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Management of severe spasticity in children is often a difficult problem. Orally administered medications generally offer limited benefits. This study examines the value of intrathecally administered baclofen in the treatment of 19 children with severe spasticity of cerebral origin: eight of whom sustained brain injury associated with trauma, near drowning, or cardiac arrest; 10 with cerebral palsy (spastic quadriplegia); and one child with Leigh's disease. At the time of entry into the study, patients ranged from 4 to 19 years of age, and all were completely dependent on caretakers for activities of daily living. Children who responded positively to a trial dose of intrathecal baclofen underwent insertion of a drug delivery system for continuous infusion. This was followed by a double-blind trial of baclofen or placebo and follow-up review at 3 and 6 months, and yearly thereafter. Seven children did not undergo pump implantation because of excess sedation or poor response. The 12 remaining children have been followed for a period of 1 to 5 years. Favorable responses were present in all 12 children as determined by the Ashworth Scale, with the greatest benefit being reduction of lower limb tone. Except in the case of one child who had reduction in lower limb tone that resulted in difficulty with transfers, the caretakers all reported significant benefits from intrathecal baclofen, with improvement in muscle tone, behavior, sitting, and general ease of care being most commonly noted. Central side effects were seen in some children who received continuous intrathecal baclofen infusion and included hypotension (two patients), bradycardia (two), apnea or respiratory depression (two), and sedation (one). During a total of 568 months of pump operation there were 10 mechanical complications, including two related to pump or side port failure and eight related to catheter kinks, extrusions, or dislodgment. Pump pocket effusion occurred in five children and a cerebrospinal fluid fistula was seen in one child. Local infection occurred in three children and meningitis in two children. The results demonstrate the potential value of continuous intrathecal baclofen infusion for treatment of severe spasticity of cerebral origin. However, this treatment can result in significant complications and more experience is required before the long-term benefits can be determined.

The product of the human immunodeficiency virus type 1 (HIV-1) vpr gene induces cell cycle arrest in the G2 phase of the cell cycle and is characterized by an accumulation of the hyperphosphorylated form of cdc2 kinase. This phenotype is similar to the effect of DNA-damaging agents, which can also cause cells to arrest at G2. We previously reported that Vpr mimicked some of the effects of a DNA alkylating agent known as nitrogen mustard (HN2). Here we extend these earlier observations by further comparing the activation state of cdc2 kinase, the kinetics of G2 arrest, and the ability to reverse the arrest with chemical compounds known as methylxanthines. Infection of cells synchronized in the G1 phase of the cell cycle with a pseudotyped HIV-1 resulted in arrest at G2 within 12 h postinfection, before the first mitosis. Similar to that induced by HN2, Vpr-induced arrest led to a decrease in cdc2 kinase activity. Vpr-mediated G2 arrest was alleviated by methylxanthines at concentrations similar to those needed to reverse the G2 arrest induced by HN2, and cells proceeded apparently normally through at least one complete cell cycle. These results are consistent with the hypothesis that Vpr induces G2 arrest through pathways that are similar to those utilized by DNA-damaging agents.

Twenty-eight children with developmental disorders underwent an interdisciplinary assessment for diagnosis and recommendations about management. Following this assessment, the degree of agreement on diagnosis and recommendations between parents and the team was determined. There was substantial agreement for diagnosis of clearly identifiable conditions such as genetic disorders, autism, and mental retardation but less agreement for milder disorders such as learning disabilities, attention deficit disorder, and emotional disorders. Agreement on management varied, being higher for speech therapy and psychosocial interventions but lower for use of stimulant medication and diet. The parents identified additional diagnostic labels in their child and mentioned more recommendations than the clinicians prescribed. The results suggest the need for careful attention to parent perceptions following interdisciplinary assessment.

During a 9-month period at a small surgical center, seven cases of postarthroscopic septic arthritis occurred after 352 arthroscopic procedures, for an infection rate of 2.0%. Electrocardiographic cables contaminated with Pseudomonas aeruginosa from an unsterile cleaning solution probably led to two shoulder infections. Five other infections (one definite Staphylococcus aureus and three definite and one possible coagulase-negative staphylococci) were attributed to inadequate arthroscope disinfection. In the initial phase of the outbreak, use of intraoperative intraarticular corticosteroids correlated with the occurrence of infection.

