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The aim of the current study was to determine whether plate augmentation was a successful treatment algorithm for selected femoral nonunions initially managed with intramedullary nailing. A total of 30 femoral nonunion cases were managed using the plate augmentation strategy with 13 primary cases and 17 multi-operated femurs (avg 2.8 ineffective procedures). Adjunctive strategies included autologous bone grafting and/or BMP for atrophic/oligotrophic and bone defect cases. Deformity correction was performed when required. Osseous union occurred in 29 of 30 cases. One multi-operated case with bone defect and prior infection required repeat autologous grafting prior to union. Plate augmentation should be added to the armamentarium for management of selected femoral nonunion that have failed initial intramedullary nailing.

Background Gestational lead exposure (GLE) produces novel and persistent rod-mediated electroretinographic (ERG) supernormality in children and adult animals. Objectives We used our murine GLE model to test the hypothesis that GLE increases the number of neurons in the rod signaling pathway and to determine the cellular mechanisms underlying the phenotype. Results Blood lead concentrations ([BPb]) in controls and after low-, moderate-, and high-dose GLE were ≤ 1, ≤ 10, approximately 25, and approximately 40 μg/dL, respectively, at the end of exposure [postnatal day 10 (PND10)]; by PND30 all [BPb] measures were ≤ 1 μg/dL. Epifluorescent, light, and confocal microscopy studies and Western blots demonstrated that late-born rod photoreceptors and rod and cone bipolar cells (BCs), but not Müller glial cells, increased in a nonmonotonic manner by 16–30% in PND60 GLE offspring. Retinal lamination and the rod:cone BC ratio were not altered. In vivo BrdU (5-bromo-2-deoxyuridine) pulse-labeling and Ki67 labeling of isolated cells from developing mice showed that GLE increased and prolonged retinal progenitor cell proliferation. TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and confocal studies revealed that GLE did not alter developmental apoptosis or produce retinal injury. BrdU birth-dating and confocal studies confirmed the selective rod and BC increases and showed that the patterns of neurogenesis and gliogenesis were unaltered by GLE. Conclusions Our findings suggest two spatiotemporal components mediated by dysregulation of different extrinsic/intrinsic factors: increased and prolonged cell proliferation and increased neuronal (but not glial) cell fate. These findings have relevance for neurotoxicology, pediatrics, public health, risk assessment, and retinal cell biology because they occurred at clinically relevant [BPb] and correspond with the ERG phenotype.

The effect of mercury as Hg2Cl2 and HgCl2 on the antioxidant enzyme levels and its toxicity was investigated in an insect model comprised of adult females of the common housefly, Musca domestica, and fourth-instar larvae of the cabbage looper moth, Trichoplusia ni. HgCl2 was found to be more toxic than Hg2Cl2 to both M. domestica and T. ni. The LC50s for M. domestica were 1.17% and 0.38% w/v concentration for Hg2Cl2 and HgCl2, respectively. For the more tolerant T. ni, the LC50S were 5.15% for Hg2Cl2 and 0.96% w/w concentration for HgCl2. The minimally acute LC5 dose of both oxidation states of Hg was approximately 0.005% for both insects (w/v for M. domestica and w/w for T. ni). At the LC5, both forms of Hg significantly induced the activity of superoxide dismutase in both insect species. Catalase was induced by both Hg2Cl2 and HgCl2 in M. domestica but was only induced by HgCl2 in T. ni. Glutathione-S-transferase, its peroxidase activity, and glutathione reductase activities were also significantly altered in most cases by Hg in both insects although the pattern of alternation was different between the two insects. It is evident that mercury induces oxidative stress in insects as it does in vertebrates. Our findings suggest that insects may serve as a valuable, non-mammalian model species to assess Hg-induced oxidative stress as a component of environmental toxicity.

Summary This report describes a toddler with chronic diarrhea, vomiting, and hypotonia due to surreptitious administration of syrup of ipecac by his mother (Munchausen's syndrome by proxy). Several features of this case distinguish it from previous reports of chronic ipecac ingestion in childhood: the development of grossly bloody stools; radiologic, endoscopic, and biopsy evidence of a chronic moderate colitis resembling ulcerative colitis; and the histologic finding of pseudomelanosis coli, providing an important clue to toxic ingestion. The significance and possible mechanism for genesis of pseudomelanosis coli is discussed. This case emphasizes the variability in presentation and difficulty in diagnosing long-term ipecac ingestion by proxy. Ipecac toxicity should be considered in children with unexplained colitis and vomiting.

