Conduct disorders in children and adolescents.
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Biomedical subjects
Publications and source records attributed to S E Gottlieb.
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This article examines the function of play in the care of children who have undergone bone marrow transplantation. The serious nature of the children's illnesses, the rigors of treatment, and the restrictions posed by the environment make the provision of quality play a challenging endeavor. It is clear that the child's play behavior varies with the stage of the transplant procedure. Each phase of the process is a unique condition posing its own set of problems and solutions. Familiarity with these stage-related behaviors may assist health care professionals in working optimally with these patients.
This study reports on the characteristics of children referred for developmental services in two different communities. Delayed language development was the most frequent presenting complaint. Children seen at the less affluent setting had significantly more severe problems at presentation. They were referred for evaluation of language problems at a significantly later age. Parents at both settings were aware of their children's problems. Recommendations for improving the early detection of developmental disabilities are outlined.
The impact of an unanticipated primary cesarean section on the mother, on the infant, and on their interaction was studied during the perinatal period and at 1 month following delivery. Thirty-four mother-infant pairs participated in the study. Fourteen subjects delivered by nonelective, nonemergency cesarean section. Twenty mothers, who delivered vaginally, served as the controls. All subjects had attended a series of prepared childbirth classes. Maternal questionnaire and infant observational data were collected on day 2 and on day 30. Mother-infant interactions in teaching and play sessions were assessed on day 30. The cesarean group was found to have a higher number of obstetrical complications, an increased incidence of maternal depression, and a more difficult convalescence. Previous experience with children emerged as an important mediating variable in the analysis of maternal affective status. No infant behavioral differences were detected as a function of mode of delivery. The discussion highlights the interventions that can be utilized to minimize the negative emotional consequences for women who deliver by cesarean section.
A series of 48 patients with high-voltage electrical injuries managed over a six-month period was reviewed. The line voltage at the time of injury was recorded for 40 of the patients, with an average of 14,200 volts. The mean duration from injury to admission was 11 hours. The study group of 48 patients was readily divided into two subgroups: a majority (31) sustained a "true" high-voltage, prolonged contact electrical injury, and a smaller subgroup (17) sustained flash and clothing burns. There was no difference between the two subgroups in the magnitude of voltage exposure. However, patients in the "true" high-voltage subgroup sustained a wide variety of injuries to almost every organ system. Transient EKG abnormalities were noted in 16 patients. The occurrence of myoglobinuria and/or hemoglobinuria was nearly universal and was treated by volume expansion alone without bicarbonate or mannitol. Resuscitation of the "true" group required an average of 7 cc/kg/% BSA of Ringer's lactate. No incidence of acute tubular necrosis was observed. Initial debridement was almost always performed on patients in the "true" subgroup on the day of admission. Flap coverage and/or amputation was required in 70% of these 31 patients. Wound management required an average of 2.4 debridements and 2.2 wound closure procedures. There was no evidence of delayed or progressive tissue necrosis. The principles of resuscitation and aggressive operative management are discussed.
A patient had full-thickness loss of abdominal wall from clostridial myonecrosis. Initial care consisted of resuscitation, debridement, and transfer to a hyperbaric chamber facility. After control of sepsis, multiple enteric fistulas were managed by enterotomies, gastric and duodenal defunctionalization with closed-loop gastrojejunostomy, gastrostomy, and end jejunostomy. Good nutritional status was maintained with total parenteral nutrition over a three-month period. Total abdominal wall reconstruction was accomplished by rotation of bilateral tensor fascia lata musculocutaneous flaps. Reconstruction was successful as the patient was able to return to an active life.
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The process of early testosterone (T) secretion and Leydig cell differentiation in humans was studied to explore the steroidogenic capacity of Leydig cell fibroblastic precursors. Seven cryptorchid boys received hCG prior to orchidopexy. Patients CP, PB, and MR received one injection of 1000 IU; patients JR and GG, three daily injections of 1000 IU, and patients MP and MM, five daily injections of 1000 IU. A testicular biopsy was obtained at the time of operation, 24 hours after the last injection. Serum T (ng/dl) before and after hCG stimulation and testicular T (ng/g) were determined by RIA. A control prepubertal testis (tumoral orchidectomy) was incubated in vitro and showed a time-dependent accumulation of T both in the medium and the testicular tissue. Testosterone released into the medium at 1, 2, and 4 hours was 0.76, 1.43, and 4.03 ng/ml, respectively. Tissue T at 0, 1, 2, and 4 hours was 9, 11, 16, and 24 ng/g, respectively. This indicates synthesis and secretion of T into the medium. Control testes showed abundant fibroblastic precursors with scanty cytoplasm, few organelles, heterochromatic nuclei, and minute nucleoli. No Leydig cells were present. After 1 day of hCG stimulation, numerous fibroblasts were activated, displaying enlarged cytoplasms with increased numbers of organelles, nuclei rich in euchromatin, and bigger nucleoli. No Leydig cells were present. Basal serum testosterone was 58.2 +/- 45.3 ng/dl and 87.3 +/- 42.0 after hCG administration, while testicular T was 974.0 +/- 686.0 ng/g (control prepubertal testicular T is 10-50 ng/g). After 3 days of hCG, activated fibroblasts increased and immature Leydig cells appeared. Basal serum T was 35.5 +/- 7.8 ng/dl and 394.0 +/- 24.0 after hCG stimulation, while testicular T rose to 2797.5 +/- 1222.6 ng/g. After 5 days, mature Leydig cells appeared for the first time. Serum T was 58 +/- 59.3 ng/dl (basal) and 641.5 +/- 390 ng/dl (after hCG); testicular T was 789 ng/g (patient MM did not have a value for testicular T). HCG induced numerous coated pits and endocytic vesicles in activated fibroblasts and young Leydig cells, suggesting receptor aggregation and internalization of hormone-receptor complexes. Peroxidase-antiperoxidase (PAP) localization of T was positive in peritubular fibroblasts and Leydig cells.(ABSTRACT TRUNCATED AT 400 WORDS)