Disabled children represent an important "at-risk" group for emotional and behavioral problems. This study determined how they assess their own social function in regular classrooms and compared them with their able-bodied peers. School principals identified 60 visibly disabled children who were integrated into regular classes for at least 50% of the time. A comparison group of 56 randomly selected, same-gender classmates was identified. Children completed the Perceived Competence Scale and a classroom sociometric scale. Parents and teachers were asked to rate each child's social function. Disabled children rated themselves lower on physical competence (mean = 2.53 vs 2.92, p = .002) but not on social or cognitive competence. However, disabled children had fewer friends and scored lower on the classroom sociometric measure than did their able-bodied classmates (mean = 2.06 vs 2.39, p = .01). There was no difference between disabled and control children when social function was assessed by parents or teachers. For all children two variables were significantly associated with the child's self-perceived social competence: the child's self-perceived physical competence (R2 = .27) and the peer sociometric rating (R2 = .13). Teacher perception (R2 = .35) and self-perception (R2 = .10) of social function were most strongly associated with the perception of peers. In both cases whether the child was disabled contributed little to the observed association. These findings support the importance of peers in the successful social function of children and suggest that teachers can have an impact on how children are perceived by other children.(ABSTRACT TRUNCATED AT 250 WORDS)

During a 4-year study of 4,256 knee arthroscopies, eighteen patients became infected (infection rate 0.42%). Occurrence of infection was strongly associated with use of long-acting intraarticular intraoperative corticosteroids. Infection was more common among patients with longer surgery operating times, increased numbers of procedures during surgery, prior procedures, and performance of chondroplasty or soft tissue debridement. Subsequent to the study, the infection rate fell to 0.1%. Twenty-four infections were studied (our eighteen plus six other concurrent community cases); twelve were due to Staphylococcus aureus, eleven to coagulase-negative staphylococci, and one to Enterobacter cloacae. Seventy percent of the patients had onset of symptoms within 3 days of surgery. Most patients with coagulase-negative staphylococcal infections had fevers less than 38.3 degrees C (101 degrees F), negative Gram stains on synovial fluid, normal peripheral leukocyte counts, and somewhat indolent, mild clinical syndromes, while most patients with S. aureus infections had higher fevers, positive synovial Gram stains, peripheral leukocytosis, and more acute and severe clinical syndromes. Knee pain, swelling, and warmth always occurred, but erythema was noted in only 30% of patients. Treatment with 2 weeks of intravenous antibiotics was successful in all but one patient. Long-term results were excellent in sixteen of twenty-two patients.

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

We report a case of presumed cryptococcal endophthalmitis that occurred in a patient with severe disseminated cryptococcosis and AIDS. Multiple small, spherical lesions appeared bilaterally on the surface of the retina 2 weeks after cryptococcal meningitis was diagnosed; the lesions were associated with multiple blind spots, blurred vision, and the perception of flaring of light. Over the next week, many more lesions with adjacent hemorrhages appeared. Therapy with itraconazole over the next 3 months resulted in complete resolution of the lesions. Cryptococcal endophthalmitis is a rare disease. Fewer than 20 cases, including five in patients with AIDS, have previously been reported. None of these patients regained normal vision.

Two cases of adverse reaction to bacillus Calmette-Guerin (BCG) bladder instillations are reported. In both cases transient fevers and systemic symptoms developed following the instillations. After an additional instillation 1 patient had high fevers, severe myalgias and profound weakness followed by rhabdomyolysis and anuric renal failure, which required 3 weeks of hemodialysis before recovery. Extensive evaluation revealed no cause other than the BCG instillations. In the other patient a firm subcutaneous nodule gradually developed on the chest wall, which contained nonviable acid fast bacilli.

In 1988 a follow-up investigation was made of a case-control study conducted in 1962 in Iceland which tested hypotheses that trace elements in pasture grass, drinking water and cow's milk were associated through diet with cancer of the stomach. Samples were collected in 1962 from 26 farms in the northern county of Skagafjardarsysla and 30 farms in the southern county of Rangarvallasysla. The main objective of the present study was to establish the cancer experience of the 297 residents of the 56 farms since 1962. In the records of the Icelandic Cancer Registry 31 cases of cancer of all types were identified. Six were cancers of the stomach and four of these were from control farms. The revised comparison of trace element analyses for case and control farms yielded no change in earlier results for pasture grass in Skagafjardarsysla (excess levels of B, Na, AI, Fe and Cu on cancer farms), but B appeared as a significant deficiency on cancer farms in Rangarvallasysla. Drinking water results were unchanged (no significant differences), but for milk the significantly high mean values of Fe and Zn reported earlier for Rangarvallasysla did not appear. The pronounced geographical variation in Icelandic stomach cancer incidence that was widely cited from 1961-65 is now believed to have been spurious.

