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Objectives: To decrease the emotional distress of child victims of extrafamilial sexual abuse (ESA) and their families. To provide crisis intervention, individual and group treatment in response to an expressed need in the community. To pilot the use of group treatment for child victims of ESA under age 10., Method: This discussion describes intervention with a sample of 246 child victims, ages 2-14 years, and 323 parents who participated in the program from 1984 to 1991. This pilot project operated at a university medical facility and was located off campus in an outpatient child abuse center. Priority was given to child victims under age 7. Child victims and their families were evaluated after investigative interviews by law enforcement agencies were completed. A treatment plan was developed based on clinical assessment. Families participated in crisis counseling, individual treatment for the child victim and/or parent, Children's Treatment Groups, Parent Support Groups, or were referred to other resources. Clinical assessment of treatment progress included weekly case review by child and parent therapists, video analysis and observation of Children's Treatment Group sessions, consultation with parents and collateral contacts., Results: A family approach and services for parents in addition to intervention for child victims were determined to be key components in facilitating recovery. Clinical observations and client feedback showed positive outcomes for child victims and parents with crisis counseling, Children's Treatment groups, and Parent Support Groups. The extent of intervention ranged from one session to 24 months with an average participation of 6-9 months. Follow up surveys were returned by parents for 48 child victims and results are reported. Themes, parallels in responses, and recovery factors for child victims and parents are discussed., Conclusions: The need for intervention and a community-based program was demonstrated by (1) the significant disruption in functioning that occurred for child victims of ESA and their families, (2) the risk for long term sequelae, (3) the high incidence of extrafamilial sexual abuse, and 4) the consistent, large number of requests for services. Family-centered crisis services, Children's Treatment Groups, and Parent Support Groups can be effectively based at child advocacy centers, out patient care clinics, or other community agencies. The results of formal outcome measures and longitudinal studies is needed to determine how child victims and parents benefit from specific treatment modalities and to better guide the use of limited resources.

We performed a phase I trial to evaluate the safety and tolerability of repeated skin injections of IL-2-transfected autologous melanoma cells into patients with advanced disease. Cell suspensions, propagated from excised metastases, were IL-2 gene transfected by adenovirus-enhanced transferrinfection and X-irradiated prior to injection. Vaccine production was successful in 54% of the patients. Fifteen patients (37%) received two to eight skin vaccinations of either 3 x 10(6) (intradermal) or 1 x 10(7) (half intradermal, half subcutaneous) transfected melanoma cells per vaccination (secreting 140-17,060 biological response modifier program units of IL-2/10(6) cells/24 hr). Analyses of safety and efficacy were carried out in 15 and 14 patients, respectively. Overall, the vaccine was well tolerated. All patients displayed modest local reactions (erythema, induration, and pruritus) and some experienced flu-like symptoms. Apart from newly appearing (4 of 14) and increasing (5 of 14) anti-adenovirus and newly detectable anti-nuclear antibody titers (1 of 15), recipients developed de novo or exhibited increased melanoma cell-specific delayed-type hypersensitivity (DTH) reactions (8 of 15) and vitiligo (3 of 15) and showed signs of tumor regression (3 of 15). This supports the idea of a vaccine-induced or -amplified anti-cancer immune response. None of the patients exhibited complete or partial regressions, but five of them experienced periods of disease stabilization. Three of these individuals received more than the four planned vaccinations and their mean survival time was 15.7 +/- 3.5 months as compared to 7.8 +/- 4.6 months for the entire patient cohort. These data indicate that IL-2-producing, autologous cancer cells can be safely administered to stage IV melanoma patients and could conceivably be of benefit to patients with less advanced disease.

Partial abstraction of apical methyl groups is observed in aminopyridinatoniobium alkyne complexes, as exemplified with the synthesis and characterization of 1. This results in cationic complex fragments, which facilitate the polymerization of ethylene and in the presence of methylalumoxane the selective dimerization of 1-butene., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)

Enantiomeric excesses of up to 99 % could be obtained in the synthesis of the biologically interesting acylated α-aminophosphinic acids 1 (R 1 =Me, Ph; R 2 =H, Me, Et; R 3 =H, F, iPr) by asymmetric hydrogenation with rhodium complex catalysts and subsequent hydrolysis [Eq. (1)]. cod=1,5-cyclooctadiene., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)

