Abordaje translaberíntico y rehabilitación vestibular: eficacia en el tratamiento de la disfunción vestibular en pacientes con schwannoma vestibular / Translabyrinthine approach and vestibular rehabilitation: efficacy in the treatment of vestibular dysfunction in patients with vestibular schwannoma

Introducción: En los schwannomas vestibulares (SV), la incidencia de disfunción vestibular como principal síntoma es del 10%, sin embargo, producen un notorio impacto en la calidad de vida de los pacientes. Objetivo: Evaluar el impacto funcional que produce la exéresis de SV por via translaberintica y la rehabilitación vestibular sobre los síntomas vestibulares, en los pacientes tratados en nuestro hospital. Material y Métodos: Se realizó un análisis prospectivo de 2 pacientes con diagnóstico de SV y disfunción vestibular agregada. En ambos pacientes, se realizó la resección a través de un abordaje translaberíntico. Los pacientes fueron evaluados funcionalmente antes y después de la cirugía. El impacto de la misma sobre la calidad de vida se evalúo mediante la Escala de Discapacidad por Mareo (DHI). Todos los pacientes realizaron un plan de rehabilitación vestibular personalizado y a los 12 meses postoperatorios presentaron una mejoría clínica significativa en comparación con el preoperatorio. Discusión: Las posibles opciones de tratamiento en estos pacientes resultan limitadas. En la literatura, se ha demostrado que la laberintectomía es un tratamiento eficaz para el tratamiento de síntomas vestibulares persistentes e incapacitantes, en los pacientes sin audición funcional. La calidad de vida de los mismos es reducida, y mejoraría significativamente después de la cirugía translaberintica y de un programa personalizado de rehabilitación vestibular. Conclusión: Debido a su eficacia comprobada, el abordaje translaberíntico y la resección de la lesión, acompañado de la realización un programa de rehabilitación vestibular, como estrategia de tratamiento para estos pacientes debe ser considerado.

Introduction: The incidence of disabling vestibular symptoms in vestibular schwannoma patients has been reported at roughly 10%. Despite their relative rarity, however, such symptoms can lead to physical and social limitations and reduce patients' quality of life. Unfortunately, published evidence on possible treatment options for vestibular schwannoma patients with disabling vestibular symptoms is limited. Objective: To report the functional impact of trans-labyrinthine microsurgery and vestibular rehabilitation, performed at our hospital, in two vestibular schwannoma patients with disabling vestibular symptoms. Methods: A prospective analysis was performed of two patients with a unilateral vestibular schwannoma, without serviceable hearing in their affected ear, and severely handicapped by attacks of rotatory vertigo and constant dizziness. Trans-labyrinthine surgery, with complete tumor resection, was performed in both patients. Preoperative and postoperative quality of life was measured using Dizziness Handicap Inventory (DHI) scores. Both patients also underwent a customized vestibular rehabilitation program and had a final evaluation 12 months post-operatively. Results: Relative to their preoperative evaluation, both patients experienced significant clinical improvement that persisted through 12 months of post-operative follow-up. Conclusions: Consistent with the few prior reports already published, we found that surgical removal of vestibular schwannomas by trans-labyrinthine surgery and vestibular rehabilitation was safe and effective for persistent, disabling vestibular symptoms. Postoperative vertigo and quality of life both improved significantly when microsurgery was combined with a personalized vestibular rehabilitation program. Disabling vestibular symptoms that impair quality of life in patients with vestibular schwannoma without serviceable hearing in the affected ear should be considered for trans-labyrinthine microsurgery and personalized vestibular rehabilitation.

Clinicopathological analysis of six cases of disabling pansclerotic morphea / 中华皮肤科杂志