The synthesis and antimicrobial evaluation of novel bicyclomycin analogues are described. The series of analogues were prepared from the basic 8,10-diaza-2-oxabicyclo[4.2.2]decane-7,9-dione, 7,9-diaza-2-oxabicyclo[3.2.2]nonane-6,8-dione 8,10-diaza-5-methylene-2-oxabicyclo[4.2.2]decane-7,9-dione and 7,9-diaza-4-methylene-2-oxabicyclo[3.2.2]nonane-6,8-dione nuclei. For compounds where R1 = p-methoxybenzyl, deprotection of the lipophilic amides with ceric ammonium nitrate affords the corresponding lipophobic free amides. The basic bicyclic nucleus of bicyclomycin (8h, R1 = R2 = R3 = R4 = H) has been synthesized for the first time as well as increasingly more complex congeners bearing the C-6 OH, 5-methylene; C-1'-C-3' trihydroxyisobutyl group. In general, it has been found that the bicyclic nucleus of bicyclomycin is devoid of antimicrobial activity, the entire structure of bicyclomycin being generally obligate for activity. In one instance, the racemic analogue 10c (R1 = CH2Ph, R2 = OH, R3 = H) showed interesting antimicrobial activity against several Gram-positive organisms; the minimum inhibitory concentrations were of the same order of magnitude as bicyclomycin displays toward Gram-negative organisms. Totally synthetic (+/-)-bicyclomycin was half as active as the natural antibiotic. The design, synthesis, and antimicrobial activity (and/or lack thereof) of bicyclomycin and the analogues are discussed in the context of a proposed chemical mechanism of action.

The role of testosterone in follicular development was investigated by immunizing female rabbits (mean wt 1.4 kg) to testosterone-3-bovine serum albumin (T-3-BSA). Controls received BSA. Follicular diameters and histology, and ovarian and uterine weights were recorded at intervals up to 11 weeks. At 5 weeks T-3-BSA ovaries did not differ from controls in either histology or follicular diameter (number of follicles greater than or equal to 1.0 mm were 12.5 +/- 3.4 and 17.0 +/- 1.0 for BSA and T-3-BSA treated animals respectively). By 8 weeks T-3-BSA animals had multiple cystic and hemorrhagic follicles. T-3-BSA ovaries contained more follicles greater than or equal to 1.0 less than 1.5 mm (27.3 +/- 3.1 vs. 15.3 +/- 2.9, p less than 0.01) and greater than or equal 1.5 mm diameter (5.8 +/- 1.7 vs. 0.4 +/- 0.3, p less than 0.005). At 11 weeks T-3-BSA ovaries contained more follicles less than 1.5 mm in diameter (5.0 +/- 0.9 vs. 0.9 +/- 0.3, p less than 0.001). Increased vascularization, some thecal hypertrophy and marked interstitial cell hypertrophy were characteristic of the T-3-BSA ovaries at 8 and 11 weeks. These results suggest that testosterone has a role in the regulation of follicular development.

The history of efforts to establish a cancer registry in Malaysia since 1961 is reviewed. In 1980, the staff of the Institute for Medical Research in Kuala Lumpur was authorized to develop an official registry that would combine the resources of the various university faculties, the hospitals, research institutes, and the Cancer Society. Special registries operate for oral precancerous conditions and for nasopharyngeal carcinoma (NPC). The topics of recent epidemiological studies include: a review of all cancers diagnosed at the University Hospital during 1972-74, the association of Epstein-Barr virus and NPC, social and environmental factors associated with NPC, oral cancers, and childhood cancers.

Research on attitudes toward the disabled generally has focused on adult perceptions of disabled adults, or children's attitudes toward peers. In view of changing social practices, such as mainstreaming in education and community integration of children with special needs, measures of adults' attitudes toward disabled children are needed. This paper reports on the development and validation of a 30-item self-report questionnaire assessing parental attitudes toward children with handicaps, and presents information concerning several determinants of parental attitudes. The measure is easy to use, reliable, and shows good evidence of construct validity. It detects differences among parents by gender, by parental education and occupational status, by cultural background of parents, by parental familiarity with a handicapped person, and by stimulus (physically disabled vs. mentally retarded child referent). Results are discussed in relation to determinants of parental attitudes toward handicaps. Potential applications of this measure for evaluation of teacher attitudes are suggested.

Malaysia and Hawaii have several advantages for epidemiologic and laboratory studies on nasopharyngeal carcinoma. Both have multiethnic populations with different incidence rates of nasopharyngeal carcinoma and different life-styles. Malaysia has large populations of Chinese, Malaya, and Indians, and the number of cases of nasopharyngeal carcinoma at any one time is comparatively large. Incidence rates for 1968--72, age-standardized to the World population, for Guangdong hua (Cantonese Chinese) in Malaysia were 24.3/100,000 for males and 12.0/100,000 for females. In Hawaii, the ratio was 12.9/100,000 for males and 6.7/100,000 for females. The small number of cases in Hawaii would require that research in that State be conducted in collaboration with research elsewhere with larger case numbers.

