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The state of the art of definition of community violence as it relates to child development was examined in terms of the definitions used in 23 empirical studies. In all cases community violence was defined in terms of what were assumed to be measurements obtained as linear combinations of a priori numerical weighting of responses to questions--asked either of a child or of the parent of a child--about experiencing and/or witnessing and/or hearing about instances of violence. Thus, the definitions can be seen to represent the perspectives of 2 kinds of observers--the child or the child's parent--and 3 levels of closeness to violence--experiencing, witnessing, or hearing about violence. Combining these perspectives and levels, the following 8 different definitions could be seen to be used in the practice of 1 or more of the 23 empirical studies: Child Self-Report (perception) of either (1) experiencing, or (2) witnessing, or (3) experiencing and witnessing, and hearing about violence; or Parent Report (perception) of the Child (4) experiencing, or (5) witnessing, or (6) experiencing and witnessing and hearing about violence, or (7) = (1) + (4), or (8) = (3) + (6). In almost all the examples of research definitions it was assumed implicitly and without test of the assumption that different violent events were interchangeable, and usually it was assumed (again without test) that the magnitudes of different violence events were equal. Usually, an unstated theory of stress appeared to guide the measurement definition, but in one study definitions were developed and tested in terms of a clearly-stated theory of learning. It was concluded that definition of community violence is a measurement problem; that very likely it is multidimensional; that it could be more nearly solved if better attention were given to specifying it in terms of theory that can be put to test and by attending to basic assumptions and principles of measurement.

A 41-year-old man had a peripheral neuroectodermal tumor develop at the distal third of the fibula 4 years after radiotherapy for relapsed villonodular synovitis. This type of sarcoma usually is classified into the heterogeneic group of small round-cell bone tumors as a subdivision of Ewing's sarcomas. The immuno-staining positivity of the neoplastic cells for the neuron-specific enolase allowed the authors to make the diagnosis of a tumor with neuroectodermal origin. When the histologic study confirmed the diagnosis, the patient was treated with chemotherapy, surgical excision of the tumor, and adjuvant radiotherapy. Radiotherapy is thought to be involved in the genesis of osteogenic sarcomas as it has been shown in several reports, but there is no evidence in the literature of a peripheral neuroectodermal tumor developing after radiotherapy.

Background: Intra-abdominal pressure rises in some circumstances and can cause abdominal compartment syndrome. Severe acute pancreatitis frequently causes abdominal compartment syndrome., Objective: Our objective was to identify the relationship between severity of pancreatitis and abdominal pressure., Material and Methods: From September 2001 to September 2002, all patients with acute severe pancreatitis were included in the study; exclusion was effected with history of abdominal surgery for pancreatitis or ventral hernias. In all patients, we carried out laboratory tests to establish ranson criteria, Apache II score, and indirect measurement of abdominal pressure. Lineal regression and chi-square test were done., Results: A total of 25 patients was included, 10 men and 15 women, average age 49.4 years, 11 with mild pancreatitis and 14 with severe acute pancreatitis. Abdominal pressure was 2 to 19 cm H2O. On statistic analysis, there was strong positive correlation between Apache II score and IAP and 0.781 of correlation coefficient and 99.5% confidence interval.

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.

We reviewed the results of the treatment of 24 cases of open tibial fractures using unreamed intramedullary locking nailing. The fractures were classified, following the Gustilo system as grade I-7, grade II-7 and grade III-10. The average time to achieve bony union was 22 weeks with a 26% incidence of pseudoarthrosis. There were no cases of deep infection. Five cases healed with shortening of over 1 cm, but we did not observe angular deformity in any of the patients. In 2 fractures with associated articular lesions, joint motion was limited at final follow up. The nail broke in 2 cases and the screws in 5. The surgical procedure is well tolerated by patients, allows good management of soft tissue lesions and rehabilitation with low rate of infection and malunion. The main disadvantages have been the relative high incidence of nonunion and breakage of metal.

We report a prospective study of 30 patients who underwent total hip arthroplasty for osteoarthrosis in order to investigate the haemodynamic and respiratory changes which occur during operation. Cement was used in 17 cases and the implants were not cemented in 13. Pulmonary and cardiac function, blood levels of methylmethacrylate monomer, intramedullary pressure and transoesophageal echocardiography were recorded. Two well differentiated echogenic patterns appeared consistently during the operation. The intramedullary pressure became raised as the cement was inserted. The following changes occurred within seconds and continued for some minutes: elevation of mean arterial pressure and mean pulmonary artery pressure; decrease of arterial oxygen tension and of mixed venous PO2, and greater tissue consumption of oxygen. Although we recorded raised concentration of methylmethacrylate monomer in venous blood after the cement was inserted, there is no evidence that the monomer is responsible for the haemodynamic changes which take place.

A passenger-side occupant of a car involved in a collision suffered bilateral Smith's fracture after extending both arms for protection and being hit by the deploying airbag.

One of the main functions of alpha 1-antitrypsin (A1AT) is to inhibit the activity of most proteases. It has been suggested that a deficiency in this protein may favor invasion by cancer cells--consequently, individuals with A1AT-deficient alleles (null, S and Z) may be at greater risk of tumoral invasion due to their lower capacity of response to proteolytic enzymes. This work examines the frequencies of A1AT phenotypes in breast cancer (BC) patients. A sample of patients classified as having infiltrative ductal carcinoma was chosen to be studied as it is a highly invasive tumor, and a sample of patients with BC and a familial history of cancer has also been studied. An increase in the frequency of A1AT-deficient phenotypes was not observed in any of the three groups. One possible explanation could be the immunosuppressive activity of A1AT.