Removal of lead from gasoline and other environmental sources has decreased the median blood lead concentration ([BPb]) of children in the United States < 10 μg/dL: the current low level of concern [Centers for Disease Control and Prevention (CDC) 1991]. However, there is compelling cross-sectional and prospective epidemiological evidence that [BPb] in children ≤ 10 μg/dL causes cognitive decline (Canfield et al. 2003; Hu et al. 2006; Lanphear et al. 2005; Rothenberg et al. 2002; Winneke et al. 1990). Recently, Gilbert and Weiss (2006) suggested that the BPb action level in children should be 2 μg/dL. Developmental lead exposure also has been linked to a variety of neurological and neurodegenerative disorders in children and adolescents, including attention deficit hyperactivity disorder (ADHD) (Braun et al. 2006), auditory and language impairments (Dietrich et al. 1992; Rothenberg et al. 2000; Yuan et al. 2006), retinal deficits (Rothenberg et al. 2002), neuromotor dysfunction (Bhattacharya et al. 1990, 2006; Ris et al. 2004), and schizophrenia (Opler et al. 2004). Few studies, however, have examined the long-term effects of low-level gestational lead exposure (GLE) despite findings that children with prenatal lead exposure have reduced cognitive functions (Baghurst et al. 1992; Hu et al. 2006; Schnaas et al. 2006; Wasserman et al. 2000), neuromotor and visual motor dysfunction (Ris et al. 2004; Wasserman et al. 2000), and altered auditory and retinal function (Dietrich et al. 1992; Rothenberg et al. 2000, 2002; Wasserman et al. 2000). Maternal lead exposure results from inhalation, diet, and/or eating in lead-contaminated work areas (Correa et al. 2006; Min et al. 1996). Maternal skeletal bone lead from prior exposure mobilizes during pregnancy and lactation (Manton et al. 2003). Lead easily crosses the placental and mammary barriers (Bornschein et al. 1977; Korpela et al. 1986). Thus, the developing fetus and child are at risk, as evidenced by findings that fetal and maternal [BPb] are similar (Korpela et al. 1986). The adverse cognitive consequences of prenatal and postnatal exposure to moderate-level ([BPb] 11–39 μg/dL) and high-level ([BPb] ≥ 40 μg/dL) lead have been studied in rodents (Cory-Slechta 1997; Crofton et al. 1980; Kuhlmann et al. 1997; Wasserman et al. 2000). Several reports also link moderate-to-high-level lead exposure to altered motor activity (Crofton et al. 1980; Ma et al. 1999) and dopaminergic signaling (Antonio and Leret 2000; Cory-Slechta 1997). To date, there are no experimental studies on the effects and mechanisms of low-level GLE on neuromotor function, despite evidence that low-level lead exposure produces these deficits in children (vide supra). In this report we present a new model of human equivalent GLE and the sex-specific physiological, behavioral, and neurochemical abnormalities in year-old GLE mice. These studies were conducted because the long-term consequences of GLE are unknown and increasing evidence indicates that early developmental exposure to neurotoxicants accelerates age-related functional decline and/or produces delayed neurotoxicity (Barone et al. 1995; Basha et al. 2005; Landrigan et al. 2005; Newland and Rasmussen 2000; Rice and Barone 2000; Weiss 1990; Weiss et al. 2002). Sex differences were examined because a) early developmental lead exposure produces a heightened risk for attention, visual motor, and fine-motor deficits in males (Bhattacharya et al. 1990, 2006; Ris et al. 2004); b) male and female animals exhibit differences in exposure and susceptibility to chemicals and lead neurotoxicity (Cory-Slechta et al. 2004; Vahter et al. 2007); and c) this is an important and underexplored area of toxicology (Vahter et al. 2007). Our results show that GLE produced age-related, sex-specific, and non-monotonic dose–response alterations.

Tarsometatarsal joint dislocations and fracture-dislocations are uncommon injuries most frequently resulting from high-energy trauma as encountered in crush injuries, falls, and motor vehicle accidents. Although less common in athletes, this injury is being recognized with greater frequency and may carry a poor prognosis for return to high levels of competition. These injuries present a considerable challenge to orthopedic surgeons caring for athletes because of the prolonged period of recovery often required [ 1,2,5,6,12]. The literature contains descriptions of this injury in football players, gymnasts, tennis players, and track and field athletes [2,5,9]. To our knowledge, no report of such a Lisfranc injury to a hockey player has been described. This is a case report of a National Hockey League player that sustained a Lisfranc injury requiring surgical stabilization, but was able to return to elite hockey play. Language: en

Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology.The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration.The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day.Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.