The reaction of a neodymium "ate" complex and an electron-rich transition metal chloride by salt elimination is an efficient method for synthesizing heterobinuclear compounds which contain a lanthanide and a Group 9 or 10 metal [Eq. (1), H 2 Ap=2-amino-4-methylpyridine]. The use of bisaminopyridinato ligands allows extremely short distances between Rh or Pd and Nd., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)

A ligand transfer from yttrium to palladium and the regeneration of 1 are the crucial steps in the efficient synthesis of the very strained amidopallium complex 2 from [(cod)PdCl 2 ] and 1 (cod=cyclooctadiene). In the light of the numerous "ate" complexes of early transition metals, this synthetic route should have enormous potential., (© 1998 WILEY-VCH Verlag GmbH, Weinheim, Fed. Rep. of Germany.)

Itasetron hydrochloride is a new 5-hydroxytryptamine3 (5-HT3) antagonist. Experimental investigations show that orally it is rapidly absorbed (about 90 min), is highly bioavailable (greater than 90%), has a long half-life (about 12 h) and is more potent (about 10 times) in animal models than ondansetron, currently standard therapy for the prophylactic control of chemotherapy induced nausea and vomiting. This paper describes the results of a study designed to assess the efficacy and tolerability of five (0.5, 1, 2, 4 and 8 mg) twice-daily doses of itasetron hydrochloride, in comparison with 8 mg b.i.d. ondansetron. Assessments were made in patients (n = 104) with histologically confirmed cancer (excluding head and neck tumors) and about to receive their first course of moderately emetogenic chemotherapy. Itasetron hydrochloride demonstrated comparable efficacy to ondansetron; no statistically significant between-group differences were observed in the primary (complete response rate) or secondary (nausea and delayed emesis) efficacy criteria. Adverse events were similar in type and incidence across all treatment groups, and were those expected for this therapeutic class. The tolerability of itasetron hydrochloride was assessed as 'very good' or 'rather good' by 81% of patients and 89% of physicians. In conclusion, itasetron hydrochloride is effective and well tolerated in patients receiving moderately emetogenic chemotherapy. Oral doses of 1 mg b.i.d. or above will be used in further clinical studies.

The reaction of trimethylsilyl-substituted 2-aminopyridines with mixed chloro(dialkylamido)metal complexes (titanium and zirconium) leads via amine elimination to octahedral group 4 metal complexes that contain amine, amido, and aminopyridinato ligands. The X-ray crystal structure analyses of (4-Me-TMS-APy)(NMe(2))(HNMe(2))TiCl(2) (1) (crystallographic data: P2(1)/c (No. 14), monoclinic, a = 16.754(2) Å, b = 14.395(2) Å, c = 17.890(3) Å, beta = 110.28(1) degrees, Z = 8) and (6-Me-TMS-APy)(NEt(2))(HNEt(2))ZrCl(2) (2) (crystallographic data: P2(1)/n (No. 14) monoclinic, a = 10.125(1) Å, b = 16.331(1) Å, c = 15.276(2) Å, beta = 93.90(1), Z = 4) prove the compounds to be mononuclear with a cisoid arrangement of the two chloro ligands embedded in a reactive pocket determined by the steric demand of the three nitrogen containing ligands. Oligo- and polymerization studies with propene and 1-butene reveal the following results. First, 1 is a remarkably active precatalyst in contrast to the very low activity of 2. Second, MAO, a 1:1 mixture of i-Bu(3)Al/B(C(6)F(5))(3) (homogeneous polymerization) and ethylaluminum sesquichloride (if 1 is incorporated in a MgCl(2)-matrix) have shown to be the most active cocatalysts. Third, the polymers and oligomers are atactic.