Objective To investigate clinical and pathological features of 6 cases of disabling pansclerotic morphea (DPM).Methods Clinical and pathological manifestations of and follow-up results in 6 patients,who were clinically and histopathologically diagnosed with DPM in the Department of Pathology,Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College from 2007 to 2017,were retrospectively analyzed.Results Among the 6 patients,4 were male and 2 were female.The age of onset ranged from 3 to 10 years,with an average age of 6.5 years.The average duration from the occurrence to the confirmation of the diagnosis was 6.2 years (range,2-10 years).At all the lesional sites,skin atrophy,thining and tightness occurred,and the limbs became thin.Additionally,there were muscular atrophy and visible deep thick veins on the surface of the limbs.The contracture,deformity and dysfunction of the adjacent joints occurred in 4 cases,and the lower limbs were obviously shortened in 2 cases.Peripheral blood examination showed no increase of eosinophils or hypergammaglobulinemia.Imaging examination revealed smooth cortical bone and clear trabecular bone,and no osseous abnormality was observed.Histopathological examination of contracted skin lesions of the lower limbs revealed atrophic and thinned epidermis,hyperpigmentation in the basal layer,hyperplastic,thickened,hardened and partly homogenized collagen fibers in the middle to deep dermis,subcutaneous adipose tissue region and deep tissue of the skin.Conclusions DPM usually does not affect viscera,but often involves deep tissue of the limbs.Histopathologically,DPM is mainly characterized by obviously hyperplastic and hardened collagen fibers in the dermis and subcutaneous tissue.

Forensic neuropsychological assessment: clinical case of depression and working incapacity / Avaliação neuropsicológica forense: caso clínico de depressão e incapacidade para o trabalho

Issues related to mental health in relation to court matters have increasingly required the participation of the psychologist. We present the use of forensic neuropsychological assessment in a case of retirement reversal. Incapacity was attested due to disability resulting from depression of a 35-year-old attorney, and the case was forwarded from the courts to the Forensic Psychiatry and Psychology Unit at the USP Clinical Hospital. A clinical interview and application of cognitive tests was conducted. Despite the depression, significant cognitive losses that would prevent return to his professional assignments were not detected. The neuropsychological assessment has been shown to be an important tool in the forensic context, as it assists with diagnostic value for clarification of functional aspects in the various psychopathological areas in terms of disabilities or potentialities.

Assuntos relacionados à saúde mental na corte vêm demandando crescente participação de psicólogos. Sob este mote, apresentamos uma aplicação de um assessment neuropsicológico em um caso de reversão de aposentadoria por invalidez. Trata-se do caso de um juiz de 35 anos, que chegou à nossa Unidade de Tratamento Forense Psicológico e Psiquiátrico, no Hospital das Clínicas da Universidade de São Paulo. Para suprir a demanda, inicialmente conduzimos uma entrevista clínica e, em seguida, aplicamos uma bateria neuropsicológica, a partir da qual foi revelada a inexistência de limitações do desempenho cognitivo, as quais recomendariam a reafirmação do afastamento do profissional. Tal como revelado, o uso adequado do assessment neuropsicológico mostra-se uma importante ferramenta em contexto forense, auxiliando o esclarecimento de aspectos funcionais do diagnóstico, em vários contextos psicopatológicos.

Demographic and Hearing Related Variables Important for Prediction of Disabling Hearing Impairment: A Community Based Survey.

Aim: The aim of this study was to estimate the prevalence of Disabling Hearing impairment and describe socio-demographic and hearing related risk factors as possible predictors of disabling hearing impairment. Study Design: This was a Cross-sectional and descriptive study Place and Duration of Study: A semi-urban district called Kumbotso in Kano state, Northern Nigeria. 3rd March 2013. Methodology: Data came from 58 participants, (39 females, 19 males; age range 5-50 years) who completed audiometric testing during the Ear diseases/Hearing impairment survey. Audiometric testing was performed on the participants, air-conduction hearing thresholds in decibels hearing level (dB HL) were obtained for each ear at frequencies of 0.5-4 kHz. Disabling Hearing loss was defined as pure-tone average of air conduction thresholds of ≥ 35dB HL for adults and children while identifying independent risk factors using logistic regression. Results: Out of 91 subjects, 58 subjects had pure tone audiometry giving a participation rate of 63.7% with a prevalence rate for disabling hearing loss of 31%. Controlling for gender, duration of hearing impairment, family history and relationship with subject with hearing loss, odds ratio for associations with Disabling Hearing impairment were 14.57 (95% CI: 2.14-99.44) for age and 61.55 (5.60-112.82) for aetiology of hearing loss. These variables particularly young age and ear diseases were the strongest predictors. Conclusion: Age, aetiology of hearing loss particularly, young age and the presence of ear disease are potential indicators for the development of disabling hearing impairment/loss during rural and/or community-based surveys.

