Gratification disorder ("infantile masturbation"): a review.

BACKGROUND: Little has been published on gratification disorder ("infantile masturbation") in early childhood. AIMS: To expand on the profile of patients diagnosed with this condition. METHODS: Retrospective case note review; Fraser of Allander Neurosciences Unit paediatric neurology outpatient department 1972-2002. RESULTS: Thirty one patients were diagnosed (11 males and 20 females). Twenty one were referred for evaluation of possible epileptic seizures or epilepsy. The median age at first symptoms was 10.5 months (range 3 months to 5 years 5 months). The median age at diagnosis was 24.5 months (range 5 months to 8 years). The median frequency of events was seven times per week, and the median length 2.5 minutes. Events occurred in any situation in 10 children, and in a car seat in 11. Types of behaviour manifested were dystonic posturing in 19, grunting in 10, rocking in 9, eidetic imagery in 7, and sweating in 6. Two children had been previously diagnosed as having definite epilepsy. In nine cases home video was invaluable in allowing confident diagnosis. CONCLUSION: Gratification disorder, otherwise called infantile masturbation, is an important consideration in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of events often prevents unnecessary investigations and treatments.

A nocturnal enuresis service for a deprived inner city.

AIM: Glasgow is a city where 80% of the most deprived children in Scotland live within 20% of the overall population. Of 168,000 children in Glasgow, an estimated 5000 aged 5-15 y have primary nocturnal enuresis. The aim of this study was to establish a nocturnal enuresis service for Glasgow. METHODS: Needs assessment was performed and the incident cases were documented at school entry healthcare appraisal, at the age of 5 y. A cohort of these children was followed up at 8 y of age and symptom resolution was no better than natural remission. Parents, general practitioners, clinical medical officers and a hospital paediatrician were interviewed face-to-face about their need for a service. RESULTS: Ten of 11 general practitioners expressed a need for a specialist service. Ten school nurse-led local nocturnal enuresis clinics were established. Accommodation, funding, default and managing alarms were major problems. School nurses enjoyed extra training and quickly became skilled therapists. Two research projects highlighted that most children at first attendance did not believe they could ever be dry, which predicted outcome. Deprived families, once motivated, could successfully undertake complex behavioural therapies. CONCLUSION: A comprehensive nocturnal enuresis service begins when children stop using night nappies at the age of 3-4 y. Appropriate waterproof mattress, duvet and pillow coverings should be advocated until 5 y, when desmopressin may be helpful. For continued wetting at the age of 7 y, a local service should be led by a team of well-trained nurses using enuretic alarms.

1,8-Dihydroxynaphthalene monoglucoside, a new metabolite of Sclerotinia sclerotiorum, and the effect of tricyclazole on its production.

Isolate SS7 of Sclerotinia sclerotiorum was previously shown to produce and excrete into agar medium copious amounts of the melanin precursor 1,8-dihydroxynaphthalene. Much reduced quantities of this product were produced in the presence of tricyclazole, an inhibitor of pentaketide melanin biosynthesis. In this study, we demonstrate that young cultures of isolate SS7 produce 1,8-dihydroxynaphthalene monoglucoside, a new natural product not previously reported from fungi. When cultured in the presence of tricyclazole, such young cultures also accumulated two new monoglucosides of 1,3,8-trihydroxynaphthalene, which, as well as 1,8-dihydroxynaphthalene monoglucoside, were also obtained from cultures of two other isolates of S. sclerotiorum. It is proposed that rapid glucosylation of 1,3,8-trihydroxynaphthalene in young tricyclazole-inhibited S. sclerotiorum cultures accounts for the failure to observe 2-hydroxyjuglone or other metabolites usually associated with blockage of the pentaketide pathway to melanin in fungi.

Anatomic placement of the Herbert-Whipple screw in scaphoid fractures: a cadaver study.

An anthropometric cadaver study was performed to determine the optimal placement of a Herbert-Whipple screw in the scaphoid. Twenty pairs of cadaver wrists were examined and anthropometric analysis of the scaphoids using plain radiography, computed tomography, and en bloc resection was performed. Scaphoid vascularity was evaluated using India ink injection. Radiographic and actual measurements of height and width confirmed symmetry in paired scaphoids. Anatomic evaluation defined a safe zone for screw placement. K-wire placement defined the extent of this zone. The entry point of this zone was found by moving dorsally and distally 15% of the lateral radiographic length of the contralateral scaphoid from the volar aspect of the scaphoid tuberosity. Moving 10% of this same length from the membranous central portion of the scapholunate ligament defined the target site. Computed tomography confirmed proper position of the screw to maximize bony purchase and avoid articular penetration while maintaining dorsal vascular integrity.