We conducted a case-control study of nasopharyngeal carcinoma among Malaysian Chinese to test inhalants, salted fish consumption, and use of tobacco, alcohol, and nasal ointments as risk factors for the disease. Interviews with 100 cases and 100 controls indicated that salted fish consumption during childhood was a significant risk factor (relative risk, 3.0; p = 0.04); childhood daily consumption of this food item compared to nonconsumption carried a relative risk of 17.4 [95% confidence interval = (2.7, 111.1)]. Occupational exposure to smokes (relative risk, 6.0; p = 0.006) and to dusts (relative risk, 4.0; p less than 0.001) was also significantly associated with nasopharyngeal carcinoma. The two risk factors (consumption of salted fish and exposure to smoke and/or dust) were independent of each other. There was no association between nasopharyngeal carcinoma and tobacco, alcohol, or nasal ointments.

No population-based cancer registry exists in Malaysia; thus our main sources of incidence data were biopsy series. We determined the frequency of cancers by body site, sex, and ethnic group from biopsy records of the Division of Pathology of the Institute for Medical Research in Kuala Lumpur for the years 1969-71. We then made comparisons of leading sites with data from the Singapore Cancer Registry. Relative risk values for 21 sites indicated significant differences among ethnic groups for cancers of the nasopharynx, larynx, lung, bone, skin, cervix, ovary, prostate, and penis and for lymphomas.

Of 33 patients who underwent 49 breast implantations for reconstructive surgery, 8 (24%) patients developed implant infections. All 8 of these patients were among a subgroup of 15 having immediate breast reconstructions with tissue expander implants after simple or modified radical mastectomy (a 53% infection rate). The infection rate increased substantially when bilateral procedures involving implants were performed as opposed to unilateral implants. Nine implants were removed (an overall implant loss rate of 18%). Patients who underwent other breast reconstruction techniques (i.e., including immediate reconstruction with permanent implants or delayed reconstruction with or without tissue expanders) did not develop infection unless they had had simultaneous immediate reconstruction with a tissue expander in the contralateral breast. The most frequently isolated organism was the coagulase-negative staphylococcus. The study concludes that neither the tissue expander nor immediate reconstruction is a risk factor, but the combination may lead to an unacceptable infection rate, especially in the face of bilateral breast procedures.

The effects of active immunization of female rabbits against testosterone on various endocrine parameters during pregnancy were examined. Peripheral blood samples were obtained from immunized rabbits at timed intervals after mating up to the 29th day of pregnancy, when the rabbits were killed and various tissues were analyzed. Progesterone concentrations were higher in testosterone-immunized rabbits (TIR) than in controls during pregnancy. Luteinizing hormone (LH) and follicle-stimulating hormone concentrations were not significantly different in controls and TIR during pregnancy. Both progestins and gonadotropins showed the expected coitus-induced increases, but LH levels were higher in TIR. The binding of testosterone in fetal plasma and amniotic fluid was higher in TIR than in controls. Weights of fetuses and litter size were not significantly different in TIR and controls. These data suggest that testosterone may play a role during pregnancy in the rabbit.

We conducted 2 case-control studies with Malaysian and Hong Kong Chinese and investigated the association between salted fish intake and nasopharyngeal carcinoma (NPC). Both studies show a highly significant association between salted fish intake, especially during childhood, and NPC. Furthermore, from our results we estimate that the majority of NPC cases occurring in the southern Chinese can be attributed to their consumption of this food early in life.

The evidence for a hypothesis that eating salted fish is associated with nasopharyngeal carcinoma (NPC) is reviewed. The hypothesis was tested among Malaysian Chinese using a matched case-control design. The kinds of salted fish and patterns of use were also investigated in a control group comprising 100 Chinese, 50 Malay and 50 Indian households. During 1980, in Selangor, Malaysia, interviews with 100 Chinese cases of NPC and 100 non-disease controls indicated that salted fish consumption during childhood was a significant risk (relative risk = 3.0, P = 0.04), with an elevated risk for daily as opposed to less frequent consumption. Salted fish consumption during adolescence was a less significant risk, and current consumption not at all. There were 19 kinds of fishes reported as being eaten as salted fish by the 200 control households. There were marked differences between ethnic groups in preference for different kinds: Chinese preferred red snapper (74% of households), Malay jewfish (54%) and Indian red snapper (28%). Salted fish was hardly ever eaten daily by any household; weekly was a moderate frequency in all ethnic groups; less than weekly most common. There were no statistically significant differences between Chinese NPC case and non-disease control participants in kind of salted fish eaten. Results were the same when the data were analyzed by sex, subethnic group and income.