The Teenage Access Project (TAP) was supported by the Special Projects of National Significance Program to expand and ensure access to health and support services for disadvantaged, human immunodeficiency virus (HIV)-positive, and at-risk adolescent and young adult women aged 10-21 years by: (a) preventing further HIV transmission through empowerment and reduction of risk behavior, (b) providing HIV counseling and testing to increase screening of young women, and (c) facilitating referrals to medical and psychosocial services through the TAP activities. TAP served 403 young people (82% African-American and 83% young women). The basic elements of the TAP service model components were: (a) outreach to community agencies serving high-risk, disadvantaged young women; (b) My Individual Responsibility Reduces Our Risk (MIRROR), a six-module risk-reduction and empowerment activity specifically designed for young women in Jefferson County, using a small group format; and (c) the Adolescent Testing Center (ATC), a center for age and culturally appropriate HIV testing, pre- and posttest counseling, risk assessment, and referrals. HIV testing and pre- and posttest counseling were provided confidentially in both clinical and community settings. More than 200 participated in the MIRROR activity. A total of 101 young women received HIV counseling and testing services.

The purpose of this study was to determine how children's preoperative focus of attention on the stresses of surgery related to their preoperative coping and return to usual activities during recovery. Children's attention was classified according to three different foci: concrete-objective, emotion, and vague. Children (N = 97) between the ages of 8 and 17 years who were undergoing major orthopaedic surgery participated in the study. Data were collected the day before surgery, and at 3, 6, and 9 months postoperatively. Children who focused on the concrete-objective aspects of surgery had the most positive activity outcomes, followed by the emotion-focused attention group. Children who were classified as having vague focused attentions had the least favorable activity outcomes. When there were significant coping by attention interaction effects, vigilant copers who had a concrete-objective focus of attention had the most favorable activity outcomes at each time of measurement. Children who were able to focus their attention on concrete aspects of the experience tended to use vigilant coping and were able to return to their usual activities sooner.

The validity of the Ego-Grasping Orientation Scale (EGO) was tested. Theoretically, the EGO is a measure of mental health based on Taoistic (i.e., Ancient Chinese) philosophy. A total of 68 research participants completed the EGO along with measures of Eastern/Western orientation, self-esteem, assertiveness, desire for control, social interest, anxiety, and depression. Results indicated that the EGO may be a better measure of Taoistic mental health when combined with scales of Eastern/Western orientation, depression, self-esteem, and social interest.

To identify a sensitive marker for extramammary Paget's disease and to identify histochemical and immunohistochemical features that suggest occult pelvic cancer in patients with extramammary Paget's disease, we retrieved all cases between 1983 and 1992 with a Standardized Nomenclature of Medicine code of extramammary Paget's disease in the Vanderbilt University Medical Center (Nashville, Tenn) surgical pathology archives. All were stained for alcian blue/dPAS (periodic acid-Schiff), mucicarmine, AE1/AE3, cytokeratin (CAM 5.2), cytokeratin (CK) 7, CK 20, carcinoembryonic antigen (CEA), orthokeratin, prostate-specific antigen, and S-100. Sixteen cases (2 men, 14 women) were retrieved. Two had pelvic malignancies: one rectal adenocarcinoma and one transitional carcinoma. Only CK7 marked all cases. Mucins were sensitive but focal, a potential problem in small biopsy specimens. The transitional tumor had a unique staining profile (CEA- and mucin-negative). CK20 strongly marked Paget cells associated with rectal cancer; its presence suggests a large bowel lesion but is not specific. No case expressed prostate-specific antigen; its presence in a man suggests prostatic carcinoma.