2-(Methylamino)pyridine (Me-APy-H), 2-anilinopyridine (Ph-APy-H), and 4-methyl-2-((trimethylsilyl)amino)pyridine (TMS-APy-H) were used to synthesize mononuclear monochloro complexes that contain two or three such aminopyridines as strained amido ligands. The reaction of 2 or 3 equiv of in situ generated lithium aminopyridinate with TiCl(4)(THF)(2) or TiCl(4) afforded just in the case of Me-APy-H a red crystalline product (Me-APy)(3)TiCl (1a) but in unacceptably low yield. An alternative way to synthesize 1a and (Ph-APy)(3)TiCl (1b) is amine elimination, starting from mixed chlorodimethylamido complexes like (Me(2)N)(3)TiCl or (Me(2)N)(2)TiCl(2). The reaction of (Me(2)N)(3)TiCl with 2 equiv of Me-APy-H, Ph-APy-H or TMS-APy-H afforded (Me-APy)(2)Ti(NMe(2))Cl (2a), (Ph-APy)(2)Ti(NMe(2))Cl (2b), or (TMS-APy)(2)Ti(NMe(2))Cl (2c). These compounds represent novel unusual highly nitrogen-coordinated titanium complexes. X-ray diffraction studies of 1a established its monomeric structure as having a disturbed pentagonal bipyramidal coordination geometry. X-ray crystal structure investigations of 2a-c proved these compounds to be monomeric with a slightly distorted octahedral coordination geometry. The eta(2) binding mode of the strained aminopyridinato ligands is discussed in comparison to the related amidinato ligand system by averaging bond distances and angles of the determined structures. The N(Py)-C-N(amido) angle of 108(1) degrees instead of the desired 120 degrees indicates the highly strained tweezers-like bonding mode. The Ti-N(Py) distances vary within the known range. The Ti-N(amido) distances are more than 0.1 Å longer than the expected values and indicate weak amido bonds. Variable-temperature NMR investigations of complex 2c are indicative of exchange processes which proceed most likely via tetrahedral transition states. Crystallographic data (distances, Å; angles, deg): 1a, C(18)H(21)ClN(6)Ti, a = 9.313(1), b = 10.277(1), c = 11.302(1), alpha = 98.15(1), beta = 108.28(1), gamma = 102.98(1), triclinic, P&onemacr;, Z = 2; 2a, C(14)H(20)ClN(5)Ti, a = 8.725(1), b = 9.258(1), c = 10.778(1), alpha = 83.288(7), beta = 79.977(9), gamma = 78.766(8), triclinic, P&onemacr;, Z = 2; 2b, C(24)H(24)ClN(5)Ti, a = 17.652(3), b = 7.959(1), c = 18.017(3), beta = 111.37(1), monoclinic, P2(1)/a, Z = 4; 2c, C(20)H(36)ClN(5)Si(2)Ti, a = 10.786(1), b = 14.053(1), c = 18.144(1), beta = 97.06(1), monoclinic, P2(1)/c, Z = 4.

Twenty-four children attended a therapeutic preschool for physically and sexually abused children, the Kempe Early Education Project Serving Abused Families (KEEPSAFE), over a 3-year period from 1985-1988. The program provided early education and therapy for abused children so that they could improve developmentally, socially, and emotionally, with the aim that the children would be suitable to enter the public education system. The therapeutic preschool was combined with a home visitation program for the child's parents or primary caretaker, focusing on improving the quality of interaction between the adult and child. The majority of children made developmental gains at a faster rate than would normally be expected as measured by the McCarthy Scales of Children's Abilities and the Peabody Picture Vocabulary Test. Although all 24 children were thought at onset of intervention to be unable to participate in a public school setting, after 12 months in the program over 79% were staffed into the public school system eight (33.3%) into a regular classroom. Three others (12.5%) needed residential care, and two were too young to enter public school. Even though a therapeutic preschool is expensive in terms of the high staff to child ratio needed, it is likely to be beneficial in improving the developmental skills of abused children.

Infants hospitalized for non-organic failure to thrive in the first six months of life are in a life-threatening situation and are already at risk for poor bonding with mother. In light of this, the meaning and use of foster care and how this separation affects the developing mother-child relationship are the issues addressed through examination of 16 cases in which 8 of the infants were placed in foster care and 8 discharged home after the failure to thrive hospitalization. This paper examines (1) maternal histories of pregnancy, labor and delivery and the neonatal status of placed and non-placed infants; (2) the developmental and weight status of placed children; (3) the nature of the decision criteria for after-hospital care; and (4) the mother-infant relationship at initial intake in terms of mother's report of events and observations of feeding and play interactions during a videotaped assessment process. The study found that the interactions between mother and infant in those situations which required foster care were clearly more dysfunctional when compared to those in which the baby was discharged home to mother. Babies in the two groups were comparable in weight status at the time of hospitalization although babies in foster placement had slightly lower scores on the Bayley Scales. Maternal histories of pregnancy, labor, and delivery were similar for the two groups as were the birth and neonatal histories of the infants.

