ABSTRACT
Hydroxocobalamin has been administered in the United States since 2006 by first responders and burn centers as a safe antidote for cyanide toxicity, a serious complication of smoke inhalation. There are no current contraindications to the use of this rescue measure. A recent retrospective French publication reported a potential correlation between hydroxcobalamin administration and acute mesenteric ischemia (AMI) in critically ill burn and inhalation injury patients. The purpose of this study is to characterize the risk of AMI related to hydroxocobalamin. A retrospective review of hydroxocobalamin administration among adult burn patients was conducted at a regional burn center over a 2-year period. Injury characteristics, demographics, and outcomes including presence of mesenteric ischemia (defined as presence of pneumatosis or perforation on CT scan or necrotic bowel on laparotomy) were recorded. Of 17 confirmed inhalation injuries, patients had a median (interquartile range) age, total body surface area (TBSA), and abbreviated burn severity (ABSI) index as follows: 60 (45, 65 IQR), 8.5 (1.8, 39 IQR), and 6 (5,7 IQR). Inhalation injury was diagnosed with bronchoscopy, carboxyhemoglobin, or clinical suspicion. Eighty-two percent of those with bronchoscopy had an inhalation grade of 2 or greater. None (0%) of the patients showed signs of mesenteric ischemia, tube feeding intolerance, pneumatosis/perforation on CT, or necrotic bowel on laparotomy. Aware of the study limitations, we conclude that hydroxocobalamin does not increase risk for AMI.
L'hydroxocobalamine (OHB12), antidote peu dangereux en cas d'intoxication cyanhydrique (complication grave de l'inhalation de fumées), est administrée depuis 2006 par les premiers secours étatsuniens. Il n'existe actuellement pas de contre- indication à son utilisation. Une étude rétrospective française récente a rapporté la possible association entre OHB12 et ischémie mésentérique (IM) chez des brûlés graves ayant inhalé des fumées. Cette étude se propose d'étudier cette éventuelle corrélation. Il s'agit d'une étude rétrospective conduite pendant 2 ans dans un CTB régional. Les caractéristiques démographiques, celles de la brûlure et l'évolution (en recherchant particulièrement une IM) ont été relevées. Le diagnostic d'IM était posé devant des images scannographiques évocatrices (pneumopéritoine, perforation digestive) ou la constatation per- opératoire d'une nécrose digestive. Dix- sept patients avaient une inhalation de fumées confirmée par endoscopie (dans ce cas, 87% des patients avec inhalation de fumées avaient des lésions de grade 2 ou plus) ou carboxyhémoglobine ou simple suspicion clinique. Leur âge médian était de 65 ans (Q1: 45, Q3 : 35), leur surface brûlés de 8,5% (Q1: 1,8, Q3 : 39), leur ABSI de 6 (Q1 : 5 ; Q3 : 7). Aucun patient n'a développé une IM ni une intolérance digestive. Bien que cette étude ait des limitations, nous concluons que OHB12 n'est pas un facteur de risque d'IM.
ABSTRACT
BACKGROUND: Scaphocephaly increases the rate of some modifications of cognitive and mood profile in a manner that remains to be elucidated. OBJECTIVE: We aimed to describe the impact of scaphocephaly on neuropsychological profile and more particularly on the executive functions. PATIENTS AND METHODS: An experimental group of 19 children older than 5 years, operated on for scaphocephaly, was compared with a control group of 10 children operated on for trigonocephaly, using IQ tasks, attention tasks and mood scales. A group of 6 children from 2 to 4 years old, operated on for scaphocephaly, and a group of 6 children with non-operated scaphocephaly are also described. RESULTS: Both the experimental group and the control group showed unchanged IQ, whereas attention deficit and anxiety disorder were more frequent in the experimental group. Cognitive profiles differed between groups, with a higher rate of impaired inhibitory control of visual processing in the scaphocephaly group, contrasting with a higher rate of impaired auditory verbal working memory in the trigonocephaly group. Comparable profiles were also found in groups of younger or non-operated children with scaphocephaly. CONCLUSIONS: Many children with scaphocephaly must cope with a specific neuropsychological profile throughout development. This study suggests the interest for these children and their families of specific follow-up in reference centers.
Subject(s)
Craniosynostoses/complications , Craniosynostoses/psychology , Nervous System Diseases/etiology , Child , Child, Preschool , Craniosynostoses/surgery , Humans , InfantABSTRACT
Swallowing and speech disorders are the dramatic consequences of bulbar and pseudo-bulbar syndrome in ALS. Evaluation is necessary to guide speech therapy and to measure the effects of treatment. This article revues the different examinations used to assess bulbar and pseudobulbar involvement in an ALS patient: oromotor assessment, evaluation of the functions with self assessment, perceptive and objective evaluation of speech disorders, fiberoptic endoscopic evaluation of dysphagia (FEES) and videofluoroscopy.