Incapacidad de los pacientes por acontecimientos adversos en la Unidad de Cuidados Intensivos Polivalentes / Inability of patients due to adverse events in the Polyvalent Intensive Care Unit

INTRODUCCIÓN: la seguridad del paciente se basa en la necesidad de contrarrestar los efectos nocivos que tienen los eventos adversos sobre los pacientes. OBJETIVO: determinar el impacto de los acontecimientos adversos, en término de incapacidad, que aparecieron en los pacientes en que se reportó dicho incidente adverso. MÉTODOS: se realizó un estudio descriptivo prospectivo en la Unidad de Cuidados Intensivos Polivalentes del Hospital Provincial de Cienfuegos durante los meses de febrero-abril 2010. Para determinar la gravedad según categoría y su relación con invalidantes del paciente, se revisó el formulario internacional de la Sociedad Española de Medicina Intensiva y Unidades Coronarios. El universo lo constituyeron los 110 pacientes ingresados en el servicio durante el periodo de estudio. RESULTADOS: los de mayor prevalencia fueron los de categoría B y C para un total de 28,18 % y 25,45 %, representando los 31 y 28 incidentes comunicados; los de mayor gravedad fueron los incidentes asociados a la vía aérea, el 25,45 %; a pesar de dichos eventos adversos los pacientes no sufrieron invalidantes en términos de incapacidad física. CONCLUSIONES: se identificó la gravedad de los acontecimientos adversos y se determinó que no hubo invalidantes fatales en los pacientes que participaron en el estudio.

INTRODUCTION: patient safety is based on the need to counter the harmful effects that adverse events on patients. OBJECTIVE: To determine the impact of adverse events, in terms of disability, which appeared in patients in whom this adverse event was reported. METHODS: A prospective study was conducted at the Polyvalent Intensive Care Unit of the Provincial Hospital of Cienfuegos during the months of February to April 2010. To determine the severity according to category and disabling the patient regarding the international form of revised Spanish Society of Intensive Care and Coronary Units. The universe was composed of 110 patients admitted to the service during the study period. RESULTS: The most prevalent were those of category B and C for a total of 28.18% and 25.45%, representing 31 and 28 reported incidents; The most serious incidents were associated with airway, 25.45%; despite these adverse events suffered no crippling patients in terms of disability. CONCLUSIONS: The severity of adverse events were identified and it was determined that there were no fatal disabling in patients enrolled in the study.

Embarazo en la adolescencia y su repercusión biopsicosocial sobre el organismo de la madre y de su futuro hijo / Pregnancy in adolescents and its biological, psychological and social impacts on the mother´s body and her future child´s body

La temática del embarazo en la adolescencia resulta de gran importancia en la actualidad debido a la trascendencia de este grupo etáreo para el desarrollo y su impacto en la población mundial, particularmente en América Latina, el Caribe y Cuba. Este en edades cada vez más tempranas se está convirtiendo en un problema social de salud pública de alcance mundial. Mediante el resultado del análisis crítico de la información disponible sobre el tema en la bibliografía consultada, se demuestra cómo las consecuencias de este problema repercuten en la calidad de vida de la madre joven, su familia y la comunidad, siendo pocas las acciones que se realizan, por lo que cada año el número de adolescente embarazadas se acrecientan cada vez más, determinando un riesgo importante para su descendencia. Es necesario comenzar las acciones a partir de la constitución de la célula básica de la sociedad, siendo el primer grupo al cuál pertenece el ser humano. Resulta imprescindible el rol de los profesionales de la enfermería a nivel de los consultorios del médico de familia como un elemento clave para mediante la labor educativa prevenirlo, a través de los círculos de adolescentes y otras acciones que contribuyan a la prevención y a enfrentar los riesgos que esta condición determina, haciéndose preciso desarrollar acciones que contribuyan al desarrollo del profesional de enfermería en esta temática en la Atención Primaria de Salud para prevenir el embarazo en la adolescencia(AU)

