Validation of a brief nurse-administered migraine assessment tool.

Objective: To validate a brief tool for screening migraine.

Background: Migraine is a common, but underdiagnosed condition. Effective utilization of nonphysician personnel to reliably screen patients for migraine may improve identification of migraineurs for clinical treatment and research.

Poliovirus vaccine options.

As a result of the success of immunization, indigenous wild poliomyelitis has disappeared from the United States. Of 142 confirmed cases of paralytic poliomyelitis reported in the United States from 1980 to 1996, 134 were classified as vaccine-associated paralytic poliomyelitis (VAPP). Persons with VAPP have a disabling illness, and this has caught the attention of the lay media.

Evaluating hoarseness: keeping your patient's voice healthy.

Hoarseness is the term often used by patients to describe changes in their voice quality. The causes of hoarseness are determined after obtaining a detailed medical history of the circumstances preceding the onset of hoarseness and performing a thorough physical examination. The latter may include visualization of the vocal cords, possibly using indirect laryngoscopy, flexible nasolaryngoscopy or strobovideolaryngoscopy.

Role of the primary care provider in expediting care of children with acute appendicitis.

Objective: To assess the role of the primary care provider (PCP) in the diagnosis and treatment of acute appendicitis in children by determining whether there were differences in the treatment and outcome of children whose parents contacted the PCP before taking the child to the hospital compared with those who did not.

Design: Retrospective review of medical records of pediatric patients discharged from the hospital with the diagnosis of acute appendicitis.

Setting: An urban children's hospital.

Bone lead levels and delinquent behavior.

Objective: To evaluate the association between body lead burden and social adjustment.

Design: Retrospective cohort study.

Setting: Public school community.

Optical mapping reveals that repolarization spreads anisotropically and is guided by fiber orientation in guinea pig hearts.

Guinea pig hearts were stained with a voltage-sensitive dye and imaged on a photodiode array to record fluorescent action potentials (APs) from 124 sites. Activation and repolarization patterns were recorded from the epicardium during stimulation at different loci and correlated with the underlying fiber architecture. Endocardial APs were recorded by inserting a light guide into the ventricular cavity or by dissecting out the ventricular free wall to expose the endocardium.

Sleep disturbances in children with atopic dermatitis.

Objectives: To test hypotheses based on clinical impressions that children with atopic dermatitis (AD) have frequent sleep-related problems, including difficulty falling asleep, night waking due to itching and scratching, and daytime symptoms of tiredness and irritability.

Design: Sleep habits and behaviors were assessed using the Child Sleep Behavior Scale (a 22-item Likert-type questionnaire for parents) in children with AD compared with normative data for age. Twelve questions were added to the questionnaire to address sleep-related habits relevant to night time pruritus, and to assess daytime behavioral symptoms of inadequate sleep.

Plasma from women with preeclampsia increases endothelial cell nitric oxide production.

In preeclampsia, a factor in the maternal circulation alters endothelial function via a reduction in nitric oxide synthesis. We measured the in vitro effects of 2% plasma from women with preeclampsia, compared with 2% plasma from normotensive pregnant women, on cultured endothelial cell nitrite production and nitric oxide synthase activity. On finding differential effects, we measured the effects on cellular viability (assessed by lactate dehydrogenase levels) and performed a time course study.

Duration of neuroleptic treatment and prevalence of tardive dyskinesia in late life.

Background: Although increasing age is the most consistently cited risk factor for the development of tardive dyskinesia for patients in the second to sixth decades of life, this relationship may not hold within geriatric populations.

Methods: Consecutively admitted geropsychiatric inpatients were examined with the Abnormal Involuntary Movement Scale within 72 hours of admission; comprehensive demographic, diagnostic, and psychometric data were also obtained.

Results: Seventy-four (19.

Intensive care for critically ill elderly: mortality, costs, and quality of life. Review of the literature.

The literature on outcomes of intensive care for the elderly with regard to intensive care unit utilization, mortality, hospital costs and charges, and quality of life after intensive care were reviewed. Publications in the English literature, which evaluated intensive care and included elderly populations, were obtained from review of Index Medicus and MEDLINE. We conclude that age alone is not an acceptable predictor of critical illness with regard to mortality and quality of life of survivors.

