Fine needle aspiration of secretory breast carcinoma resembling lactational changes. A case report

The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.     

Validity of two methods for assessing oral health status of populations

OBJECTIVE: This investigation assessed two methods for estimating epidemiologic indicators of oral health status among children: (1) a visual-only screening, performed independently by a dental hygienist and a registered nurse; and (2) a parent- or guardian-completed questionnaire. The indicators included dichotomous variables measuring dental caries and treatment needs, presence of sealants, injuries to the anterior teeth, and dental fluorosis. METHODS: Following training and calibration, data were collected over an eight-day period in April 1994 among 632 elementary schoolchildren (aged 5 to 12 years) in Monticello, Georgia. Both screening and questionnaire findings were compared pairwise with results from visual-tactile examinations done by a dentist. Validity, represented by sensitivity, specificity, and predictive values, was assessed for screening results from the dental hygienist, the nurse, and the parent-completed questionnaire. RESULTS: Validity was high for screening for caries and treatment needs (> 90% for sensitivity, specificity, and predictive values in a sample having 30% to 40% prevalence). Less valid data--mainly an effect of false negatives--were obtained for fluorosis, injuries, and presence of sealants. No significant difference in validity was observed between the nurse and the dental hygienist. One-third of respondents to the questionnaire did not know if their children needed fillings (a proxy for untreated decay) or had received sealants; only knowledge of restorations was comparable to results from screening. Intraexaminer reliability for the two screeners ranged from 85 to 100 for percent agreement and 0.70 to 0.93 for kappa scores. CONCLUSIONS: Screening by dental hygienists or nurses can provide valid data for surveillance of dental caries and treatment needs. Training for visual assessment of fluorosis and injuries must be improved to diminish the proportion of false negatives. A parent-completed questionnaire is less effective than visual screening for evaluating oral health status in children.     

Children pain during dental treatment

This research work was done on the set of 69 children and adolescents 6-14 years old at the children's department of the dental clinic, university hospital in Hradec Králové. We found their expectancy of dental pain inadequate to reality: 67% children overestimated expected pain, 12% underestimated it. It does not see that children feelings prior to very performance would signalize in advance how much unpleasant or painful the dental procedure is going to be. We have not found any significant difference in either understanding the instruction or sticking to them, or general cooperation of children. The average time interval of dental procedures fluctuated between 18 and 40 minutes, children were not given any anesthetics (with exception of two cases of extractions) which could be one of the causes of distress. From all the children 35% experienced pain in the dental chair and were able to assess it by VAS and verbally characterize its quality. According to the view of children assessing the subjectively experienced pain intensity there exist two types of dental procedures: the first type being represented by painless but demanding patience procedures, the second group of painful treatment (making fillings or extractions). There were no statistical difference between girls and boys in their experiencing pain but there was some difference between girls and boys as went for an approach of health workers: these much more often tried to support girls.     

Guidelines for the design and conduct of clinical trials on dentine hypersensitivity

Clinical trials on dentine hypersensitivity have been numerous and protocols varied. To date there is little consensus as to the conduct of studies on this poorly-understood yet common and painful dental condition. A committee of interested persons from academia and industry was convened to discuss the subject of clinical trials on dentine hypersensitivity and a consensus report is presented. A double-blind randomized parallel groups design is recommended, although cross-over designs may be used for the preliminary screening of agents. Subjects may have multiple sites scored. Sample size will be determined by estimating the variability in the study population, the effect to be detected and the power of the statistical test to be used. Subject selection is based on a clinical diagnosis of dentine hypersensitivity, excluding those with conflicting characteristics such as currently-active medical or dental therapy. The vestibular surfaces of incisors, cuspids and bicuspids are preferred as sites to be tested. A range of sensitivity levels should be included. Tactile, cold and evaporative air stimuli should be applied. Negative and benchmark controls should be incorporated. Most trials should last 8 weeks. Sensitivity may be assessed either in terms of the stimulus intensity required to evoke pain or the subjective evaluation of pain produced by a stimulus using a visual analog or other appropriate scale. The subject's overall assessment may be determined by questionnaire. Outcomes should be expressed in terms of clinically significant changes in symptoms. Follow-up evaluation is required to determine the persistence of changes. At least 2 independent trials should be conducted before a product receives approval.     