To test the hypotheses that preparatory informational interventions based on self-regulation theory delivered to radiation therapy (RT) recipients by staff nurses would reduce disruption in patients' usual life activities and have a positive effect on the moods of patients who tended to have pessimistic expectations about outcomes.A quasi-experimental design with repeated measures.University-affiliated RT department.226 patients receiving RT for breast or prostate cancer.The control-group patients received the nursing care that was the standard of practice before the experimental interventions were introduced. The experimental-group patients received theory-based interventions four different times from staff nurses. Patient data were collected by interview four different times.Type of nursing interventions generated, optimistic or pessimistic expectations about outcomes (Life Orientation Test), amount of disruption in usual life activities (Sickness Impact Profile), and moods (Bi-Polar Profile of Mood States).The patients who received the self-regulation theory-based nursing interventions experienced less disruption in their usual life activities during and following RT. Among the patients who tended to be pessimistic, those who received the theory-based interventions had a more positive mood than those who did not receive the interventions.Staff nurses should use self-regulation theory-based interventions to help patients cope with RT.

Anticipation is a genetic phenomenon wherein age of disease onset decreases and/ or severity increases in successive generations. Anticipation has been demonstrated for several neuropsychiatric disorders with expanding trinucleotide repeats recently identified as the underlying molecular mechanism. We report here the results of an analysis of anticipation performed with multiplex families segregating schizophrenia. Thirty-three families were identified through the NIMH Genetics Initiative that met the following criteria: had at least two affected members in successive generations and were not bilineal. Affectation diagnoses included schizophrenia, schizoaffective disorder-depressed, and psychosis NOS. Additional analyses included the Cluster A personality disorders. Three indices of age of onset were used. Disease severity was measured by several different indices. Four sampling schemes as suggested by McInnis et al. were tested, as well as additional analysis using pairs ascertained through the parental generation. Anticipation was demonstrated for age of onset, regardless of the index or sampling scheme used (P0.05). Anticipation was not supported for disease severity. Analyses that took into account drug use and diminished fecundity did not affect the results. While the data strongly support intergenerational differences in disease onset consistent with anticipation, they must be viewed cautiously given unavoidable biases attending these analyses.

We report a case of cycloserine-induced Stevens-Johnson syndrome (SJS) in a 38-year-old male with the acquired immune deficiency syndrome (AIDS) and multidrug resistant tuberculosis (MDR-TB). The patient developed a cutaneous reaction after 60 days of therapy with ofloxacin, streptomycin (SM), pyrazinamide (PZA), ethambutol (EMB), and cycloserine (CSN). All drugs were stopped and the rash improved. Due to the severity of his disease, anti-tuberculosis drugs were resumed, one at a time. The patient developed a recurrent rash consistent with SJS, which began when CSN was restarted. CSN was stopped and the SJS began to gradually resolve with palliative treatment despite continuation of the other anti-tuberculosis drugs. However, the patient's overall condition gradually deteriorated and he died. To our knowledge, this is the first case of probable CSN-related SJS.

To test the hypotheses that pessimists might benefit from concrete objective information based on self-regulation theory and that optimists might benefit from instruction in self-care and coping based on self-care theory, 62 patients receiving radiation therapy (RT) for prostate cancer were studied. The two experimental and control intervention messages were given three times during RT. Mood and disruption of activities were assessed three times during and three times after RT. The self-care instruction had no effects on either outcome. The prediction from self-regulation theory was supported, in part, with concrete objective information having a positive effect on mood among pessimistic patients. Concrete objective information resulted in less recreation and pastime disruption in both optimistic and pessimistic patients at the times they experienced the most RT side effects.

The present research examined attributions of shy persons in the interpersonal situation of romantic relationships. Two hundred fifteen undergraduate psychology students were administered the Beck Depression Inventory (BDI), the Social Avoidance and Distress Scale (SAD), and the Romantic Relations Attributions Questionnaire (RRAQ). Correlations are reported for both the SAD and the BDI with the RRAQ. Partial correlations of the SAD with the RRAQ with depression removed also are reported. Results suggest that shy people attribute causality in romantic relationships in ways typically associated with depressed people. Moreover, observed gender differences suggest that shy females may be more committed to making a relationship work, whereas shy males may be more willing to abandon a problematic relationship.

A case of congenital, unilateral absence of a left pulmonary artery is described in a patient presenting with exertional dyspnea. Data from cardiopulmonary exercise testing suggest that the mechanism of dyspnea is secondary to a paradoxic elevation of the physiologic dead space to tidal volume ratio (VD/VT) during exercise.