Effects of acute psychological stress on serum lipid levels, hemoconcentration, and blood viscosity.

Background: While there is substantial evidence that psychological stress enhances risk for coronary artery disease, the mechanisms underlying such an influence remain unclear. We examined the effects of short-term psychological stress on serum lipid levels, hemoconcentration, fibrinogen level, and plasma viscosity.

Methods: Forty-four healthy young adults were randomly assigned to perform a distinctly frustrating cognitive task for 20 minutes (stress condition) or to rest quietly for the same period (control condition).

Adult immunizations--a practical approach for clinicians: Part I.

Vaccine-preventable diseases cause needless sickness and death in adult Americans. Most adults 65 years of age or older have not been immunized against influenza or pneumococcal disease. In addition to an age of 65 years or older, indications for influenza and pneumococcal vaccines include chronic obstructive pulmonary disease, hemodynamically significant cardiac disease and infection with the human immunodeficiency virus.

Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors.

Objective: To assess those factors associated with and predictive of cranial nerve preservation after stereotactic radiosurgery in patients with small acoustic tumors identified by magnetic resonance imaging.

Design: We performed a retrospective analysis of our experience with 31 patients with preserved hearing and acoustic tumors measuring 10 mm or smaller (pons-to-petrous dimension). All patients underwent clinical and audiologic evaluations varying from 6 to 48 months (mean, 20 months) after stereotactic radiosurgery performed with use of the 201 source cobalt 60 gamma unit.

Quantitative and morphologic analysis of bacterial translocation in neonates.

Objective: To elucidate the mechanisms of bacterial translocation in animals fed a conventional formula by correlating transmucosal bacterial passage in vitro with the structural characteristics of the neonatal intestinal mucosa.

Design: Newborn rabbits were randomized to receive a conventional formula or breast milk. Bacterial translocation to the mesenteric lymph nodes, liver, and spleen was quantitated after 7 days, and transmucosal passage of bacteria was measured in vitro using the Ussing chamber.

Architectural remodeling of lung allografts in acute and chronic rejection.

The mesenchymal and extracellular matrix alterations that occur in acute and chronic rejection of the lung allograft were studied immunohistochemically, utilizing a wide panel of antibodies. In early rejection, perivascular and peribronchiolar mononuclear infiltrates were associated with basement membrane disruption of the vessels and airways and an ingrowth of muscle-specific actin-, vimentin-positive, desmin-negative spindle cells accompanied by type IV collagenase-positive histiocytes. Subsequent fibrous scarring was manifested by perforation and reduplication of the basement membrane of airways and vessels and dense collagen deposition, primarily type III.

Tinea pedis in children.

Objective: To demonstrate that tinea pedis should be considered in the differential diagnosis of children with foot dermatitis.

Design: Patient series.

Setting: Outpatient dermatology practice at the Children's Hospital of Pittsburgh (Pa).

Assessment of middle-ear status during experimental otitis media using magnetic resonance imaging.

Magnetic resonance imaging has proved to be a useful tool for in vivo imaging of a variety of tissues. In this study, magnetic resonance imaging was applied to the middle ear of experimental animals with otitis media. Results showed that the presence and distribution of effusion within the middle-ear space could be readily determined.

Anogenital warts in children. Clinical and virologic evaluation for sexual abuse.

Seventy-three children with anogenital warts were examined for sexual abuse during a 2-year period. Our data suggest that nonsexual transmission is common, particularly in children under 3 years of age. Approximately 25% of these children were younger than age 1 year, and another 50% were between the ages of 1 and 3 years.

Liver transplantation for polycystic liver disease.

Four female patients with severe complications of polycystic liver disease were treated with liver replacement; two patients were also given kidneys from their liver donors. All four of the patients were suffering from extreme fatigue. Three of the recipients have survived for 8, 11, and 60 months with normal liver function and present good health.

Hypothalamic hamartomas and sexual precocity. Evaluation of treatment options.

We describe four male patients with hypothalamic hamartomas associated with sexual precocity. Our assessment of their management suggests that resection using current microsurgical techniques is a valid treatment option if the patient has a normal pubertal endocrine makeup, if the hamartoma is pedunculated, and if the patient is young enough to require years of parenteral medical treatment. Such surgical treatment can be curative, and subsequent growth and development can be normal (patients 1 and 2).