Ultrasonography and neuropathological findings in premature infants

At most maternity units all premature infants are investigated by cranial ultrasonography as a routine. We examined the correlation between autopsy findings and ultrasound examination in 30 premature newborn. The ultrasound examination demonstrated bleeding in 17 (65%) of the 26 cases where autopsy had revealed bleeding. In these 17 patients good correlation was found between the degree of bleeding in the two examinations (ultrasonography and autopsy). In ten patients autopsy showed periventricular leucomalacia, but ultrasonography showed this condition in only two of these. In five cases bleeding made the examination and interpretation of the ultrasound findings difficult. In three patients ultrasonography was thought to be normal, while autopsy demonstrated periventricular leucomalacia.     

Insanity and adultery: forensic implications of a divorce case

Legal responsibility for acts presumes that a person's behavior is rationally intentional and under voluntary control. Automatism, a type of insanity defense, contends that the person's conscious, voluntary control of behavior has been impaired by a mental disorder. In a recent case in South Carolina, automatism was offered as a defense to adultery, an at-fault grounds to divorce. On appeal, the State Supreme Court recognized the novel application of mental impairment defenses in domestic litigation and remanded the case for rehearing. Implications of the ruling for clinical and forensic practice in family court are discussed.     

Brain death and organ donation

Large-scale picture archiving and communication systems (PACS) have not been widely implemented in this or other countries. In almost all radiology departments film remains the medium for diagnostic interpretation and image archive. Chest imaging is the dominant screening examination performed within most imaging departments and as such, is an extremely high-volume, low-margin examination. Digital technologies are being applied to chest imaging to overcome limitations of screen-film receptors (limited latitude) and current film management systems (single-image copy). Efficient management of images and information is essential to the success of a chest imaging program. In this article we report on a digital imaging and communications in medicine (DICOM)-based centralized printing network for chest imaging. The system components and their operational characteristics are described. Our experience integrating DICOM-compliant equipment supplied by several vendors is described. We conclude that the print model supported by DICOM is adequate for cross-sectional (eg, computed tomography and magnetic resonance) imaging but is too simplistic to be generally applied to projection radiography.     

Brain stem death and organ donation

Rhabdomyolysis was diagnosed in two dogs with babesiosis. The first animal presented with muscle pain and caramel-coloured urine, and had markedly elevated serum myoglobin and muscle enzymes. Acute renal failure complicated the clinical picture. The second dog exhibited muscle pain and tremors, together with neurological signs and pulmonary oedema, and died soon after admission. Muscle necrosis and haemorrhage were found at necropsy. In human malaria, a disease clinically similar to canine babesiosis, rhabdomyolysis is unusual, but clinically silent muscle damage appears to be common. Likewise, biochemical evidence of muscle damage is readily found in experimental bovine babesiosis. Muscle enzymes were mildly elevated in three dogs with severe babesiosis and pigmenturia but there was no obvious muscle damage, indicating that this might also apply to canine babesiosis. The pathogenesis of infection-associated rhabdomyolysis and acute renal failure remains unclear, but inflammatory cytokines and nitric oxide could play an important role.     

The undetermined form of Chagas' heart disease: concept and forensic implications

The undetermined form of Chagas' disease is diagnosed in asymptomatic subjects with a positive blood test for Chagas' disease, normal resting electrocardiogram, chest X-ray, barium esophageal and large bowel radiological studies. Other investigation methods are not recommended for identification of other organs damage lesions in this phase of the disease. When other methods of investigation were employed, cardiac and digestive abnormalities of small magnitude were detected without prognostic implications. These findings do not warrant frequent examinations of patients with undetermined form of the disease except for the electrocardiogram or if the patients report other clinical manifestations. The benign course of the disease does not preclude ability to work and the subjects should be considered apt for work in any profession.     

L-2-Hydroxyglutaric aciduria: neuropathological correlations and first report of severe neurodegenerative disease and neonatal death