We prospectively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit (MICU) using nurses' and residents' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care. Either readmission to the MICU or death was considered a negative patient outcome. Nurses' reports of collaboration were significantly (p = 0.02) and positively associated with patient outcome, controlling for severity of illness. Patient predicted risk of negative outcome decreased from 16%, when the nurse reported no collaboration in decision making, to 5% when the process was fully collaborative. There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation. When alternatives were available, collaboration was more strongly associated with patient outcome. There was no significant relationship between residents' reports of collaboration and patient outcomes. The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low (r = 0.10).

Previous estimates of body composition in children by measurement of total body potassium (TBK) have employed adult derived values for the ratio of K/fat free body mass (FFBM) to calculate the FFBM. To evaluate the appropriateness of this practice, body composition was determined in 30 children (14 boys, 16 girls) between the ages of 9 and 14 years by hydrostatic weighing, bioelectric impedance, and whole body counting of 40K. Estimates of body fat percentage by TBK measurements were significantly greater (p less than 0.05) than by either the hydrostatic or bioelectric impedance techniques. When current estimates for the FFBM density in children were employed to derive the K/FFBM, the value for boys was 58.9 mEq and for girls, 54.2 mEq. These data indicate that the FFBM will be underestimated in pediatric populations when adult derived values for K/FFBM are used.

The thoracic flight muscle from adult male NAIDM house flies was examined, from emergence to very old age. Thin sections stained with uranyl acetate and bismuth showed no myofibrillar or mitochondrial degeneration from 1 day to 19 days post-emergence, contrary to earlier reports. Some progressive loss in glycogen content and increase in mitochondrial size were observed for muscle from young to very old flies. However, there was no conclusive evidence of fusion of smaller mitochondria into larger ones with advancing age, despite exhaustive examination of representative sections of muscle samples of adult males of different ages.

Upon exposure to specific antigen in tissue culture, sensitive lymphocytes released macrophage migration inhibition factor and other lymphokines into the supernatant culture medium. Migration of peritoneal macrophages from nonsensitive animals was inhibited in the presence of such supernatants. However, with previous techniques it was found that an inhibitory effect was present at only low low titers (less than 10(2)). It is therfore of great interest that by increasing cellular density, the total number of cells being kept constant, inhibitory activity can be amplified by a factor as great as 10(10). This amplification was observed only when lymphocytes and macrophages were loosely packed, as by spontaneous sedimentation in a conical test tube. The effect was abolished by dispersing the cell suspension in a flat-bottomed flask or, alternatively, by shaking the test tube so that intimate prolonged intercellular contact was prevented.

The use of fluoroscopic guidance for transbronchial biopsy (TBB) during flexible fiberoptic bronchoscopic examination has been controversial. Patient records and bronchoscopy reports for 112 transbronchial biopsies performed with fluoroscopy over a seven-year period were reviewed and compared with those of 135 transbronchial biopsies performed without fluoroscopy over the same interval. Complication rates with regard to pneumothorax, fever, and hemorrhage were compared, as were yield data for neoplasm, sarcoidosis, and other miscellaneous pulmonary diagnoses. Complication rates were low in both groups and not statistically different; yield data were likewise comparable, particularly in diffuse neoplasm and sarcoidosis. This report suggests that TBB without fluoroscopy (in the basilar segments) is safe and that diagnostic yield, particularly in sarcoidosis and diffuse neoplasm, is good.

Examined three hypothesis shared in common by several contemporary theoreticians of depression: (1) depressogenic parents maintain unrealistically high ideals for their offspring; (2) depressogenic parents negatively evaluate these offspring; (3) depressive offspring show lowered self-evaluations. Phenomenological perceptions of parental ideals and attitudes were reported by depressed and nondepressed college students (N = 48). These data supported the latter two hypotheses, but not the first. Results are discussed in terms of interpersonal attraction theory as well as in terms of a possible model of mutual influencability in the family interactions of depressives.

The relative effects of preadmission self-instructional information on levels of performance and time needed to achieve level of mastery of exercise behaviors were examined using a sample of 130 presurgical cholecystectomy and herniorrhaphy patients. Experimental interventions were (1) no preadmission information, (2) specific preadmission instructions, and (3) nonspecific preadmission instructions. Preadmission instructions consisting of either a specific or nonspecific booklet mailed to patients focused on techniques for coughing, deep breathing exercises leg movements, and ambulatory behaviors. During hospitalization, patients' exercise behaviors and the length of teaching time required for patients to perform the exercise steps were measured. Findings showed that subjects in the specific exercise instruction group performed significantly more of the exercise behaviors common to both booklets than subjects in the nonspecific exercise instruction group. Subjects in the specific instruction group also performed significantly more of the behaviors available to them than the nonspecific instruction group. Required postadmission teaching time did not differ significantly between the specific and nonspecific information groups, but both the groups required significantly less teaching time in the hospital than the no-preadmission instruction group.