Pregnancy in adolescents is a topic of greater importance at present, due to the significance of this age group for the development, and its impact on the world population, particularly Latin America, the Caribbean and Cuba. Pregnancy at ever increasingly younger ages is turning into a social and public health problem worldwide. Based on the critical analysis of the available information on this topic, there was shown how the consequences of pregnancy affect the quality of life of the young mother, of her family and the community as well. The amount of actions carried out is low, so the number of pregnant adolescents increases every year, thus bringing a significant risk to their offspring. It is necessary to take actions within the family, the basic cell of the society to which the human being first belongs. It is indispensable that the nursing professionals play their role at the family doctor´s offices, as a key element to prevent pregnancy through educational work, through the work of the teenager clubs and other types of actions that might contribute to prevent and to manage the risks of this condition. Therefore, it is required to develop actions to assist in the development of the nursing professional at the primary health care, in order to prevent pregnancy at younger ages(AU)

Embarazo en la adolescencia y su repercusión biopsicosocial sobre el organismo de la madre y de su futuro hijo / Pregnancy in adolescence: Its biosychosocial repercussion on the mother organism and of her future child

Hoy en día es muy importante abordar la temática de la adolescencia, debido a la trascendencia de este grupo etáreo para el desarrollo y su impacto en la población mundial, particularmente en América Latina, el Caribe y Cuba. El embarazo en edades cada vez más tempranas se está convirtiendo en un problema social y de salud pública de alcance mundial; constituye en la actualidad un reto de gran envergadura. Mediante el resultado del análisis crítico de la información disponible sobre el tema en la bibliografía consultada, se demuestra cómo las consecuencias de este problema repercuten en la calidad de vida de la joven madre y de su familia, y determina un riesgo importante para su descendencia, además de ser pocas las acciones que se realizan, por lo que cada año, el número de adolescente embarazadas y las infecciones de transmisión sexual (ITS) se acrecientan. Es por ello que se hace necesario comenzar las acciones relacionadas con estos aspectos a partir de la célula básica de la sociedad, que es la familia, pues constituye el primer grupo al cual pertenece el ser humano. Se hace imprescindible el papel de los profesionales de la enfermería al nivel de los consultorios del médico de familia como un elemento clave para prevenir el embarazo mediante la labor educativa, mediante los círculos de adolescentes y otras acciones que contribuyan a la prevención. Asimismo, para enfrentar los riesgos que esta condición determina, por lo que resulta necesario desarrollar acciones que pudieran utilizarse para continuar el desarrollo del profesional de Enfermería en esta temática en el nivel de la atención primaria de salud, con vistas a prevenir el embarazo en la adolescencia.

Nowadays is very important to approach the adolescence subject matter due to significance of this age-group for development and its impact on world population, mainly in Latin America, the Caribbean and Cuba. Pregnancy in ages more and more early becomes a social and public health problem at world scale; it is nowadays a very complex challenge. According to result of critical analysis of information available on this subject in the consulted bibliography it is demonstrated how the consequences of this problem has repercussion on the quality of life of the young mother and her family, and also to determine a significant risk for its offspring in addition to be few the actions performed, thus each year to increase the figure of adolescents pregnant and the sexually transmitted infections (STIs). For that reason, it is necessary to start the actions related to these features from the basic cell of society, that is, the family, being the first group of the human being. It is essential the nursing professionals role at level of the family physician consulting rooms as a key element to prevent pregnancy by means of an educational task, by adolescent circles and other actions contributing to its prevention and at the same time to confront the risks of this condition, being necessary to develop actions that could be used to continue the professional nursing development in this subject matter at the primary health care level to prevent pregnancy in adolescence.

The impact of acne vulgaris on the quality of life in Sarawak,Malaysia

Background There is lack of data on the impact of acne vulgaris on the quality of life in Malaysia. Thus, this study was done to determine the impact of acne vulgaris on the quality of life in Sarawak, Malaysia and to examine its relationship with the severity of acne. Methods A cross-sectional study of 173 patients in 3 dermatology clinics in Sarawak utilizing the dermatology life quality index (DLQI). Results The mean DLQI score was 4.1. Patients with family income < RM 3000 had higher mean DLQI scores (4.8 vs. 3.2, p = 0.02). There was also a tendency for indigenous groups to have higher DLQI scores compared to Chinese although it was not statistically significant (4.5 vs. 3.5, p = 0.15). Females were significantly more impaired in the domains of symptoms and feelings (2.1 vs. 1.5, p = 0.02); and work and school (0.3 vs. 0.2, p = 0.04). DLQI was weakly correlated with acne severity in patients with mild acne (Pearson coefficient = 0.27, p = 0.01) but become insignificant for patients with moderate and severe acne. No correlation was seen between DLQI and age of patients. Conclusion Acne vulgaris has a quality of life impact similar to that of psoriasis in Sarawak and must be addressed. Health care providers and administrators should view acne as a psychologically disabling disease requiring optimal management and resource allocation. Education of junior doctors and medical student on this issue is also important.