This paper describes the characteristics of thriving and failure to thrive (FTT) children and their mothers and examines the effect of short-term lay health visitor intervention in cases of nonorganic failure to thrive (NO FTT). Twenty-five FTT children and mothers received lay health visitor (LHV) intervention in addition to other community and medical treatment; 25 other FTT children and mothers did not receive the LHV intervention but did receive all other medical and community treatment. Twenty-five thriving children and mothers were matched with the FTT children and mothers in the LHV group on the child's age at intake, sex, birth weight, and the mother's age, ethnicity, and number of living children. At initial assessment, the FTT and thriving groups were found to be comparable on demographic factors, infant birth weight percentiles, apgar scores, complications of pregnancy or delivery, and separations in the newborn period. There were more premature births in the LHV group although the proportion of premature births for the FTT and thriving groups overall were similar. A majority of mothers in the FTT groups had negative memories of childhood in contrast to more positive memories in the thriving group. At initial assessment, the majority of thriving children were developmentally normal and had increased from their birth weight percentiles whereas all of the FTT children had decreased from their birthweight percentiles and over half were developmentally delayed. There were clear differences in mother-child interaction patterns in the thriving and FTT groups. Three patterns of interaction were identified in the FTT group: benign neglect, incoordination, and overt hostility. Intervention had no measurable effect on the child's weight, development, or interaction patterns. Only 8 of 37 FTT children reevaluated 6 months later showed "catch up" growth and only 7 had improved in developmental score category. Patterns of interaction were found to persist over the 6 months in all cases. One to three year follow-up of 44 families emphasized the severity of the condition and the need for differentiation of the severity of the disturbance in the mother-child relationship and for more intensive intervention than was available in this study. Of these 44 cases, 2 children had died, 5 had been physically abused or further neglected, and 10 were in alternative care arrangements.

Mechanical examinations of endothesis materials were carried out aside from microscopic, physical, and chemical trials in a program of testing the biostability of such materials. The results are reported, and the changes of their using value by the course of time are discussed.

This paper presents 6-month follow-up on a group of 16 infants hospitalized during the first months of life for non-organic failure to thrive (N-O FTT) and their mothers. Eight of these infants were placed in foster care and eight were returned home with their parents following hospitalization. The effects of placement on infant outcomes were examined through comparison of developmental scores and weight percentile changes, and the implications of foster care placements for mother-infant interactions were examined through analysis of patterns of interaction in videotaped sessions of feeding and play six months after hospital discharge. This analysis showed that (1) mothers in both groups failed to make significant progress in resolving their own emotional or psychological conflicts through treatment available; (2) weight and developmental status of the infants did not improve as expected in either group, and finally that (3) the patterns of interaction between mother and infant showed little change over time, and, regardless of placement at home or in foster care, remained concerning.

During pregnancy the thyroid is subjected to increased demands which is associated with a tendency to endogenous iodine deficiency. Under the conditions of insufficient iodine supply in the GDR the pathophysiological changes result in: 1. prevalence of goiter in about 60% of pregnant women; 2. enlargement of the extent of neck in more than 50% of all pregnant women examined only returning to the prepregnant status in 25%-40%; 3. prevalence of goiter in newborn with 5%; 12.8% of 1948 stilborn had macroscopically an enlarged thyroid gland, the highest weight being 45 g. More than 53% of the stilborn examined by autopsy had a thyroid weight of over 3 g; 4. in contrast to the regions with sufficient iodine supply renal iodine excretion was steadily decreasing during pregnancy and post partum, changing the iodine deficiency from grade II to grade III; 5. low iodine excretion in newborn: 1.3 +/- 0.2 microgram I/day in goitrous (1.2 +/- 0.2 nmol I/mmol creatinine) 2.2 +/- 0.4 micrograms I/day in non-goitrous (2.0 +/- 0.4 nmol I/mmol creatinine); 6. according to ETR more than 50% of the pregnant examined showed a hypothyroid tendency. The pathophysiological changes during pregnancy caused by insufficient iodine supply can be met efficiently by careful thyroid hormone treatment or by the administration of 150 micrograms I daily. A mandatory iodine salt prophylaxis is demanded.