Involvement of adenosine in vanadate-stimulated release of lipoprotein lipase activity

BACKGROUND: Optimal bottle weaning should occur between 12 and 15 months of age. We hypothesized that high-risk populations have different parental attitudes, learned behaviors, and knowledge of weaning practices. OBJECTIVE: To determine whether high-risk populations are less likely to wean their children by 15 months of age than low-risk populations. METHODS: A cross-sectional survey using a convenience sample of parents was conducted at 3 community-based pediatric clinics. Spanish- and English-speaking parents with weaned and unweaned children 12 to 36 months of age were included in the study. A self-administered questionnaire was completed at a clinic visit. The questionnaire addressed aspects of parents' sociodemographic characteristics and included feeding history; weaning practices; sources of information about weaning; and parental behaviors, attitudes, and knowledge of age at which the child should be weaned. RESULTS: One hundred eighty questionnaires were completed. Marital status was related to weaning behavior. Seventy-six percent of single mothers had weaned their children in a timely manner, whereas 48% of married mothers had done so (chi2 = 7.70; P = .008). Parental education, race, and income were not significantly related to the timeliness of weaning. When respondents rated the helpfulness of multiple sources, only the health clinic was found to be significantly more important for the timely weaning group (t = -2.13; P = .04). Parents with timely weaned children stated that the mean +/- SD optimal age for weaning is 13.6 +/- 3.2 months. Parents with unweaned and late-weaned children stated that the mean +/- SD optimal age is 19.9 +/- 6.6 months. Bedtime bottle feedings were reported in more than 87% of the unweaned group. Sixty-nine percent reported poor dental development associated with delayed weaning. CONCLUSIONS: Married parents are at risk of late weaning. Parents continue to allow their children to sleep with milk bottles in their mouths in bed at night. Parents are not aware of the medical problems associated with late weaning. Late-weaning parents are not knowledgeable about current weaning recommendations. Current approaches are not effective in altering set patterns of inappropriate weaning habits. Additional interventions and innovative parental education methods are needed to improve age-appropriate weaning practices.     

A pilot study of lithium carbonate plus divalproex sodium for the continuation and maintenance treatment of patients with bipolar I disorder

PURPOSE OF STUDY: To assess whether selected periapical radiographs, taken according to High Yield Criteria, can reveal as much intra-osseous pathology as universal panoramic screening. POPULATION STUDIED: The records of 1101 RAF recruits enlisted in 1988-89, average age 19 years (range 16-26). METHODS: The clinical records and bitewing radiographs of the recruits were examined and the requirement for periapical radiographs determined according to high yield criteria. A template, cut out to simulate the area covered by a periapical bitewing radiograph, was placed over the suspect region on the panoramic film and any findings found within the template recorded. The entire dental panoramic tomograph was then examined on a masked screen under 2X magnification and any further findings recorded. FINDINGS: There was a considerable number of findings reported, including three large isolated radiolucent areas, 75 periradicular radiolucent areas, four probable cysts and 1187 unerupted mandibular third molars. However, when the clinical significance of these 'lesions' was assessed only those related to dental causes appeared to have significant clinical implications and the results indicated that these could have been detected by selective radiology. CONCLUSION: This study showed that the only pathology which occurs frequently enough to justify radiographic screening of the jaws in young adults is related to teeth. It seems probable that this type of pathology can be at least as well detected by selective periapical screening, using high yield criteria, as is possible by universal panoramic screening.     

General practitioner attitudes toward mandatory reporting of doctor-patient sexual abuse

AIM: To explore general practitioner attitudes toward mandatory reporting of doctor-patient sexual abuse. METHODS: Anonymous questionnaire mailed to a randomised sample of 217 New Zealand general practitioners. Attitudes toward mandatory reporting of doctor-patient sexual contact, seductive or sexually demeaning behaviour were appraised including an indication of whom the perceived appropriate reporting body should be. RESULTS: Forty-seven per cent of respondents supported the notion of mandatory reporting for doctor-patient sexual contact, 42% for sexually demeaning behaviour and 35% for seductive verbal behaviour. These respondents indicated that the most appropriate body to report to was a Doctor's Health Advisory Service. CONCLUSION: There was a lack of strong consensus on mandatory reporting of doctor-patient sexual abuse.     