Chromolaena odorata (formerly Eupatorium odoratum) is used as a traditional medicine in Vietnam (Nghiem, 1992), where its Vietnamese common name is "co hoi." While it has been widely considered a weed by agriculturalists (Holm et al., 1991), the aqueous extract and the decoction from the leaves of this plant have been used throughout Vietnam for the treatment of soft tissue wounds, burn wounds, and skin infections. A number of clinical studies done by Vietnamese as well as foreign medical workers has demonstrated the efficacy of this extract on the wound-healing process. In this article, the effect of the Eupolin extract on hydrated collagen lattice contraction by human dermal fibroblasts, an in vitro model of wound contraction, is described. The significant inhibition of collagen gel contraction by Eupolin extract at 50 to 200 micrograms/ml is demonstrated in various concentrations of collagen. When the extract at 50 to 150 micrograms/ml was washed out of the lattices and replaced by fresh medium without Eupolin, the contraction of collagen by cells was resumed. The visualization of cells in the lattices by incubation in a tetrazolium salt for 2 h showed live cells at 50 to 150 micrograms/ml of extract. In contrast, all cells were killed in the higher extract doses of 300 or 400 micrograms/ml. These preliminary results showing the inhibitory effect of Eupolin extract on collagen contraction suggest that a clinical evaluation of its effect on wound contraction and scar quality should be made. This work illustrates that traditional remedies that are used by folk practitioners to improve healing can be examined in a scientific manner using in vitro wound-healing models. It could be that the synergistic properties of components of the natural extract contribute to the positive effects demonstrated on various wound-healing mechanisms.     

Brain infarction in young adults: etiology and imaging findings

The causes of stroke in young adults differ substantially from those in older adults. In many instances, the diagnosis can be made by taking a clinical history and performing laboratory studies (e.g., in patients who have multiple thromboses associated with anti-phospholipid antibodies). In other circumstances, clues to the diagnosis can be found on routine CT and MR studies. However, in many circumstances, imaging tailored to a specific diagnosis is important (e.g., MR imaging of the neck in patients with suspected arterial dissection). In yet other cases, additional studies (e.g., echocardiography in suspected cardiogenic embolism) are important to establish the cause.     

Developing medicolegal death investigator systems in forensic pathology

As a result of recent national events involving high-profile murder cases, medicolegal death investigation has begun to slowly receive the attention it deserves. Despite continued local problems of financial support and political control, the development of regionalized centers of forensic excellence is gradually improving the access of rural and suburban areas to high-quality forensic science services. Recent efforts to improve the quality of lay death investigators through hiring practices, training, and certification promises to eventually provide more professionally qualified and experienced death investigators.     

Technology and independent practice: Survey findings and implications.

Today's rapid rate of technology change introduces both opportunities and challenges for psychologists. A Technology and Practice Questionnaire was sent to 1000 psychologists in independent practice, half of whom were contacted by e-mail and the other half by U.S. mail. A total of 237 of the 433 deliverable surveys sent by U.S. mail were returned (54.7% response rate), but only 49 of the 458 deliverable surveys sent by e-mail (12.9% response rate). Respondents were asked to rate the frequency of 51 behaviors in their practice and to indicate whether the behavior is ethical. The results suggest a relatively low rate of technology use among independent practitioners and a high degree of ethical uncertainty regarding the use of various technologies in practice. Implications for training and practice are considered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The echocardiographic findings in patients with brain death. The implications for their selection as heart transplant donors

INTRODUCTION AND AIMS: Brain death causes myocardial impairment by some mechanisms not yet well understood. The aim of this work was to assess the echocardiographic features found in these patients and their implication in donor selection for heart transplantation. METHODS: With this aim, we have studied 38 consecutive patients with brain death assessed as possible donors for heart transplant in our hospital in the last 3 years. Age was 23 +/- 13 years; 77% were male. No history of cardiac disease was present in any patient. An adequate transthoracic echocardiogram was obtained in 74% of patients; transesophageal view was used in the remaining 26%. RESULTS: Echocardiogram was strictly normal in only 14 patients (37%). Mild valvular alterations were found in 5 patients (13%); a dilated aortic root in 1 (3%); moderate concentric left ventricular hypertrophy in 5 (14%); mild pericardial effusion in 1 (3%); mild septal hypokinesia with normal left ventricular ejection fraction in 4 (10%); abnormal left ventricular diastolic function in 7 (18%); and diffuse hypokinesia with ejection fraction less than 60% in 14 (37%). In 7 patients (18%) ejection fraction was lower than 40% (one of them was cocaine-addict). Mean ejection fraction was 59 +/- 15% (23 to 83%). Only 2 of the 19 (10%) donor hearts implanted in our hospital showed early dysfunction after transplant, but no relation to pretransplant ejection fraction was found. Ejection fraction increased from 62% pretransplant to 73% at one week after transplant in the other 17 cases. CONCLUSIONS: Brain death commonly causes alterations of left ventricular function, and this impairment is severe in almost 20% of cases. These echocardiographic features must be known when selection of donors for heart transplantation is concerned.     