Analysis of trends of occupational injury in the Philippines: Implications for policy

OBJECTIVE. This study aimed to assess the prevalence and incidence of occupational injuries in the Philippines. METHODS. Data were collected from various agencies, namely, Bureau of Labor and Employment Statistics (BLES) of the Department of Labor and Employment (DOLE), Labor Force Survey of National Statistics Office, Occupational Safety and Health Center (OSHC), National Electronic Injury Surveillance System (NEISS) under Department of Health (DOH), Overseas Employment Statistics (OES) of the Philippine Overseas Employment Administration (POEA), and International Labor Organization (ILO). Hospital-based data and surveys were also used in this study. RESULTS. The study revealed about 358,000 fatal and 337 million non-fatal occupational accidents occurring around the world. In the Philippines, there were 22,65 cases of occupational injury in 2003 and 47,235 cases in 2007. The manufacturing industries registered the highest number of cases. The reported cases of occupational injury resulted in 178 deaths in 2000 and 116 deaths in 2007. As for the frequency rate of injury, it was estimated to occur at six injury cases per 500 full-time workers. In the following years, the frequency rate of injury declined to 4.07 in 2003, and further declined to 2.79 in 2007. Superficial injuries and open wounds were the most common type of injury in 2000, 2003 and 2007. Acute poisoning and infections rapidly increased by 2.39 times from 2003 to 2007. Other serious injuries reported were burns, corrosions, scalds, and frostbites, with 2,065 cases reported in 2007. In 2007, 1839 cases of fracture were reported. Based on hospital records, a total of 9,521 injury cases were reported in 2007. In 2007, 1,839 cases of fracture were reported. Based on hospital records, a total of 9,521 injury cases were reported for the first quarter of 2010 at 77 government and private hospitals in the country. Most injuries were sustained on the road (44.4%) and work-related injuries were reported at 7.8%. CONCLUSION AND RECOMMENDATION. The data showed that occupational injury is prevalent and presents a problem in the country. It is suggested that data collection on occupational injuries be performed on a national scale, and3not merely through the random collection of data for small, medium and large industries. Data on occupational safety and health should also include the agricultural sector, the informal sector, and small enterprises.

The Efficacy of Microvascular Decompression in Disabling Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Disabling positional vertigo (DPV) refers to the cross-compression of the eighth cranial nerve from vessels in the posterior fossa which causes symptoms of vestibular disturbances. The most common symptom is a whirling sensation that is worse when the head is in a specific position and is abated with total bed rest. Many patients with DPV also have symptoms of auditory nerve and/or adjacent cranial nerve involvement, such as tinnitus, hearing disturbance, geniculate neuralgia, facial twitching. To analyze DPV, the authors reviewed patients with DPV who underwent microvascular decompression (MVD) in our institution. SUBJECTS AND METHOD: A retrospective study was performed on 11 patients with DPV who underwent MVD from January 2002 to September 2007. Information was collected on sex, age, symptoms, offending vessels, the success rate, surgical complications. RESULTS: Three patients were male and eight were female. Their mean age was 55.1 years (range 37-70). The most common offending vessel was AICA in 7 cases (64%) and second vessel was PICA in 3 cases (27%). Only one case (9%) had a vein. Patterns of improvement after MVD could be divided into 3 clinical types. There was complete recovery after operation in 8 cases, partial recovery in 2 cases, and recovery failure in 1 case. There were no major complications except hearing impairment in 1 case. CONCLUSION: This study shows that MVD provides a high rate of success with low morbidity, and can be regarded as one effective procedure for DPV.

