The psychosocial consequences of pediatric multiple sclerosis.

Although psychological distress and cognitive dysfunction are well documented in adults with multiple sclerosis (MS), they are poorly understood in children with the disease. Psychosocial difficulty experienced by children and adolescents with MS involves factors common to all chronic illnesses in children, as well as MS-specific factors. The psychosocial manifestations of the disease may affect the patient's self-image, role functioning, mood, and cognition to adversely affect schooling, interpersonal relationships, and treatment compliance. Furthermore, the impact of having a family member with MS may affect overall family functioning. Assessment and interventions for psychosocial and cognitive problems in pediatric MS should be multidisciplinary in nature and address the child's functioning at home, school, and among peers, as well as the effect on the family.

Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa.

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

The Foley catheter in the management of epistaxis.

The Foley urinary catheter has been used in the management of epistaxis for many years, yet it has never been designed or licensed for this purpose. We performed a telephone questionnaire of senior house officers in 90 ENT departments in England and Wales. The aim was to determine how many departments used the Foley catheter for epistaxis management, whether licensed nasal balloon devices were available and if there had been any complications associated with their use. Eighty-three (92%) ENT departments in the study used the Foley catheter for epistaxis management and 44 (49%) departments had licensed balloon devices available. Only 22% of ENT senior house officers questioned were aware that the Foley catheter was not licensed for use in the nose. Most complications associated with the use of nasal balloon devices appear to be due to Foley catheters.

Attitudes toward physician-assisted suicide among persons with multiple sclerosis.

This study was conducted to estimate the level of interest in assisted suicide among persons with multiple sclerosis (MS), the hypothetical conditions under which they would consider assisted suicide, and the factors associated with such interest. The sample of 511 members drawn from the Oregon and Michigan chapters of the National Multiple Sclerosis Society (NMSS) completed a mail questionnaire indicating whether they had ever considered assisted suicide, under what conditions they would consider it, and the correlates of considering assisted suicide. Close to one third of persons with MS in this study had thought about assisted suicide as an option for themselves. One quarter to one half would consider assisted suicide in five hypothetical circumstances, including experiencing unbearable pain, being unable to do things that made them happy, causing financial burden to caregivers or family members, or experiencing extreme emotional distress. Religiosity, social support, depressive symptomatology, MS symptoms, NMSS chapter, years since diagnosis, and gender were associated with some or all of the responses to the hypothetical conditions. The clinical and policy implications of these findings are discussed.

A skull base extradural hypoglossal neurilemmoma resected via an extended posterolateral approach.

The case of a 43-year-old man with a right skull base hypoglossal neurilemmoma excised via the extended posterolateral approach is presented. There is only one previous case of hypoglossal neurilemmoma in the literature. The surgical technique described is a new approach to the posterior skull base involving a suboccipital craniectomy, mastoidectomy and the removal of the lateral process of the atlas. It provides an inferior approach to the jugular foramen and hypoglossal canal that allows the lower cranial nerves to be identified as they exit from their skull base foramina. In the discussion we compare this technique to other surgical approaches previously described for access to the region of the jugular foramen.

Sexuality and multiple sclerosis.

This article addresses sexuality within the context of living with multiple sclerosis (MS). A discussion of MS-related dysfunction is followed by assessment tips and a range of interventions. Psychosocial and societal issues are reviewed as well as practice implications for health professionals.

International scale for assessment of disability in multiple sclerosis.

The Minimal Record of Disability (MRD) is an assessment tool developed under the auspices of the International Federation of Multiple Sclerosis Societies. It represents a synthesis of several scales designed to assess disability and handicap in patients with multiple sclerosis. This article will define the Minimal Record of Disability and other scales, explain the pertinent components and numerical values of each, and describe the field testing conducted for the MRD. Implications for nursing will also be considered.

Radioisotope studies of neurogenic bladder in multiple sclerosis.

Urinary dysfunction is a frequent and often serious manifestation of multiple sclerosis. If ignored, urinary tract pathology can cause disabling symptoms and life-threatening complications. Symptomatic relief and preventative measures are available once the underlying neurogenic pathology has been identified. The conceptualization of the categories "Failure to Store," "Failure to Empty," or "Combined" provide practical diagnostic and treatment catagories. One important diagnostic test to help define treatment parameters is the radioisotope renal/residual urine study.

Chronic foreign body aspiration diagnosed by lung scan.

The case of a two-year-old child with foreign body aspiration is presented. It was complicated by a delay in diagnosis and treatment. Lung scan was helpful in eventually establishing the diagnosis. Key points in the management of patients with foreign body aspiration are reviewed and pathophysiologic mechanisms are discussed.