Progressive multifocal leukoencephalopathy: virological and neuropathological aspects

Progressive multifocal leukoencephalopathy is a subacute demyelinating disease of the central nervous system due to an opportunistic infection by a polyomavirus, most often JC virus, which predominantly infects oligodendrocytes. Progressive multifocal leukoencephalopathy used to be a rare condition, usually complicating lymphoproliferative diseases. Since the onset of the AIDS epidemic, its incidence has considerably increased and HIV infection has become, by far, the main risk factor for the disease. In AIDS patients, progressive leukoencephalopathy frequently shows atypical clinical and pathological features. The development of malignant glial tumors, within demyelinating regions, in patients with progressive multifocal leukoencephalopathy, has been reported in exceptional cases. The course of progressive multifocal leukoencephalopathy is invariably fatal. The diagnosis can only be made with certainty by histopathological examination of the brain, on cerebral biopsy or at postmortem. However, neuroradiological features may be extremely suggestive in many cases and PCR seems to be a reliable technique for demonstrating viral genome in the CSF. A few antiviral treatments have been proposed, however their efficacy is difficult to assess due to the low prevalence of the disease and the occurrence of rare cases with spontaneously prolonged survival.     

Wolfram syndrome: a neuropathological study

Neuropathological examination was carried out on a patient aged 37 years who had suffered from Wolfram syndrome. Atrophy of the olfactory bulbs and tracts, atrophy of the optic nerves and chiasm, loss of neurons in the lateral geniculate nuclei mainly affecting the small cell layers, atrophy of the superior colliculus, loss of fibers in the cochlear nerve and mild loss of neurons in the cochlear nuclei and inferior colliculus, mild olivopontocerebellar atrophy, and demyelination of the pyramidal tracts were the main neuropathological findings. These correlated with anosmia, loss of vision, loss of hearing, cerebellar symptoms and signs, Babinski sign, and clonus, respectively, clinically observed in this patient. Mild neuron loss and gliosis in the preoptic and paraventricular area of the hypothalamus and mild motor neuron loss in the spinal cord did not reach thresholds of impaired function, although loss of neurons in discrete bulbar nuclei might have accounted for the late episode of food aspiration and suffocation. The relationship between memory loss, personality disturbances, and signs of prefrontal release and mild loss of neurons in the anterior and dorso-medial nuclei of the thalamus remains unclear.     

The national occupational therapy practice analysis: findings and implications for competence

OBJECTIVE: This article reports some of the findings from a national study of occupational therapy practice conducted by the National Board for Certification in Occupational Therapy (NBCOT) as part of its fiduciary responsibility to ensure that its entry-level certification examination is formulated on the basis of current practice. METHOD: The NBCOT developed a survey with input from approximately 200 occupational therapy leaders and then used it to solicit information about current practice from 4,000 occupational therapists and 3,000 occupational therapy assistants. The sample included geographical location, experience level, and practice area distributions. RESULTS: Approximately 50% of the sample responded to the survey. Data indicate similarities and differences in occupational therapist and occupational therapy assistant practice (e.g., occupational therapists spend more time conducting evaluations, planning interventions, and supervising, whereas occupational therapy assistants spend more time providing interventions), an increased emphasis on population-based services (e.g., serving a business or industry rather than an individual worker), and an emphasis on occupation as a core knowledge base for practice. From a continuing competency perspective, the data can be useful to the profession; we can plan continuing education to address topics that practitioners have indicated are critical to their practice. CONCLUSION: The findings will be useful for revising the entry-level certification examination and may guide thinking about the parameters of continuing competence because the responses represent a cross-section of the profession.     

Necropsy as a control of death certification: some unexpected findings

A comparison of death certificates and necropsy findings in a group of premenopausal women suggests that a number of diseases are either underdiagnosed in life. Atypical cases of intracerebral haemorrhage are frequently misdiagnosed. These occur in the frontal, temporal or parietal lobes in non-hypertensive women and may be suitable for surgical treatment. Their aetiology remains obscure. Pulmonary embolus is habitually underdiagnosed in premenopausal women and myocardial infarcts appear to be overdiagnosed. The study reemphasizes that death certificates are inaccurate and that low necropsy rates render accurate statistics of diseases in the community difficult ot obtain.     

Trust in leadership: Meta-analytic findings and implications for research and practice.

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k=106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Technology, professional practice, and ethics: Survey findings and implications.

If a psychologist loses treatment records because of a computer failure, is it an ethical violation? The widespread growth of technology has outpaced the development of ethical standards for questions such as this, resulting in areas of uncertainty for psychologists. Four hundred twenty psychologists in independent practice rated the ethicality and their frequency of using 40 technologies. Technologies pertaining to the support functions of a psychologist's office are commonly used, but those technologies directly affecting clinical services are rarely used. more than half of the 40 items received equivocal ratings on ethicality, suggesting psychologists need guidelines and training for the use of technology in professional practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)