The Results of Revascularization for Disabling Intermittent Claudication

PURPOSE: Traditionally vascular reconstruction has been reserved for patients with limb threatening ischemia. So, the surgery for claudication has been discouraged by the fear of bypass graft failure, limb loss, and significant perioperative complication that may be worse than the natural history of the disease. However, in a minority of patients with claudication, the symptoms progress and a severe disability can result, which limit normal daily activities. In these patients intervention may be regarded as worthwhile. METHODS: To evaluate the benefit or risk of revascularization that performed in patients with disabling or incapacitating intermittent claudication, the clinical data of patients who underwent the revascularization for disabling claudication at Yeungnam University hospital were collected and analyzed retrospectively. RESULTS: From January 1990 to June 1999, 98 patients with disabling claudication were performed the surgical or interventional management (13.7% of all lower limb arterial disease registration in our unit). The patients were 93 males and 5 females ranging from 35 to 76 years of age. The mean age was 59, with the highest incidence among people in their 50s, followed by those in their 60s and then in their 70s. History of smoking was noted in 82.7% of the cases. The major arterial occlusive site were aortoiliac artery in 42 cases (42.9%), femoral artery in 23 cases (23.5%), iliofemoral artery in 13 cases (13.3%), popliteal artery in 4 cases (4.1%), tibial artery in 5 cases (5.1%) and multi-level occlusion in 11 cases (11.2%). The operative procedures for disabling claudication were bypass graft operation in 70 cases, thromboembolectomy in 5 cases, endarterectomy in 4 cases and percutaneous transluminal angioplasty (PTA) in 19 cases. Arterial bypass operations were aortobifemoral or aortobipopliteal bypass in 17 cases, iliofemoral bypass in 8 cases, femoropopliteal bypass in 16 cases, femorotibial bypass in 3 cases, popliteotibial bypass in 6 cases, axillobifemoral bypass in 7 cases and femorofemoral bypass in 13 cases. In 98.4% of the operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria and cumulative 12, 24, 60-month primary and secondary patency rates were 83.3%, 76.4%, 71.3% and 87.8%, 86.3%, 81.8%. The operative mortality rates were 0% and no limb loss was noted in this series. CONCLUSION: In summary, arterial reconstruction for disabling claudication is noted as safe and durable procedure in some selective patients. Therefore, surgical intervention are valid treatment option in selected patients with disabling claudication.

Squamous Cell Carcinoma Arising from Chronic Ulcerative Lesion in a Patient with Disabling Pansclerotic Morphea

Authors report herein a case of a 27-year-old male patient who had been suffering from chronic ulcerative dermatitis with scar-like changes and successive involvement of the ankles, limb folds, nape and abdomen, and no tendency to heal from age 4. At the age 14, an immunologic study showed a selective IgA deficiency with partial T-lymphocyte inactivation. Ten years later, at age 24, he showed a severe form of morphea over a generalized area and disabling joint contractures, and was diagnosed as disabling pansclerotic morphea with an IgA value that returned to a near normal level. At the age 27, an adult-fist, 7×6×4cm sized, squamous cell carcinoma with an easy bleeding tendency like an overgrowing granulation tissue vascular tumor had developed on the chronic ulcerative lesion on the posterior aspect of the right ankle for 2 months. Aggressive metastatic lesion occurred on the right popliteal area 3 months later. He died 1 month thereafter.

Disabling Pansclerotic Morphea / 대한피부과학회지

Disibling pansclerotic morphea, a severe form of generalized morphea, has a relentless clisabling course, producing marked contract,ion and joint deformity due to sclerosis of the skin and the deeper structures. We report herein an unusual case of morphea in a 25 year old male who had suffered from chronic recurrent ulceration with scar like sclerotic changes overlying limb folds, ankles, nape and abdomen since 4 years of age. The indurated lesions on the chest and abdomen were ivory colored, sclerotic guttae and plaques having a, violac ous border. At l4 years of age, the skin lesions were diagnostically ambiguous, wherea.s the immunologic results revealed a selective IgA deficiency with partial T lymphacyte inactivation. About 10 years later, the follow up visit showed this severe form of morphea over generalized area and disabling contractures of knees, elbows and alkles, but IgA value returned nearly to the nomal level.