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The three main conclusions of an Oxford study of deliberate self harm in under 16 year olds (British Journal of Psychiatry 1996;169:202-8) were that paracetamol poisoning has increased (from 20% of episodes in 1976–81 to 55% in 1988–93), nearly 10% repeat the self harm within a year, and psychiatric referral should be made in all cases. Of 854 episodes in 755 patients, 801 were poisonings alone and a further 23 were poisonings plus self injury. Girls outnumbered boys by nearly 6:1 and only 12 patients were less than 12 years old. Clashes with parents were the most common problem volunteered.
In the early 1980s a group of young male orphan elephants was transferred from South Africa’s Kruger National Park to a smaller game reserve after their herd had been culled. They were reared without maternal input and lacking the discipline which older bulls are known to administer to young aggressive bulls in the mating season, and that, say elephant experts, may explain why there has been an increase in attacks on other animals and on people by these elephants in recent years (New Scientist 1996;July 20:5). In future the integrity of families will be preserved when elephants are transferred between reserves.
A study of 19 adult volunteers in Augusta, Georgia (Ophthalmology 1996;103:1139-43) may have implications for the correction of minor degrees of anisometropia in children. When unilateral myopia, hyperopia, or astigmatism was induced by wearing appropriate lenses the volunteers showed significant deterioration in binocular function and a suppression zone (scotoma) appeared in the ametropic eye. Significant loss of stereoscopic vision occurred with small (1 dioptre) degrees of anisometropia. It may be necessary to correct even small differences of visual acuity between the two eyes in children in order to preserve full binocular vision.
Experiments on the sciatic nerve of a toad may result in improved hearing for cochlear transplant recipients (Nature Medicine 1996; 2 :928-32 and 860-2). Adding background noise to the system improved the nerve response to vowel sounds as delivered to the nerve through a cochlear implant device. Improving the information content of systems by adding random ‘noise’ is called stochastic resonance (Greek, stochastikos, a guess or conjecture, applied to randomness) and the mathematical theory involved was first applied to climatology.
About one in 20 children presenting to a skin clinic in Italy with nappy rash had characteristic dry, glazed, papyraceous, brown skin largely confined to the inguinal and gluteal skin folds (Dermatology 1996;193:36-40). Personal or family atopy was common. The usually upper class parents had changed the nappies frequently and washed the skin with acidic liquid detergent. Less frequent nappy changes, stopping detergent washes and zinc oxide preparations, and substituting oil based detergents and emollient creams produced resolution within two weeks.
Twenty two American children aged 3–14 years had marrow transplants from sibling donors for severe sickle cell disease (New England Journal of Medicine 1996; 335 :369-76). One to four years later 15 of them were cured. Two died, one from intracranial bleeding and one from graft-versus-host disease, and four others had graft rejection or late graft failure. One had no symptoms 18 months after transplantation but had mixed chimerism with 30% haemoglobin S.
Studies in AIDS patients may provide answers to the treatment of atypical mycobacterial infections. An American study of adults with AIDS and Mycobacterium avium bacteraemia (New England Journal of Medicine1996;335:377-83) showed a combination of rifabutin, ethambutol, and clarithromycin to be better than four drug treatment with rifampicin, ethambutol, clofazimine, and ciprofloxacin.
A study of 141 young people aged 12–16 years who had had neonatal intensive care in Ontario, Canada after being born weighing less than 1000 g (Journal of the American Medical Association 1996; 276 :453-9) has shown that most of them rated their health related quality of life (HRQL) highly despite a 27% rate of neurological impairment. Some 71% of the extremely low birthweight survivors and 73% of controls rated their quality of life at 95% of maximum or higher. Mean HRQL scores were 87% for extremely low birthweight subjects and 93% for controls.
A financially driven move in the USA towards outpatient tonsil and adenoid surgery makes it important to define those children for whom it is safe. At the Cincinnati Children’s Hospital (Archives of Otolaryngology - Head and Neck Surgery 1996;122:811-4) the following criteria are taken to indicate overnight stay or postponement of operation: upper respiratory infection within four weeks, age under 3 years, significant associated medical conditions (such as neuromuscular problems or chromosomal anomalies), and a history of airway obstruction (breathing difficulty in sleep, restlessness in sleep, or loud snoring with apnoea). Children who do not snore seem to be at low risk of postoperative airway problems.
Prolonged lactation necessitates maternal calcium mobilisation and over six months there is about 5% loss in bone mineral density but the mechanisms controlling the mother’s calcium turnover during this time are unclear. Raised prolactin concentrations may lead to relative hypoestrogenism with consequent bone mineral loss but data from the USA (Journal of the American Medical Association 1996; 276 :549-54) suggest an important role for parathyroid hormone related peptide (PTHrP). This substance, first identified in patients with hypercalcaemia of malignancy, may be produced in response to hypothalamic oxytocin and prolactin. Its exact role in controlling bone loss during lactation, and subsequent recovery, remains to be clarified.
The 11 year old children of mothers who in the early 1980s ate Lake Michigan fish contaminated with polychlorinated biphenyls had decreased full scale IQs and problems with memory, reading, and attention (New England Journal of Medicine1996;335:783-9). These compounds have been banned as insulating materials in transformers and capacitors for 20 years but they are still around and may contaminate dairy foods and fatty meats as well as fish.