Socio-economic burden of asthma, allergy, and other atopic illnesses.

Asthma and atopic illness account for a substantial burden of social morbidity. The purpose of this brief report will be to provide an overview of the different dimensions to the socio-economic burden of asthma and other atopic diseases and suggest areas where future research in this area may advance our understanding of the impact of various treatment strategies of these diseases. While there are occasional studies which describe the full dimensions of this social and economic burden, more studies are needed to complete our understanding of this burden especially studies that investigate the relative cost-effectiveness of medical and non-medical interventions.

Early journals in hypnosis: an update.

To date, 139 journals concerned primarily with hypnosis have been identified. This article lists another 20 periodicals, including the first American journal, the Magnet, which was briefly published in 1835 in Hanover, New Hampshire.

The current management of thyroid tumors in childhood.

Thyroid cancer is a rare but intriguing malignancy when it occurs in childhood and adolescence. Although it often presents at a more advanced stage than similar adult thyroid tumors, the biologic behavior is more benign, accounting for improved survival. Therefore, pediatricians and surgeons have debated the wisdom of aggressive versus conservative surgical approaches.

Connective tissue diseases.

The classic connective tissue diseases (lupus erythematosus, dermatomyositis, and scleroderma) have been described with respect to their pathogenesis, clinical picture, laboratory diagnosis, and management. Because the aim of this volume is to provide an interface between plastic surgery and dermatology, the cutaneous manifestations, both shared and pathognomonic for each of these diseases, have been emphasized. An attempt has been made to point out opportunities for surgical management of some of the problems associated with these diseases.

A unique presentation of non-Hodgkin's lymphoma in the foot.

Non-Hodgkin's lymphoma of the foot is a relatively uncommon pedal neoplasm. The authors discuss the etiology, incidence, histology, morphology, metastatic rate, and treatment of this entity. Non-Hodgkin's lymphomas rarely present as destructive lesions of bone; when they do, they usually involve the axial skeleton or proximal long bones.

Clinical assessment of emotional milestones in infancy and early childhood.

It is now possible to monitor, assess, and, where necessary, facilitate emotional development in infants, young children, and their families. The focus on the infant and the family from multiple aspects of development has made it possible to formulate developmental stages that focus on the infant's social and emotional functioning. This article includes an outline for the emotional evaluation of infants and young children.

Immune abnormalities in the pathogenesis of juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatic disease of childhood. Although the etiology remains unknown, immunoregulatory imbalances are thought to be important in the pathogenesis of JRA. Numerous immunologic abnormalities have been described in these patients, but it remains unclear which are fundamental to the pathogenesis of the disease and which are secondary.

Pudendal neuralgia.

We call attention to a group of patients with chronic vulvar burning (vulvodynia), who do not have apparent infections or easily discernible abnormal physical findings, but who on simple sensory testing have allodynia, hyperalgesia, hyperpathia, and hypoesthesia in varying permutations within the areas innervated by the pudendal nerve. We propose that pudendal neuralgia (pain along the pudendal nerve) is one of the causes of idiopathic vulvodynia. In those patients in whom a neurologic, metabolic, infectious, traumatic, or malignant cause for neuralgia is not found, medical management with tricyclic antidepressants, antiepileptic agents, or both may prove helpful.

Vulvar vestibulitis syndrome: an overview.

Vulvar vestibulitis syndrome is a constellation of symptoms and findings involving and limited to the vulvar vestibule that consists of: (1) severe pain on vestibular touch to attempted vaginal entry, (2) tenderness to pressure localized within the vulvar vestibule, and (3) physical findings confined to vulvar erythema of various degrees. Histopathologic findings are consistent with a chronic, nonspecific inflammatory response that is occasionally associated with metaplasia of the minor vestibular glands. The cause is likely multifactorial, and to date the syndrome has been seen in association with subclinical human papillomavirus, chronic recurrent candidiasis, chronic recurrent bacterial vaginosis, chronic alteration of vaginal pH, and the use of chemical and destructive therapeutic agents.

Travel medicine and travel clinics.