Reduced accommodative function in dyskinetic cerebral palsy: a novel management strategy.

A 9-year-old boy with dyskinetic cerebral palsy secondary to neonatal encephalopathy is described. He presented with blurring of near vision which had begun to impact on his school work. Objective assessment of accommodation showed that very little was present, although convergence was almost normal. The near-vision symptoms were completely removed and reading dramatically improved with the provision of varifocal spectacles. Varifocal lenses provide an optimal correction for far, intermediate (i.e. for computer screens), and near distances (i.e. for reading). Managing this type of patient with varifocal spectacles has not been previously reported. It is clearly very important to prescribe an optimal spectacle correction to provide clear vision to optimize learning.

Medication errors in a paediatric teaching hospital in the UK: five years operational experience.

BACKGROUND: In the past 10 years, medication errors have come to be recognised as an important cause of iatrogenic disease in hospital patients. AIMS: To determine the incidence and type of medication errors in a large UK paediatric hospital over a five year period, and to ascertain whether any error prevention programmes had influenced error occurrence. METHODS: Retrospective review of medication errors documented in standard reporting forms completed prospectively from April 1994 to August 1999. Main outcome measure was incidence of error reporting, including pre- and post-interventions. RESULTS: Medication errors occurred in 0.15% of admissions (195 errors; one per 662 admissions). While the highest rate occurred in neonatal intensive care (0.98%), most errors occurred in medical wards. Nurses were responsible for most reported errors (59%). Errors involving the intravenous route were commonest (56%), with antibiotics being the most frequent drug involved (44%). Fifteen (8%) involved a tenfold medication error. Although 18 (9.2%) required active patient intervention, 96% of errors were classified as minor at the time of reporting. Forty eight per cent of parents were not told an error had occurred. The introduction of a policy of double checking all drugs dispensed by pharmacy staff led to a reduction in errors from 9.8 to 6 per year. Changing the error reporting form to make it less punitive increased the error reporting rate from 32.7 to 38 per year. CONCLUSION: The overall medication error rate was low. Despite this there are clear opportunities to make system changes to reduce error rates further.

Anxiety sensitivity and the five-factor model of personality.

Relations between anxiety sensitivity (AS) and the higher-order and lower-order dimensions of the 'Big Five' model of personality were examined in 317 university students. AS was significantly associated with a number of personality domains and facets of the NEO-PI-R. Regression analyses indicated that only the higher-order domains of neuroticism and extraversion (negatively) and the lower-order N facets of anxiety and self-consciousness, significantly predicted AS. Three lower-order factors within AS were identified and were also compared to NEO-PI-R domains and facets. In a hierarchical regression, the three AS factors significantly predicted variance in a measure of panic-related anxiety after the effects of the six N facets were statistically controlled. Results are discussed in the context of previous work with a Big Three taxonomy of personality and implications for understanding the nature and possible origins of AS are outlined.

Pitfalls of pedicle screw fixation in the sacrum. A cadaver model.

Five male cadavers were used to evaluate anatomically structures at risk using sacral pedicle screw fixation. Risk was defined as the likelihood of penetration by K-wires placed through the pedicles and cortices at the S1, S2, and S3 levels. A scale based on the distance from the wire to the vital structure was developed to quantify risk. Instrument insertion techniques were classified as direct and lateral. The direct technique at S1 placed the left common iliac vein and the sympathetic chain at high risk. The sympathetic chain was also at high risk at the S2 and S3 levels. The lateral technique placed the lumbosacral trunk at high risk at the S1 level, as well as the S1 nerve root with screw placement at the S2 level. Anterior cortical penetration during sacral pedicle screw fixation places anatomic structures at variable risk depending on the technique used.

Bone fragments a body can make.

Data obtained from various analytical techniques applied to a number of small bone fragments recovered from a crime scene were used to provide evidence for the occurrence of a fatality. Microscopic and histomorphometric analyses confirmed that the fragments were from a human skull. X-ray microanalysis of darkened areas on the bone fragments revealed a chemical signature that matched the chemical signature of a shotgun pellet recovered at the scene of the crime. The above findings supported the deoxyribonucleic acid (DNA) fingerprint evidence which, along with other evidence, was used to convict a man for the murder of his wife, even though her body was never recovered.