A patient with culture-negative infective endocarditis is presented in whom detailed serological studies were indicative of acute infection with murine typhus. The patient had aortic and mitral regurgitation with congestive heart failure and typical peripheral manifestations of subacute endocarditis, but no documented fever. Aortic and mitral valve replacement surgery and a 6-week course of doxycycline therapy produced a clinical cure in this patient, as well as a diagnostic fall in markedly elevated preoperative typhus indirect fluorescent antibody (IFA) and complement fixation (CF) titers. Serological studies were consistently negative for Q fever.

Thirty-four patients (thirty-seven feet) had a reoperation for pain that persisted after excision of a plantar interdigital (Morton) neuroma. A longitudinal plantar incision was used in thirty-three feet and the previous dorsal web-space incision was used in four feet. Of the thirty-nine pathological specimens that were obtained intraoperatively, twenty-six (67 per cent) contained elements either of primary interdigital neuroma tissue or of an interdigital neuroma in association with an amputation-stump neuroma, indicating that the recurrent pain in these patients had probably resulted from an incomplete initial excision. All but one of the thirty-four patients were available for follow-up at an average of seventy-six months (range, ten to 124 months) postoperatively. Twenty-two patients (67 per cent) had complete relief from or marked improvement in pain, three (9 per cent) had improvement but had persistent pain, and eight (24 per cent) had no improvement or had worse pain. The longitudinal plantar incision was satisfactory in all but one patient and did not result in a painful plantar scar. The number of previously unsuccessful attempts that had been made to excise the neuroma did not adversely affect the results of reoperation in this group of patients.

Evaluated the ability of self-regulation and emotional-drive theories to explain effects of an informational intervention entailing descriptions of the experience in concrete objective terms on outcomes of coping with radiation therapy (RT) in men (N = 84) with prostate cancer. The experimental group had significantly less disruption in function during and for 3 months following RT than the comparison group. The intervention had no significant effect on negative mood. Consistent with self-regulation theory, similarity between expectations and experience and degree of understanding of the experience mediated the effect of the intervention on function. Emotional-drive theory was not supported. These results are consistent with prior research with surgical patients and support the relevance of the information-processing explanations of self-regulation theory to coping with stressful experiences associated with physical illness.

Assessed the self-perceptions with regard to depressive mood states among high depression scoring Ss and non-depressed Ss. Twenty high scorers and 20 low scorers on the MMPI D scale were selected from a larger group and were given three adaptations of the DACL: A present or "Now" version, an ideal-self or "Like to Be" version, and a new "Deserve to Be" form of instructions. Results showed significant differences between the two groups on the "Now" and the "Deserve to "Be" adaptations of the DACL, but not on the "Like to Be" adaptation. Results were discussed in terms of the cognitive theory of depression.

The effect of an informational intervention that provided objective descriptions, in concrete terms, of the usual experiences during the various phases of radiation therapy was tested in a random clinical trial. The patients had Stage A, B, or C prostatic cancer. Forty-two control patients received the information routinely provided to all patients in the treatment setting. Forty-two experimental patients received, in addition, four informational messages during the course of radiation therapy. The first message described the experience of treatment planning; the second described the experience of receiving a radiation treatment; the third described side effects that usually occur, their onset, their characteristics, and activities to lessen their impact; and the fourth described the usual experiences during the months following radiation treatments. The experimental group of patients, compared with those in the control group, reported significantly less disruption in usual activities during and following radiation therapy. The amount of emotional disturbance was low and did not differ by study group. The results of this study, with respect to the interventions' effect on radiation therapy patients' quality of life, were consistent with prior research in other health care situations.

The assumption that is implicit in nearly all methods for determining body composition is that the fat-free body has a constant composition and that fat content can vary from some minimal amount to over 70 per cent. Fat estimations, however, are almost always indirect and are based upon estimating some fat-free component of the body. Some fifteen different methods are described in terms of the principle involved, the cost, and the applicability for routine use. A review is presented of a large number of regression equations that have been developed to predict body density from many types of anthropometric equations. The accuracy or comparative accuracy of body composition methods cannot be evaluated with human subjects. Methods can be validated only by using the method on an animal model, then performing chemical analyses on the same animal. Data of this type are limited.