The utility of chest radiography in the follow-up of pneumonia

AIM: We conducted this study to determine whether chest radiography was clinically useful in the follow-up of uncomplicated pneumonia affecting children aged between 6 weeks and 15 years. METHOD: We examined the case records of all 78 paediatric admissions for pneumonia to our hospital over one year. Thirteen children were excluded on account of age or other complicating factors. RESULTS: Of the 65 study cases, the mean age was 3.5 years (range 0.4-13 years). On admission 51 (79%) had cough, 53 (82%) fever, 53 (82%) tachypnoea and 50 (77%) had abnormal chest signs. Elevation of C reactive protein was recorded in 43 (66%) cases and leukocytosis in 42 (65%). All children received initial chest radiographs which showed unilobular/lobar changes in 34 (53%), bilobar changes in 19 (29%) and diffuse abnormalities in 7 (11%). Forty-one patients were followed up both clinically and radiologically, usually (31 cases) between four and six weeks after discharge. Thirty-seven children had no abnormal symptoms or signs and had normal chest radiographs. The remaining four had symptoms and signs, their radiographs showed either slight resolution or no change from the admission films. CONCLUSION: In cases of uncomplicated pneumonia, follow-up chest radiography should be deferred until at least four weeks after discharge and is not indicated if symptoms and signs are absent.     

Blood-injury-injection phobia and dental phobia

The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent for the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.     

The prevalence of clinically significant anaemia and haemoglobinopathy in children requiring dental treatment under general anaesthesia: a retrospective study of 1000 patients

There is little information on the possible value of screening children who are liable to haemoglobinopathies as part of pre-operative assessment for dental treatment under general anaesthesia. The present retrospective investigation examined, first, the number of patients having low haemoglobin levels among 1000 patients who had undergone haematological investigation prior to general anaesthesia in a dental outpatient unit, and, secondly, the subsequent clinical management of these patients. Haemoglobin levels of 10.0 g/dl or less were found in 31 children: 13 Asian, 7 Afro-Caribbean, 5 Mediterranean, 3 Arabic, 1 white Caucasian and 2 Oriental children. In addition, 17 patients had sickle-cell trait and 2 had beta-thalassaemia trait, but there was no relationship between the presence of haemoglobinopathy and low levels of haemoglobin. The planned general anaesthesia was undertaken for 22 of the 31 children who had low levels of haemoglobin and for the 19 children with haemoglobinopathy. Only 6 children ultimately did not undergo general anaesthesia, all failing to return. It is concluded that pre-anaesthetic haematological assessment of children needing minor dental surgery is rarely of any significant clinical value.     

Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark

Gastroesophageal reflux (GOR) is often a self-limiting condition but nevertheless is a common cause of morbidity in childhood. Studies of adult patients with hiatus hernias and GOR have suggested that there is an increased incidence of dental erosion in these individuals. The aim of this study was to investigate the relationship between dental erosion and GOR in children. Fifty-three children aged 2 to 16 yr (mean 4.9 yr) with moderate to severe GOR, defined by pH monitoring, were examined for dental erosion. A questionnaire investigating dietary habits, other relevant medical conditions, and erosion risk factors was also completed. Results showed that the prevalence of dental erosion was low, when compared with the UK National Survey, with only 9 (17%) children showing any signs of erosion, and of these only one had erosion involving dentine. These results suggest that dental erosion may not be as great a problem in children with GOR as it is in adults. It may be that refluxing is limited to the oesophagus, and further work is needed to investigate those children that positively reflux into the mouth.     

An evaluation of the role of suction rectal biopsy in the diagnosis of intestinal neuronal dysplasia

BACKGROUND: German pathologists have developed a consensus for histological features of intestinal neuronal dysplasia. METHODS: A blind reevaluation of ganglionic suction rectal biopsies from infants and children who initially presented with symptoms of intestinal dysmotility was made. RESULTS: 84 of 411 specimens had sufficient depth of submucosa for adequate assessment. Questionnaires or clinical interviews were employed 3-5 years after biopsy in these 84 patients to assess the relationship between histological changes and persistent symptomology. Eighteen children were lost to follow-up, 4 others had Hirschsprung's disease the study biopsy specimen having been taken from the pulled-through bowel after surgical resection of the aganglionic segment. The remaining 62 patients were divided into three groups. There were six patients in group A (both obligatory criteria) and 28 in group B (nonessential, or just one of the obligatory criteria), and 28 in group C (normal appearances). On follow-up, two of the 28 (7%) in group B, and six of the 28 (21%) in group C had persistent dysmotility symptoms. CONCLUSIONS: Histological criteria of the consensus of German Pathologists for intestinal neuronal dysplasia was unhelpful in predicting the clinical outcome and therefore, should not influence clinical management. As one of the obligatory criteria, hyperplasia of the submucosal plexus was significantly more common in neonates (< 4 weeks), it is concluded that this is an age-related variation.     

