complication, because a delay in diagnosis may result in widespread dissemination. Unless initially suspected, culture and identification will be delayed, as selective media for isolating Nocardia are not routinely used in most clinical laboratories. It is also important to differentiate N. farcinica from other Nocardia species due to its resistance to many antibiotics that are routinely used to treat abscesses, including cephalosporins. A case report along with literature review is presented in an effort to stress the importance of including this pathogen in the differential diagnosis of immunocompromised patients with abscesses.

Spinal Burkitt's lymphoma in adults.

Adult Burkitt's lymphoma is an uncommon disease. Few cases of spinal involvement in adults with sporadic Burkitt's lymphoma are reported in the literature. We present a case of a middle-aged man who was found to have an epidural mass in the thoracic spine when investigated for back pain and lower extremity weakness. He underwent a laminectomy with resection of the epidural mass. Histologic examination revealed a primary Burkitt's lymphoma of the spinal cord. He was treated with aggressive chemotherapy and is now experiencing remission of his disease. We also present a review of the literature for the etiology and clinical features of other spinal lymphomas and Burkitt's lymphoma involving the spine in adults.

Pure primary squamous cell carcinoma of the breast: a rare presentation and clinicopathologic comparison with usual ductal carcinoma of the breast.

Pure and primary squamous cell carcinomas of the breast are exceedingly uncommon lesions. To the best of our knowledge, based up on review of the literature, only four studies of patients with these tumors, which presented clinically as breast abscess, have been reported previously. We present a woman who sought medical attention for breast pain and was initially diagnosed with a breast abscess. When she did not respond to antibiotic therapy, an incision as well as drainage was performed. Histologic examination of the material revealed a pure squamous cell carcinoma. An extensive work up ruled out other primary sites. She was treated with mastectomy and radiation therapy and has seen disease-free 3 years postdiagnosis. We also review the literature for presenting features, value of imaging studies, role of cytology in diagnosis, and therapy of such tumors in comparison to the usual ductal carcinomas of the breast.

Can the value of training be measured? A simplified approach to evaluating training.

Measuring the value of any training intervention has long baffled trainers and managers alike. Complex models for calculating the return on investment offer little help in attempting to measure the results of these programs. Unfortunately, while the difficulty in measuring these programs has not lessened, the need to justify training costs in the health care field has increased dramatically. In this article, the authors offer a perspective of how 1 hospital dealt with this complex issue and offer a guide for a simpler approach to measuring the value of training programs that can be used by trainers and managers without resorting to complicated formulas.