Teaching strategies for a new specialty constitute a challenge to ensure the rapid development of human resources for the purpose of supporting these activities. In the health economics field a plan was applied for coping with the needs of teaching activities in the field. The activities developed in the plan are presented in this paper, included under the following items: A. Theoretical organization of the contents of the subject. B. Organization of contents according to the students' needs. C. Support given to teachers. D. The whole strategy also includes: academic interchange, technical advisory services, dissemination of results through meetings, publications and academic organizations. E. Median term agenda: Human resources; Financial resources; Teaching strategies; Interaction between health services and decision makers; and Collaborative network.

To compare the muscle relaxing effect of pancuronium, atracurium and vecuronium, 99 patients operated on under neuroleptanesthesia were divided in three groups depending on whether they had received, during induction, pancuronium 0.1 mg/kg, atracurium 0.5 mg/kg, or vecuronium 0.1 mg/kg. One-fourth of the initial dose was repeated if necessary. The electromyographic study of the muscle relaxing effect was carried out with stimulation of the cubital nerve with courses of supramaximal square wave electric stimuli in 'trains of four'. The time to maximal blockade (TMB), the time of clinical effectiveness (TCE), the total duration time (TDT), the time of duration of the maintenance dose (DM 25) and the recovery index (RI) were measured. TMB was 4.3 +/- 1 min for pancuronium, 3.5 +/- 0.8 min for atracurium, and 3.3 +/- 0.98 min for vecuronium. The differences between pancuronium and the other drugs were statistically significant, but they were not so between the latter two. TCE was 67.9 +/- 13.5 min for pancuronium, significantly longer than with vecuronium and atracurium (28.2 +/- 5.7 and 31.5 +/- 4.7, respectively). TDT was 126.2 +/- 19.9 min for pancuronium, 61.2 +/- 11.5 min for atracurium and 55.5 +/- 16.7 for vecuronium. The mean duration of the repeated dose was 52.7 +/- 8.4 min for pancuronium, 19.9 +/- 5 min for vecuronium and 10.9 +/- 5 min for atracurium. RI, which was similar for atracurium and vecuronium (12.7 +/- 1.7 min and 12.8 +/- 3.3 min), was longer for pancuronium (27.7 +/- 4.3 min).

The effect of gamma-hydroxy, gamma-ethyl, gamma-phenyl-butyramide (HEPB) on afterdischarges produced by hippocampal stimulation in cats was studied. HEPB notably diminished the duration of afterdischarges and in some cats blocked their propagation into the substantia nigra and the amygdala. HEPB treatment also antagonized the enhancement of afterdischarge duration produced by subconvulsive doses of bicuculline, whereas treatment with diphenylhydantoin strongly potentiated this effect of bicuculline. The intracisternal injection of HEPB or gamma-aminobutyric acid (GABA) in mice resulted in a potentiation of strychnine-induced convulsions. On the other hand, neurochemical experiments in mouse brain cortex slices and in synaptosomes demonstrated that HEPB did not affect the high affinity uptake of [3H] GABA, its spontaneous or Ca2+ dependent release stimulated by depolarizing K+ concentrations, and its Na+ independent binding to synaptic plasma membranes.

Ruthenium red was administered to mice and cats intracranially or intraperitoneally. In mice, intracisternal administration produced status epilepticus and tonic convulsions. In contrast, intraperitoneal administration induced total flaccid paralysis lasting several hours. These effects of Ruthenium red were partially blocked by the simultaneous administration of CaCl2. EDTA, at doses much greater than those of Ruthenium red, produced effects similar to those of the dye, which were also blocked by CaCl2 administration. In cats, intraventricular or intrahippocampal administration of Ruthenium red through a permanently implanted cannula produced after a few minutes subclinical paroxysmal activity in all brain regions recorded. After several hours the animals developed typical grand mal seizures. Intraperitoneal injection of Ruthenium red to cats did not affect the EEG but markedly depressed muscular activity. Administration of carbachol to the latter animals produced myoclonic responses. These results are discussed in relation to the inhibitory effect of Ruthenium red on Ca2+ transport and binding to membranes, and to the role of this cation on neurotransmitter release.

This study describes the problem in the health field of integrating teaching and services, since there is no clear definition of the functions and tasks of manpower required in services nor a specification of how the manpower must be trained in the educational system. As an example of a systematic analysis of the problem, the study cites a research project carried out in Mexico, whose objectives were: to develop a technique to determine the kind and number of health personnel that must be trained; to provide a link between the training units and health service institutions and to try to integrate the curricula of each of the categories of health personnel. The subsequent stages give a detailed description of the task analysis process. At the educational level, the information obtained leads to the development of curricula more relevant to national needs; at the institutional level, it leads to the introduction of standards of evaluation for a better analysis of services and to the establishment of services with more extensive coverage. Another advantage is that the system can be used at the regional level without duplicating the model for each locality. In addition, the information produced is conducive to the development of curricula that provide for the lateral and vertical mobility of manpower.