Neglected victims of homicide: the needs of young siblings of murder victims

Fifteen children, aged 7-18 years, were interviewed an average of five months after the murder of an older sibling. Although most showed significant symptoms of depression, anxiety, post-traumatic stress disorder, and psychosocial impairment, few had received any community or mental health system support or services for these symptoms. Specific problems and needs are identified, and implications for research and practice are discussed.     

The effect of nonablative laser energy on the ultrastructure of joint capsular collagen

This study was designed to evaluate the effect of laser energy at nonablative levels on the ultrastructure of joint capsular collagen. The femoropatellar joint capsules of six mature New Zealand white rabbits were harvested immediately after death. Specimens were divided into three treatment groups (5, 10, and 15 watts) and one control group. Laser energy was applied using a holmium: YAG laser. Transmission electron microscopy showed significant ultrastructural alterations in collagenous architecture for all laser treatment groups, with increased fibril cross-sectional diameter for each of the treated groups. The fibrils began to lose their distinct edges and their periodical cross-striations at subsequently higher energy densities. A morphometric analysis showed that each subsequently higher laser energy caused a significant increase in collagen fibril diameter. Ultrastructural alteration of collagen fibril architecture caused by the thermal effect of laser energy is probably the dominant mechanism of laser-induced tissue shrinkage.     

Bilateral Wilms' tumor. Current treatment

Partial nephrectomy combined with chemotherapy has been the most effective treatment in bilateral Wilms tumors. We present two cases. The bilateral synchronous tumor are present in 4.2% and the metachronous tumor in 1.6%, in the world statistics. The synchronous bilateral Wilms tumor, Stage V, have an excellent prognosis: over 87% survival, compared to 40% of the metachronous bilateral Wilms tumors.     

Hb Malm? [beta-97(FG-4)His-->Gln] leading to polycythemia in a Dutch family

We have examined six individuals from a two-generation Dutch family for a suspected hemoglobin (Hb) abnormality. The propositus presented with polycythemia and complained of persistent weakness, headache, and epistaxis. All family members initially showed a normal Hb-electrophoretic pattern, but on isoelectric focusing, three of them displayed a fast-moving band associated with high packed red cell volumes (PCV) and increased red blood cell count. The Hb mutant was analyzed at the DNA level by specific gene fragment amplification (PCR), followed by direct DNA sequencing, and the mutation was confirmed by restriction enzyme analysis. We found a C-->G transversion (CAC-->CAG) at codon 97 of the beta-chain, which corresponded to the His-->Gln amino acid substitution previously described as Hb Malm?. We report here the clinical history of the patient, the effects of phlebotomy treatment, and the effect of subnormal iron conditions on the erythropoietic recovery after phlebotomy. The mechanism responsible for the induction of the higher oxygen affinity is discussed, as are some aspects concerning the occurrence, pathology treatment, and the genetic risk of Hb variants with high O2 affinity.     

Malaria chemosuppression in pregnancy. V. Placenta malarial changes among three different prophylaxis groups

The effect of malaria chemoprophylaxis during pregnancy on placenta malarial changes (PMCs) was investigated in 170 tissue sections. Women of 63 sections received daily proguanil (PROG), 61 once weekly chloroquine (CQ) and 46 the two drug combination (CQ+PROG). All were residents of a malaria hyperendemic area in Muheza District, Tanzania. Supervised prophylaxis started early in pregnancy till delivery. Parasitaemias and clinical episodes were detected early and radically treated. Overall, PMCs were mostly infrequent and light viz: fibrinous deposits (98%), fibrinoid necrosis (60%), leucocytic infiltrations (59%), macrophage containing pigment (16%), and malaria parasites (8%). The type, prevalence, and severity of the PMCs in the three prophylaxis groups were comparable. This was despite the fact that PROG and CQ+PROG were prophylactically more efficacious than CQ and despite the expectation that the prevalence and severity of the PMCs would be high in the CQ group. Prompt diagnosis and effective treatment of parasitaemias in this group contributed to the low prevalence and less severity. It is concluded that effective malaria chemoprophylaxis or prompt diagnosis and effective treatment of malaria parasitaemias have significant impact on the prevalence of PMCs. Due to various operational constraints in most developing countries, chemoprophylaxis remains the only feasible broad option for malaria control in pregnancy.     

Use of a computer for the optimal results of treatment of diabetes mellitus with insulin

The authors present material on the optimization of diabetes mellitus treatment, with the aid of a computer. There were 320 patients under observation. Mathematical models describing the process of the patients treatment and permitting to pronosticate the blood and urine sugar level during the treatment were developed. The use of the imitation experiment on a computer permitted to test several therapeutic variants for the given patient and to choose the optimum one, leading to the most rapid compensation. The second task consisted in the maintenance in the patients of blood glucose variations within definite limits, in the course of 24 hours. An individual model of blood glucose dynamics in the course of 24 hours is set on the computer, and then the optimal scheme of insulin treatment is chosen. Practical testing of such scheme showed its efficacy.