Primary granulocytic sarcoma (GS) is a rare entity, and even more unusual is the presence of primary GS of the breast. We describe such a case and report on the 19 cases of primary breast GS in the literature. Primary GS presents most commonly in skin and lymph nodes, therefore when it presents in the breast, misdiagnosis is a common problem. Primary breast GS is misdiagnosed most frequently as lymphoma or sarcoma. Histologic testing and immunostains are essential to provide the proper diagnosis. It appears that early initiation of systemic acute myelogenous leukemia (AML)-type chemotherapy is beneficial and may delay or avert the development of AML in bone marrow and blood.

OBJECTIVE:Despite recognition of the need for parenting interventions to prevent childhood behavioral problems, few community programs have been evaluated. This report describes the randomized controlled evaluation of a four-session psychoeducational group for parents of preschoolers with behavior problems, delivered in community agencies.METHOD:In 1998, 222 primary caregivers, recruited through community ads, filled out questionnaires on parenting practices and child behavior. Parents were randomly assigned to immediate intervention or a wait-list control. The intervention comprised three weekly group sessions and a 1-month booster, the focus being to support effective discipline (using the video 1-2-3 Magic) and to reduce parent-child conflict.RESULTS:Using an intent-to-treat analysis, repeated-measures analyses of variance indicated that the parents who received the intervention reported significantly greater improvement in parenting practices and a significantly greater reduction in child problem behavior than the control group. The gains in positive parenting behaviors were maintained at 1-year follow-up in a subset of the experimental group.CONCLUSIONS:This brief intervention program may be a useful first intervention for parents of young children with behavior problems, as it seems both acceptable and reasonably effective.

The display of atypical behaviors and disrupted communication during parent-infant interactions, as assessed by the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), has been linked to disorganized infant attachment, which, in turn, has been linked to psychopathology. The present study examined the usefulness of the AMBIANCE as an indicator of the efficacy of two brief interventions in reducing atypical behaviors and disrupted communication during play interactions. Twenty-eight mother-infant dyads participated (14 per intervention). All infants had feeding problems. One intervention. Interaction Guidance, focused on training caregivers to respond sensitively to their infants (play-focused intervention). The other intervention focused on training mothers to use new feeding techniques (feeding-focused intervention). Results showed a significant decrease in AMBIANCE scores in the play-focused group from pre- to postintervention. but not in the feeding-focused group. There was a significant decrease in the level of disrupted communication from pre- to postintervention sessions in the play-focused group but not in the feeding-focused group. 73% of mothers from the play-focused group and 17% of mothers from the feeding-focused group initially classified as "disrupted" attained a classification of "nondisrupted" at the postintervention session. Some limitations of the study include small sample size, differences in timing of assessment for each intervention, and use of samples of convenience. Nonetheless, these findings provide preliminary evidence both of the usefulness of AMBIANCE as an instrument for assessing clinical efficacy and the efficacy of Interaction Guidance.

To evaluate factors that may affect the timely diagnosis of children with human immunodeficiency virus (HIV) infection, we compared data derived from two population-based pediatric HIV studies. Data from anonymous newborn HIV serosurveys were used to estimate the number of children born to HIV-seropositive mothers. A statewide active surveillance project determined the number of HIV-exposed children who had been clinically recognized. Of 88,732 Massachusetts newborn specimens tested anonymously for HIV antibodies during a 12-month period (November, 1987, to October, 1988), 223 were positive. As of October, 1991, 78 of these children (35%) had been identified by a statewide network of infectious disease physicians. HIV-exposed children born in inner city hospitals were more likely to have come to medical attention than those born in suburban hospitals (47% vs. 17%). Among the 29 children with confirmed HIV infection (13% of 223), the initial evaluation for HIV occurred at an earlier age among children born in inner city hospitals than among children born in other areas. HIV testing practices that rely heavily on risk assessment may result in delayed diagnosis of HIV infection in children whose mothers are not perceived to be at risk.