In response to the vast number of American travelers to the developing world, the discipline of Travel Medicine has become an emerging specialty. There are presently no formal Board or other requirements to practice Travel Medicine, but bona fide practitioners of this field, who also usually direct travel clinics, should at the least be well-trained and experienced in tropical medicine and medical aspects of travel, and have had considerable overseas work experience. The concept of travel medicine and the need for travel clinics operated by well-qualified physicians are discussed.

Tightening the screw: statutory and legal supervision of interhospital patient transfers.

A federal statute governing the transfer of indigent patients from Medicare-enrolled hospitals was first enacted in 1986. Review of the statutory and other legal controls over interhospital transfers is precipitated by its recent amendment and the fining of a Texas physician for transferring a high-risk obstetric patient without following the statutory guidelines. These events are part of a pattern of increasing regulation of the practice of medicine.

The lap belt complex: intestinal and lumbar spine injury in children.

The "seatbelt syndrome" describes intestinal and spinal injury caused by lap-style automotive restraints. More than 2,600 children were admitted to Children's National Medical Center with blunt injury in 3 years; 395 were involved in a motor vehicle crash. Ninety-five of the crash occupants (24%) were known to be wearing safety belts.

Lung carcinoid cell lines have bombesin-like peptides and EGF receptors.

The biochemical properties of lung cancer cell lines were investigated. Bombesin-like peptides were present in three small cell lung cancer (SCLC) cell lines examined and three of four lung carcinoids but not in five non-small cell lung cancer (NSCLC) cell lines. Therefore SCLC and some lung carcinoids, but not NSCLC, are enriched in neuroendocrine properties.

Vaccines for foreign travel.

Exotic infections are a significant threat to the child traveling to or going to live in the developing world. Vaccines are available that can prevent some of these infections. It is essential that basic routine childhood vaccination be up to date and that necessary modifications be made from the usual schedule in the United States.

Autoimmune thrombocytopenia in pediatric systemic lupus erythematosus: alternative therapeutic modalities.

Three patients with pediatric systemic lupus erythematosus (PSLE) and autoimmune thrombocytopenia (AT), who developed unacceptable side effects (pseudotumor cerebri, hypertension, excessive weight gain) from treatment with steroids, were treated successfully with vincristine (2 patients) or intravenous immunoglobulin (1 patient). All patients remained off steroids without any complications for 11 to 23 months.

Race as a risk factor in the severity of infragenicular occlusive disease: study of an urban hospital patient population.

We retrospectively studied the arteriograms of 135 men admitted for evaluation of lower extremity ischemia to examine whether race influences the severity of infragenicular occlusive disease. The scoring system prepared by the Ad Hoc Committee on Reporting Standards for the Society for Vascular Surgery and the International Society for Cardiovascular Surgery was used to grade the severity of stenosis in each of the upper, middle, and lower thirds of the anterior and posterior tibial and peroneal arteries (collectively called "infragenicular" arteries). The patients were divided into two groups: 83 blacks (140 arteriogram limbs) and 52 whites (87 arteriogram limbs).

Anastomotic compression button: a new mechanical device for sutureless bowel anastomosis.

The anastomotic compression button is a new mechanical device that uses three interlocking polypropylene buttons to produce a sutureless bowel anastomosis. The device is unique in that it allows application of the buttons via a device similar to the popular intraluminal stapler, but it leaves no staples or foreign body of any kind in the bowel wall. The authors compared the 25-mm anastomotic compression button with the 25-mm intraluminal stapler in the colon of dogs.

Dominantly transmitted hematologic dysfunction clinically similar to Fanconi's anemia.

We report a family with a dominantly transmitted syndrome resembling Fanconi's anemia and spanning two generations. This syndrome was characterized by an ill-defined hematologic stem cell disorder, immune dysfunction, poor dentition, hyperpigmented skin, warts, and multiple second trimester spontaneous abortions and included one case of acute myelomonocytic leukemia (acute non-lymphocytic leukemia, M4). This family lacks the characteristic chromosomal aberrations of Fanconi's anemia.