The 1993 General Social Survey I: alcohol use in Canada

Natural dentitions of elderly people are often reduced and the remaining teeth are heavily restored. It is unknown whether they are satisfied or dissatisfied with this situation. To get more insight into this phenomenon 320 dentate non-institutionalized elderly subjects were clinically examined and interviewed by means of a questionnaire. Analysis of the data showed that only 13% of the subjects had at least a complete dentition from the right first molar to the left first molar; 50% had less than four occlusal units, 39% of the subjects were wearing a removable partial denture. Ninety per cent of the subjects was satisfied with the dental state and nearly all subjects mentioned they could chew well (97%), despite the fact that 91% of the subjects mentioned they had to deal with one or more dental discomforts. Satisfaction decreased significantly when the number of the occlusal units was reduced or a removable partial denture was present. The conclusion is drawn that although the dentitions of the elderly are often reduced they are, in general, satisfied with their dental state.     

Consensus proposal on the use of 131I in the treatment of thyrotoxicosis and thyroid cancer

A consensus meeting held by the Chilean Endocrinological Society reached to 22 consensus proposals on the use of iodine-131 in hyperthyroidism and thyroid cancer, that are reported in this paper. Some of these propositions are: 1) Hyperthyroidism: A previous 131I uptake test must be performed. A calculated or an ablative dose should be administered. Hypothyroidism must be considered an objective rather than a complication. In patients with cardiovascular risk, normal thyroid function must be attained with prophythioturacil. In cases of treatment failure, the dose should not be repeated before six months. It must be used with used with caution in children and teenagers. 2) Thyroid cancer: A iodine free diet is recommended prior to the therapeutic dose. A 100 mCi complementary ablative dose should be given after surgery, with a posterior exploration. This examination must not be done routinely, and if required, a 5 mCi dose should be used. For the treatment of metastases, a dose of 150 to 200 mCi is recommended. There is no radiation risk in hyperthyroidism or thyroid cancer. The only absolute contraindication is pregnancy. Recommendations for radiological protection are formulated. Hospitalization is suggested to protect other people from radiation exposure.     

On the structural preservation of recombinant human growth hormone in a dried film of a synthetic biodegradable polymer

STUDY OBJECTIVE: We sought to determine the incidence of radiographic findings of pneumonia in highly febrile children with leukocytosis and no clinical evidence of pneumonia or other major infectious source. METHODS: We conducted a prospective cohort study at a large urban pediatric hospital. Clinical practice guidelines for the use of chest radiography in febrile children were established by the emergency medicine attending staff. All records of emergency department patients with leukocytosis (WBC count >/= 20, 000/mm3), triage temperature 39.0 degreesC or higher, age 5 years or less were reviewed daily for 12 months. Physicians completed a questionnaire to note the diagnosis, the presence of respiratory symptoms and signs, and the reason for the chest radiograph (if one was obtained). Patients were excluded for immunodeficiency, chronic lung disease, or major bacterial sources of infection other than pneumonia. Pneumonia was defined by an attending radiologist's reading of the radiograph. RESULTS: We studied 278 patients. Chest radiographs were obtained in 225 for the following reasons: 79 because of respiratory findings suggestive of pneumonia and 146 because of leukocytosis and no identifiable major source of infection. Fifty-three patients did not undergo radiography. Pneumonia was found in 32 of 79 (40%; 95% confidence interval, 20% to 52%) of those with findings suggestive of pneumonia and in 38 of 146 (26%; 95% confidence interval, 19% to 34%) of those without clinical evidence of pneumonia. If patients who did not have a radiograph are assumed to not have pneumonia, the minimum estimate of occult pneumonia was 38 of 199 patients (19%; 95% confidence interval, 14% to 25%). CONCLUSION: Empiric chest radiographs in highly febrile children with leukocytosis and no findings of pneumonia frequently reveal occult pneumonias. Chest radiography should be considered a routine diagnostic test in children with a temperature of 39 degreesC or greater and WBC count of 20,000/mm3 or greater without an alternative major source of infection.     

