Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.

Successful teacher and speech-language pathologist interventions with traumatized children with prenatal alcohol exposure demand a paradigm shift that requires the development of new perspectives and ongoing training.

This study attempts to discover if further traumatization occurs to sexually abused children through societal system interventions. The Traumagenic Model, developed by David Finkelhor, which explains the dynamics of trauma in child sexual abuse, was employed as the theoretical framework to understand how societal system interventions can produce or reinforce the previous trauma from sexual abuse. Ninety sexually abused children ages 9 to 19 were selected from three counties that have contrasting societal system interventions. The results of the study indicated that the number of interviews children experienced and a trusting relationship with a professional were statistically significant predictors of trauma scores. Other major system interventions, testifying and removal of the child from the home, were not statistically correlated to trauma scores. The majority of the children found the system a positive support in assisting them with the stress of the intervention and personal loss.

551Treatment of anticonvulsant osteomalacia with 1 chydroxycholecalciferol Anticonvulsants cause osteomalacia,' possibly by the induction of an altered vitamin-D metabolism in the liver leading to a lack of 25-hydroxycholecalciferol (25-HCC).2 We describe the short-term treatment of a patient with anticonvulsant osteomalacia with small amounts of 1-HCC, a vitarnin-D analogue that has been used in renal osteodystrophy3 and other metabolic bone diseases. Case historyA 5 1-year-old woman with an infantile spastic paresis on the right, and epilepsy treated for 30 years with phenobarbital 50 mg and phenytoin 75 mg three times a day was seen because of fatigue and increasing pains in the trunk and legs. She had had little exposure to sunshine for six years and her diet was deficient in vitamin D. The whole thorax and vertebral column were extremely painful on palpation and percussion. Pelvic side-pressure evoked pain in the pubic region. She had spastic paresis of the right arm and leg.Relevant laboratory data were: serum Ca 2 01 mmol/l (8 04 mg/ 100 ml) and P 0-52 mmol/l (1 6 mg/ 1OOml), total protein 73 g l1(7-3 g! 100 ml), albumin 55 g I (5-5 g/100 ml), alkaline phosphatase 112 IU/l (normal < 45), 25-HCC 1 9 nmol/l (normal > 12), parathyroid hormone (PTH) 0-24 ng bovine hormone eq, ml (normal < 0 20), urinary calcium 50 mg/24 h, calcium retention after infusion of 10 mg/kg 82 <)^(normal < 60), and 47Ca absorption 15",, dose (normal >25). An iliac crest biopsy showed complete coverage of the trabeculae by osteoid with a thickness of more than 25 )m. Radiological examination showed a low contrast, especially of the vertebral column and