A 6.5-year-old horse with a history of exercise-induced pulmonary hemorrhage was admitted because of acute onset of epistaxis, dyspnea, high respiratory rate, pale mucous membranes, and dark feces. There was no clinical or laboratory evidence of a bleeding disorder, and the horse's anemia was considered to be secondary to pulmonary hemorrhage. The cause of the hemorrhage was not found on thoracic sonograms or from cytologic examination of transtracheal aspirates. Despite supportive care, the horse's health deteriorated, and it was euthanatized. Necropsy revealed blood in the thoracic and peritoneal cavities and reddish black masses in many tissues. Histologic examination confirmed a diagnosis of hemangiosarcoma. Hemangiosarcoma is a rare tumor in horses; however, as this case demonstrates, it can cause pulmonary hemorrhage and respiratory distress and may be difficult to diagnose before death.

Soft tissue lesions are often secondary to equine carpal injury. The clinical and pathological nature of soft tissue changes following carpal trauma are varied. This report describes a case of intersynovial fistula between the radial carpal joint and the common digital extensor tendon sheath. The differential diagnosis and pathological features of equine soft tissue carpal injuries are discussed.

Development of an erythematous, papulonodular to papulopustular skin eruption in four febrile, immunocompromised patients raised the possibility of a systemic mycosis when Gram's stains of unroofed lesions disclosed budding yeasts. Candidiasis, torulopsosis, sporotrichosis, and cryptococcosis were considered in the differential diagnosis, and therapy with amphotericin B was begun. Skin biopsy specimens disclosed fungi to be located exclusively within intact and ruptured hair follicles. Inability of the fungi to grow on media that were not supplemented with lipid and their structure and location all suggested the presence of Pityrosporum sp. When hematogenous dissemination of a mycosis to the skin is suspected, the diagnosis must be based on biopsy specimen demonstration of dermal invasion, ideally with positive cultures. Pityrosporum sp, common skin saprophytes, may produce folliculitis, and be mistaken for pathogenic yeasts.

Estimation of body composition by measurement of tetrapolar bioelectrical resistive impedance (R) is a technique only recently validated in adults. To evaluate this technique in children, 16 girls aged 11.6 +/- 0.9 yr (mean +/- SD) and 14 boys aged 12.5 +/- 1.0 yr were assessed for fat free mass (FFM) by hydrostatic weighing, total body potassium (TBK) by whole body counting of 40K, and R by an electrical impedance plethysmograph. Significant relationships (P less than 0.001) were demonstrated between TBK and ht2/R (r = 0.92), and FFM and ht2/R (r = 0.83). The reliability coefficient for the impedance measurements was r = 0.97. The following equation describes FFM in the present group of children: FFM (kg) = 6.86 + 0.81 x (ht2/R), r = 0.83, P less than 0.001, SEE = 4.08. These data suggest that impedance measurements are valid and reliable predictors of FFM in pediatric populations.

An intramuscular injection into a relaxed muscle is believed to result in less discomfort than an injection into a contracted muscle. When the femur is internally rotated, the gluteus maximus muscle is relaxed. The hypothesis that a dorsogluteal injection with the femur internally rotated will cause less discomfort than when the femur is externally rotated was tested in 44 surgical patients who received two injections of preoperative medication. Each patient received an injection of a narcotic medication and one of diazepam. All possible combinations of the factors--position (internal and external rotation), order of injection (first or second injection), and medication (narcotic or diazepam)--were determined, and patients were randomly assigned to one of these conditions. Patients rated their perceived discomfort after each injection on a five-point scale. The hypothesis was supported by discomfort ratings from injections of both types of medications, although diazepam injections caused significantly more discomfort than injections of narcotics. Older patients tended to report less discomfort from diazepam injections than younger patients. Sex, order of injection, and nurse administering the injection did not significantly influence discomfort ratings.

The case described here represents the first laboratory-confirmed case of inclusion blennorrhea at the Mayo Clinic since laboratory isolation of Chlamydia trachomatis was instituted in 1974. Treatment with a sulfonamide preparation proved effective. Further aspects of the diagnosis and treatment of inclusion blennorrhea are discussed.