Changes in psychovisual function after central serous chorioretinopathy

BACKGROUND: There are controversies concerning the necessity of pre-school vision screening. Aim of the study: evaluation of the prevalence of pathologic ophthalmologic findings in kindergarten children. MATERIALS AND METHODS: 1030 families were offered a vision screening. Of these, a total of 948 children, aged 3 to 6 years, voluntarily underwent a screening for strabismus, amblyopia and refractive anomalies. The examination was performed in the kindergarten in the absence of the parents. METHODS OF EXAMINATION: A questionnaire concerning general and ophthalmologic history of the child and of the family was evaluated. Visual acuity, cover-uncover-test, Lang-stereotest, retinoscopy, ophthalmoscopy (undilated pupils) were performed and the glasses were evaluated. RESULTS: The screening was highly accepted by the parents and 92% of the families (n = 948) took part. The compliance of the children was very good. A total of 38.7% (n = 381) of the children showed one or more abnormal parameters. 21.4% (n = 229) showed a reduced visual acuity. Strabismus was found in 3.7%. Half of the children with abnormal findings already had had a vision screening, but only 25% had received ophthalmologic treatment. Of those who possessed glasses, 25% came without them, and another 25% had a reduced visual acuity even with their glasses. The main problems were many false-positive results and high costs. CONCLUSIONS: Ophthalmologic and orthoptic screening in kindergarten is technically easy and conclusive in experienced hands. Ideas to reduce costs and to avoid overreferrals are an age-related lowering of the visual acuity limit and a rescreening of suspected children in a screening-setting a second time before sending them to an ophthalmologist. Another possibility to reduce costs would be to perform examinations not by ophthalmologists but by "screening-orthoptists" who should be trained in retinoscopy and ophthalmoscopy.     

Not all coarctations are born equal. Aortic arch hypoplasia and its peculiar collateral circles

OBJECTIVES: To assess the prevalence of taurodontism in a group of Jordanian adult dental patients. METHODS: Posterior periapical radiographs of 875 unselected dental patients were examined for the presence of taurodontism defined as the presence of an apically displaced pulp chamber without the usual constriction at the cemento-enamel junction. RESULTS: Taurodontism was detected in 8% of subjects and 4.4% of the teeth examined. The maxillary second molar was the most commonly affected tooth. It was equally distributed between males and females (7.9% compared with 8.1% respectively, P > 0.05). 26.7% of the taurodont teeth also had pulp stones or calcifications. CONCLUSION: Taurodontism is not uncommon in Jordan but further larger scale studies are required to assess its prevalence in the general population to compare it with other ethnic groups.     

Sedation in primary dental care: an investigation in two districts of northern England

OBJECTIVE: To determine the current provision of sedation in primary dental care and investigate the knowledge and attitudes of dental practitioners and others on the use of sedation. DESIGN: Qualitative interviews and postal questionnaire survey. SETTING: Health districts of Bradford (West Yorkshire) and South Durham, UK in 1996. SUBJECTS AND MATERIALS: 15 key individuals associated with NHS primary dental services were interviewed. Questionnaires were sent to all 260 NHS general dental practitioners and community dental service clinicians. RESULTS: 208 questionnaires (80%) were returned. 42% of respondents reported current sedation use, with oral administration the favoured technique (26%). Significant differences were found between districts for intravenous sedation use (7% Bradford, 41% South Durham, P < 0.001). Almost all participants agreed the value of sedation in dental care for adults and children, for nervous, phobic patients or in association with unpleasant forms of treatment and 45% of dentists felt that provision should be expanded. Training, availability of referral services, finance and patient demand were seen as encouraging factors. CONCLUSIONS: Substantial variations in sedation provision between the two districts were associated with teaching at the nearest dental schools. Innovative use of resources could help the expansion of provision supported in this study.     

Results of a questionnaire about smoking distributed at the 36th annual meeting of the Japan Society of Chest Diseases

To gather data about smoking habits among members of the Japan Society of Chest Diseases, a questionnaire was distributed during the 36th annual meeting. A total of 2411 out of 3725 questionnaires were returned (65%). The percentage of smokers was 23%. Smoking was prohibited in the hospitals of 281 respondents (8%). Seventy-nine percent reported that patients smoking areas were separated from patients' non-smoking areas, but only 41% reported that physicians' smoking areas were separated from physicians' non-smoking areas. Tobacco was being solid in over 50% of the hospitals represented, either via vending machines or through hospital retail stores. However, 79% of the respondents indicated that hospitals should be smoke-free. Questions of ethics in medicine are highlighted by this questionnaire. The obvious issues involved are whether or nor both patients and physicians should be required to stop smoking in health-care facilities. The larger issue is the degree and method by which the Japan Society of Chest Diseases should involve itself actively in smoking reform for the sake of society in general.