Effect of carbon tetrachloride on hamster tracheal epithelial cells.

This study was designed to assess effects of carbon tetrachloride (CCl4) in hamster tracheal epithelium. Adult, male, Syrian golden hamsters were treated with 2.5 ml/kg CCl4 ip, and controls received only the vehicle (peanut oil). Animals were sacrificed after 1, 4, 12, and 24 h. Tissue samples from upper and lower tracheal levels were fixed and embedded in glycol methacrylate for light microscopy. Some tracheal rings were also fixed in formaldehyde/glutaraldehyde cacodylate buffer for transmission electron microscopy. For histopathologic evaluation of the tracheal epithelial cells, each tracheal level was cut transversely at 3 microns and stained with toluidine blue. CCl4 produced injury to ciliated and nonciliated cells in all portions of hamster trachea, although the severity of CCl4-induced injury differed in various levels and regions. The number of damaged cells increased markedly after 1 h in the lower trachea, but not until after 4 h in the upper trachea. By 24 h, the number of injured cells had decreased so that no significant difference from control was evident. The ultrastructural alterations in epithelial cells were obvious as early as 1 h after CCl4 administration. Intracellular organelles, including smooth and rough endoplasmic reticulum, mitochondria, and Golgi apparatuses, were damaged by this chemical. Since CCl4-induced cell injury is dependent on metabolism by intracellular NADPH-dependent cytochrome P450 monooxygenases, these results suggest that hamster tracheal epithelial cells have the potential to activate CCl4 metabolically.

pULB113, an RP4::mini-Mu plasmid, mediates chromosomal mobilization and R-prime formation in Erwinia amylovora, Erwinia chrysanthemi, and subspecies of Erwinia carotovora.

The RP4::mini-Mu plasmid pULB113, transferred from Escherichia coli strain MXR, was stable and transfer proficient in Erwinia amylovora strain EA303, E. carotovora subsp. atroseptica strain ECA12, E. carotovora subsp. carotovora strain ECC193, and E. chrysanthemi strain EC183. The plasmid mobilized an array of Erwinia sp. chromosomal markers (E. amylovora: his+,ilv+,rbs+,ser+,thr+;E. chrysanthemi:arg+,his+,ilv+,leu+; E. carotovora subsp. atroseptica: arg+,gua+,leu+,lys+,pur+,trp+; E. carotovora subsp. carotovora: arg+,gua+,leu+,lys+,out+[export of enzymes],pur+,trp+), suggesting random interactions of the plasmid with the chromosomes. In E. carotovora subsp. carotovora, pULB113-mediated two-factor crosses revealed linkage between three auxotrophic markers and the out loci. The export of pectate lyase, polygalacturonase, and cellulase and the maceration of potato tuber tissue occurred with Out+, but not Out-, strains of E. carotovora subsp. carotovora, indicating the importance of enzyme export in plant tissue maceration. Erwinia sp. donors harboring pULB113 complemented mutations in various biosynthetic and catabolic genes (arg, gal, his, leu, met, pro, pur, thy) in Escherichia coli recA strains. Escherichia coli transconjugants harbored pULB113 primes as indicated by the cotransfer of Erwinia genes and pULB113 markers and a change in plasmid mass. Moreover, the PstI and SmaI cleavage patterns of selected pULB113 primes were different from those of pULB113. pULB113 primes carried DNA insertions ranging from 3 to about 160 kilobases. These findings indicate that pULB113 is useful for in vivo gene cloning and genetic analysis of various enterobacterial phytopathogens.

Morphologic and cytochemical characteristics of amine-containing globule leukocytes in rat tracheal epithelium.

