Topical nitroglycerin: a promising treatment option for chondrodermatitis nodularis helicis.

BACKGROUND: Chondrodermatitis nodularis helicis (CNH) is a painful nodule that often interferes with sleep and occurs on the helix or antihelix of the ear in older patients. Although several case reports describe a variety of seemingly effective surgical and conservative treatment options, well-studied treatment modalities have varying efficacy rates and can often demonstrate disappointing results. OBJECTIVES: The purpose of this study was to evaluate the efficacy of 2% topical nitroglycerin for the treatment of CNH. METHODS: A retrospective chart review was performed in 12 patients given the diagnosis of CNH who received 2% topical nitroglycerin twice daily for therapy. Therapeutic efficacy was determined by identifying improvement in the appearance and symptomatology of the lesion. RESULTS: A total of 13 lesions in 12 patients were treated, with 12 (92%) lesions demonstrating improvement with the use of topical nitroglycerin. Eight of 13 (61.5%) CNH lesions developed complete clearance and resolution of symptoms, requiring no further treatment. Four of 13 (30.8%) lesions were found to have only symptomatic improvement, and these patients continued to use the ointment as needed. One of 12 (8.3%) patients found no benefit with the treatment but had also failed multiple other treatments modalities. LIMITATIONS: Limitations include the small number of patients treated and the retrospective nature of the study. CONCLUSIONS: Topical nitroglycerin demonstrated efficacy in treating both the symptoms and lesional appearance of CNH in a noninvasive manner, with an overall success rate that is comparable with other published methods.

Characteristics of maternal verbal style: responsiveness and directiveness in two natural contexts.

Twenty mothers' provision of responsive, supportive behavioural directive, and intrusive behavioural and attentional directive speech was investigated during interactions with their children at ages 0;10, 1;1, 1;5 and 1;9 in two natural contexts, free play and bathtime. Issues examined included developmental change, contextual differences, consistency across contexts and stability over time. Analyses revealed increases in frequencies of maternal responsive and supportive directive utterances and decreases in maternal intrusive directives with age. Differences between contexts included more speech and supportive directiveness during play than bath. Responsiveness and intrusive attentional directiveness demonstrated considerable consistency and stability. Mothers provided greater responsiveness to girls than to boys, but more intrusive directives to boys than to girls. Mothers' production of supportive and intrusive directives was unrelated, and their rates of responsive speech were inversely associated with their rates of intrusive directive speech, highlighting the importance of distinguishing between supportive and intrusive directiveness.

Maternal responsive and directive behaviours and utterances as predictors of children's lexical development.

Predictive relations were examined between measures of 20 mothers' behavioural and verbal general and specific responsiveness and intrusive and supportive directiveness and their children's subsequent expressive vocabularies during three developmental periods with endpoints at the beginning, middle, and end of the second year: 0; 10 to 1; 1, 1 ; 1 to 1; 5, and 1;5 to 1;9. Regression analyses, controlling for mothers' utterance frequencies and children's initial lexicons, revealed considerable consistency between reported and observed lexicons but changing patterns of predictive relations with development. During the first period, behavioural, but not verbal, measures of maternal responsiveness and supportive directiveness were positively predictive. In period two, verbal, but not behavioural, measures predicted children's vocabularies, with specific responsiveness and supportive directiveness as positive predictors and intrusive directiveness as a negative predictor. During the final period, mothers' behavioural and verbal responsiveness and behavioural supportive directiveness positively predicted and their verbal intrusive directiveness negatively predicted children's lexical growth.