Amine-containing cells in the tracheal epithelium are typically of the small-granule type (diameter approximately 100 nm). However, in the rat, another amine-containing cell type has been identified that possesses the amine-handling features of the APUD-series of cells (amine precursor uptake and decarboxylation) but not the ultrastructural characteristics. It has been postulated that these cells may be related to cutaneous melanocytes. In this study, fluorescent cells were present in the laryngeal and tracheal epithelial lining of adult Sprague-Dawley rats following freeze-drying and exposure to formaldehyde vapor (FIF or formaldehyde-induced fluorescence). Microspectrofluorimetry revealed an emission maximum at 493 nm. The excitation maximum could not be calculated but appeared to be around or below 350 nm (to record spectra below requires the use of quartz optics). Yellow fluorescence also emanated from serotonin-containing mast cells (excitation and emission maxima: 401/515 nm). Tracheal segments processed according to the aqueous formaldehyde ( AFIF ) technique, for the demonstration of 5- hydroxytryptophan (5-HTP) or serotonin (5-HT), failed to identify fluorescent cells in the epithelial lining even though connective-tissue mast cells were evident. Subsequent treatment of AFIF -fixed sections with formaldehyde and HCl vapors ( AFIF -HCl) resulted in the formation of a fluorogenic compound within numerous cells in the tracheal lining (455/537 nm). This spectral shift and increase in intensity of fluorescence following acidification are characteristic for standards and/or cells that contain tryptamine, tryptophan, or peptides with NH2-terminal tryptophan and are markedly different from microspectrofluorimetric data reported for the phenylethylamines or serotonin. It is therefore postulated that these cells contain a closely related beta-(3-indolyl) ethylamine-like compound, serotonin excluded. The morphology of the fluorescent cells was similar when prepared according to the FIF or AFIF -HCl techniques. Conjunctive staining, the examination of a single section first by fluorescence microscopy and subsequently by other histochemical and cytochemical methods, demonstrated that the fluorescent granules were also methylene blue, alcian blue, periodic-acid Schiff, and ferric- fericyanide positive. Subsequent correlative electron microscopic examination of Epon-embedded AFIF -HCl-treated tracheal sections demonstrated that these amine-containing cells were globule leukocytes.

Host-Pathogen Interactions : XX. BIOLOGICAL VARIATION IN THE PROTECTION OF SOYBEANS FROM INFECTION BY PHYTOPHTHORA MEGASPERMA F. SP. GLYCINEA.

Phytophthora megasperma f.sp. glycinea, which causes soybean (Glycine max) root and stem rot, exists as several races which differ in their ability to infect a range of soybean cultivars. A glycoprotein-rich fraction (Fraction I) isolated from fungal culture fluid protects soybean seedlings from infection with compatible races. In an early study (13), seedlings were protected only by Fraction I purified from incompatible races. In 1979, seedlings were better protected by Fraction I isolated from incompatible races than by Fraction I isolated from compatible races. In 1980, seedlings were protected equally well by Fraction I from incompatible and compatible races. Materials similar in composition to Fraction I did not protect seedlings from infection. No cause could be identified for the apparent change, during the 3-year period, in the race specificity of the protection assay. Variability in the bioassay prohibited further purification or characterization of Fraction I components that protect seedlings from infection.

Nonrespiratory metabolic function and morphology of lung following exposure to polybrominated biphenyls in rats.

Exposure to polybrominated biphenyls (PBBs) resulted in increased activity of microsomal arylhydrocarbon hydroxylase and ethoxyresorufin-O-deethylase in rat lung. Clearance of 5-hydroxytryptamine (5-HT) and angiotensin 1 by perfused lungs was decreased by PBBs. However, PBBs had no effect on the activity of epoxide hydrolase, monoamine oxidase, or angiotensin-converting enzyme in lung. The only histopathologic change detected in lungs from PBB-treated rats was an increase in alveolar type II cell lamellar bodies. Selective accumulation of certain PBB congeners by lung was not observed in this investigation.

The effects of carbon monoxide and hypoxic hypoxia on amine-containing cells in the tracheal epithelium of young rabbits.

Endogenously fluorescent, singly occurring amine-containing cells in tracheal epithelium were examined in 3-, 10-, and 28-day-old rabbits. These cells are pyramidal in shape with the apex projected toward the tracheal lumen. The cytoplasm exhibits a yellow fluorescence which is predominantly supranuclear. Occasional, infranuclear, fluorescent cytoplasmic processes project from the cells. The numbers of fluorescent cells per unit length of trachea increase with age. Acute exposure of 10-day-old rabbits to 13% O2 decreases the number of detectable fluorescent cells in the tracheal compared to controls exposed to room air. Similarly, exposure to 750 ppm carbon monoxide decreases the number of fluorescent epithelial cells appearing in tracheas of 10- and 28-day-old rabbits. These results suggest that the amine-containing epithelial cells of the trachea respond to tissue hypoxia and that decreased airway pO2 is not necessary to elicit a response.